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Stages of Grief; Revisited, Refined, Reinvented

8/24/2010

The stages of grief were developed byElisabeth Kübler-Ross in her 1969 book, On Death and Dying. They are in order: Denial, Anger, Bargaining, Depression, and Acceptance. The stages of grief are a staple of current psychological theory. However like all psychological theory, it is subject to much criticism and debate. One of these critiques totally refutes the entire premise of stages of grief (you can link to it here).  With that in mind, the ThinkTank Panel (of One) has conducted an extensive analysis of these stages of grief and proposes the following refinements to the theory, designed to address inherent shortcomings, yet maintain the cohesion Kübler-Ross provides.

First the ThinkTank Panel (of One) would emphasize the sequential nature of the stages. It is well established that a person in the grieving process may go back and forth between stages several times before completing the process and overcoming their grief.     Whether one is progressing or regressing, they will experience the stages in order, there is no skipping a stage. Just as there is no way to short cut the process there is no way to be “free fall” into a previous stage without passing through the stages in-between. For example if a person finds themselves in the 4th stage of depression and has a setback which leaves them stuck in anger, they will experience a period of bargaining, however brief, before they regress to that anger stage.

Next the ThinkTank Panel (of One) proposes some minor terminology changes to the labels of the stages of grief that are more accurate description s of the psychological mechanism at play in the various stages.

First, the term “denial “is subtly misleading as it implies the griever refuses to admit the event which caused their grief actually occurred. This is inaccurate, and dangerous as it confuses a separate, yet related psychological phenomenon that professionals treating grief must also be aware of. For example: Sally is grief stricken by the sudden passing of her mother from a sudden heart attack. Sally’s initial reaction upon hearing the news is to say “What? No. This can’t be. How can she be dead? I just spoke with her yesterday. She was fine!” While most people would call this a textbook case of denial (and it may well be accurate to depict this action as a denial), it is incorrect to assume this is the first stage of grief as Sally has not yet begun to grieve. This is an example of shock, a distinct psychological issue that if prolonged could require specific mental health intervention. . Sally will not receive this intervention if her actions are incorrectly interpreted as the normal grieving process.

More accurately the denial phase of grieving should be labeled “denial of a problem” to differentiate it from the shock induced coping mechanism of denial of the event, a form of repression. It is only when Sally tries to convince herself and others “I’m fine,” that she begins the necessary, natural grieving process.

The ThinkTank Panel (of One) considered briefly adding shock as the initial stage of grief preceding denial of a problem. However it is readily apparent that Shock is not inherent to grieving, as Sally’s mother could have died from a long battle with a terminal illness, in which case Sally would have expected her passing and would not be in shock. Yet she would still need to grieve

The bargaining stage of grief attempts to describe a state of mind in which the griever is attempting to take control of their grief so that they may dictate the terms of the grief so that they may manipulate the situation into one more acceptable . For instance; Sally’s mother with a terminal illness finds it easier to accept her impending death when she aspires to survive just long enough to see her daughter’s wedding next month. Similarly, Sally negotiates with herself that she will stop missing her mother once she fulfills her mother’s lasting wish for grandchildren, by having a baby. This leads to a year of erratic and irrational behavior, characterized by midnight calls to her physician’s residence when she could not reach him at the office as Sally obsesses over conceiving and then doubly obsesses about the prenatal health and development of her baby.   In either case the griever desperately seeks continual control over something to compensate for the helplessness of their grief.

Therefore the second proposed refinement to the stages of grief is to re-label bargaining to the more apt description of desperation, as it is the desperate grasping for control which defines this phase. The bargaining merely refers to the transference of this desperation on to an object or action.

Given the new perspective due to the change from bargaining to desperation leads to the ThinkTank Panel (of One)’s 3rd proposed refinement to the stages of grief. In bargaining, the transition to depression is the idea that the grief does not keep its end of the bargain and dissipate when the griever lives up to their end of the bargain. The result is a complete loss of all hope and a deep depression. Whereas, with the new notion of desperation, there is a realization that that a person’s best efforts to exert control are in vain, which leads them to give up or surrender. Thus the ThinkTank Panel (of One) proposed that the stage of depression be re-labeled surrender.

It may sound like semantics, but the difference is the realization of one’s powerlessness is an important component to explaining how the process of grieving works. One must surrender control voluntarily before one can accept the fact that they actually have no control over a situation. And of course, acceptance is the final stage of grief.

Lastly, in light of the difference a subtle change in verbiage can have on the comprehension of the psychological processes at work, the ThinkTank Panel (of One) suggests that the 2nd stage of anger be relabeled frustration. Conceptually there is better flow between flow between Denial of Problem and Desperation with Frustration than with Anger. In psychological terms Anger implies an emotional state that can be rectified by relaxation. Frustration on the other hand implies emotional arousal in response to an obstacle that must be overcome by finding a solution, and it is the search for a solution that drives one to desperation.

So there you have it. The new ThinksIveThunk.com ThinkTank Panel (of One) approved stages of Grief are:

Denial of Problem

Frustration

Desperation

Surrender

Acceptance

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Stages of Grief; Revisited, Refined, Reinvented

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