I would like to spend some time this month exploring grief. I will explore it from different angles with the aim of developing a healthy framework for conceptualizing grief, practicing grief and helping others grieve. To start off, let’s talk about three models of grief.
Brenda Mallon’s book, Dying, Death and Grief explores various models that attempt to capture the grief process. It is a helpful read that drills down into the roots of common North American perspectives on grief. Here are two of the most influential models.
Bowlby and Parkes (1970) presented four main stages in the grief process:
- Numbness, shock and denial with a sense of unreality;
- Yearning and protest. It involves waves of grief, sobbing, sighing, anxiety, tension,loss of appetite, irritability and lack of concentration. The bereaved may sense the presence of the dead person, may have a sense of guilt that they did not do enough to keep the deceased alive and may blame others for the death;
- Despair, disorganization, hopelessness, low mood
- Reorganization, involving letting go of the attachment and investing in the future.
In the 1960s Elisabeth Kubler-Ross, a Swiss-born physician and psychiatrist, pioneered death studies. Her seminal book On Death and Dying (1970) was based on her work with dying patients. She adopted Parkes’ stages of grief to describe the five stages of dying experienced by those who were diagnosed with terminal illness:
- Denial – the patient does not believe he has a terminal illness.
- Anger – Why me? Anger towards family or doctors because they have not done enough.
- Bargaining – The patient may bargain with God or some unseen force, to give him extra time.
- Depression – The patient realizes he is about to die and feels very low.
- Acceptance – Given the opportunity to grieve, the patient may accept his fate, which may lead to a period of quiet reflection, silence and contemplation.
Kubler-Ross’ model has worked its way into the American thought process on grief. Ask most individuals about the grief process and they will likely have a version of the five stages of grief. It is intriguing how influential this model has been considering it was never intended as a model for individuals grieving the loss of someone else. It was originally research on individuals facing their own deaths.
Another way forward in this discussion is a framework called the Dual Process model. The Dual Process Model of Grief and Loss was introduced in 1995 by Margaret Stroebe and Henk Schut and was the first to state that there were no defined stages of grief.
They described two types of coping processes. ‘loss-oriented coping’ deals with the loss of the deceased person, and ‘restitution-oriented coping’ deals with specific problems and the development of new activities. People oscillate between these two as they go through grieving. Current thinking on grief encompasses both the letting go of bonds and the holding on to the attachment (Klass et al. 1996).
This Oscillation Model, going in and out of grief, remembering and forgetting, focusing on the past and paying attention to the present, seems to reflect the actual experience of the grieving process. Grief does not cooperate with our boundaries or processes. As some have said, “grief takes as many forms as there are grieving people.”