In her book On Death and Dying, Dr. Elisabeth Kubler-Ross taught that there are certain steps one goes through in the dying process: denial, anger, bargaining, depression, and acceptance. In the first stage of denial, people refuse to accept their new reality. They say, “The lab must have gotten my tests mixed up with someone else’s.” Or “This happens to other people, not me.” But their denial doesn’t work very long. So they move into the next stage: anger. They are angry at the doctors, angry at their family, angry at God. When the anger doesn’t help, they begin to bargain. They think they can bargain with God to buy more time so they say, “If I go back to church, maybe the Lord will give me more time.” When the bargaining doesn’t work, they move into deep depression. They realize there is no running, that this is the real deal. There is no escaping the inevitable. If they hang in there and do the deep work of depression, they can emerge at the other end of depression, bringing them to the final stage of acceptance. They accept that they are going to die and by their acceptance, they begin to grow, making productive use of their time (Kubler-Ross, 1969).
In this article, a comparison will be made of Dr. Kubler-Ross’s five stages of dying to how those same stages are also the steps one goes through after a trauma. Indeed, following a trauma, many habits and beliefs usually must die. In most circumstances, old approaches no longer work, which can cause great cognitive dissonance, increasing a sense of ongoing trauma as victims become uncertain of the outcomes (Strauss & Northcut, 2013). Thus, each step will be examined in order: denial, anger, bargaining, depression, and acceptance.
Trauma can leave people feeling nearly frozen with fear and uncertainty (Strauss & Northcut, 2013). The Conservation of Resources (COR) theory expresses the need that people have to “retain, protect, and build resources” (Smid, van der Velden, Lensvelt-Mulders, Knipscheer, Gersons, Kleber, 2011). According to this theory, if there is a great loss of resources, traumatized people are more susceptible to employing denial as a way to protect what was lost but cannot be returned. And perhaps there is a time for denial. Dr. Klagbrun contends: “I have always been a proponent of the benefits of denial, running away, escaping for short periods of time is healthy when being overwhelmed. Repression, up to a point and in a limited way, is good for you” (2010).
Yet, as Klagbrun points out, when denial is taken to the extreme, it can be very inhibiting to true growth. A definition of denial may help us begin to establish when denial becomes harmful. Sigmund Freud defined denial as “a form of disavowal of reality—a defense against external reality originating in painful stimuli” (as cited in Livneh, 2009). It is often interchangeably used with similar concepts such as “avoidance, disbelief, evasion, illusion, minimization, escape, repression, suppression, disavowal (of reality), unrealistic hope, dismissal, deferral, ignoring, defensiveness, wishful thinking, unrealistic optimism, negation, selective forgetting, delusional misinterpretation, and self-deception” (Livneh, 2009). Thus, denial becomes inhibiting if it is more than merely a means of temporary escape (Dryden, 2012). When reality becomes exaggerated hope, confidence, unrealistic optimism about the future, amplified self-image, overstated self-assurance about the accomplishments of future goals and plans, and the portrayal of a “business-as-usual” attitude, denial begins to threaten long-term problems as it only allows selective attention, thus narrowing one’s perceptual field (Livneh, 2009).
Trauma victims are particularly prone to not believing their reality has changed. In their efforts to hold on to what was instead of what is, they will often make themselves believe that upsetting past experiences and situations—their traumas—were actually pleasant or good for them (Bartczak & Bokus, 2016). They often employ defense mechanisms that are based on creating and demonstrating attitudes and behaviors that are opposite of their denied feelings such as abuser loyalty—pretending they are quite content and satisfied with their abuse. They believe that everything is really fine; they just need to try a little hard, work a little more—if there is a problem, it can be managed (Bartczak & Bokus, 2016). There is also a tendency to cling to the belief that things will get better, even though they aren’t. Many stay in this stage of denial because it is often easier to accept wishful-thinking tactics than it is it to face the reality of true internal turmoil. Thus, justification becomes a great friend.
However, when trauma victims realize they can no longer do the mental gymnastics of denial, according to Kubler-Ross, the response is anger (Kubler-Ross, 1969). Victims become angry that they have been robbed of their former life. They are upset that they were not protected or that their reality is so unfair and damaging to their psyche. They are often angry at the intensity, frequency, and severity of their trauma. When the stressors are extreme, it usually enhances an individual’s reactivity to other stressors, thus causing them to become more and more sensitive and susceptible to anger (Smid et al, 2011). Similarly, exposure to additional different types of trauma or situations that were previously neutral but now trigger reminders of trauma are also more likely to deepen trauma or cause hyper-arousal. Further, the more times a traumatic event is experienced, the greater the impact it is likely to have on an individual, thus the response of anger is often greater (Northcut & Kienow, 2014).
Anger is one of the most frequently felt emotions, averaging anywhere from several times a day to several times a week (Williams & Hinshaw, 2018). Perhaps this is because anger, like denial, is often used as a survival tool. People get angry when they perceive wrongdoing, disrespect, untrustworthiness, or unfairness. Thus, trauma victims are particularly susceptible to anger as they try to come to terms with the injustices and wrongs they have undergone. Consequently, rather than “turn-off” thoughts—as denial does—anger, in turn, seems to “hijack” thoughts (William & Hinshaw, 2018). Whatever causes anger grabs and holds the attention of the trauma victims. Everything wrong seems amplified. The goal of anger is to motivate the body to stop further transgressions from occurring (Williams & Hinshaw, 2018).
The goal of anger—to stop further harm—can help move trauma victims to the next step—bargaining—because anger activates a motivational system intended to overcome blocked goals, remove obstacles, and punish transgression (Williams & Hinshaw, 2018). Thus, motivated by self-protection, bargaining begins as an effort to promote settlement. When bargaining occurs, the parties “in negotiation” rarely have equivalent power. The trauma victims are usually bargaining with God or a higher power. They say, “I’ll be better; I’ll say my prayers more fervently; I’ll be even better at kindness and forgiveness if you will please just remove this cup from me.”
