Regardless of the cause, many people believe they must move through five stages of grief – from denial to acceptance. But new research shows this doesn’t reflect most people’s experiences of this complex emotion.
I think I’m in the anger stage; I’m not sure how to move through it,” says Jane*, a recently separated stay-at-home-mum in her late 30s. Meanwhile, Joe*, another of my clients, describes the reaction of his first child following the arrival of a new baby: “He seems a bit morose and hasn’t gotten to the acceptance stage yet.”
As a clinical psychologist, I hear many myths about grief, like those above, expressed in my office. They are often based on the five-stage model of grief – one of the most well-known theories used to describe the grieving process.
The 5 stage model
Developed by Swiss psychiatrist Dr Elisabeth Kübler-Ross, the model was originally based on a study of terminally ill patients, and proposed that there are five stages of grief that people must move through until they reach acceptance. These stages were published in her 1969 book On Death and Dying. These five stages (denial, anger, bargaining, depression and acceptance) have since been applied to a range of losses including divorce, redundancy, death, illness and retirement.
However, there is little evidence that most people pass through these five stages of grief. Grief is not a linear process and people don’t go through emotions in any order. In 2005, a year after Kübler-Ross’s death, her final book On Grief and Grieving was published. In it Kübler-Ross and her co-author, David Kessler, state that the stages “have been very misunderstood … they were never meant to help tuck messy emotions into neat packages”.
While Kübler-Ross’s model has always just been a theory based on observations of her patients in the 1960s, the model has remained wildly influential over the years.
Studies to test the theory (for example, one published in 2010 in Omega: Journal of Death and Dying) have also generally found limited support with most finding that the stage theory is not indicative of the majority of people’s experiences, as most people are able to accept the loss at the beginning.
As we all know, living and dying is messy and complex, and it is hard to make sense of painful emotions when we are experiencing them. Humans like to feel in control and usually want some certainty. The five stages are a readily understandable framework to make sense of painful circumstances and emotions, putting order into chaos.
Many people still swear by the five stages as a model to provide some explanation of their emotions, and it is widely used. Psychologist Dr Christina Birkin says that she commonly explains to her clients that “grief comes and goes like a wave … it’s not uncommon for people to feel better and feel like they’re making progress and then to feel right back in the thick of it. At these times, they might despair and feel like they’re back at the beginning.
Other times they may feel happy but then feel guilty that they are experiencing happiness … some people find the stages of grief helpful as they move back and forth through different emotions.”
EXPRESS YOUR EMOTIONS?
“It is 10 years since my father died,” Susan* commented, “and I don’t feel like I’ve ever processed the grief.” Susan is reflecting another common belief, the need to somehow methodically sort out or deal with your grief, which most people think means talking it through with a professional counsellor. Recent evidence shows that although grief is a response to loss, it is not necessary to ‘process’ it. While some people will find it useful to talk over what has happened, it is by no means necessary for everybody to do this. Some people like to do their grieving in private and this is no less valid than those who want more active verbal support.
Additionally, research in the last few years has shown that most people do not need grief counselling, and it is only beneficial to about 10 to 15 per cent of people who are struggling with grieving six months or more after the loss. Psychologists call this “complicated grief”. Birkin states that “most people will cope on their own, with support from family and friends”. Most people’s functioning after experiencing loss returns to their normal (pre-loss) level.
While there is evidence that traumatic deaths more often lead to complicated grief reactions, recent research indicates that it is the meaning people make from the death, rather than the objective way of dying that determines how they cope in the months and years afterward.
WHAT IS COMPLICATED GRIEF?
Painful emotions are usually intense and severe after a loss but most people come to accept the loss and find a way of continuing to live their life with purpose. For a minority of people this does not occur. These people find themselves focussing on the loss, feeling numb or preoccupied, bitter, not enjoying life, having difficulty with usual routines, and withdrawing from socialising.
There have been three types of factors that have been found to predict complicated grief:
1 Factors related to the death (traumatic deaths e.g. suicides, homicides and car accidents are more likely to lead to complicated grief);
2 Personal factors (a history of unsupportive relationships; a prior psychiatric history, prior experience in trauma or loss, or a close relationship with the deceased);
3 Interpersonal factors (low support from family and friends).
Birkin explains that if you have had a complicated relationship with a person (for example, experiencing conflicting emotions while they were living, as in the case of someone that you have loved but had to take care of physically, emotionally or financially), you might experience relief or other emotions that feel somehow wrong, as part of your grief.
*Names have been changed