Grief Doesn't Come in Stages and It's Not the Same for Every
Why we're wrong about grief
Posted October 26, 2009
Most people cope quite well with loss or potentially traumatic life events. Nobody wants a loved one to die. Nobody wants to deal with serious injury or threat. But unfortunately these things happen, and when they do, it's never easy. Most of us suffer, at least for a short period of time, and we have to adapt. But the truth—the empirical reality—is that most of us do cope well. We take it, we suffer; we suck in our gut, and move on. Our research has shown this over and over. The funny thing is, if I can use the word funny, is that most of us don't want to believe the empirical reality. We simply don't believe the data.
Take grief for example. Most people believe that grief is more or less the same for everybody and that the only way to get over a loss is to work through a series of phases or stages. The most well-known version of this idea comes from the late Elizabeth Kübler-Ross. She argued that bereaved people typically pass though five unique stages: denial, anger, bargaining, depression, and acceptance. People can get stuck in a stage, this theory tells us, and if they skip a stage they will end up suffering for a longer period of time. It's a simple scheme. Although not everyone endorses it, many do and some people swear by it. People like stages models, I think, because they appear to help us know what to expect, to prepare for the pending psychological onslaught that we anticipate when a loved one dies.
But what if the stage idea is wrong? Even if its helpful, it is important to know whether or not its true. Surprisingly, when we look at the research on bereavement, we don't see anything remotely like stages of grief. In fact, as I summarized in my recent book The other side of sadness: What the new science of bereavement tells us about life after loss, when my colleagues and I actually followed bereaved people over long periods of time we always found tremendous variability in how people react to loss. Over the years, we have tried to make sense of this variability and eventually we began to identify the most common or characteristic patterns of grief reaction over time. One of these patterns, which we have called chronic grief or "prolonged grief," represents an extreme and enduring grief reaction. We see prolonged grief in about one in every ten bereaved people. It is an unfortunate outcome. People with prolonged grief struggle for years, yearning and pining for the lost loved one. They never seem to get any better. For them, grief is one long horrible experience and it only seems to get worse over time.
Another pattern we call the "recovery" pattern. Recovering people also experience intense suffering but for a shorter period of time, usually a few months, maybe as long as a year, and then gradually pull themselves back. As they get over the loss, they slowly began begin to look and act like the person they were before the loss. Although people who show the recovery pattern seem healthy and for the most part they are, they still hurt, even years later. And if you talk with them about grief, they say things like, "a loss is forever, you never get over it."
The recovery pattern is about as common as prolonged grief. Together these two outcomes account for only a relatively small portion of bereavement people, usually about a third. What about the remainder?
By far the most common response we see in our research is a pattern we call "resilience." We see this pattern in between one third and two thirds of bereaved people. It looks like the term suggests. People who show a resilient outcome struggle initially with the pain of loss, as almost everyone does, but they manage to deal with the sadness and distress with equanimity. Their pain is acute, usually lasting most pointedly for a few days to a few weeks but then begins to subside. It is not that they don't grieve, or that they didn't care; far from it. Rather, they are able to put the pain aside when they need to and they continue to meet the demands of their life. They work, they take are of loved ones. They even laugh and experience moments of joy. They accept the loss, readjust their sense of what is, and move on.
We have seen these patterns in virtually every study in which we have looked for them, in bereavement studies but also studies of potentially traumatic life events, and even in different countries. For example, we've seen the same three patterns after divorce and after the loss of a job. We've also seen the same patterns among people who were in or near the twin towers of the World Trade Center on the day of the September 11th terrorist attacks. We've also seen more or less the same patterns among people in Hong Kong who were infected with SARS but survived the 2003 pandemic, and among people who were hospitalized for emergency surgery after near-fatal accidents, like automobile crashes. Sometimes there are other patterns; we've seen improvement and then gradual return and also delayed reactions, but for the most part these same three patterns-prolonged suffering, recovery, and resilience-are common reactions to nearly every major life stressor.
So why don't we believe it? Why do we instead expect that loss or other stressors are the same for everyone? Why do we expect stages that everyone must go through? That's another story. Part of the answer is in my book, but I'll also get to it in the coming installments of this blog.