The Truth About the Five Stages of Grief

Summary

The video script explores the complexities of grief and the evolution of understanding it, beginning with the Kübler-Ross model's five stages and its limitations. It delves into alternative models like the dual-process model and task-based approaches, highlighting the individual and cultural variations in grieving. The script also touches on complications such as disenfranchised grief and Persistent Complex Bereavement Disorder, concluding that while grief is challenging, most people can navigate through it with time and therapy.

Takeaways

• 🌼 Traditional mourning practices like wearing black or receiving flowers and food from neighbors have changed over time, but the experience of grief remains a universal part of life.
• 😢 Grief is a deeply personal and individual process, with psychologists acknowledging that it is normal and varies greatly from person to person.
• 📚 The Kübler-Ross model, which includes five stages of grief (denial, anger, bargaining, depression, and acceptance), is widely recognized but not without its criticisms and limitations.
• 👩‍⚕️ Elisabeth Kübler-Ross, the psychiatrist who introduced the five stages of grief, initially developed the model for terminally ill patients dealing with their own mortality, not for those grieving others.
• 🔬 There is a lack of empirical evidence supporting the Kübler-Ross model, with some studies finding mixed results in terms of the sequence and experience of the stages.
• 🤔 The model has been criticized for not providing an underlying explanation for why grief would follow sequential stages or how individuals progress through them.
• 🚫 The Kübler-Ross model may create unrealistic expectations about the grieving process, potentially leading to feelings of inadequacy if one's experience doesn't align with the model.
• 🔄 The dual-process model of grief suggests a more fluid process, with grievers oscillating between loss orientation (focusing on the loss) and restoration orientation (adjusting to life changes).
• 📝 The task-based model of grief proposes four tasks that grievers engage in without a set order: accepting the reality, processing the pain, adjusting to life without the loved one, and finding a lasting connection.
• 🛤️ Grief can follow multiple trajectories, as identified in a study that found common patterns such as common grief, depressed-improved, chronic grief, chronic depression, and resilience.
• 🏥 Persistent Complex Bereavement Disorder is a recognized condition in the DSM-5, characterized by intense, long-lasting symptoms of grief that interfere with daily life.
• 💔 Disenfranchised grief refers to the grief experienced for losses not socially acknowledged, such as the death of an acquaintance or a miscarriage, which can be more difficult to process due to societal expectations.

Q & A

What is the main theme of the video script?

The main theme of the video script is the exploration of the concept of grief and the various models that have been proposed to understand the grieving process.

What is the Kübler-Ross model and how does it relate to grief?

The Kübler-Ross model, originally proposed for individuals facing their own death, outlines five stages of grief: denial, anger, bargaining, depression, and acceptance. It has been widely adopted to describe the process of grieving for a loved one, even though it was later adapted without a scientific basis.

Who was Elisabeth Kübler-Ross and what is her contribution to the understanding of death and dying?

Elisabeth Kübler-Ross was a psychiatrist known for her work with terminally ill patients. She helped change attitudes towards death, encouraged open discussions about it, and was a strong advocate for hospice care, focusing on comfort and patient involvement in decision-making during their final days.

What are some criticisms of the Kübler-Ross model as it applies to grief?

Criticisms of the Kübler-Ross model include a lack of empirical evidence, no underlying explanation for why grief would be organized into sequential stages, and the model's creation of potentially problematic expectations for how grief should be experienced.

What is the dual-process model of grief and how does it differ from the Kübler-Ross model?

The dual-process model of grief, proposed in 1999, suggests that grievers switch between two orientations: loss orientation, where they focus on the person they've lost, and restoration orientation, where they focus on adjusting to life changes. It differs from the Kübler-Ross model by offering a more flexible approach that accounts for individual and cultural differences.

What is the task-based model of grief and what are the four tasks it identifies?

The task-based model of grief, proposed in 2008, identifies four tasks that grievers engage in: accepting the reality of the loss, processing the pain of the grief, adjusting to the world without the loved one, and finding a lasting connection with the deceased.

What does the term 'disenfranchised grief' refer to?

Disenfranchised grief refers to the type of grief that is not generally acknowledged by society, such as when someone experiences a loss that is not socially recognized or acceptable to grieve, like the death of an acquaintance or a miscarriage.

