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Confused by my grief counselor
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Confused by my grief counselor

› Forums › Caregiver Community › Confused by my grief counselor

  • Post
    • April 11, 2013 at 1:23 pm
    POW
    Participant

      My brother was diagnosed with Stage IV melanoma last June and passed away from the disease 3 weeks ago. Even though we live in different states, during his illness I broke my neck and did everything I possibly could to get him the best possible care and to ensure that his quality of life was as good as it could be all the way up to the very end. It was, of course, a very stressful time for everyone in the family.

      My brother was diagnosed with Stage IV melanoma last June and passed away from the disease 3 weeks ago. Even though we live in different states, during his illness I broke my neck and did everything I possibly could to get him the best possible care and to ensure that his quality of life was as good as it could be all the way up to the very end. It was, of course, a very stressful time for everyone in the family. I knew that I was stressed and grieving (and I did take care of myself as best I could) but it wasn't until after he had passed and I had done all the necessary paperwork that my stress and grief REALLY hit me. I guess I'm one of those people who is able to push my emotions into a corner of my mind and get on with what needs to get done. I suppose that is a characteristic of all of us caregivers.

      From time to time over the last 9 months I have seen a very good grief counselor. She is very experienced in hospice work and she seems to "get" me and how I operate mentally and emotionally. I saw her the other day for the first time since my brother died. I told her that I was doing OK. Yes, I get overwhelmed with sadness sometimes and start to cry some. But it passes quickly and I get back to doing a lot of things that I have let slide over the months (house cleaning, grocery shopping, freelance work, etc.).

      By the end of the session she said that she did not think that I was "doing OK".  She said that 3 times during our session I had gotten all choked up and fought back tears. People who are "doing OK" don't behave that way. I replied that I thought that type of behavior was to be expected when one was grieving. I figured that it would take time for the intensity of the feelings to subside. One just had to be patient and get through it. She said, "No". She said that the only way to really get through grief was to talk about it and cry about it for as often and as long as necessary. Rehash the same upsetting memory again and again if necessary until the grief is gone. It doesn't have to be with her; I could relive the memories and express my grief with my spouse or my family or with my close friends. But her advice was to do so in order to experience emotional healing. 

      That approach is foreign to me. In my family, we keep our mouths shut about distressing emotions. If you start feeling badly, distract yourself, change the topic of conversation, push the emotions away. Letting it out, rehashing and reliving the stressful past and anticipating the unhappy future, or crying openly in front of other people is shameful and just makes you feel worse. No good can come of it.  

      So now I don't know if I should trust this therapist and continue seeing her for periodic "crying sessions" or whether I should do what I have been taught to do by my upbringing and experience– stiff upper lip the whole thing. Since this is my first experience with losing someone close to me, I can't imagine how to do things differently from the way that comes naturally to me. I can't imagine how emoting all over the place will help me. But maybe I'm just suffering from a lack of imagination here. Maybe I should try it the therapist's way.

      This is where I could use your input. In your experience with grieving (either now or in the past), have you allowed yourself to frequently talk about and cry about your loved one and how sad you are that they had to endure the misery of their disease and how much you now miss them now? Do you think that's a healthier approach than just pushing your grief into a corner and getting on with life? Is the emotional end result– say 6 months or a year later– any different with the two approaches?

      I would appreciate hearing about your experience and insight.  

    Viewing 14 reply threads
    • Replies
        • April 11, 2013 at 2:16 pm
        JC
        Participant
          The Myth of Stages of  Dying, Death and Grief
          By Russell Friedman and John W. James
           
