Why the ‘5 stages of grief/bereavement’ model should be retired. Permanently. Now.
Since starting my blog last year this is the first time I’ve skipped two blog days in a row. It happened because I was planning on writing this particular blog (which proved challenging for me) and because I don’t actually decide which blog to write next. What happens is that the next topic pops up in my brain and will refuse to step aside for any other blog topic until I’ve written it. Sounds strange I know…but these things have a life of their own. So while I’ve been putting off writing this one none of the others have been allowed even a second thought.
I’ve put this off not because I’m unclear about how I feel on this topic, but because it is so incredibly different from almost everyone I meet in my field. But seriously…enough of this 5 stages business. This has gone on long enough and it is really, really, really time for a change.
So here is my take on the 5 stages of grief/bereavement. The model is misused, misunderstood, and ridiculously outdated and it is time people started questioning it’s wisdom and value, because this happens far too little. It is time we stopped using it. I mean completely stopped using it.
Now if you’ve read my blogs before you’ll know I don’t make statements like that without backing them up…so bear with me….
You probably know of the 5 stages of grief. Even if you don’t know what they actually are or that there are 5, most people are aware that there are supposed stages that you go through when you’ve lost someone. That’s how commonly accepted this model is. But few people know the background of this model…and that’s where the questions need to start.
The 5 stages or ‘Kübler-Ross Model’, as it became known, was first described by renowned psychiatrist Elisabeth Kübler-Ross in her book ‘On Death and Dying’ in 1969. Kübler-Ross became known (and is probably still considered by many) as the leading authority on death and grief. In this book she outlines the 5 stages – denial, anger, bargaining, depression and acceptance.
Kübler-Ross herself states time and time again that her model was grossly misunderstood in that she ‘never meant for messy emotions to be put into tidy little boxes’. She explained that the ‘stages’ weren’t in chronological order, nor did you finish one completely and move to another. You might spend minutes, weeks, or months in one, she said, before flitting to another and back to one of the earlier. They were meant to be a range of expected emotional responses rather than steps. The only one with a set place was ‘acceptance’ which comes after the others.
What few people realise is that the 5 stages model was not originally based on people who were grieving. Kübler-Ross’ original work was with people who had found out that they had a terminal illness and had a limited time to live. The stages didn’t come about through engaging with people who were grieving the past death of a loved one, but through observing (note this word, we’ll be coming back to it in a serious way in a minute) those who were dealing with their own imminent future death.
By the time she wrote ‘On Grief and Grieving’ Kübler-Ross had identified the same ‘stages’ or emotions showing up for people grieving as well and this is why the model was also applied here. And, unfortunately, it stuck.
The problem with this is that while, yes, both situations may cause the same emotions e.g. anger, depression…the reasons why you feel angry or depressed are completely different. In fact I can’t think of a single traumatic event in your life that wouldn’t provide the opportunity to feel angry and depressed for example but the reasons why you feel this way will be wildly different. And if you don’t identify the ‘why’ underneath the emotion you may as well have it tattooed on your skin…because you won’t be able to resolve it.
Grief is not a set of stages or steps. Grief is a very specific set of emotions, feelings, thoughts, and questions. And depending on who you have lost these feelings, thoughts, and questions will be very different and will come up for very different reasons. Simply identifying the surface emotion without questioning it doesn’t help anyone at all with any element of their grief…which leads me to my final point.
Don’t get me wrong. I have a tremendous amount of respect for Elisabeth Kübler-Ross and have read much of her work. And I really like the woman. She didn’t take much crap from people and she was determined to continue her work no matter how she was challenged (and she was seriously challenged in some frightening ways throughout her career). She was a thought leader of her time. She looked at an area that often went completely ignored and misunderstood and asked questions and looked for answers that few had before her, certainly very few in her field. She worked incredibly hard, was a prolific writer, and helped people who, until then, had had no option for real help or assistance and had often been neglected. But she was a psychiatrist. And that was 1969.
1969 was 42 years ago. That is an incredible amount of time for a model like that to stand, virtually unchallenged, without any real additions or subtractions. There are reasons why it stood (and not because the model was so sound) that I will get to in a minute.
And the psychiatrist bit. Now if you had a problem today – say with work, a relationship, depression, an eating disorder, stress of any kind, or a drug addiction – are you more likely to see a psychiatrist or a specialist coach?
I would be very surprised if you said ‘psychiatrist’.
A psychiatrist’s work is not about change, or empowerment, or changing your perception with ‘quality questions’. Psychiatrists’ work then (and still largely now) was about diagnosis and treatment. It was about understanding through observing (there’s that word again) rather than actual change. So, although Kübler-Ross was certainly a more enlightened psychiatrist than most, her work was not about challenging grief, overcoming it, or healing from it. It was, very simply, about watching it closely and seeing what it looked like. (And if you’d like to argue that she did talk about healing then consider that her definition was a little weak. She says herself in ‘On Grief and Grieving’ that acceptance is not about being ok with the loss of your loved one. That no-one is ever ok with it…and that acceptance is pretty much just accepting finally that they are gone and learning to cope with that fact. That doesn’t sound like healing to me).