What is Persistent Complex Bereavement Disorder and how is it recognized in the DSM-5?

Persistent Complex Bereavement Disorder is a proposed diagnosis in the DSM-5 for individuals experiencing intense, prolonged grief symptoms, such as longing for the deceased, preoccupation with the death, and distress and impairment lasting over a year.

What did a 2008 meta-analysis published in Psychological Bulletin find regarding the effectiveness of grief therapy?

The 2008 meta-analysis found that grief therapy did not significantly help the average person, but it did provide some assistance to those having the most trouble coping, particularly in cases involving complications.

What are some of the physiological symptoms associated with acute grief?

Acute grief is associated with various physiological symptoms, including exhaustion, an empty feeling in the stomach, and a lump in the throat.

What is the general consensus among researchers regarding the ability of most people to move past their grief?

Most researchers agree that most people can move past their grief, particularly the most difficult stage known as acute grief, within three to six months, allowing them to continue living their lives while still missing their loved one.

Outlines

00:00

😢 Understanding Grief and the Kübler-Ross Model

This paragraph introduces the complexities of dealing with grief after the loss of a loved one. It discusses how modern cultures often lack meaningful ways to process grief beyond the funeral, leaving individuals to navigate their sorrow in isolation. The script delves into the Kübler-Ross model, a popular framework that suggests individuals experience five stages of grief: denial, anger, bargaining, depression, and acceptance. The model's origin is traced back to Elisabeth Kübler-Ross, a psychiatrist known for her work with terminally ill patients and her advocacy for hospice care. Despite its widespread acceptance, the paragraph hints at the lack of scientific evidence supporting the model's application to grief, as it was initially intended for those facing their own mortality.

05:01

🤔 Critiques and Alternatives to the Kübler-Ross Model

The second paragraph critiques the Kübler-Ross model, highlighting the lack of empirical evidence and the absence of a clear hypothesis explaining the sequential nature of the stages. It points out the inconsistency in classifying some stages as emotional states and others as cognitive processes. The paragraph also discusses the potential harm of the model in creating expectations that might lead individuals to doubt their own grieving process if it doesn't align with the stages. As alternatives, the paragraph introduces the dual-process model of grief, which involves oscillating between loss orientation and restoration orientation, and a task-based model that emphasizes four grief-related tasks without a set order. Additionally, it mentions research identifying various grief trajectories, emphasizing the individuality of the grieving process.

10:02

🏥 The Role of Therapy in Grief and Coping Mechanisms

The final paragraph explores the role of therapy in managing grief and whether it can be beneficial. It references a meta-analysis suggesting that while grief therapy may not significantly help the average person, it can assist those experiencing the most difficulty, such as those with complicated grief. The paragraph also touches on the concept of disenfranchised grief, which is not widely acknowledged by society, making it more challenging to process. It concludes with a note on the potential for most people to move past acute grief within three to six months and the importance of establishing a lasting connection with the deceased as part of the coping process. The script ends on a hopeful note, reassuring viewers that grief, though complex and intense, is a normal process that individuals can navigate and overcome.

Keywords

💡Grief

Grief is the emotional suffering experienced due to the loss of a loved one. In the video, it is described as a distressing process that varies for everyone, characterized by emotional turmoil and psychological distress. The video emphasizes that grief doesn't cease with the conclusion of funeral ceremonies but is a prolonged, personal experience.

💡Kübler-Ross Model

The Kübler-Ross model outlines five stages of grief: denial, anger, bargaining, depression, and acceptance. Initially proposed for terminally ill patients, it has been widely adopted to describe the grieving process. The video discusses the model's popularity and critiques, highlighting its lack of empirical evidence and its impact on societal expectations of grief.

💡Bereavement

Bereavement refers to the state of loss when someone close to us dies. The video explains this as the broader context within which grief occurs, differentiating between the experience of loss and the emotional response (grief) that follows.

💡Dual-Process Model

The Dual-Process Model suggests that grieving individuals oscillate between focusing on the loss and addressing life changes. The video highlights its flexibility, allowing for individual and cultural differences, and contrasts it with stage-based models, providing a more dynamic understanding of grief.

