Beware the 5 Stages of "Grief"
Editorial - TLC Group
Few concepts have insinuated themselves into the popular culture as thoroughly as the so called "5 Stages of Grief": Denial, Anger, Bargaining, Depression, Acceptance. We've heard it from professionals in all areas of the healthcare system (who should know better) as well as from lay persons of all ages (who shouldn't). There is even a lengthy comedy routine about it by Dustin Hoffman playing Lenny Bruce in the movie Lenny. The time has now come to ditch it as the concept has done more harm than good.
Three Common Myths about the 5 Stages
1. The 5 Stages of Grief were defined by Elisabeth Kubler-Ross
In her book "On Death and Dying", Macmillan Publishing Company, 1969, she presents 5 stages terminally ill persons may go through upon learning of their terminal illness. She presents them as "an attempt to summarize what we have learned from our dying patients in terms of coping mechanisms at the time of a terminal illness".
These stages were not originally the 5 stages of Grief but better: The 5 Stages of Receiving Catastrophic News. Over the next 28 years, healthcare professionals, clergy, nurses, doctors, caregivers, students, and other readers of the book somehow mutated the stages into the 5 stages of Grief.
2. The 5 Stages define the process a bereaved person must go through in order to resolve their grief.
Grief is a complicated, multi-dimensional, individual process that can never be generalized in 5 steps. In fact, as will be shown, a person will generally have to go through the 5 stages before true grieving can even begin.
3. A person who isn't progressing through the 5 stages in sequence and in a timely manner needs professional help.
This common belief has caused a lot of problems and misunderstandings. One researcher has shown that some caregivers have actually gotten angry at the bereaved person for not following the stages in order! The person shouldn't be Angry yet because they haven't been through Denial.
All of the above points to a basic misunderstanding about what Grief is to begin with so it's not surprising that myths continue to propagate. This is most likely because the pervasiveness and impact of grief wasn't really recognized by the psychological community until around the 1980s and even then it was slow in coming.
For example, in 1974 "The Handbook of Psychiatry" defined Grief as "...the normal response to the loss of a loved one by death." Response to other kinds of losses were labeled "Pathological Depressive Reactions".
In 1984, Dr. Terese Rando---a noted grief specialist, researcher and author---defined Grief as "...process of psychological, social and somatic reactions to the perception of loss".
In 1991, the Grief Resource Foundation of Dallas, Texas found that, for them, a good working and practical definition of Grief as "the total response of the organism to the process of change".
Today, in December 1996, we at TLC Group have come to accept the Grief Response as the Unified Field Theory of All Mental Illness (a subject of another Tip of The Month!)
Curiously, most non-grief specialists commonly accept the definition of grief given in 1974. So what is grief and what produces it? A helpful equation, which proves itself daily in all instances is: Change=Loss=Grief.
This means that:
1. A Change of circumstance of any kind (a change from one state to another) produces a Loss of some kind (the stage changed from) which will produce a Grief reaction.
2. The intensity of the grief reaction is a function of how the change-produced loss is perceived. If the loss is not perceived as significant, the grief reaction will be minimal or barely felt.
3. Significant grief responses which go unresolved can lead to mental, physical, and sociological problems and contribute to family dysfunction across generations.
So, are the 5 Stages without value? Not if they are used as originally intended, as The 5 Stages of Receiving Catastrophic News. One can even extrapolate to The 5 Stages of Coping With Trauma. Death need not be involved.
As an example, apply the 5 stages to a traumatic event most all of us have experienced: The Dead Battery! You're going to be late to work so you rush out to your car, place the key in the ignition and turn it on. You hear nothing but a grind; the battery is dead.
1. DENIAL --- What's the first thing you do? You try to start it again! And again. You may check to make sure the radio, heater, lights, etc. are off and then..., try again.
2. ANGER --- "%$@^##& car!", "I should have junked you years ago." Did you slam your hand on the steering wheel? I have. "I should just leave you out in the rain and let you rust."
3. BARGAINING --- (realizing that you're going to be late for work)..., "Oh please car, if you will just start ONE MORE TIME I promise I'll buy you a brand new battery, get a tune up, new tires, belts and hoses, and keep you in perfect working condition.
4. DEPRESSION --- "Oh God, what am I going to do. I'm going to be late for work. I give up. My job is at risk and I don't really care any more. What's the use".
5. ACCEPTANCE --- "Ok. It's dead. Guess I had better call the Auto Club or find another way to work. Time to get on with my day; I'll deal with this later." This is not a trivial example. In fact, we all go through this process numerous times a day. A dead battery, the loss of a parking space, a wrong number, the loss of a pet, a job, a move to another city, an overdrawn bank account, etc. Things to remember are:
1. Any Change Of Circumstance can cause us to go through this process.
2. We don't have to go through the stages in sequence. We can skip a stage or go through two or three simultaneously.
3. We can go through them in different time phases. The dead battery could take maybe 5 to 10 minutes, the loss of a parking space 5 to 10 seconds. A traumatic event which involves the Criminal Justice System can take years.
4. The intensity and duration of the reaction depends on how significant the change-produced loss is perceived.
It was mentioned above that Grieving only begins where the 5 Stages of "Grief" leave off. Grief professionals often use the concept of "Grief Work" to help the bereaved through grief resolution. One common definition of Grief Work, based on J. William Worden's "Four Tasks of Mourning" as outlined in his book Grief Counseling and Grief Therapy, can be summarized by the acronym TEAR:
T = To accept the reality of the loss
E = Experience the pain of the loss
A = Adjust to the new environment without the lost object
R = Reinvest in the new reality
This is Grief Work. It begins when the honeymoon period is over, the friends have stopped calling, everyone thinks you should be over it, the court case is resolved, "closure" has been effected, and everything is supposed to be back to normal. It's at this point that real grieving begins.
Notice that the first step of Grief Work is ACCEPTANCE, the last stage of the 5 Stages of Grief. Let's throw out the 5 stages of grief and replace it with a greater understanding of Grief Recognition and Resolution.
TLC Group grants anyone the right to use this information without compensation so long as the copy is not used for profit or as training materials in a profit making activity such as workshops, lectures, and seminars, and so long as this paragraph is retained in its entirety.