An Examination of the Five Stages of Grief in the Elder Law Setting

We who work in Elder Law and Estate Planning confront grief on a regular basis. Often it is after a loss, as the family is trying to cope with their loss while, unfortunately, pressing business or financial matters have to be dealt with. Alternatively, it is at the juncture where planning intersects with harsh reality, as we try to put things in place to deal with impending death.

By now, the “5 Stages” of grief — denial, anger, bargaining, depression, and acceptance — have become so ingrained in American culture that few question them. In fact, they are recited as necessary steps to cope with any kind of loss, from a loved one’s death and national disasters, to having your favorite player traded by your local team.

It would surprise many people to learn that the origin of the 5 Stages was a book (1969’s On Death and Dying by Elisabeth Kübler-Ross) about the experience of facing one’s own death, not someone else’s. But once the author introduced the catchy concept of the 5 Stages, others quickly spread it to grief in general, and other more remote losses.

Grief, therefore, became a “process” or a “journey” to be completed, with a set of phases to be accomplished, often with the help of counselors and other professionals. The grief or loss industry, therefore, developed a self-perpetuating life of its own, even though there was little or no empirical data to support it. Witness, for example, how many news stories about tragic or unsettling events end with the mention that “grief counselors” are being deployed to help fellow employees, students, etc. deal with their feelings.

But the latest research indicates that grief often may not be experienced as a series of steps, but rather a “grab bag” of feelings that come and go and, eventually, simply lift. In fact, many common myths about grief have been questioned lately. Indeed, the Center for Advancing Health concluded that the information being used to help the bereaved was woefully misaligned with the latest research on the subject. For example:

Myth # 1 – We grieve in stages: This, of course, is the mother of all grief myths. Part of the reason that it is so persistent is that it seems pretty intuitive. Yet controlled scientific studies have not borne this out. Instead, studies have found that recently bereaved people did not seem to have to go through the stages to finally get to acceptance — they accepted that their loved one was gone from the outset, and the feeling they most commonly felt was not anger or depression but yearning. The bottom line is that some people will go through some version of the stages, and some won’t, and most evidence shows that the various feelings will be in a random hodge-podge of appearing, subsiding, and often reappearing, in no particular order.

Myth # 2 – It is better to express your grief: The common wisdom is that it is better to express it rather than repress it and keep it to yourself. This may sound appealing, but studies have shown that expressing negative emotions can often prolong them. Studies showed that people who recently lost a spouse or child, as well as those who experienced loss in the 9/11 attacks, and did not express their negative emotions, were less anxious and depressed and had fewer health problems than those who did. Suppressing the negative feelings (called “repressive coping”) seems to be a protective mechanism that evolved in humans.

Myth # 3 – Grief is harder on women: This stereotype seems to have many roots, from the choice of subjects (older widows), to the lag behind changing times (studies of older women of course involved those more dependent on their husbands over long stretches of time), to the organizations that espoused the view. Even the well meaning intentions of the counselors came into play as more females become counselors than men, and the female counselors seemed to show a greater bias in believing that there were gender differences in bereavement. While the genders may, in general, handle loss and grief in different ways, and individuals within the groups vary, recent studies came to a surprising conclusion: relatively speaking, men often suffer more from grief; yes widows measured higher on depression scores than widowers, but not once women’s pre-bereavement or control-group depression levels were factored in.

Myth # 4 – Grief never ends: Kübler-Ross herself declared that “the reality is that you will grieve forever”. Amazingly, however, studies have shown that there is indeed a timetable to grief. A recent study showed that the biggest block of participants (45%) had gone back to normal life, without “shock”, “despair”, “anxiety”and “intrusive thoughts”, after 6 months. Of course, they missed the deceased, still had thoughts of the deceased, and some melancholy, but they were largely able to return to normal functioning. A smaller group, about 15%, was still having problems after 18 months, which has been termed Prolonged Grief Disorder. The vast majority of participants, however, showed great resilience and recovery.

Myth # 5 – Counseling helps: Despite the vast grief counseling industry that has developed, and despite its being routinely given (and often legally mandated), researchers have found no evidence that counseling helped most bereaved individuals any more than the plain passage of time.

A balanced view would be that some people indeed go through the 5 Stages in that exact order, while others do not — and that’s all right because people differ. Factors that influence all of this include whether the bereaved has enough money to avoid that worry from adding to the bereaved’s anxiety and depression, the extent to which other stresses exist in the bereaved’s life, whether the bereaved has a support network of family and others, and a multitude of upbringing and cultural factors.

Where is the “silver lining” in all of this? Research is showing us that we are more resilient than we thought, that different people can face loss in their own different ways and still get through it, and that time indeed heals.

Disclaimer: This entry summarizes published research and conflicting views that are necessarily simplified here. Nothing in this entry should be viewed as medical advice, and no action or refraining from action should be based on it. Anyone who needs to deal with the issues presented in the entry are advised to promptly consult their health care professional.