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Tag Archives: The Other Side of Sadness

The myth of the “five stages of grief”


We’ve all heard about the five stages of grief, right? Many of us have them memorized, or could name at least two or three of the stages. But, do we know where they came from? Do we know what they are based on? Does it occur to us to question whether or not they are based on actual research? Nine months ago, my answers would have been no, no, and no.

But here I am today, almost nine months after Julian‘s death, with a whole new perspective. As I mentioned in one of my early blog posts, one of the first things I did after I came out of my initial shock was ask a friend, “What are the 5 stages of grief, again?” I wanted a roadmap for my future. I wanted a to-do list. Then, I learned that the theory of “The Five Stages of Grief” — also known as the “Kübler-Ross Model” — is neither based on bereavement nor scientific research. Surprised? I was. So I decided it deserved another blog post.

I wasn’t just surprised, I was disappointed when I learned the facts about Kübler-Ross’s five stages. I was mostly disappointed because I liked the idea of having a map or path through this process, which I could follow and track my progress through a journey that by definition (I assumed) had a beginning, middle, and end. But I was also disappointed to learn that these five stages had become conventional wisdom in the field of psychology and mental health without any scientific research to back it up.

So who was Elisabeth Kübler-Ross, and where did these five stages come from? In the ’60s, she was one of the first psychologists to dedicate her career to working with terminally ill patients. She became a respected lecturer on the topic of how nurses and doctors could/should interact with their terminal patients. Because of the uniqueness of her work and her lectures, she was offered a book deal. It was then — after signing her book deal, and with a deadline looming — that she came up with the stage theory.

She wrote her book based on her work (not “research”) with terminally ill patients (not “bereaved people”). That first book, On Death and Dying, was published in 1969 and was interpreted as fact, and also turned her into a bit of a celebrity. Perhaps it was because of her sudden fame that she didn’t go out of her way to point out that the five stages were simply her “theory,” not proven through research. But in reality, as the introduction to the 40th anniversary edition says, “It is essential to note that … On Death & Dying is not a work of research. It is a popular book of description, observation and reflection based on a series of dialogs with dying people.”

The unfortunate thing for people like me is that the “conventional wisdom” of the five stages has made a negative impact on our experience of grief (as if it weren’t bad enough to be grieving in the first place). One of the most helpful and interesting books I’ve read in this past 6 months, The Truth About Grief by Ruth Davis Konigsberg, confirms what I have experienced: the embrace of the “Kübler-Ross model”…

“…has actually lengthened the expected duration of grief and made us more judgmental of those who stray from the designated path. We have been misled by the concept that grief is a series of steps that ultimately deposit us at a psychological finish line, even while social science increasingly indicates that it’s more of a grab bag of symptoms that come and go and, eventually, simply lift.”

Kübler-Ross, standing on the shoulders of Freud before her, set the foundation for today’s understanding of grief. Unfortunately for all of us, this foundation is fundamentally flawed. To quote The Truth about Grief again:

“a subject that is not supposed to be discussed… is the possibility that grief may be finite. ‘There is no timeline for grief,’ is how the advice books and web sites put it. Even the concept of recovery itself is seen as a misleading elusive goal. Though Kübler-Ross identified acceptance as her final stage, implying some kind of end point, she also said that you could never fully close the chapter on grief. “The reality is that you will grieve forever,” she concluded in On Grief and Grieving. “You will not ‘get over’ the loss of a loved one; you will learn to live with it.” This undoubtedly may be true for many, but the grief movement has taken that statement to mean that no one should ever get over such a loss, although that rule seems to get more strictly applied to women than men.”

Did you catch that last part? That rule seems to get more strictly applied to women than men. For me personally, it’s the judgement of myself and others (real or imagined) that has been hardest part of my grieving process. After those first couple weeks of shock, my instincts told me to focus on moving forward — but I couldn’t stop the voice that would pop up in my head that questioned, “Wouldn’t a ‘good mother’ actually never move forward from losing her child? What does that say about me that I want to survive this? What will this say about me if I’m actually successful?”

Now, almost nine months later, I don’t ask myself those questions anymore. I know there are people who read this blog, or see me going about my day, and ask those questions in their head. (“How can she work? How can she be functional? How can she be smiling and laughing? If my child died, I wouldn’t be able to do any of those things. She must be in denial.”) These people worry that I’m not grieving correctly, and someday it’s going to finally “hit me.” The reality is, the only “denial” I experienced was Julian’s last day in the hospital. I was in absolute denial that he could die. Until he did. (You can read about that day on his CaringBridge site.)

I believe that the concern about denial and other judgement is primarily based assumptions about the stages of grief, and society’s expectation that no one should get over the loss of a child (especially a mother). But the truth is, both science and my natural instincts tell me that those people (including Kübler-Ross) are wrong.

We all need to re-think and re-discover what grieving really looks like. 

 
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Posted by on December 1, 2011 in the second six months

 

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The six-month milestone.

Here it is. Six months. Some call it an “angelversary.” Or as a wise friend said recently, “I like to think of it as his birthday. His new birthday. The day he was born into whatever comes next.” I like that. Happy six-month new birthday, little one.

For me and my family, it means six months of the “after.” It’s the six-month milestone of “new normal.” In charts and graphs about grief and bereavement, it’s often the first milestone in the timeline, like this one from The Other Side of Sadness by George Bonanno (yellow highlighting is mine):

I first saw this chart, and the book that contains it, around the two-month mark. It meant so much to me to learn that science shows that bereaved people fall into one of three categories — chronic grief, recovery, and resilience. Until that point, I’d only found memoirs and books written by therapists that made it seem that most people were chronic grievers who only reached a sense of “recovery” after years of therapy and support groups (if ever).

Turns out, many of us — perhaps even most of us — fall into the “resilience” category. It’s hard for researchers to know for sure what the percentages are, because these aren’t the people writing memoirs or visiting therapists for years on end, and therefore aren’t on the radar of the therapists and grief counselors who are writing books about their work.

I wrote a lot about The Other Side of Sadness in my two-month blog post, and it seems fitting to revisit it again now. One of the most fascinating details about the scientific research described in this book is that they studied people both before and after their loss. Because of this, the researchers were able to discern the difference between someone who started displaying frequent and prolonged grief symptoms after their loss, vs. someone whose personality and outlook on life was grief-like even before the loss.

The researchers were able to identify personality traits of each group that were apparent before and after their loss. My friends and family would probably agree that the traits observed in “resilient” people sound a lot like me (and my husband, too). The research showed that resilient people are:

  • optimistic
  • flexible (can share AND suppress emotion)
  • can find benefits, and believe that “the world is basically a decent place, and life is good”
  • have a support system of family and friends
  • are “able to evoke comforting memories of the lost loved one”

With six months behind me now, I have a new appreciation for Mr. Bonanno‘s observation that “the human inquiry into the mysteries of life and the nature of the soul is acute during bereavement. When a loved one dies, we have no choice but to face up to nearly imponderable questions…. Many of us discover, in fact, that we have found something quite profound hidden in the experience.”

I’ve now had six months of “facing up to imponderable questions.” I wholeheartedly agree that “the mysteries of life and the nature of the soul is acute during bereavement.” I’ve pondered the imponderable. I’ve inquired into the mysteries of life. I have a new understanding of what it means to be human, and what it means to be alive. If there could possibly be a silver lining to this experience, that’s it.

I’ve survived six months of the after. I’ve spent six months creating new normal. I don’t know where I’ll be in 6, 12, and 18 months from now, but I know I’m resilient. And I know my future will be filled with happiness — because I choose to make it that way.

 
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Posted by on September 3, 2011 in the second six months

 

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