Photographs by Jennifer Loeber

Is Anxiety the Missing Stage of Grief?

Science tells us that anxiety, like other mental health issues, often develops or worsens following major life changes, good (graduation, marriage, a new job) or bad (divorce, financial losses, major injury). And at the top of the scale of stressful life events—a real thing called the Holmes-Rahe Life Stress Inventory, which ranks events by their traumatic potential in “life change units”—is the death of a loved one.

As much as we try to prepare for loss, there’s only so much we can do to brace ourselves for the mental and emotional impact of grief—especially when the “five stages” we’ve learned to expect are incomplete. Anxiety is a real and underrecognized stage of grieving, says Los Angeles–based therapist Claire Bidwell Smith, LCPC. Bidwell Smith experienced panic attacks after her parents died of cancer when she was eighteen and twenty-five years old, and she has become an expert in grief-related anxiety. Using resilience-building techniques, like mindful meditation and expressive writing, Bidwell Smith helps people overcome anxiety disorders that emerge in the wake of loss, which is the topic of her new book, Anxiety: The Missing Stage of Grief, out September 2018.

Why Anxiety Is the Missing Stage of Grief—and How to Overcome It

By Claire Bidwell Smith, LCPC

People ask me all the time how I do the work I do. I’ve been a therapist specializing in grief for over a decade, and the answer is simple: I see so much beauty within loss. Losing someone we love is one of the most difficult things we will experience during our lifetime, but the grief we endure as a result can be transformative—after all, grief is the ultimate reflection of love.

However, this is easy for me to say twenty years out from my own personal losses and after so many years of helping others. When you yourself are in the throes of grief, it’s not always so easy to see the beauty. The multitude of emotions that come with a significant loss can be completely overwhelming. Sadness, anger, and confusion may dominate your days—these are the commonly understood symptoms of grief. Yet there is another symptom, often overlooked, that comes with loss: anxiety.

It’s understandable that loss causes anxiety. When we lose someone significant, we are reminded of our mortality and of how little control we have over our lives. This can be a dizzying realization. We may begin to feel fearful that we will experience more loss or that we ourselves will also die soon. All of these feelings and fears may feel foreign and very overwhelming. And many people do not understand the connection between their grief and their anxiety until they are really suffering and in need of help.

“Sadness, anger, and confusion may dominate your days—these are the commonly understood symptoms of grief. Yet there is another symptom, often overlooked, that comes with loss: anxiety.”

I had my first panic attack at eighteen, around the same time my mother died of cancer, and it wasn’t until years later that I connected the dots, linking my anxiety to the loss of my mother. Later, in my career as therapist, I began writing articles about grief-related anxiety and, before long, my office was filled with clients who were experiencing similar symptoms: panic attacks, hypochondria, social phobias, and a constant underlying feeling of dread—all after experiencing a significant loss. For some of my clients, that loss was recent; for others, the loss was decades old. And some of them had experienced anxiety before the loss, but many had not. Either way, they were desperate for help.

In my work to help people overcome their grief-related anxiety, I do several things. I firmly believe that a great deal of anxiety is rooted in unresolved grief, so even though I do a lot of work around the anxiety itself, I find that it is also important to go back and trace through various aspects of the loss that a person has not fully processed.

Most people I work with express a lot of confusion regarding Elisabeth Kübler-Ross’s famed five stages of grief: denial, anger, bargaining, depression, acceptance. They worry that they have gone about the grieving process all wrong, that they haven’t followed the formula correctly, or that they’ve skipped a stage or dwelled too long in another.

“The five stages were originally written for people who were dying, not people who were grieving, and because of this, the stages don’t organically fit the emotions that a person experiences following a loss.”

I take time to remind them that the five stages were originally written for people who were dying, not people who were grieving, and because of this, the stages don’t organically fit the emotions that a person experiences following a loss. In fact, there are elements of grief that are still being explored, anxiety being one of them.

I do believe that there is a very real process to grief, but I think that it looks different for every individual. I think that each person must sift through their own waves of sadness and anger, anxiety, and regret. And most of all, I believe that the part of the grieving process that can bring the most healing is when we can find ways to stay connected to our loved ones rather than feeling like we have to let go of them.

It makes sense that loss causes anxiety. Losing someone we love is one of the most difficult things we will ever experience during our lifetime. The impact of loss permeates all areas of our life and can often bring us to a standstill. Death reminds us that our lives are nothing if not precarious, and that everything can change at a moment’s notice. It is an experience unlike anything else. And it is one that we cannot truly prepare for, no matter how hard we try.

“We will never get over the death of someone we love, but we can learn to live with it.”

Once we can acknowledge this and begin the work that grief requires of us, we can heal. And the good news about anxiety is that once you have an understanding of how it works and learn a few tools to help you cope, it’s quite easy to manage. Following the grief processing, I work with my clients to get a handle on their anxiety using meditation, yoga, and cognitive behavioral shifts. The combination of these tools along with deep grief processing enables most people to return to a peaceful and more fulfilled way of living.

In grief, we must walk a path of fire and pain, of deep sadness, and crippling anxiety in order to get to the other side, to a place where we can experience the beauty life has to offer and to find a renewed appreciation for our time here.

It is by understanding this journey and stopping to take stock of what it means to live and die in this world that we can emerge more peacefully on the other side, having been transformed into a person with greater compassion and empathy, not just for the world at large, but for ourselves as well.

We will never get over the death of someone we love, but we can learn to live with it. We can learn to connect with our lost loved ones in new ways, we can free ourselves of anxiety, and we can open ourselves up to the world again.

Claire Bidwell Smith is a Los Angeles–based author and therapist. Anxiety: The Missing Stage of Grief is her third book about grief and loss, following The Rules of Inheritance and After This.