Where does the ‘five stages of grief’ approach come from?
Most people have heard about the ‘five stages of grief’. After all, it’s the way the grieving process is often portrayed in the movies and media. However, the ‘five stages of grief’ didn’t actually start out as a framework to explain grief.
Dr Elisabeth Kubler-Ross was a psychiatrist who spent time with and interviewed many people who were dying. She studied their psychological reactions to knowing their death was impending and what they experienced as they faced the inevitability of their death.
In 1969, she published a book called “Death and Dying” where she described 5 stages that dying people typically go through – denial, bargaining, anger, depression and acceptance.
The work that Kubler-Ross did was revolutionary in helping us understand the dying process and bringing forward much needed conversations about death.
However, as time passed, these five stages of dying started being applied to the grieving process, which went beyond their original context. I think this is in part due to our desperation to put some kind of structure around grief. Having a framework for grief is seen as a way to help us understand and navigate grief with more certainty.
It is our human nature to want to bring order and structure to difficult and chaotic states we find ourselves in. With grief being unpredictable and overwhelming, it’s understandable that researchers and society in general, have latched on to the five stages of grief model.
Over time, the model was expanded to include additional stages. One version is called the “7 stages of grief cycle” and includes: shock and denial; pain and guilt; anger and bargaining; depression, reflection and loneliness; the upward turn; reconstruction stages and acceptance. There are many different versions of the model floating around mainstream literature. Within the field of counselling, the 'stages of grief' framework is generally considered to be an outdated model. However, we can clearly see this approach still being shared across many different platforms, as the primary way to conceptualise grief.
Problems with the stages of grief model
Whether used in the context of dying or grieving, Kubler-Ross didn’t intend for the stages model to used in any rigid linear way. She recognised that the human experience is unique.
The last book that Kubler-Ross wrote, “On Grief and Grieving” was co-authored with David Kessler and in it, they explain that the stages “are tools to help us frame and identify what we may be feeling. But they are not stops on some linear timeline in grief. Not everyone goes through all of them or goes in a prescribed order” (Kubler-Ross & Kessler, 2005).
The five stages of grief are often used in movies and the media in a prescriptive way, as if all grieving people will go through each of the 5 stages, in order. “Oh, so you are feeling angry... you must be in the anger stage... next up is the depression stage so get ready for that one!” Nope, that’s not how grief works!
Our grief is unique and not everyone will experience the same emotions. Some people never experience anger or depression while grieving. Some people may resonate with feeling a few of the emotions these stages describe, but in a completely different order.
One of the major problems with the five stages of grief model is that it positions the stage of ‘acceptance’ as the ultimate final stage of grief, almost like a goal. The stages of denial, bargaining, anger and depression all have negative connotations to them so we can be forgiven for thinking that these emotional states are maladaptive or unhealthy in some way and the goal is to reach 'acceptance'.
Many people will never experience anything remotely comparable to acceptance in relation to losing their loved one. It creates unrealistic expectations and grieving people may feel pressured to quickly process their other emotions to get to the point of acceptance. Some may inadvertently suppress their true emotions in order to try and emulate a sense of acceptance if they believe that this is the ultimate goal of the grief journey.
My personal frustration with applying this model to grief is that I believe it normalises certain emotions over others. There is such a wide range of healthy and normal grief responses. Grieving people can experience so many other emotions as part of their grief, but when they google to learn about grief and the predominant model being discussed in mainstream culture is the 5 stages model, they may feel that what they are personally experiencing isn’t considered normal. People need to have their grief validated and know that what they are experiencing, however complex, confusing or messy, is normal. Even if it doesn’t fit into one of the ‘five stages’ or ‘seven stages’. By putting grief into a definitive framework, I think we risk invalidating the diversity of human emotional responses and experiences.
Another criticism of the five stages of grief model is that it isn’t supported by empirical data. Kubler-Ross interviewed 200 terminally ill patients and her qualitative research formed the basis of her five stages of dying model. With the model subsequently being applied to grief in general, there is a distinct lack of evidence to support it as a model of understanding grief.
While I recognise the stages theory has some value in understanding psychological states that a terminally ill person may face during the dying process, I think that it’s helpfulness in relation to understanding and supporting grief and loss is limited.
Contemporary models of grief
Due to the limitations of the stages model of grief, researchers have explored and proposed alternative models that increasingly recognise the uniqueness of grief responses and the nuances involved.
There are many contemporary models of the grief process which have contributed in various ways to our understanding of grief. Modern approaches to grief tend to acknowledge the complexity of the grief process as well as emphasise the need for individualised, personalised and holistic grief support.
Some examples include the dual processing model, narrative and meaning making approaches, and the continuing bonds paradigm. These approaches focus on how people can adjust to their new life after loss and integrate their grief. Newer models of grief also tend to acknowledge the influence of various individual and cultural factors which affect the grieving process.
Thanks to Elisabeth Kubler-Ross
When I reflect on the work of Elisabeth Kubler-Ross, I think that she was quite revolutionary with regard to her approach of spending time with people who were dying. She emphasised listening to the needs of the dying and placing them at the centre of end-of-life care discussions. This may seem like common sense to us nowadays but in the 1960s, there was still a significant taboo around death, limited patient autonomy and people dying were often isolated in hospitals.
Kubler-Ross’s work challenged end-of-life processes of the time and highlighted the emotional needs of the dying. She advocated for open discussions around death and dying and raised awareness about the importance of patient autonomy and palliative care in the home where possible. Kubler-Ross’s central message was to listen to the dying and I think this part of her work translates seamlessly to supporting those who are grieving. We need to listen to the grieving.
Your experience with grief is unique and deserves to be honoured in all it’s complexity and nuance. There is no set grief process or instruction manual for how to navigate your grief. However, there are many things we can work through together to ease the suffering you may be feeling and help you adjust to the loss of someone special.
In a future blog post, I will share more about some of the contemporary models of grief. Please subscribe to my blog and follow me on social media where I share more about grief support, grief education and grief counselling.
Thanks for being here and sharing in this conversation about grief. I look forward to connecting with you soon.
Michelle Marazakis - Counsellor
Grief Space
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