Five Stages of Acceptance

I have been a person with diabetes more than 40 years, and I have had Rheumatoid Arthritis (RA) for about 15 years. During that time I have come to understand that disease is as much an emotional journey as a physical one. The emotional journey is often a twisted road with many detours. I believe it is one all people with chronic disease must undertake in order to maximize their life.

It is generally agreed that there are five stages of grief. Readers might ask how being diagnosed with a chronic disease equates to grief. Grief occurs anytime we experience loss. Chronic disease fits that description very well, because when diagnosed one often feels a loss of independence, or the opportunity to live life on one’s own terms. I know of course this is not the case, but for a newly diagnosed person with a chronic disease they are often overwhelmed with thoughts of all they have lost. Those feelings of loss often initiate the process of grieving either for the person with the disease, the family or both.

Denial

The first stage of grief that most experience is denial. One simply decides to live as if we are not a person with a chronic disease. We do not care what happens to us or how to move past the initial shock of the situation. In order to get past this step one must first take responsibility for their condition. I believe it is important to encourage as much responsibility for the management of disease as soon as possible. Of course there are appropriate boundaries, but the sooner a person takes responsibility the better chance of not becoming stuck in this dangerous stage.

Anger

The second stage of grief is anger. One may feel their potential has been tampered with, additional restrictions have been imposed and life has been altered. This is a difficult stage to move beyond. Often when stuck in denial it is because we do not yet want to face the potential consequences of our disease. However, knowledge of complications alone will not help many people move forward. In my case I often try to find others to help so that I may look outside of myself.

Bargaining

The third stage of grief is bargaining. People with a chronic disease in general but people with diabetes in particular are often excellent bargainers. When I was diagnosed with diabetes I learned how to bargain with my doctors, parents, and school officials. These of course are one sided bargains. No matter if we strike a deal to avoid a test, or fake out our spouse or parent we bear the ultimate burden. I think it is important to remind the bargainer that there is no escaping the truth, one either has control or one does not, there is no in between. Doctors and others may let us escape a diagnostic test, but that never changes the facts. We must remember that if our A1C is high, it is high and not testing will not change that fact.

With RA, the bargain is different and perhaps more immediately perilous. We bargain that exercise hurts so we will rest today. Or that walking at the store is too much, so we send our spouse in. The issue is that the less we exercise the worse movement is. It seems we bargain and lose most times, so why do we do it? I have no idea.

Grief

The fourth step of grief is depression. I know I usually become depressed when my bargains fail. When my doctor calls my bluff or my wife asks I test my blood sugar and it was low while I am contending I am fine. I am depressed when my best laid plans to avoid disease are not enough. This can lead to outbursts or sometimes withdrawal; however a seasoned person with a chronic disease learns to adjust when they find themselves in this state of grief.

Acceptance

Finally, we are told that following depression we find acceptance. Of course to some degree acceptance is forced on people with chronic disease. The day we give our first injection or take our first pill we have tenuous acceptance. There is a difference between compliance and acceptance. What often looks like acceptance is often tacit compliance. We must learn to acknowledge that compliance is good however acceptance is what we must achieve in order to live with chronic disease.

There is no diabetic nirvana for people with a chronic disease. It is a process, one I have to relive most days as I move forward and back along the continuum of emotions. The key for all of us is not getting stuck, we must realize that acceptance of a chronic disease is a complex and ever evolving process. I have not concluded my journey of accepting either diabetes or RA, I doubt I ever will. But I have evolved a great deal, just as all people with a chronic disease inevitability must do. It is this constant evolution though the stages of grief that helps me to be ready for the next challenge right around the corner, whatever that might be.

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