For Many, Grieving Process Defies Traditional Model

It's taught in medical schools and psychology classrooms around the world: the stage theory of grief which says the grieving process follows five clear stages, beginning with a sense of disbelief or numbness and moving on through anger, bargaining and depression before arriving at acceptance--after which the process of putting one's life back together finally begins.

The stages were introduced in 1969 by late psychiatrist Elisabeth Kübler-Ross in her book On Death and Dying. Though based on her experiences working with terminally ill patients, the theory had never been empirically tested. Throughout the years, however, many therapists, medical professionals and mourners have noted the course of grief often runs contrary to the stage theory, with stages at times overlapping or omitted. Many people, for example, never experience anger or feel a growing sense of acceptance that begins when they first learn the news of a loved one's death. For others, "depression" does not properly articulate the feelings of sadness felt so much as simple "heartache."

Noting this, researchers in the Yale Bereavement Study set out to examine the grieving process in a three-year assessment of 233 individuals who had lost a spouse or family member due to natural causes.

They found that no one set of stages was universally experienced by everyone. Furthermore, acceptance--and not disbelief--was the most common emotion experienced as individuals began to grieve, and increased with the passage of time. Meanwhile, yearning or pining for the person was found to be the dominant negative grief indicator, often lingering long after other feelings had disappeared.

"It's important both for clinicians and the average lay person to understand that yearning and not sadness is what bereavement is really all about," said study author Holly G. Prigerson, director of Dana-Farber's Center for Psycho-Oncology and Palliative Care Research and associate professor of psychiatry at Harvard Medical School.

"It's about yearning, pining, longing and being angry and protesting that you can't have this person back," Prigerson said. Not everyone follows the exact same pattern of grieving, but most do, she said.

Given this data, health professionals should better be able to understand the normal grieving process and to better identify cases where additional help may be needed. The authors indicate, for example, that regardless of how the grief is experienced, negative emotions should considerably decrease by six months and may otherwise suggest a need for further evaluation.

Link: Scientists measure 5 stages of grief
Press Release: Yearning Most Salient Feeling Following a Loss
ABSTRACT: An Empirical Examination of the Stage Theory of Grief