Despite older adults having more experience with grief, the classic grief study that has determined grief counseling was developed for children.

Most everyone knows of the Swiss physician Elizabeth Kubler-Ross stages of grief. Based on earlier work by the psychologists Bowlby and Parkes, Kubler-Ross crystalized the stages in her 1969 book On Death and Dying. What was unique is focusing on communication during grieving. She singlehandedly overturned how physicians were treating dying patients—as medical failures to be ignored until they expired. 

The theory states that we go through a series of stages before we come to accept the loss. Kubler-Ross defines five stages starting with an initial short period of Denial (D) that it could not happening, moving into Anger (A) when the loss is taken personally, followed by a series of Bargaining (B) strategies to try and reverse the outcome, and then once the realization of the loss is seen as permanent, Depression (D) and eventually, at the end of the grief there is Acceptance (A) that we cannot change these events. DABDA model of stages of dying morphed into stages of grief.

It is the only grief theory discussed in psychology training. The stage theory of grief is also part of the medical curricula and part of the grief education at the National Cancer Institute. It has been accepted widely across the globe. It is the script provided to grieving relatives and has even entered into product market research to understand the reaction to the “death” of iPhone 4 in favor of iPhone 5. It is a pervasive theory.

Despite its popularity, how accurate is it for older adults?

George Bonanno with Teachers College, Columbia University, New York, has been the main counterpoint for these stages. Bonanno takes a diametrically opposing approach. He argues that there are no stages. In fact having no stages is healthy. In 2002, Bonanno studied elderly bereaving spouses and nearly half showed no signs of shock, despair, anxiety, or intrusive thoughts six months after their loss. This he termed as resilience. Suggesting that grief stages are not prescriptive, dispelling "grief work hypothesis."

This idea of expressing grief in order to cope was also dispelled by the Dutch husband-and-wife Dutch research team Wolfgang and Margaret Stroebe of Utrecht University. They found that widows who avoided confronting their loss were not any more depressed than widows who "worked through" their grief—talking or writing about the experience. More recently, in 2008, Mark Seery from State University of New York and his colleagues studying reactions to the attacks of September 11, 2001, reported similar findings. There are no stages. It is not prescriptive to healthy coping.

But what these stages have done is that it allowed grieving to be accepted as healthy. It is the first time since Victorian times that grief is validated. Because there were assumed stages, people felt more comfortable to allow others express their grief—thinking, this is only a stage, it will pass. Although there are many valid criticisms, focused on the meaning of constructs and the therapeutic value of expressing loss, one outcome has been that we are discussing grief. And that is healthy, because grief is real and painful.

 © USA Copyrighted 2014 Mario D. Garrett

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