Saturday, July 7, 2012

Stages of Grief - Is It Time For a New Model?

The face of Grief and mourning in our society is changing.

One wonders why the myth, that mourning or grieving happens in stages or phases, is still so prevalent in our enlightened society.

After all, there are other, more descriptive models that better describe the process. So what’s wrong with stage-based models of mourning?Well, several things.

Stage Theories
If there is a multitude of stage theories, which one is correct? There are theories involving three, four, five, six, seven, ten, and twelve different stages.

The most famous model is a misapplication of Elizabeth Kubler-Ross’s five stages of coping with dying. The stages, popularly known by the acronym DABDA, include:
  1. Denial — "I feel fine."; "This can't be happening, not to me."
    Denial is usually only a temporary defense for the individual. This feeling is generally replaced with heightened awareness of possessions and individuals that will be left behind after death. Denial can be conscious or unconscious refusal to accept facts, information, or the reality of the situation. Denial is a defense mechanism and some people can become locked in this stage.
  2. Anger — "Why me? It's not fair!"; "How can this happen to me?"; '"Who is to blame?"
    Once in the second stage, the individual recognizes that denial cannot continue. Because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy. Anger can manifest itself in different ways. People can be angry with themselves, or with others, and especially those who are close to them. It is important to remain detached and nonjudgmental when dealing with a person experiencing anger from grief.
  3. Bargaining — "I'll do anything for a few more years."; "I will give my life savings if..."
    The third stage involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the individual is saying, "I understand I will die, but if I could just do something to buy more time..." People facing less serious trauma can bargain or seek to negotiate a compromise. For example "Can we still be friends?.." when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death.
  4. Depression — "I'm so sad, why bother with anything?"; "I'm going to die soon so what's the point?"; "I miss my loved one, why go on?"
    During the fourth stage, the dying person begins to understand the certainty of death. Because of this, the individual may become silent, refuse visitors and spend much of the time crying and grieving. This process allows the dying person to disconnect from things of love and affection. It is not recommended to attempt to cheer up an individual who is in this stage. It is an important time for grieving that must be processed. Depression could be referred to as the dress rehearsal for the 'aftermath'. It is a kind of acceptance with emotional attachment. It's natural to feel sadness, regret, fear, and uncertainty when going through this stage. Feeling those emotions shows that the person has begun to accept the situation.
  5. Acceptance — "It's going to be okay."; "I can't fight it, I may as well prepare for it."
    In this last stage, individuals begin to come to terms with their mortality, or that of a loved one, or other tragic event. This stage varies according to the person's situation. People dying can enter this stage a long time before the people they leave behind, who must pass through their own individual stages of dealing with the grief.
This model for mourning is the most egregious one since it is a totally erroneous application of her work.

Complex Process
Regardless of which one you chose, each stage theory attempts to portray a complex process involving the emotional, behavioral, cognitive, spiritual, and social facets of a person with a few simplistic terms.

While simplicity can help describe something, it can also be very misleading. There is no empirical proof that any stage-based model describes everyone’s bereavement experience.

The models have been based on observations of select populations and not, until recently, subjected to empirical study.

A Car Wash Approach

Stages imply that mourning is passive. A good analogy is a car wash. First is the “vacuuming the floor” stage, followed by the “clean the bugs off the windshield” stage, followed by the “wash, and rinse” stage, followed by the last stage - the “drying off” stage.

The car doesn’t do anything but be there, and everything happens to it so it comes out of the process bright and shiny clean. Mourning is not a passive process like a car wash; it is a highly active one.

Simple Expectations
Stage models create expectations of what mourning is supposed to be like. To me, this is a major shortcoming because of the potentially detrimental effect on the bereaved.

A widely published list of stages sets people up to expect certain reactions after the death of a loved one.

When those expectations don’t happen or don’t happen in the “correct” order, the bereaved individuals can think there is something wrong with them.

I have had several clients come to me stating they haven’t experienced one stage or another, and they're scared they're not grieving the way they should.

Once I explained to them that stages are an artificial construct, they were definitely relieved. There are typically enough complex and emotional possibilities for a bereaved person to work through, without adding whether he/she has adequately encountered all the 'defined' stages of grieving or whether the stages have occurred in the 'proper' sequence.

It is NOT a checklist that defines an established path. It is time we stopped trying to distill the inter-personal and intra-personal complexities of mourning into a simplistic template and a set of dogmatic steps.

Mourning is a highly individualistic process based on many complex factors in the bereaved person’s life.

It is a process for finding meaning in a distressing time of loss, transforming and /or creating a new relationship with the deceased, reintegrating the deceased into the bereaved person’s being, and learning how to live in the world under a new set of conditions and assumptions.

If you or anyone you know is experiencing difficulties dealing with their loss and bereavement then they should seek advice and support from a professional who can provide guidance and insight.

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