They often even try bargaining with their abusers. They promise to be more obedient if they can just be left alone. They may offer cheap apologies, hoping that will make the problem go away. Bargaining is the Band-Aid attempt but trauma victims are grabbing at straws because they know from past experiences there is a slim chance they might be rewarded for good behavior and be granted a wish for special services. They just want to be rid of pain or discomfort and go to great measure to try all angles in an attempt to alleviate the suffering (Kubler-Ross, 1969). Thus, victims attempt a “trade-off” in an effort to resolve strong emotions (Williams & Hinshaw, 2018).
When trauma sufferers see a Band-Aid will not and cannot contain the wound, they move into what therapists call “the hard work of depression” (Peck, 1993). Depression sweeps the soul as trauma sufferers see there is no way out; they feel so sad, so hopeless, so alone. They see their inevitable need for true help, bringing about the onset of depression because when the problem is understood to be within the self and to be potentially unsolvable, depression is more likely to take hold (Rosales & Tan, 2017). The view that God has allowed one’s trauma can be a great cause of depression as well (Buser, Buser, & Rutt, 2017).
With depression, rumination often takes hold, which is one of the key dysfunctions underlying depression (Rosales & Tan, 2017). Rumination does not cause depression in and of itself, but it does heighten vulnerability because it involves increased self-focused problem solving. Thus, rumination is a problematic cognitive obstacle, making depression a cognitive disorder in thinking (Rosales & Tan, 2017). Depression becomes particularly addictive as the thinking patterns and negative, automatic thoughts focus mainly on three areas of experience: the self (me), the personal future, and the world (Bartczak & Bokus, 2016). As a result, several cognitive functions are disrupted, including those that are key in metaphorical processing. Thus, people with depression dedicate a lot of their cognitive resources to processing information related to mistakes.
Because of the intensity and difficulty of depression, many defense mechanisms accompany depression, including regression back to denial, anger, and bargaining (Peck, 1993). Negative stimuli—including verbal ones—attract the attention of the depressed in a particularly strong manner, which often leaves trauma victims feelings even more anger (Bartczak & Bokus, 2016). Thus, if it appears that overcoming the problem is not a possibility, it may feel safer to regress back to former emotions that seem to allow more personal control.
If trauma sufferers do not become stagnant or regressive by pushing through the hard work of depression, they will finally break the cycle, and acceptance can begin its journey. There are many actions that can help one move toward this journey of acceptance. One is finding an internal space where sufferers can regain some degree of control in their recovery. Becoming aware and open to internal experiences such as thoughts, feelings, and bodily sensations without judgment or self-condemnation is vital in moving toward acceptance (Rosales & Tan, 2017). When trauma victims begin to feel an acceptance and awareness of their body and mind, a partnership with healing can become a promising future (Strauss & Northcut, 2013). Rather than feeling they are forever-victims of circumstance, sufferers can take a proactive position in which they recognize and accept their need to mentally heal and redefine reality. They begin to access a means that allows for healing on an emotional level of mindful awareness.
Trauma sufferers often find peace and acceptance by turning to God as a way to cope (Buser et al, 2017). Solace is often discovered as they feel a higher power supports them. Many, including those who do not believe in a higher power, also find strength by quieting their mind. Through the means of meditation, one becomes aware of thoughts or worries as they enter the mind, helping them discover they are not stuck. They allow their minds to accept life as is without judgment, bringing themselves back to the here and now. The inward concentration of meditation trains the mind to focus on the present moment (Strauss & Northcut, 2013). In doing so, meditation seems to help trauma strugglers develop a greater capacity to accept, rather than be consumed by their new reality. In conjunction with meditation, breathing is interestingly the only function that can be automatically and consciously controlled, effectively becoming a bridge between mind and body, and is therefore a powerful mechanism to center the mind (Strauss & Northcut, 2013). Additionally, when one integrates yoga movements with the breath, the mind has been shown to stop its obsessive thinking and starts to slow down. It is an ideal way to preserve health and longevity in the body, regulate the nervous system, and allow the mind to withdraw inward toward acceptance and relaxation (Strauss & Northcut, 2013). These principles are often taught through therapy, which is frequently a common instrument in helping trauma victims through the dying of their old selves as they learn to accept their traumas and build new lives.
Dying is hard work. When trauma victims try all the tactics of denial, anger, bargaining, and depression only to find that the reality is still beating at the door, acceptance seems nearly impossible to achieve. Sufferers often feel like they have just stepped into active battle without any basic training—or they have stepped out of a battlefield only to find they have really just stepped into another one. Uncertainty is at every bend, increasing a feeling of helplessness and despair. Yet, when sufferers learn to surrender, they emerge into the most beautiful step of all: acceptance. Through it, they find the beauty and awe of rebirth. In doing so, suddenly the prospects of the future can seem endless as a new heart is opened and discovered. Because dying requires much courage and strength, higher vision than ever before is often required. The former life must be examined while taking charge of what time is left. The support and vision of professionals is frequently vital in this process. They can teach trauma sufferers how to rest their former beliefs in life with dignity—allowing their past its place and giving beautiful possibilities to the future. Mindfulness, resiliency, and cognitive flexibility will initiate posttraumatic growth, allowing the trauma victim to discover a kind of beauty that can only be found after death.
**Danna is the creator of The Mormon Trauma Mama. She is actively involved in advocating for those suffering from church trauma and is currently getting her Master’s degree in Pastoral Counseling from California Southern University. She and her husband have four delightful children. For more information on church trauma, watch this presentation.