But this isn’t how we operate these days. If we go to a coach or specialist for nutrition advice, fitness, mental health issues, money worries, career concerns, relationship issues…you name it… a) we don’t expect to be given the same info/advice that would have been handed out in 1969, and b) we expect to be helped. We expect this specialist to help us create real change in our situations and lives and get somewhere that we cannot get to by ourselves. We do not expect just to be observed.
We want a fitness expert to get us fit. We want a physio to reduce or remove our pain. We want a coach to help reduce or remove our stress. We don’t see a business coach and expect them to listen to our woes, assure us things will get better over time, and make the next appointment. We don’t get help with depression so the professional we see can hand us tissues, offer us a hug…and make the next appointment. That isn’t helping, it isn’t empowering, and it simply isn’t good enough.
We live in a time of change. We understand that things don’t have to be how they first seem. We understand that true healing is possible from all sorts of things and that a change in how you look at something can change absolutely everything for us. Except when we are dealing with death and grief. In this area, for some reason, people don’t believe real healing is possible or desirable. They don’t expect grief counsellors and coaches to reduce or remove their pain. They expect them to listen, understand, offer a hug and make the next appointment. But we would not tolerate this is almost any other area of life. So why here?
Here is what I think are the main reasons why this is an area that we don’t challenge, ask questions, or expect more. Death is too big. It’s scary. People don’t want to face it. Here in the UK I see a constant battle to raise discussion and awareness around death, planning, wills, etc. But this isn’t something people like to do – think about death. It’s something you avoid, don’t touch, look at out of the corner of your eye. So while the world is changing and we are questioning how many other things are done and dealt with, this one managed to slip by…because everyone is too busy pretending they can’t see it anyway.
The other reason is that not only is the general public not questioning grief, but the people they often see for help aren’t either. This is totally understandable when the basis of a lot of teaching and training in this area is around the 5 stages model. More and more, as I meet newer and more open-minded people in this industry I am encountering different and more logical, empowering views, but the larger percentage of workers around grief and death still believe what they’ve always been told….the 5 stages. So this is what they teach you too.
And so the 5 stages of grief/ bereavement have stood the test of time….not because they’re right, but because few people ever dared to question them.
Grief is not steps, stages, and it is certainly not a permanent place to live. As I stated earlier, it is a specific set of emotions, thoughts, feelings, and questions, that get in the way of you remembering and loving the person you have lost. And if you leave them unresolved (which most do) and never ask questions about them then yes, you may well bounce from anger, depression, denial, etc until you reach acceptance (which is basically where you get to when you have nowhere else to go and you start to forget them because it hurts too much to do anything else).
Take this quick example. I worked with a client who had lost her mother a few years ago and was still very much grieving and in pain. The thing that hurt her most was that she hadn’t been able to get to the hospital in time and wasn’t with her mother when she died. And she was in great pain over this. Perfectly understandable right? A bit of denial and depression happening? She hadn’t yet reached acceptance…and anyway, this was something she would just have to learn to live with as it isn’t something you could ever truly heal from. Right?
Not. Good. Enough.
Through some simple questioning I realised that the big problem was that she actually hadn’t wanted to be there at the time (hence why she was late) and felt so incredibly guilty, and like a bad daughter…and that was why she was in so much pain. Once I helped her see that it was ok not to want to be there, it was ok that she wasn’t there (it’s tough experience, can be frightening, and it’s certainly not the best idea for everyone to be there), and that it worked out better for her mum that she wasn’t, it changed everything. She describes herself now as grief-free and can think about and remember her mum so much easier than before when she was in pain. Simply understanding and observing her grief through the 5 stages model rather than assuming that healing is possible and asking some practical questions would have left her exactly where she was.
If we don’t question what we are going through we will be stuck in it for a very, very long time.
I got into the work I do after losing my dad as well as a number of other family members in a short time and having some serious questions around the experience. I don’t need to tell you that the pain was indescribable….but early on I realised two things didn’t make sense to me. 1) that an event (death in our life) that was guaranteed to happen many, many times over would also weigh us down and hurt us forever. It didn’t make sense that there wasn’t another answer, and 2) that the very thought of my dad, a man I loved and love so dearly, would be a cause of pain for me for the rest of my life, that this would be his legacy. This was absolutely unacceptable to me.
True healing is possible from grief. There are no stages or steps unless you don’t do anything to resolve what you are feeling, thinking, and asking.
It’s time we started questioning grief the same way we do other areas of life. It’s
time to stop accepting that the best thinking of 1969 is still the best thinking of today. That is very rarely the case…and it certainly is not here. It is time to retire this model and put it to bed. We needed it before, we had no other model to use effectively to understand this experience….but that was then…..it had it’s time but we don’t need it anymore.
Please feel free to comment below. I would love to hear your views, whether you agree or disagree with me. There needs to be waaaaaaaaay more discussion around this topic than is going on out there right now.