Grief: Stages, Waves and Tasks

Clare Bidwell Smith has written a worthy essay on grief and anxiety, one that challenges Elizabeth Kübler-Ross‘s ‘bargaining’ stage:

Many of my clients immediately begin to assess their current state in terms of where they are with denial, anger, bargaining, depression, and acceptance. But while the stages were meant to be helpful, this is often where people begin to get confused. I don’t think I’m following the stages correctly, they’ll admit in a worried tone.

I don’t understand the bargaining part. I’ve been depressed for too long. I skipped the anger stage—is that okay? I don’t know where my anxiety fits in. These are the kinds of things I hear over and over again. In fact, I’ve heard them so often that I’ve now come to believe that when the five stages are applied to grief, bargaining should be replaced with anxiety.

Contemplating © 2013 by Anders Engelbøl

Not every mourner gets a soothing vista to grieve by.

Smith deserves kudos for drawing attention to anxiety’s role in grief. The loss of a loved one is a hole in our safety net. It reminds us of our own mortality. How does one not feel anxious about that? Her suggestion we make anxiety a stage of grief, on the other hand, propagates long-standing problems with the model.

For all of its cultural dominance, Kübler-Ross’s magnum opus has taken heavy fire. Bonnano, Wortman, et al (1)  found grief might take five different paths, including one of resilient recovery.  Maciejewski, Zhang et al (2) found symptoms of grief such as yearning, anger and depression rose and fell along overlapping curves, while acceptance rose along a steady upward slope.  Kübler-Ross herself freely admitted not everyone will experience each stage, the stages may not come in order, and that stages might recur once they’ve faded.  So, why describe grief in such terms?

A figure from Maciejewski and Zhang's research. While each psychological response peaks about a month apart, they all begin within three weeks of the loss and remain present throughout the process.

A figure from Maciejewski and Zhang’s research. While the first four ‘stages’ peak about a month apart, all begin within three weeks of the loss and continue nearly to the end. (see complete figure at the link)

James William Worden’s ‘task’ model drops the view of grief as a commuter ride on the Dysphoria Local.  Worden, professor at Biola University’s Rosemead School of Psychology, frames mourning as a set of chores:

  1. Accept the reality of the loss. Completely.
  2. Work through all of the emotions tied to the loss. All of them.
  3. Make all the adjustments needed to function without that person – inside and out.
  4. Find a way to maintain a link to the loved one, while you move on with your life.

Each task can be worked on a bit at a time. They don’t need to be completed in order. Anxiety, yearning, anger, depression? Each fits each task. No one needs to wonder why they still feel angry after being depressed for so long.  Worden’s model empowers our clients, because it makes grief a mission to complete, not a storm to be weathered.

The flaw in Smith’s plan to substitute ‘anxiety’ for ‘bargaining’ is the same that undermines Kübler-Ross’ model.  Symptoms like anger and anxiety rise and fall, but they don’t come in stages. They pervade the process. Let’s reassure our clients the loss of a loved one can be terrifying. Let’s not shoehorn that anxiety into an misfired concept like ‘stage’.

Citations:

1: Resilience to loss and chronic grief: A prospective study from preloss to 18-months postloss. Bonanno, George A.; Wortman, Camille B.; Lehman, Darrin R.; Tweed, Roger G.; Haring, Michelle; Sonnega, John; Carr, Deborah; Nesse, Randolph M. Journal of Personality and Social Psychology, Vol 83(5), Nov 2002, 1150-1164. doi: 10.1037/0022-3514.83.5.1150

2: Maciejewski PK, Zhang B, Block SD, Prigerson HG. An Empirical Examination of the Stage Theory of Grief. JAMA. 2007;297(7):716-723. doi:10.1001/jama.297.7.716.

@ 2013 Jonathan Miller All Rights Reserved

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8 Comments

Filed under anxiety

8 responses to “Grief: Stages, Waves and Tasks

  1. thanks for this, I too have been taught the Kubler-Ross stages and this is refreshing to get another view or model to the bereavement or greiving process. The question this raises for me is when does greiving become a problem? I see from the graph, that it can take up to 2 years for full acceptance and for the 4 greif indicators to settle, I suppose I am answering this myself as after 2 years acceptance hasn’t been reached or the indicators haven’t settled??????

    • I wish you strength and perseverance in your mourning. It’s sad we can’t all recover at the median rate! When does grieving become a problem? That’s an excellent question. If you’ll bear with me, you’ve inspired another blog post. Stay tuned for a more detailed answer.

  2. Each of us will experience grief in our own way, in our own time. There is no “right” or “wrong” way. When we can trust in our own process, we will find the peace and the ‘understanding’ we seek. Each of our individual journeys towards “acceptance” will carve a unique and worthwhile path.

  3. John Burik

    The writer (Jonathan?) asks: “So, why describe grief in such terms?”

    Thing is, it’s a model. If it’s helpful, use it. If not, don’t. A co-presenter and I used to tell our group participants that they may, or may not, experience all these steps, or in this order, and they may find themselves going through all the steps while driving between one traffic light and the next.

    I’ll check out citations provided. Look interesting.

  4. What I see in clients struggling with loss is an enormous amount of blame and self doubt. I agree with John B that a model can be double edged – helpful by giving some idea of what to expect, hurtful if a person thinks they’re supposed to be living by the model, ie, what’s wrong with them if they are not. We in our Western culture give precious little permission or room to grieve, but we are given “instruction,” with well intended models and guidelines. Personally I have found grief the singular most painful experience of my life, in the moments I allow myself to surrender to it. Yet perhaps the very allowing of those awful moments was what gave me freedom to move on. I see people terrified of grief, and touching any side of it too often opens up layers and layers of untended loss. Thus, we numb. Maybe someone should write a book called The Numbing of US – how our abundance-focused lifestyles have robbed us from inner peace. Because except for circles of therapists and healers, it’s a conversation we keep avoiding. Want to address the drug issues, addictions that lead to crime and vehicular homicide? Address grief.

    That said, Thank you Jonathan Miller for raising the subject on this forum. And all who’ve responded.

  5. I tell people about Kübler-Ross’ model and say “just don’t use it like model. Its is something to be aware of, not set up expectations around. I think ones stance towards grieving and healing is as important as anything else. Some people feel that any pain is not acceptable. Others feel that any pain is catastrophic. Acceptance of some suffering, acknowledging that you will be changed, is a key element.

  6. Sara

    This highlights my problem with models: they tend to assume things always happen in order, like Kubler-Ross’ model of grief. And when they don’t, people wonder if they’re doing something “wrong.” I think models are a good starting point for understanding something, but they seem to allow little to no variation in their steps, or phases. They don’t allow much room for the way people really do things. What I’m getting from this article is that it’s important for clients to know they don’t have to follow anyone’s “model” for grieving. They have to do it their own way, and in their own time.

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