Denial. Anger. Bargaining. Depression. Acceptance.
The five stage-model for dealing with grief or loss, first proposed by the late Elizabeth Kübler-Ross in her 1969 book, On Death and Dying, is among the most widely recognized concepts in contemporary culture—deployed in every context from TV comedy to our own awkward attempts to comfort bereaved friends and relatives.
Unfortunately, it doesn’t really work.
As journalist Ruth Davis Konigsberg C’90 reveals in The Truth About Grief: The Myth of Its Five Stages and the New Science of Loss, the model does a terrible job of predicting how most of us actually respond to the loss of a loved one, and may actually do harm by making people feel guilty about getting on with their lives. Oh, and Kübler-Ross based it on very little—and mostly bad—science, and was herself a bit of a nut.
Konigsberg was an English major at Penn, but she says that some of her best-remembered academic experiences were studying intellectual history with Alan Kors and sociology with the late Philip Rieff (whose 1966 Triumph of the Therapeutic: Uses of Faith After Freud she “revisited” while writing her own book). As a magazine writer and editor after graduation, she became interested in psychology and the social sciences, she says, despite having worked mostly at “very mainstream, general-interest publications, such as New York magazine and Glamour.”
That work led her, in a roundabout way, to The Truth About Grief. While reporting for various stories, she’d seen cases where widows did not react according to stage theory. Then she learned about recent research done at Yale, which found that “most people actually accept the death of a loved one from the beginning and also experience pining more than anger or depression,” Konigsberg says. “Like many Americans, I’d been taught Kübler-Ross in high school, and I was surprised and a little dismayed that a theory that had so little empirical evidence had nonetheless become so inculcated. The book is an attempt to explain how and why that happened.”
Konigsberg answered some questions from Gazette editor John Prendergast.
How much did you know about Kübler-Ross’s life?
I knew next to nothing about Kübler-Ross aside from her theory, but as I dug into her story I was amazed at how ungrounded she was in science, despite her medical training. One of her former assistants even wrote a paper about how she was more a charismatic religious leader than a doctor. Shortly after she published On Death and Dying, which was based on interviews she had conducted with the terminally ill, she became obsessed with life after death and proclaimed that “death does not exist.” She believed in spirits and opened up a healing center for people to commune with their dead loved ones. She eventually got embroiled in a scandal when it was discovered that one of her favorite healers had been pretending to channel the dead husbands of female visitors as a ruse to get them into bed with him.
Given the lack of evidence for the five-stage model, what has given it such wide appeal?
The stages give people a sense of control over the unmanageable emotions of loss, and they also give practitioners a road map to follow. They’re easy to understand and seem to make intuitive sense, but fall prey to confirmation bias, so that if you happen to experience anger on a given day, you’ll think you’re in the anger stage while discounting that you might also have felt sad, or anxious, or distressed, or even happy, on the same day. The research shows that people tend to oscillate greatly, instead of going through some kind of lock-step progression.
Besides it being wrong, what’s the harm?
As one researcher told me, stage theories are great for people who experience emotions that happen to be consistent with them, but are incredibly pathologizing for those who don’t. In other words, the theory has narrowed our emotional repertoire for loss and stigmatizes reactions that diverge from its prescribed path. It also gave rise to several other myths, such as the notion that one has to do one’s “grief work” in order to heal properly, and that if you don’t, you’re setting yourself up for psychological problems. Research shows that talking about one’s loss or expressing one’s negative emotions actually doesn’t lead to better adjustment. Some people exhibit what’s called “repressive coping,” which is not pathological at all but has a protective function.
You cite more recent research that paints a different picture of how grief works. Who’s doing the most useful work and why isn’t it more widely known?
George Bonanno at Columbia University Teachers College is really the pioneer in resilience after trauma and loss. His findings are gradually reaching the public, but it takes a while for new research to get disseminated, first to other researchers, then to practitioners, then to paraprofessionals (hospice volunteers, for example), and then to the general public. And there is usually resistance to new ideas, which I find fascinating but is a well-known phenomenon.
The book suggests that some counselors’ attachment to the notion that overcoming grief is a long, complex process derives from self-interest. How does that play out?
In general, I think counselors have good intentions and are not a sinister bunch trying to make a buck off of other people’s misery, but they are also inevitably invested in the notion that grief is long and hard and requires outside help. It would be the rare counselor who would tell someone who was recently bereaved, “You don’t need my help, you already have what you need to get through this on your own,” even though meta-analyses of outcomes on bereavement interventions show that’s largely the case. The only time when outside help does seem beneficial is for the small minority of people, maybe 10 to 15 percent, who are having prolonged and pronounced difficulties.