💡Persistent Complex Bereavement Disorder

This is a condition characterized by prolonged and intense grief that impedes daily functioning, lasting over a year. The video discusses its inclusion in the DSM-5, indicating severe grief symptoms like preoccupation with the deceased, which can significantly impact an individual's mental health.

💡Disenfranchised Grief

Disenfranchised grief occurs when the loss is not socially acknowledged, such as in cases of miscarriage or the death of someone not personally known. The video explains how such grief can be more challenging to process due to lack of social support and recognition.

💡Freud's Grief Work

Freud's concept of grief work involves detaching emotional energy from the deceased and reinvesting it elsewhere. The video references Freud's idea that failure to complete this process could lead to psychological issues, showcasing the historical evolution of grief theories.

💡Stages of Grief

The stages of grief, as proposed by Kübler-Ross, are sequential phases people supposedly go through when coping with loss. The video discusses these stages in detail, noting the lack of scientific backing for their strict sequence and the potential issues with applying them universally.

💡Grief Therapy

Grief therapy aims to help individuals process their grief, though its effectiveness varies. The video highlights research indicating mixed results for therapy, with it being most beneficial for those struggling significantly, underscoring the diverse nature of grieving processes.

💡Acute Grief

Acute grief is the intense, early phase of grief characterized by physical symptoms and deep emotional pain. The video explains that this stage, often involving feelings like emptiness and throat constriction, typically subsides within three to six months as individuals begin to adapt to their loss.

Highlights

Grief is a normal and individual process that can be hard and lonely, with no fixed end.

The Kübler-Ross model, with its five stages of grief, originated from work with terminally ill patients and was later adapted for bereavement.

Elisabeth Kübler-Ross's work on hospice care and changing attitudes towards death has had a significant impact on society.

The original Kübler-Ross model was not scientifically based and has been criticized for its lack of empirical evidence.

Psychologists have issues with the Kübler-Ross model due to its lack of underlying explanation and mixed psychological states.

The model creates expectations that can lead to people believing they are not coping properly if they do not follow the stages.

The dual-process model of grief suggests a more flexible approach, with grievers oscillating between loss and restoration orientations.

Task-based models of grief propose four tasks to be engaged in, without a specific order, allowing for individual differences.

Research has identified five common trajectories of grief, indicating the diverse ways people experience loss.

Grief can become complicated by factors such as disenfranchised grief and Persistent Complex Bereavement Disorder.

Therapies for grief have shown limited effectiveness for the average person but may help those with more severe difficulties.

Most people can move past acute grief within three to six months, adapting to life without their loved one.

Establishing a lasting connection with the deceased is part of the coping process in grief.

The complexity of grief is underscored by the multitude of research and theories attempting to understand it.

Despite the prevalence of the Kübler-Ross model, psychologists continue to search for a unified narrative to describe grief.

The episode concludes with a reminder that grief is a normal process and encouragement for those experiencing it.

Transcripts

[INTRO ♪]

There are a lot of ways to mark the passing of a loved one.

But in many modern cultures, once the funeral’s over,

all that’s left are too many flowers and that well-meant

soggy casserole your neighbor made for you.

Those black mourning dresses Scarlett O’Hara hated so much

have gone out of style, but grief doesn’t stop

just because the public ceremony of saying goodbye is over.

Grief can be hard and lonely, and sometimes it can feel like it’ll never end.

Psychologists have been trying to figure this out for over a century.

And the only good answers they’ve got are that

it’s a totally normal process, and that it’s different for everyone.

Bereavement is the technical term that psychologists use

to talk about the loss of a loved one by death.

Grief is what they call the distress caused by that loss.

And when you think about grief in a psychological sense,

the first thing that probably comes to mind is the Kübler-Ross model.

You might not recognize that name,

but it gets talked about a lot in pop culture.

You might, for instance, know it from

that Robot Chicken video of a giraffe stuck in quicksand.

Basically, the Kübler-Ross model says

we all go through five stages as we process our grief.

We start off by denying that whatever happened is real,

which helps us temporarily deal with it.

Next, we get angry.

And then, we try to bargain our way out of it,

by making a deal with God, or the universe,

or whatever we believe has the power to change what has happened.

When that doesn’t work, we experience depression.

And finally, we get to acceptance.

Everything might not be okay, but we’ve learn to live with it.

