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New Ways to Think About Grief

17 minute read
Ruth Davis Konigsberg

The five stages of grief are so deeply embedded in our culture that they’ve become virtually inescapable. Every time we experience loss — whether personal or national — we hear them recited: denial, anger, bargaining, depression and acceptance. They’re invoked to explain our emotional reaction to everything from the death of a loved one to the destruction of the Gulf of Mexico after the BP oil spill to LeBron James’ abandoning the Cleveland Cavaliers for the Miami Heat.

The stages have become axiomatic, divorced from the time and place of their origin. If you were to read Elisabeth Kübler-Ross’s On Death and Dying — the book that in 1969 gave the five stages their debut — for the first time today, you might be surprised to discover that Kübler-Ross, then a staff psychiatrist at Billings Hospital in Chicago, was actually writing about the experience of facing one’s own death, not the death of someone else. It was other practitioners, having found the stages so irresistibly prescriptive, who began applying them to grief, a repurposing that Kübler-Ross encouraged. After all, there was no specific data set to contradict, no research protocols to follow: Kübler-Ross had based her theory on onetime interviews she had conducted with terminally ill patients, but she never asked them specific questions about the stages, because by her own account, she only conceived of them while up late at night after she had already been commissioned to write On Death and Dying.

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The book was a surprise best seller, and Kübler-Ross became the fulcrum for the nascent death-and-dying movement. To her credit, she helped shatter the stoic silence that had surrounded death since World War I, and her ideas certainly raised the standard of care for dying people and their families. But she also ushered in a distinctly secular and psychological approach to death, one in which the focus shifted from the salvation of the deceased’s soul (or at least its transition to some kind of afterlife) to the quality of his or her last days.

It wasn’t long before a solution was put forth to help the bereaved as well, one promoted by an entirely new professional group specializing in the task of mitigating grief’s impact. From the 1970s to the 1990s, thousands entered the field, offering individual counseling, setting up healing centers and hosting support groups at hospitals, churches and funeral homes. These counselors introduced their own theories, modifying Kübler-Ross’s stages into a series of phases, tasks or needs that required active participation as well as outside professional help. Grief became a “process” or a “journey” to be completed, as well as an opportunity for personal growth. Few questioned the necessity of a large corps of private counselors dedicated to grief, despite the fact that no country other than the U.S. seemed to have one.

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Our modern, atomized society had been stripped of religious faith and ritual and no longer provided adequate support for the bereaved. And so a new belief system — call it the American Way of Grief — rose up to help organize the experience. As this system grew more firmly established, it allowed for less variation in how to handle the pain of loss. So while conventions for mourning, such as wearing black armbands or using black-bordered stationery, have all but disappeared, they have been replaced by conventions for grief, which are arguably more restrictive in that they dictate not what a person wears or does in public but his or her inner emotional state. Take, for example, the prevailing notion that you must give voice to your loss or else it will fester. “Telling your story often and in detail is primal to the grieving process,” Kübler-Ross advised in her final book, On Grief and Grieving, which was published in 2005, a year after her death. “You must get it out. Grief must be witnessed to be healed.” This mandate borrows from the psychotherapeutic principle of catharsis, which gives it an empirical gloss, when in fact there is little evidence that “telling your story” helps alleviate suffering.

But that’s not the only grief myth to have been debunked recently. In the past decade, researchers using more sophisticated methods of data collection than their predecessors did have overturned our most popular notions about this universal experience. Here are some of the biggest misconceptions about grief:

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Myth No. 1: We Grieve in Stages

One of the reasons that the five stages became so popular is that they make intuitive sense. “Any natural, normal human being, when faced with any kind of loss, will go from shock all the way through acceptance,” Kübler-Ross said in an interview published in 1981.

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Two decades later, a group of researchers at Yale decided to test whether the stages do, in fact, reflect the experience of grief. The researchers used newspaper ads and referrals to recruit 233 recently bereaved people, who were assessed for “grief indicators” in an initial interview and then in a follow-up some months later. In the Kübler-Ross model, acceptance, which she defined as recognizing that your loved one is permanently gone, is the final stage. But the resulting study, published in the Journal of the American Medical Association in 2007, found that most respondents accepted the death of a loved one from the very beginning. On top of that, participants reported feeling more yearning for their loved one than either anger or depression, perhaps the two cornerstone stages in the Kübler-Ross model.

Skepticism about the stages has been building in academia for a long time, and yet they still hold sway with practitioners and the general public. A 2008 survey of hospices in Canada found that Kübler-Ross’s work was the literature most frequently consulted and distributed to families of dying patients. “Stage theories of grief have become embedded in curricula, textbooks, popular entertainment and media because they offer predictability and a sense of manageability of the powerful emotions associated with bereavement and loss,” says Janice Genevro, a psychologist who was commissioned by a Washington nonprofit now called the Center for Advancing Health to do a report on the quality of grief services. In her 2003 report, Genevro concluded that the information being used to help the bereaved was misaligned with the latest research, which increasingly indicates that grief is not a series of steps that ultimately deposit us at a psychological finish line but rather a grab bag of symptoms that come and go and, eventually, simply lift.

