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That sticky ‘stage theory’ of grief

By Leanne Billiau

“Every one can master a grief but he that has it.”
-William Shakespeare

Those of us who are passionate about hospice admire the ground-breaking work of Swiss American psychiatrist Elisabeth Kubler-Ross. She was part of the hospice movement and her work with the dying put the topics of death and grief on the table for many. Even though she studied people who were dying and the emotional impact of getting that kind of traumatic news, her theory is prevalent in pop culture as “The Five Stages of Grief”.

It is in our nature to try and make sense of our world. We attempt to create order out of chaos, and the world can feel very chaotic and out of control for those who are grieving. This desire to create order leads us to want to categorize and structure even our normal, natural, emotional response to loss.

It is understandable, then, why so many people have grasped onto the well known “Five Stages of Grief” theory. However, one of the most significant changes in the area of grief and loss in recent years is the move away from using Elisabeth Kubler-Ross’ stages of grief model. The reasons for this are many.

While it can be a tool that can help frame and identify the emotions we may be feeling, one of the problems is that it doesn’t fit everyone’s experience. I have seen countless bereaved people who come in feeling that something is wrong with them or that they are not grieving as they should because “I haven’t gotten angry”, “I skipped over denial”, or “I made it to acceptance, but now I slipped back into depression”. Anyone who has felt the pain of grief knows there are enough “shoulds” to go around already.

The fact is that not everyone does feel angry or depressed and the stage theory can make people feel guilty that they are not feeling what they think they should feel. It can give people who are grieving and those that love them unrealistic expectations, further complicating an already complex emotional process.

Having an order of events can give us an illusion of control over the uncontrollable. The word “stage” itself implies not only a certain fixed pattern, but also an end point. There is a myth that after a period of time, one should “get over” their grief, but this is not a process with a defined end point. It is rather a continued adjustment to our new world without the person we loved. The reality is that grief is a highly individualized and personal process. No two people will ever grieve in exactly the same way nor will the same individual grieve two losses exactly the same.

The important thing to remember is that there is no right or wrong way to grieve. No prescribed formula is going to apply to every single person, so try to ignore the “shoulds” and follow your own natural process. The goal is really to experience and express your grief in the style that is most natural to you. From doing this work, I know that we all really do possess the strength and resilience to get through even the deepest pain. When we allow ourselves to feel that pain, we can begin to find our way through it.

15 Comments Post a comment
  1. Abbygirl #

    Thank you or writing this. After the recent sudden loss of my mother I keep waiting for the bad or difficult feelings, the tears… I have felt somewhat bad that I have not been feeling what I think I am suppose to feel. This has been very helpful. I will stop waiting and watching and just live and experience what I experience.

    October 25, 2012
    • Abby,
      I’m so sorry for the sudden loss of your mom. The statement you made, “I will stop waiting and watching and just live and experience what I experience.”, is perfect. Thank you for commenting.

      October 29, 2012
  2. i agree, there is no right or wrong way to grieve. i can remember when my dad died in my arms after caring for him for one year while he fought bone cancer. he was the hero of my life. about six or seven months later, i was at my daughter’s home visiting and i broke down crying. she slammed her hand on the counter top and said mom, get over it, it has been a long time since he died. he will be gone five hears this december, and i have still not gotten over it, but have gotten through it

    October 25, 2012
    • Terry,
      I’m sorry for the loss of your dad. It can be hard for people who love you to see you hurting, but it’s important to grieve in your own way despite their expectations. Thank you for sharing your story and thank you for following Caring with Confidence.

      October 29, 2012
  3. I agree that the “stages of grief” can cause anxiety if presented as a pattern one will or should follow. On the other hand, the theory can be helpful in knowing what to expect. After suffering a loss, many people are surprised and guilt ridden when they are angry at the person they lost. The most important thing, though, is sharing our personal stories, encouraging others to share theirs, and letting them know they are not alone. Thanks for a great article.

    October 25, 2012
    • Linda,
      I agree that people do often experience guilt when they find themselves angry at the person who died. Elisabeth Kubler-Ross’s theory did much to help normalize the feeling of anger in grief. She was even very diligent in saying the “stages” are not linear, that not every person experiences all of them, and that one can move back and forth between the “stages”. Unfortunately, many still think it is a pattern that should be followed. Perhaps that is because the word “stage” itself implies a pattern to be followed and perhaps it is because people do want to know what to expect. Many hospice agencies, like Holy Redeemer Hospice, hold workshops or informational sessions for new grievers to discuss what to expect in the grief journey and many of these can be attended by anyone in the community who may have had a recent loss. This is another forum in which to share personal stories of loss and sharing these stories with one another can be a very powerful experience. Thank you for your comment.

      October 29, 2012
  4. nivadorellsmith #

    Thanks for this great article. When I lost my husband Kaz I looked up the Kubler-Ross stages of grief and was both relieved to see that I was “on track” with my emotions, and frustrated to learn that the stages don’t happen in a linear fashion and for some don’t happen at all. I was hoping for a “roadmap” but alas, none exists. Basically, we’re all riding the wave.

    October 25, 2012
    • Nivadorell,
      I’m sorry for the loss of your husband. You are so right that we are all “riding the wave”. Thanks for your comment.

      October 29, 2012
  5. So very, very true. Each individual is just that – INDIVIDUAL! There is no formula that applies to all and I’m so glad this article addresses the “one size doesn’t fit all” theory isn’t always applicable. Thank you.

    October 25, 2012
    • Boomer,
      I agree that “one size doesn’t fit all”. Thank you for commenting.

      October 29, 2012
  6. Wonderful post Leanne. Although I like EKRs stages I recently came upon an article about Janice Penrod who’s a professor of nursing and director of the Center for Nursing Research. Her work about caregiving through end of life and on into grief is described as a process that goes through 4 stages: sensing disruption, challenging normal, building a new normal and reinventing normal, where “reinventing normal” is the bereavment part. An article put out by Penn State University describes her work and says that Penrod and colleagues, “… compared their own theory of caregiving through the end of life to a theory specifically about bereavement by G.A. Bonnano, a clinical psychologist and pioneer in the field of bereavement. That theory suggests grief oscillates, and eventually the grieving caregiver will ‘return to a state of equilibrium.’ ”

    I definitely experienced (and still experience) parts of EKR’s stages and find that as time passes some others show up a little here and there. Being able to identify it really helps. But I like Penrod’s look at bereavement as something that oscilates, strives for equalibrium and reinvents a new normal. I couldn’t describe what’s been happening to me any better. Here’s a link to the article:

    October 28, 2012
    • Mr. Woods,
      Thanks for the link to an interesting article. I agree that it can help to be able to identify your experiences and am glad you found something that feels like a “fit” for you. You might want to check out William Worden’s 4 tasks of mourning, Theresa Rando’s 6 R’s, or even Stroebe & Schut’s dual-process model of coping with bereavement as well. Thanks for your comment and thank you for following Caring with Confidence.

      November 20, 2012

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