Grief, Revisited: Transcending Kubler-Ross

A wonderful article in New Yorker magazine describes how, on an autumn day in 1964, Elizabeth Kubler-Ross found her calling-- and subsequent international fame-- while raking leaves₁. That seasonal exercise led her to form the Five Stages of Dying (and later, Grieving): Denial, Anger, Bargaining, Depression and finally, Acceptance. Consequently, given the press that her seminal work On Death and Dying has received since that fine autumn day, we are all familiar with these stages, and often find ourselves applying its terms to our own losses. But as we experience it, grief is not that tidy; defiantly, our moods and the subtle shifts of grief's own process refuse to fit in such neat compartments. Indeed, understanding grief in terms of stages can add unecessary additional stress to the greiving person who is already embroiled in the stressful occupation of mourning. The awful unintended side-effect of this now-conventional approach leaves mourners to think they are doing it wrong, or grieving off-schedule, or that something is really wrong with them. It turns out, there is a better way to grieve.

Kubler-Ross' work still brings comfort and relief, but grief theory has developed a lot since 1990. When you open a copy of her landmark On Death and Dying, you'll note the most recent publising date is 1991; however, keep in mind that the original research was completed and the book released in 1969. The edition issued in 1991 simply adds the caveat that while the original 5 stages are predictable, they are not sequential or singular. Also, Kubler-Ross adjusts those 5 stages into a three-step process wherein denial, anger, bargaining, depression, and acceptance fall under a first step of “resistance”; these familiar stages are then followed by a second step of “finishing old business” and finally, “transcendence”. This is to say that by 1991, 22 years after the original work, Kubler-Ross herself recognized the limitations of a grief theory presented as set stages and the error of misinterpreting them as some kind of benchmark for normal grief response.

Some refer to this practice as "Kubler-Rossing" a bereaved client. An example of just how pervasive this practice remains even today in popular psychology appeared as a USA Today report on World Trade Center widows (Jerry Shriver, Trade Center Survivors Build at their Own Pace, 9/11/03). The article begins, “Grief counselors say that when the world suddenly stops amid death and destruction, it’s normal to experience denial, anger, bargaining, depression, and, finally, acceptance.” The author then adds, “But two years after the Sept. 11, 2001, terrorist attacks, some people whose lives were rocked the hardest say they’ve endured a long, unforgiving sixth phase….of putting their lives back in motion.”

This article provides a good example of why it is so important to consider the more contemporary works available on grief theory—because the hurt does not end, as many assume, with “acceptance”.

One such theory embraced by many hospices is William Worden’s Four Tasks of Grieving (1991): First, the bereaved must accept the reality of the loss. Second, he or she must experience the pain of grief. Third, the person must adjust to an environment in which the deceased is missing. Finally, the bereaved must emotionally relocate the deceased and go on with their own lives. More recently, Frank Ostaseski of Zen Hospice Project in San Francisco (Tricycle Magazine, Fall 2003) renders these steps as 1) facing loss, 2) mourning, 3) letting go, and finally 4) moving on. However they are worded, inherent in these "new" theories is the understanding that grief does not go away after a specific time period or sequence of stages; instead, it is a life-long process of exploration and integration.

Therese Rando (1993) expanded these further into the “Six R’s” of Mourning: Recognize the loss, React to the separation, Remember the person, Relinquish the attachment, Readjust to the world, and Reinvest. These steps relate to Brown & Stoudemire's (1983) stages of shock, obsession, and resolution, and are reminiscent of Friedman & James’ Grief Recovery Handbook's (1989) “5 Tasks to Recover from Grief". Still, there has been an effort to move away from the practice of understanding the process of grief in terms of "tasks" altogether. These orientations embrace grief as not something to recover from, but to learn by and live through. This includes the transitional and meaning-making Coping, Dual-Process, and Adaptive theories of Parkes (1993)/ Niemeyer (1998), Stroebe, Schut, & Stroebe, (1998), and Doka & Martin, (2000) respectively, who challenged the stage- and task-orientation of earlier theories.

These new formulations help to clarify the original stages posited by Kubler-Ross and serve the counselor and bereaved alike by providing a wider scope of grief itself. Here we find the familiar grief responses of denial, anger, bargaining, depression, and acceptance, with a better understanding of their purpose, rather than their order. We do ourselves a great disservice if we do not allow that there is a purpose for grief responses—not just that they are normal, but that just like the autumn leaves that one day will turn into food for the rest of the forest, grief serves an organic function in helping us to readjust to a world that has been so radically and painfully altered.