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Myth No. 2: Express It; Don’t Repress It

The American way of grief places great importance on the expression of your darkest emotions. “Anger is a necessary stage of the healing process … [It] means you are progressing,” Kübler-Ross wrote. This may sound good, but it’s proving to be inaccurate: expressing negative emotions can actually prolong your distress. In a 2007 study of 66 people who had recently lost a spouse or child, those who did not express their negative emotions six months after their loss were less depressed and anxious and had fewer health complaints at 14 and 25 months than those who did express negative emotions. The study, which included a control group of nonbereaved participants and which was conducted by George Bonanno, a professor at Columbia University’s Teachers College who specializes in the psychology of loss and trauma, suggests that tamping down or avoiding those feelings, known as “repressive coping,” actually has a protective function.

A related myth is the “grief work hypothesis,” which defines grief as a project that must be tackled in order to prevent psychological problems. This notion can be traced back to Freud, who wrote that the “work of mourning” was for the ego to detach itself from the deceased so that it could reattach itself to someone else. In the 1970s, Freud’s definition of grief as work became the guiding metaphor for modern grief theory. But a 60-person study conducted by the husband-and-wife research team Wolfgang and Margaret Stroebe of Utrecht University found that widows who avoided confronting their loss were not any more depressed than widows who “worked through” their grief. As to the importance of giving grief a voice, several other studies done by the Stroebes indicated that talking or writing about the death of a spouse did not help people adjust to that loss any better.

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This seems to hold true for other traumatic events, like the terrorist attacks of Sept. 11, 2001. In a study published in the Journal of Consulting and Clinical Psychology in 2008, more than 2,000 people were given the chance to express their reactions in the immediate aftermath of 9/11 and were then followed for the next two years. Contrary to popular belief, people who did not express their initial reactions showed fewer signs of distress later on, while people who did express their reactions had a harder time adjusting.

Myth No. 3: Grief Is Harder on Women

This stereotype can be traced back to a survey of 430 widows in Boston that was conducted from 1967 to 1973 — a time when women, especially older ones, were more dependent on their husbands, both for a sense of identity and financial security, than is the case today. Although no men were included in the survey, the author, psychologist Phyllis Silverman, argued that the death of a spouse weighs more heavily on women because it presents a massive identity crisis for them: “While men need others, their self-development focuses more on individuation and autonomy. A woman’s identity is largely framed by relationships … In losing an essential relationship, she loses an essential part of herself.”

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It’s hard to say whether Silverman’s analysis was colored by gender stereotypes popular in psychology at the time or whether it was swayed by her method of recruiting study participants. Most of the women who responded to her widow-to-widow outreach program were full-time homemakers when their husbands died. (Many of them did not even know how to drive.) It was the women who declined help from Silverman’s outreach program — and therefore never became part of her study — who had worked outside the home before their husbands’ death and continued to work. Of them, Silverman noted, they were “correct in their appraisal” that they didn’t need help when it was offered, although that assessment did not change her final conclusion that widowhood universally does major and long-lasting damage to women.

The gender beliefs of the people who write about and attempt to help others cope with loss have surely contributed to this misconception. According to a survey sent to counselors who had been certified by the Association for Death Education and Counseling, female grief counselors are more likely than male counselors to believe that there are sex differences in bereavement and that women need more time to work through their grief. Women are also more likely to become grief counselors in the first place.

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In 2001, the Stroebes examined all studies that had attempted to measure who suffers more, men or women. To be included, the studies had to meet one of two conditions: widows and widowers had to be compared with a control group of married men and women, or they had to have been evaluated before the loss of their spouse to establish a baseline of their mental health. As the Stroebes pointed out, mental distress is not unique to grief alone, and women suffer higher rates of depression in general, regardless of whether they’ve lost a husband or not. The resulting analysis came to a surprising conclusion: relatively speaking, men suffer more from being bereaved. Yes, widows measured higher on depression scores than widowers, but not once women’s prebereavement or control-group depression levels were factored in.

Myth No. 4: Grief Never Ends

Our grief culture asserts that it’s perfectly normal to get mired for a long time in a state of despair after losing a loved one. Although Kübler-Ross implied an end point by identifying acceptance as the fifth and final stage, she also concluded that “the reality is that you will grieve forever.”

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In fact, researchers have now identified specific patterns to grief’s intensity and duration. And what they have found is that the worst of grief is usually over within about six months. In a study published in the Journal of Personality and Social Psychology in 2002, Bonanno tracked 205 elderly people whose spouses died, and the largest group — about 45% of the participants — showed no signs of shock, despair, anxiety or intrusive thoughts six months after their loss. Subjects were also screened for classic symptoms of depression, such as lethargy, sleeplessness, joylessness and appetite problems, and came up clean on those as well. That didn’t mean they didn’t still miss or think about their spouse, but by about half a year after their husband or wife died, they had returned to normal functioning. (So much for the often repeated saying that “the second year is harder than the first.”)