Even if you haven’t taken a psychology class,

you’re probably familiar with this idea.

But you might not know where the model comes from.

Elisabeth Kübler-Ross was a psychiatrist who worked with terminally ill patients.

She helped change attitudes about dying

and encouraged people to actually talk about death.

And rather than just worrying about the salvation of the soul,

she was a strong supporter of hospice care,

which focuses on making the patients’ final days comfortable

and keeping them involved in the decisions that affect them.

This is all super important stuff that has affected

how we think about people who are dying.

But she also wrote a book called On Death and Dying.

Published in 1969, it was based on interviews with over 200 dying patients.

Kübler-Ross was influenced by the work of two psychiatrists

who proposed that, after a separation or a loss,

grief was a process that involved four sequential stages.

So in her book, she proposed five stages we all go through

as we come to terms with dying.

Not while grieving for someone else, but while dying ourselves.

The book sold really well, and the five stages took off in the public’s imagination.

People started applying the stages to grief even though they weren’t meant to describe it.

And so, Kübler-Ross and her coauthor eventually went back

and adapted the same five stages so that they made sense for grieving, too.

But! There wasn’t really any scientific basis for that adaptation.

Of course, we didn’t always think of grieving as a pattern of psychological responses.

Since death is inevitable, people have been studying grief for a while.

In the 17th century, it was believed that too much grieving could be deadly.

And in the 19th century, Charles Darwin wrote about grief

and noted that monkeys and apes also seemed capable of feeling it.

Freud had something to say about it too.

In 1917, he proposed that the living had to detach their emotional energy

from the dead person and channel it into some other aspect of their lives.

He called this grief work.

And if people didn’t do grief work?

He believed they had a much higher risk of developing a psychological illness

because of their supposedly pathological grief.

Yeah, Freud had… a lot of ideas, and they weren’t always great.

But, of all these ideas, the Kübler-Ross model is the one that really stuck around.

Some psychologists think that its staying power

comes from the fact that it’s such a good narrative.

Our brains like to organize things, and this model offers

a nice, neat progression through five well-defined stages—

and ultimately, has a happy ending.

But even though we might like the way it sounds,

psychologists nowadays have a few big issues with these five stages.

First of all, there’s a lack of empirical evidence.

Many researchers argue that the interviews it’s based on

weren’t conducted with enough scientific rigor.

In the years since the book was published,

some studies have attempted to replicate and verify the findings.

For instance, one study published in 2007 followed 233 people over three years.

And a 2010 study looked at 614 undergraduates and surveyed them once,

all at different points in their grief.

Both studies asked the subjects to assess their grief on a scale

for disbelief, yearning, anger, depression, and acceptance.

And they all had mixed results.

The 2007 study found that acceptance was the most common reaction,

even right after death.

But after averaging all the data over time

the different stages did peak in the order that Kübler-Ross had suggested.

The 2010 study found that their results didn’t support Kübler-Ross’s stage theory,

but they didn’t completely disprove it either.

And how much people were thinking about the loss

seemed to influence what they were experiencing more than the passing of time.

A second criticism is that the stages don’t really have an underlying explanation.

There’s no hypothesis for why grief would be organized

into sequential stages, what function they serve,

or how people move from one stage to the next.

On top of that, the stages are kind of random, psychologically speaking.

Some of them are emotional states, like anger and depression,

while others are cognitive processes, like acceptance and denial.

And lastly, researchers have noted that the Kübler-Ross model

seems to create problematic expectations for how grief should be dealt with.

The five stages can make people expect

to experience certain things in a certain order.

And if they don’t do that, or they don’t hit certain stages at all,

people might believe that they aren’t coping properly.

That expectation could also lead to unhelpful support

from their social networks or health care professionals.

But psychologists aren’t just critiquing the Kübler-Ross model,

they’re also trying to figure out new ways to think about grief.

There’s a ton of research to sift through, but there are a few prominent ideas.

The dual-process model of grief was proposed in 1999.

Developed from other studies on cognitive stress,

it suggests that the griever switches back and forth

between two patterns of behavior, called orientations.

In the loss orientation, someone spends time

thinking about the person they’ve lost and what life used to be like.

They might look at old pictures or tell stories,

and they’ll express a lot of emotion about the loss.

