Sometimes a psychological phenomenon becomes so well-known that even people with no training whatsoever in psychology are familiar with it. That’s true for the five stages of grief, as described by the psychiatrist Elisabeth Kubler-Ross back in 1969. When someone dies, she suggested, the first reaction of the loved ones left behind is denial. Anger comes next, then bargaining, then depression. Finally, after all those stages have passed, mourners experience some acceptance of their loss.
Originally, Kubler-Ross formulated the stages of grief to describe the reactions of patients who had terminal illnesses. But she never conducted a systematic study of people’s reactions to the death of a loved one, and whether those reactions change over time in the way she predicted. Over the years, researchers have stepped in to try to see whether Kubler-Ross was right.
They found that, with regard to the order in which various reactions peak over time, Kubler-Ross was spot on. She was wrong, though, about the frequency with which the bereaved experience different emotions. The most important conclusion of research on stages of grief, though, is that there is no one way to grieve. Different people mourn in different ways. Their stages may be different than the ones Kubler-Ross described, or they may not go through different stages at all.
The Unfolding of Grief for 2 Years After the Loss of a Loved One: A Test of the 5 Stages
In “An empirical examination of the stage theory of grief,” published in the prestigious Journal of the American Medical Association, Paul K. Maciejewski and his colleagues studied the bereavement process in 233 people from Connecticut who had recently experienced the death of a loved one. Beginning one month after the loss, and continuing for two years, the researchers asked the mourners about their experiences.
Professor Maciejewski included in the study only those people whose loved one died of natural causes and not from violence or some other traumatic event. Most of the mourners who agreed to participate were white. On the average, they were 63 years old. Most often, the person who had died was a spouse, though some people in the study were mourning the loss of an adult child, a parent, or a sibling.
The researchers did not ask about one of Kubler-Ross’s five stages — bargaining. That’s the stage in which mourners are preoccupied with what they could have done differently (for example, “if only I had asked for a second opinion”). They asked instead about a different stage — yearning. People who are yearning experience “a sense of emptiness.” They are “preoccupied with the person who has been lost, seeking reminders and reliving memories.”
If Maciejewski and his colleagues had studied Kubler-Ross’s stages, they would have looked at these reactions, and expected them to occur in this order:
Instead, they tested a slightly different sequence:
- Disbelief (denial)
The researchers found that if they looked at the frequency with which people experienced each of those reactions, Kubler-Ross got it wrong:
- Mourners experienced acceptance more often than every other reaction. That was true at each of the three major periods of time — between 1 and 6 months after the loss; between 6 months and a year after the loss; and between 1 and 2 years after the loss.
- Yearning was always experienced next-most-often.
- Depression was always the third most often experienced reaction of the five that were studied.
- Disbelief and anger were experienced least often.
However, there’s another way of thinking about this. For each reaction, when does it reach its peak? For example, even though mourners experienced acceptance more often than any other reaction during every time period, when did acceptance reach its peak? When was it most likely to be experienced? If Kubler-Ross is right, then acceptance should reach its peak at the last stage.
That’s what the authors found. Acceptance increased over time, reaching its peak at the end of the study — two years after the loss.
All of the other reactions also reached their peak in the predicted order:
- Mourners were most likely to experience disbelief (denial) soon after the loss.
- Yearning reached its peak next — about 4 months after the loss.
- Anger reached its peak about 5 months after the loss.
- Depression peaked 6 months after the loss.
- Acceptance increased steadily over time, reaching its highest level when the study ended, 2 years after the loss.
These results offer a different answer to the question of whether reactions to grief unfold in the way that Kubler-Ross predicted: Yes, each reaction peaks exactly in the order that she predicted. One of the reactions she discussed, bargaining, was not assessed in the study, so we cannot know how often mourners really do experience that, or when it peaks.
Mental health professionals learned something important from this study. In writings about grief, and in the Diagnostic and Statistical Manual (DSM), the official guide to diagnosing mental disorders, depression gets all the attention. Yearning is not even mentioned in the bereavement section of DSM. Yet, it is the most commonplace of all the negative reactions to the death of a loved one.
The good news from this study is that, on the average, after 6 months, all of the negative reactions declined. A half year after the death of their loved one, mourners experienced disbelief, yearning, anger, and depression less often than they had before. The one positive reaction that was studied, acceptance, continued to increase over time.
In this study, as in all research in the social sciences, the findings describe the average reactions across all the people in the study. Many people, though, have different experiences.
The Most Important Finding Across All Studies of Grief: Different People Grieve in Different Ways
The experience of grief is deeply personal. There is no one way, and certainly no one “right” way, to experience the death of a person you loved. As psychology professor Nick Haslam noted:
“Some of the stages may be absent, their order may be jumbled, certain experiences may rise to prominence more than once, and the progression of stages may stall. The age of the bereaved person and the cause of death may also shape the grief process.”
Not everyone will be fortunate enough to experience less pain over the loss after six months have passed. In his discussion, Haslam described another study of people who had recently been widowed. Some of them, he said, “fell into a long-lasting depression.” Others were depressed before their spouse died and recovered afterwards. Still others “were fairly resilient and had experienced low levels of depression throughout.”
Whatever form your journey through grief takes, be kind to yourself. Don’t judge yourself or try to meet someone else’s standards for how you should be doing. The death itself is hard enough without adding any other needless pressures.