Harvard Women's Health Watch

Prolonged illness and grieving

When terminal illness lasts a long time, so does saying goodbye.

The death of someone you love is never easy to experience, whether it comes suddenly or after a long illness. And the way we grieve depends on the circumstances. Over the years, experts have proposed many models of grief to help people understand what they're going through. Elisabeth Kbler-Ross introduced the idea of "five stages of grief" (denial, anger, bargaining, depression, and acceptance) in 1969 in her landmark book, On Death and Dying. In those days, sudden and unexpected death was more common than it is now. Thanks to advances in diagnosis and treatment, people are living longer with life-threatening illnesses, such as cancers and heart disease. One book argues that this changing reality has changed the grieving process as well.

In Saying Goodbye: How Families Can Find Renewal Through Loss, Barbara Okun, a psychologist and clinical instructor at Harvard Medical School, and psychologist Joseph Nowinski propose a new five-stage model — crisis, unity, upheaval, resolution, and renewal — for what they call the "new grief." (See "Stages of the new grief.") In the book, which is co-published by Harvard Health Publications (publisher of Harvard Women's Health Watch), Okun and Nowinski also suggest how families can better negotiate the challenges of protracted and likely terminal illnesses. We spoke with Okun about some of the issues involved. Here are some excerpts from that interview.

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