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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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