The Five Stages of Grief: Do they still apply, and to whom?

Grief descends on anyone who is facing loss. We most often think first of a person

who has lost a loved one to death, but grief does not restrict its reach. Before the loved ones are visited by grief, It first has affected the person who is ill with a life-threatening condition, who is facing both the disease and possibly a shortened time on earth. In fact, the five stages of grief that are so often called up to explain grieving started out almost 50 years ago as the result of interviews with hospital patients with life-threatening conditions.

Psychiatrist Elisabeth Kubler-Ross was on a mission to change the attitude of physicians of the day who were reluctant to even discuss end-of-life issues with their patients. She shared her observations from these interviews in her book On Death and Dying, and they became immediately popular. Later, the concept of five stages was gradually extended to those of us who grieve the loss of a loved one, even though her original conclusions had been not been peer-reviewed by a panel of experts as is customary. Despite that gap, the theory coalesced into conventional wisdom that still holds sway today.

Kubler-Ross’ observation was that the patients she interviewed experienced stages of Denial, Depression, Anger, Bargaining, and Acceptance. As a counselor, I was frequently asked by new clients (who were adopting the model to describe their own experience) to verify which stage they were in.

As a novice counselor, I tried to make this theory work. I had a handout chart that described each stage, laid out in a giant circle that ended happily at Acceptance. I soon noticed however that many people simply did not get angry, or bargain, with God or anyone else. Some were not even beset with crippling depression. All were concerned that they were missing the boat. I started to suspect that the theory itself was missing the boat.

I developed more faith in my clients’ lived experience than the chart in my hand. And I figured out that the real question my clients were posing was: am I doing this right? Or more directly, how do I grieve, anyway? The real answer: we do not all grieve alike, and shouldn’t have to try. And we each get to craft our own way to grieve.

Does the experience of people at the end of life match the experience of their loved ones, as conventional wisdom would have it? I do think that grief itself does have some core elements: the recognition that loss causes seismic changes in a life, that it takes all that we’ve got to respond, that nothing is harder, that we need to draw strength from outside ourselves, and that we can gain comfort by creating meaning.

The questions that end-of-life raises however seem to differ from those for the grievers who are left behind. End-of-life questions are often about evaluating what you’ve accomplished, what is left undone, what legacy to leave, what is in store, how to die well. Survivors’ questions are often about how to go on, how to adjust to a new normal, how to fit the loss into an ongoing life story, how to live on. Which underlines the need for each of us to grieve in our own particular way that meets our own particular needs.