Only about 15% of the participants in Bonanno’s study were still having problems at 18 months. This small minority might be suffering from a syndrome clinicians are starting to call Prolonged Grief Disorder. Most people respond to loss with resilience, which is often mischaracterized as pathological or delayed grief. Or, to borrow Bonanno’s paraphrasing, “If you’re resilient after a horrible accident or a traumatic event, then you’re a hero, but if you’re resilient after a death, then you’re considered cold.” Knowing that this was a common conclusion, he asked the subjects in his 2002 study about the quality of their marriages and found no significant differences between those who recovered quickly and those who took much longer. Nor were the resilient grievers found to be more aloof or distant when interacting with others. As for the possibility that they were repressing their grief, Bonanno followed the group for up to four years (some participants dropped out) to see if people who initially showed lower distress levels had delayed reactions. None of them did.

It’s hard to tell what makes people resilient. “Personality probably predicts only about 10% of resilience,” says Bonanno. “Having money helps, having social support helps, having minimal sources of other stress helps, but no one thing is a big predictor.” What we do know is that while loss is forever, acute grief is not.

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Myth No. 5: Counseling Helps

Grief counseling is now routinely offered in a range of settings, beginning with the places where most people die: hospitals, palliative-care units and, most of all, hospices, where a minimum of one year of counseling after a loved one’s death is mandated by federal legislation passed in 1982. If family members don’t encounter someone offering to help in one of those places, they surely will at one of the nearly 20,000 funeral homes across the U.S., where the industry-approved term for bereavement support is “aftercare services.” There are also freestanding organizations across the country that offer a wide array of treatments. Some of these organizations are not-for-profit, but others are all for it: the Grief Recovery Institute in Sherman Oaks, Calif., has trademarked the term grief recovery and charges $995 for a three-day workshop.

For a practice that has become so ubiquitous, it has been awfully hard to verify its effectiveness, no matter how well intentioned its advocates may be. When Robert Neimeyer, a psychology professor at the University of Memphis, and his colleague Joseph M. Currier analyzed the results of more than 60 controlled studies on grief interventions in 2008, they found no evidence that counseling helped most bereaved individuals any more than the simple passage of time. “Instead of finding that people who received counseling got better or stayed the same and that people who didn’t receive counseling got worse or stayed the same, we found that everyone just got better,” Currier says.

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The only instance in which counseling showed a benefit was when it was targeted at people displaying marked difficulties adapting to loss. “Given the current research, we cannot say that grief counseling is as effective with adults who are showing a normative response,” says Currier, referring to the statistical norm for grief’s length and intensity.

That doesn’t mean that no one is ever helped by counseling but rather that counseling doesn’t, on average, seem to hasten grief’s departure. In retrospect, the practice was likely popularized before there was enough solid research on normal grief to base it upon. And while counseling may have enriched a few of its practitioners, its propagation was driven more by ideology than money. Grief counselors are, by and large, not a sinister bunch out to make a buck off other people’s misery, but they do, in the interest of self-preservation, have a stake in convincing us that grief is long and hard and requires their help.

A Different, More Liberating Message

One unfortunate result of all this mythmaking is that we’ve become more inflexible in our expectations of other people’s grief — quite a paradox, considering that awareness and tolerance were among the primary goals of the death-and-dying movement. Instead of rushing to prescribe ways to grieve, it would be more helpful to spread a different, more liberating message based on what the science is beginning to tell us: that most people are resilient enough to get through loss on their own without stages or phases or tasks. A small minority will have a much harder time of it, and clinicians should focus their efforts on tailoring interventions for this group that are based on evidence, not assumptions. As with all social science, these new findings are not the last word, but they do give us a better sense of the different responses to bereavement and their prevalence.

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Drawing a clearer distinction between common and unusual reactions to loss might ultimately encourage those who don’t need outside help and better assist those who do. That does not mean that grief could — or should — be diminished. But perhaps just the knowledge that our survival instinct is strong and that a great many people have not only endured terrible losses but also thrived can be a source of hope, something in scarce supply in our grief culture.

As a society, we will most likely be unable to face grief without some sort of script. “No culture before has abandoned all recommendations as to how to mourn,” notes sociologist Tony Walter of the University of Bath. But it certainly seems time to move beyond our current habit of using untested theories to create unnecessarily lengthy — and agonizing — models for coping with grief that have created more anxiety about the experience instead of alleviating it. Losing someone is hard enough as it is.

Adapted from The Truth About Grief, by Ruth Davis Konigsberg. © 2011. Published by Simon & Schuster Inc.

This article originally appeared in the Jan. 24, 2011 issue of TIME.

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