Grief is a unique and personal journey. While Kübler-Ross's 5 Stages of Grief are useful, they may be better viewed as fluid states, rather than orderly stages.

States of Grief

A New Perspective

by Ron Davis, LSW, MSW

Published June 26th, 2017

Elisabeth Kübler-Ross is known in many circles as the definitive expert on the grieving process. She coined five stages of grief from her famous book, On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy and Their Own Families, where they are defined as the following:

  1. Denial — Individuals here believe the diagnosis is somehow mistaken, clinging to false hope or a preferable reality.

  2. Anger — Frustration occurs, often at proximate individuals. Common discussions center around “Why me? It’s not fair.” “How can this happen to me?” and “Who is to blame?”

  3. Bargaining — This stage involves hope that the individual can avoid a cause of grief. Usually this is done in exchange for a reformed lifestyle. For example, when bargaining, the individual may state: “I’ll never drink again if you give them back to me.”

  4. Depression — The individual begins to despair at the realization of their own mortality. In this state, the individual may become silent, refuse visitors, and spend time alone in a mournful and sullen state.

  5. Acceptance — In this stage, individuals embrace their own mortality and inevitable future, or that of a loved one. An example of a statement during this phase is “It’s going to be okay.”

Kübler-Ross’s stages of grief are a valuable tool for many. Where it becomes controversial to some is the belief, per Kübler-Ross, that the above stages happen in sequence, meaning you must go from stage 1 through 5 in order to have officially completed the grief process.

This presents a problem to many people going through grief. With the invention of the internet, one can complete a simple Google search for “grief” and find themselves staring at a Wikipedia page on Kübler-Ross and her stages of grief.

It runs the risk of making a person feel that something is wrong with them if they do not feel that they have experienced all five of the stages written. However, there is good news: New research shows that while Kübler-Ross remains a quintessential authority on grief, not all people will experience the stages of grief as she lists in her research.

In the book On Our Way: The Final Passage Through Life and Death (2004) Professor Robert J. Kastenbaum found no evidence within his own research that people actually move from stage 1 through stage 5 as Kübler-Ross’s theory suggests. Additionally, he noted that the theory of grieving does not take into account individual characteristics, environmental factors, and social systems of the family.

Furthermore, I would argue that Kübler-Ross’s theory itself is not a one-size-fits-all approach. The access we have to this information today is vastly different than the date Kübler-Ross’s text was written in 1969.

When preparing for grief, an individual can perform a basic Google search for “grief” and find Kübler-Ross and these stages within the search in a matter of seconds. Sadly, this can cause anxiety after the death of a loved one, when the same person performs a search and begins to question why they aren’t experiencing grief in that specific order, or at all. These feelings of anxiety surrounding how one ought to feel while grieving commonly give rise to thoughts such as “What’s wrong with me?” and “Am I that messed up?”

Most recently, Sheryl Sandberg and Adam Grant support an idea of states of grief rather than stages in their 2017 book, Option B. Sandberg and Grant state research showing Kübler-Ross’s concept needs to be looked at as states of grief and not stages of grief. They believe that the research shows much more extensively that people can shift in and out of these 5 states, many times out of order, and can experience these shifts between states multiple times a day.

Sandberg presents as not only an expert, but as someone who has recently dealt with sudden grief herself. Her husband, Dave Goldberg, former CEO of SurveyMonkey, died unexpectedly at the age of 47 while the two of them were on vacation in 2015. Throughout the book, Sandberg details her own battles with grief, the effect of normalization, and how journaling impacted her ability to, as she puts it, “Lean into the grief” (Sandberg and Grant, 2017).

The term “states of grief” seems less overwhelming to someone who may be experiencing grief. It also helps in normalizing emotions and feelings that a person may or may not experience. Often, someone going through grief will ask a care provider: “Is this normal?” Looking at grief from a state approach lends itself very well to helping someone not feel overwhelmed or depressed that they aren’t experiencing grief in the “correct” way. This may even help families of different cultures.

"...grief does not follow a set schedule..." Ron Davis, LSW, MSW Tweet

In some of my practice experiences, I have seen instances where culture becomes problematic in application of the theory. I’m not talking about general norms within specific cultures, but the cultures that individual family units have created for themselves.

Many theories concerning grief fail to take into account broken family units with only one parent, and on the opposite end, large family units with family members approaching double figures. Complex family dynamics and unique family culture can often blur how theoretical approaches to grief might be applied, as behaviors and emotions — such as anger — may be suppressed or more readily expressed depending on how the family unit emotionally and spiritually influences its members.

I’ve seen it often when working with a medical team. One member of the team overhears a daughter, for example, saying something a certain way and immediately feels that the daughter is not coping well or acting out in denial. Finally, after having a conversation with a care provider or social worker, it is discovered the daughter is more in line with showing levels of acceptance based on her stories of how the family unit was created, due to the mother teaching children the need to care for each other and love each other regardless. Chances are, in this example, that the children associated with this family member may never experience anger during their grief process due to the values instilled within the family unit.

Unique cases such as these, with complex family dynamics and culture, can cause strain for the medical team and creates room for potential misdiagnoses of spiritual and emotional distress, as behavior that may initially seem distressing may prove to be a healthy part of that person’s unique healing process. For example, to many, a daughter climbing into bed with a family member soon after their death and playing a Beatles song appear to be distressing behavior, but brings great comfort and emotional healing to the daughter and her family.

At the end of the day, grief is a broad term. Despite having theoretical applications, stages of grief or states of grief are not foolproof, all-encompassing definitions. Furthermore, grief does not follow a set schedule. It can ramp up at the oddest of times or initially lay dormant.

The best method for maintaining your wellbeing when navigating through the grief experience is to find someone with whom you can freely speak and openly share your feelings as you cope with your loss. Family members can be fantastic for this, as well as church clergy.

Once everyone realizes that the process will be navigated at its own pace and time frame, the better everyone will be at realizing — whether state or stage — that grief is being dealt with appropriately and you too are, in fact, normal.

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About Ron Davis

Ron Davis, LSW, MSW is the Support Services Director at Crossroads Hospice and Palliative Care in Green, OH.

Ron Davis, LSW, MSW

Support Services Director at Crossroads Hospice and Palliative Care in Green, OH

Ron Davis, LSW, MSW is the Support Services Director at Crossroads Hospice and Palliative Care in Green, OH. In addition to his dedicated work with patients and caregivers, Ron is an Assistant Professor at the University of Akron and is a proud board member of The Grief Care Place in Stow, Ohio. Ron enjoys helping others pursue improved health and wellness, writing, and spending time with his wife and two boys.

References

  1. Kastenbaum, Robert. On our way: the final passage through life and death. Berkeley, CA: U of California Press, 2004. Print.
  2. Sandberg, Sheryl, and Adam Grant. Option B: Facing Adversity, Building Resilience, and Finding Joy. New York City, NY: Knopf, 2017. Print.
  3. Kübler-Ross, Elisabeth. On death and dying: what the dying have to teach doctors, nurses, clergy and their own families. New York City, NY: Macmillan Co. Publishers, 1969. Print.

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