In the restoration orientation, someone focuses on

the changes that need to be made.

It’s more of a problem-solving state of mind.

They might work on establishing a new identity for themselves

or adjusting to do things that the deceased used to do,

like doing the dishes after you cooked.

What’s unique about the dual-process model is that it suggests that

a person who’s grieving switches back and forth between these two orientations

until eventually, they don’t need to think about certain aspects of the loss anymore.

It’s a more flexible model, with room for individual and cultural differences.

One of the best known task-based models of grief was proposed in 2008 by a

clinical psychologist with a lot of experience treating people dealing with grief.

While this one also doesn’t have a ton of empirical evidence,

unlike stage-based models, it tries to account more for

people going through grief differently.

The model says that grieving is a process of engaging in four tasks—

all in no particular order.

Essentially, they include: accepting the reality of the loss,

processing the pain of the grief, adjusting to the world without the loved one,

and finding a lasting connection with them somehow.

The task-based model also points out seven factors

that can affect the individual experience of each griever,

which may help healthcare professionals understand what someone’s going through.

These factors are things like their relationship to the deceased,

how the person died, or other stress that they’re under.

Another prominent way of thinking about grief

identifies multiple possible grieving processes,

reinforcing that it can be very different for different people.

This idea started with a 2002 study on 205 people who lost their spouses.

The researchers tracked subjects for several years before the death until 18 months afterward.

And they used this information to identify five common trajectories of grief.

The trajectories include common grief,

in which the subjects experience a lot of depression at six months,

but not before the death or at 18 months.

There’s also depressed-improved,

in which the subject experienced depression before the death,

but had largely returned to normal by six months.

In chronic grief and chronic depression trajectories,

the subject experienced many grief symptoms

and high levels of depression at six months and 18 months.

These were both associated with higher dependence on the spouse before death.

But they were distinguishable.

In the case of chronic depression,

the subject experienced depression before the death as well,

and it was associated with marital strife.

The most common trajectory was actually resilience,

in which a person experiences relatively low and stable levels of depression

before and following the loss.

Nearly half the subjects experienced this pattern.

Now, all these ideas suggest that grief can be different

depending on the circumstances and the person—

which makes a lot of sense!

Grief is really complicated.

But there’s just so much research out there.

And some psychologists worry that without a tidy, unified narrative,

it will be hard to dislodge the Kübler-Ross model in the general public’s mind.

The other thing to know is that there can be complications

that make grief extra hard to deal with.

For example, there’s disenfranchised grief,

which is what psychologists call grief that isn’t generally acknowledged by society.

Like, when someone you didn’t actually know dies

or when you experience a miscarriage.

It’s not as socially acceptable to feel and talk about those kinds of grief,

which can make them harder to process.

But even typical grief can become a problem.

The DSM-5, an evolving guide that professionals use to diagnose mental illness,

includes proposed criteria for Persistent Complex Bereavement Disorder.

These criteria are things like: longing for the deceased, intense suffering,

and preoccupation with the death that causes distress and impairment lasting over a year.

So if grief is such a complicated, intense experience... can therapy help?

Unfortunately, a 2008 meta-analysis published in Psychological Bulletin

found that, most of the time, grief therapy didn’t seem to

significantly help the average person.

It did somewhat help the people who were having the most trouble coping, though.

Like if they're experiencing some of the complications we just talked about.

But to be clear: we here at SciShow aren’t health professionals,

and everyone processes grief differently.

So even though some research says therapy might help

certain people more than others, it’s not worth writing off completely.

The good news, though, is that most people can move past their grief.

Or at least, they can move past the most difficult stage of it, known as acute grief.

That’s the really sucky part with all of the physiological symptoms…

where you’re exhausted, your stomach feels empty, or you have a lump in your throat.

Most people seem to be able to move beyond this in three to six months.

They still miss their loved one, but they can get on with living their lives.

And plenty of researchers see establishing a lasting relationship

with the deceased as part of coping.

The thing is… grief really is a normal process.

It can be really tough on the mind, but you’ll get through it okay.

Thanks for watching this episode of SciShow!

If you want to learn more about brains and why humans act the way that we do,

you can come check out our other channel SciShow Psychology, at youtube.com/scishowpsych.

[OUTRO ♪]