Stages of Grief - Time For a New Model
It's time to quit describing grieving as occurring in stages.
Posted Apr 20, 2008
Again, it appeared in print - the stages of grief. This time it was in an Austin American Statesman article about a soon-to-be closed bar near the University of Texas campus. A young man who is a patron of the bar stated that he was going through the seven stages of grief, but was stuck on anger. Ignoring for now the possibility of mourning over the closing of a bar, I wonder why the myth that mourning (grieving) happens in stages or phases is still so prevalent in our society. After all, there are other, more descriptive models that better describe the process. So what’s wrong with stage-based models of mourning? There are several:
There is a multitude of stage theories, so which one is the correct one? There are theories involving three, four, five, six, seven, ten, and twelve different stages. The most famous model is a misapplication of Elizabeth Kubler-Ross’s five stages of coping with dying: denial, anger, bargaining, depression, and acceptance (DABDA for short). This model for mourning is the most egregious one since it is a totally erroneous application of her work.
Regardless of which one you chose, each stage theory attempts to portray a complex process involving the emotional, behavioral, cognitive, spiritual, and social facets of a person with a few simplistic terms. While simplicity can help describe something, it can also be very misleading.
There is no empirical proof that any stage-based model describes everyone’s bereavement experience. The models have been based on observations of select populations and not, until recently, subjected to empirical study. In the February 2007 edition of the Journal of the American Medical Association (Vol. 297, No. 7), Maciejewski, Zhang, Block, and Prigerson reported on their study that apparently confirmed a five-stage model of mourning adapted from Kubler-Ross’s model. However, many critical reviews regarding the researchers’ methodology, including their highly selected study sample, cast serious doubt on the validity of their conclusions.
Stages imply that mourning is passive. A good analogy is a car wash. First is the “vacuuming the floor” stage, followed by the “clean the bugs off the windshield” stage, followed by the “wash, and rinse” stage, followed by the last stage - the “drying off” stage. The car doesn’t do anything but be there, and everything happens to it so it comes out of the process bright and shiny clean. Mourning is not a passive process like a car wash; it is a highly active one.
Stage models create expectations of what mourning is supposed to be like. To me, this is a major shortcoming because of the potentially detrimental effect on the bereaved. A widely published list of stages sets people up to expect certain reactions after the death of a loved one. When those expectations don’t happen or don’t happen in the “correct” order, the bereaved individuals can think there is something wrong with them. I have had several clients come to me stating they haven’t experienced one stage or another, and they're scared they're not grieving the way they should. Once I explained to them that stages are an artificial construct, they were definitely relieved. There are typically enough shouldas, wouldas, and couldas for a bereaved person to work through without adding whether he/she has adequately encountered all the stages of grieving or if the stages have occurred in the proper sequence.
I believe it is about time we quit trying to distill the interpersonal and intrapersonal complexities of mourning into a simplistic set of dogmatic steps. Mourning is a highly individualistic process based on many factors in the bereaved person’s life. It is a process for finding meaning in a distressing time of loss, creating a new relationship with the deceased, reintegrating the deceased into the bereaved person’s being, and learning how to live in the world under a new set of conditions and assumptions. It is NOT a checklist.