In her classic book On Death and Dying (1969), Swiss-American psychiatrist Elisabeth Kübler-Ross identified five emotions experienced by persons experiencing grief. Later in her life, Kübler-Ross noted that these are not a linear and predictable progression and admitted that she regretted calling them “stages.” Although commonly mentioned in popular culture, studies have not shown that these are universal (i.e., experienced by all or even most people). The model is considered by some to be outdated, inaccurate, and unhelpful in explaining the grieving process.
David Kessler, who co-authored several books with Kübler-Ross, contributed a sixth stage – “Finding Meaning” – to the model. In my opinion, this makes the model more useful in describing the experience of grief; though the model still provides little guidance on how to navigate the process.
Here are the six stages, as described by Kübler-Ross and Kessler:
Denial – Typically, but not always, the first reaction. Individuals believe “this didn’t really happy,” and cling to a false, comforting version of reality. This can actually be helpful if it doesn’t go on too long, as it allows us to do what we must, in spite of our grief.
Anger – When we recognize that denial cannot continue, we may become frustrated, often taking our anger out on the people closest to us. We might blame others, saying things like “Why me? It’s not fair!” or “How can this happen to me?” or “Who is to blame?” or “Why would this happen?”
Bargaining – This response involves the hope that the individual can avoid a cause of grief. Often, the negotiation for an extended life or lessened suffering is made in exchange for a reformed lifestyle. We might try to bargain or seek compromise. Examples include the terminally ill person who “negotiates with God” to attend a daughter’s wedding, an attempt to bargain for more time to live in exchange for a reformed lifestyle or a phrase such as “If only I could trade my life for theirs.”
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?” We might despair at the recognition of our own mortality. In this state, we may become silent, refuse visitors, and spend much of the time mournful and sullen.
Acceptance – “It’s going to be okay.”; “I can’t fight it; I may as well prepare for it.” We might embrace mortality or inevitable future, or that of a loved one, or another tragic event. People dying may beat their survivors to acceptance, or may not reach it at all! This was the final stage in the Kübler-Ross model, and I never found it satisfactory. I do not want to just “accept” my fate; I want to learn and grow as a result of my experiences. That takes us to Kessler’s sixth stage.
Meaning – Meaning can emerge from tragedy. Making meaning is relative and personal, takes time, and does not require understanding. It cannot be rushed and not everyone finds meaning in their losses. But, according to Kessler, “if we allow ourselves to move fully into this crucial and profound sixth stage—meaning—it will allow us to transform grief into something else, something rich and fulfilling.” Ultimately, meaning comes from finding a way to sustain love for the person after their death while we are moving forward with our lives. That does not mean we will stop missing what we have lost, but we may experience a heightened awareness of how precious life is. This is the experience of death or loss that can lead to resilience, courage, and creativity.
Remember, not everyone experiences all of these “stages” of grief, and no two people will experience them in exactly the same way or in exactly the same order. There is no “right” or “wrong” way to grieve.
The Four Tasks of Mourning
The six stages of grief discussed above can be useful for describing the experience and for helping us to see our grief as “normal.” They also give us a common language for describing our experiences. But they do not help us to move through the process and successfully mourn our losses. For that, I prefer a more action-oriented process developed by Psychologist J. William Worden, who describes four “tasks” of mourning:
Task 1: Accept the Reality of the Loss – First, we must come face-to-face with the reality that the person is gone; that reunion is impossible, at least in this life. Many people who have sustained a loss find themselves calling out for the lost person. They might actually think they have encountered the person on the street and have to remind themselves “No, that isn’t my friend; my friend really is dead and gone.” Writer Joan Didion, for example, experienced this after the death of her husband and wrote about it in her book The Year of Magical Thinking (2005).” Before we can move on with the grief process, we must fully accept the reality of the loss on all levels, including the fact of the loss, the meaning of the loss, and the irreversibility of the loss.
Task 2: Process the Pain of Grief – We must acknowledge and work through the emotional and behavioral pain of loss, or it can manifest itself through physical symptoms or some form of problematic behavior. Anything that continually allows us to avoid or suppress the pain will prolong the course of mourning. This could include alcohol or other drugs (including medications prescribed by well-meaning physicians), avoidance, or any number of other strategies. It is important to remember, though, that not everyone experiences the same level of pain, or feels it in the same way. We must not judge ourselves harshly for not being sufficiently devastated after a loss. It is also important to remember that different cultures and subcultures have different approaches to grief, which must be respected. Our current COVID-19 world has created special problems in this respect, as some of our funerary traditions (e.g., gathering in groups) are currently considered too dangerous.
Task 3: Adjust to a World Without the Deceased – There are three areas of adjustment that need to be addressed after a loss. External adjustments are those we must make to changes in our everyday functioning in the world. We might have to develop new skills and take on new roles. We might even have to move to a new community or make other changes in our lives. We must also make internal adjustments to the way the loss affects our sense of self. “Who am I now?” “What is my place in the world?” “How do I relate to others in my world?” Some studies suggest that for women who define their identity through relationships and caring for others, bereavement means not only the loss of the significant other but also the sense of a loss of self. For many, spiritual adjustment is the hardest. This is adjustment to one’s sense of the world. A major loss can shake the foundations of the world a person has known, including their values and beliefs. We might feel that we have lost direction in life. Three basic assumptions that are often challenged by a loss are that the (1) world is a benevolent place, (2) that the world makes sense, and (3) that the person is worthy.
Task 4: Find an Enduring Connection with the Deceased While Embarking on a New Life — The goal is not to give up our relationships with who or what we have lost (i.e., “moving on”). We must, instead, find an appropriate place or role for the lost in our emotional lives – a place that will enable us to go on living effectively in our world. If we do not, there is a danger that we will stop living. Many people report that they feel that their lives ended with the loss and have not resumed. For example, we might shut ourselves away, making a pact with ourselves to never love again, to protect ourselves from the pain.
These tasks should not be looked at as a fixed progression. As with the six stages of grief, these can be and often are revisited and worked through again and again. They can also be worked on at the same time. Grieving is a fluid process that is influenced by many individual and cultural factors. These include the what we lost, the attachment one had to the lost, how the loss occurred, stigma associated with the loss (e.g., suicide, overdose), past experiences with loss, social factors, other stressors, personality variables and more.
Mourning is not a simple or easy task and should not be rushed. By the same token, we should not be shamed for appearing to have too easy a time mourning a loss.