The Myth of "Stages of Grief"
In 1969, psychiatrist Elizabeth Kubler-Ross wrote the book, On Death and Dying, in which she outlined the now famous 5 stages of grief (also known as DABDA). These are the stages of dying as she observed them in terminally ill patients. These stages are postulated to be likely to be experienced by a dying patient. “Might be” experienced are really the operative words here. Dr. Kubler-Ross made it quite clear that the patient may not go through all the stages, and they may not go through them in sequence.
Over time, there have been many who have disputed the findings of Dr. Kubler-Ross, but our point is that these have become stages of grief now. When seen as a model for the stages of grief, this model has done more harm than good to grieving people.
From the above noted article, Friedman and James refute the stages and have added a response to the work done in February, 2007 in the Journal of the American Medical Association where the Yale Bereavement Study (YBS) was examined. YBA came up with stages of grief as well. The following refutes both models:
(Disbelief, Shock, Numbness)
In the thousands of interactions that Friedman and James have had with grievers, they have never found anyone who was in denial that a loss had occurred. When asked what happened they say, “My mother died.”
- Disbelief: The YBS study uses this term. It is a figure of speech to describe the feeling of loss rather than a stage.
- Shock: Emotional shock after a traumatic loss is very possible. The person is in a suspended state, totally removed from the events in the real world. This state is rare and doesn’t last very long. Most deaths are not sudden and traumatic and therefore do not produce shock.
- Numbness: Grief related numbness is the result of an overload of emotional energy in reaction to a death. Many grievers report numbness as intermittent in the immediate aftermath of a death. It causes a lack of focus or limited concentration. Numbness, though common, is not a stage.
When an elderly loved one dies at the end of a long term illness, there’s usually no anger in those left behind. There are feelings of sadness and there may be also a sense of relief that the suffering is over. There can be anger at doctors or hospitals; the drunk driver who killed our loved one; even anger at loved ones who did not take good care of themselves, or took their own lives. Anger at God or the disease is also present with some grievers. But anger is not universal among grievers, and therefore is not a stage.
Bargaining, as defined by Dr. Kubler-Ross, may make sense for someone diagnosed with a terminal illness, but it doesn’t relate to the grief people feel when someone important to them has died.
Yearning is the word that the YBS substitutes for bargaining. 83.8% of the participants in that study had lost their spouse, most over the age of 60, so it is no surprise that many of them yearned for their lost partner. Most widows and widowers do miss the person who died. Missing someone who has been a constant part of your life is expected, but calling it a stage suggests a time frame and builds expectancy for an end. That expectation is harmful to grievers.
Depression due to grief or clinical depression is the heart of the matter. Which is it? There are symptoms of clinical depression such as the following:
- Inability to concentrate
- Disturbance of sleeping patterns
- Upheaval of eating patterns
- Roller coaster of emotions
- Lack of energy
One list fits clinical depression and grief related depression and that is the problem. Are grievers clinically depressed? The answer is “no.” If a person suffers from clinical depression before the loss, they remain with clinical depression and will benefit greatly from the Grief Recovery Outreach Program in dealing with grief related depression. Grief is the normal reaction to loss, but clinical depression is abnormal and requires different treatment. Again, the conclusion is that depression is not a stage because time alone will not cause the sad feelings due to the loss of a loved one disappear as if moving out of a stage.
Acceptance, as it relates to psychology or emotions, is a vague term. Acceptance is a confusing term, if not moot. The YBS study asked grievers to assess the level of acceptance they’ve achieved about the death of someone important to them. They would have had to accept that the death occurred or they would not have been in a bereavement study. There is no evidence this is a stage either.
One more non-stage, Guilt
Many dozens of books include guilt as part of grief. As they most often define it, guilt “more accurately represents things the griever wishes had been different, better or more in relation to the person who died; rather than a sense of having done something with the intent to harm the person who died, for which the idea of guilt might make sense.”
To quote the opening paragraph of On Grief and Grieving by Elizabeth Kubler-Ross: “The stages have evolved since their introduction, and they have been very misunderstood over the past three decades. They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grief is as individual as our lives. Not everyone goes through all of them or goes in a prescribed order.”
As Friedman and James conclude, “if there are no typical responses to loss and no typical losses, and not everyone goes through them or in order, how can there possibly be stages that universally represent people’s reactions to loss?”
“Stage theories put grieving people in conflict with their emotional reactions to losses that affect them. No matter how much people want to create simple, iron clad guidelines for the human emotions of grief, there are no stages of grief that fit every person or relationship.”