                In 1969 the psychiatrist Elizabeth Kubler-Ross wrote one of the most influential books in the history of psychology, On Death and Dying. It exposed the heartless treatment of terminally-ill patients prevalent at the time. On the positive side, it altered the care and treatment of dying people. On the negative side, it postulated the now-infamous five stages of dying-Denial, Anger, Bargaining, Depression, and Acceptance (DABDA), so annealed in culture that most people can recite them by heart. The stages allegedly represent what a dying person might experience upon learning he or she had a terminal illness. "Might" is the operative word, because Kübler-Ross repeatedly stipulated that a dying person might not go through all five stages, nor would they necessarily go through them in sequence. It would be reasonable to ask: if these conditions are this arbitrary, can they truly be called stages?
               Many people have contested the validity of the stages of dying, but here we are more concerned with the supposed stages of grief which derived from the stages of dying. As professional grief recovery specialists, we contend that the theory of the stages of grief has done more harm than good to grieving people. Having co-authored three books on the impact of death, divorce, and other losses, and having worked directly with over 100,000 grieving people during the past 30 years, our reasons for disputing the stages of grief theory are predicated on the horror stories we've heard from thousands of grieving people who've told us how they'd been harmed by them.
          From Dying to Grief
          Elizabeth Kübler-Ross was a fearless pioneer who openly took the medical profession to task for its callous disregard for the feelings of dying people. The subtitle of On Death and Dying explains the book's primary focus: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families. The lessons Kübler-Ross learned from those dying people, coupled with her compassionate regard for them, became a focal point of the emergent Hospice movement. Somehow, over the years, the real virtues inspired by her work have been subordinated to the inaccurately named, largely imaginary stages.
               During the 1970s, the DABDA model of stages of dying morphed into stages of grief, mostly because of their prominence in college-level sociology and psychology courses. The fact that Kübler-Ross' theory of stages was specific to dying became obscured. Students who eventually became therapists, social workers, or doctors carried what they learned about the stages into their careers. The media also played a role in disseminating the idea that specific, inexorable stages of grief exist. When a tragedy makes the news, newscasters and alleged experts recite the DABDA model of grieving. Medical and mental health professionals and the general public accepted the theory without ever investigating its provenance or validity.            
               In fact, Kübler-Ross' stage theory was not the product of scientific research. In the second chapter of On Death and Dying she laments: "How do you do research on dying, when the data is so impossible to get? When you cannot verify your data and cannot set up experiments? We [she and her students] met for a while and decided that the best possible way we could study death and dying was by asking terminally ill patients to be our teachers." She then explains her methods: "I was to do the interview while they [her students] stood around the bed watching and observing. We would then retire to my office and discuss our own reactions and the patient's response. We believed that by doing many interviews like this we would get a feeling for the terminally ill and their needs which in turn we were ready to gratify if possible."
               The phrase, "we would get a feeling" is especially revealing since Kübler-Ross' feelings were processed through the filter of her life-long unresolved grief and retained anger. We know that because she went public about the anguish of her past in her final book, On Grief and Grieving, coauthored with David Kessler and published shortly after her death in 2004. In the final chapter, titled My Own Grief, she tells the gruesome story about an episode involving her father and a cherished childhood pet that caused her to make an oath never to cry again. That event, along with a host of other personal grief incidents, resulted in her bottling up a lifetime of anger that she admitted she didn't deal with until very late in life.
               When you read about Kübler-Ross' life, you sense how much her painful past may have colored her interpretation of her interviews with dying patients. Interestingly, anger is the only stage Kübler-Ross contends is absolute for everyone- in dying, or in grieving relationships with those who have died. It seems as if the palpable anger she carried for years caused her to insist we all must have anger about loss.
               We're not sure why Kübler-Ross felt compelled to convert her observations from the interviews into stages. Possibly she believed that what she heard in her interviews with dying people was actually stages that needed to be quantified, or perhaps she simply attempted to put a scientific face on anecdotal evidence.
          When Does Wide Acceptance Equal Scientific Fact?
          On February 21, 2007, The Journal of the American Medical Association (JAMA) published the results of the Yale Bereavement Study (YBS): An Empirical Examination of the Stage Theory of Grief. The YBS evaluated a hodge-podge of alleged stages. It starts with the assumption that stages of grief exist, and then attempts to use that assumption to prove that they do. However, the existence of stages has never been established as fact. The results appeared to confirm some stages, negate others, and reposition their order and value. We cannot give any credence to the YBS because its premises and conclusions are flawed. But, since the study's own language perpetuates the myth that stages of grief even exist, we'll use it to make our case.
               The YBS begins: "The notion that a natural psychological response to loss involves an orderly progression through distinct stages of bereavement has been widely accepted by clinicians and the general public." It concludes: "Identification of the normal stages of grief following a death from natural causes enhances understanding of how the average person cognitively and emotionally processes the loss of a family member." We are troubled by the assumption that stages of grief are normal and distinct and progress in a specific order. We also wonder, when does "wide acceptance" equal scientific fact?
               Contrast the alleged wide acceptance of an "orderly progression of stages" with this from the inside cover of Meaning Reconstruction & the Experience of Loss, edited by Robert A. Neimeyer: "Debunking the notion that an invariant sequence of stages of grief occurs among all who experience the death of a loved one, this groundbreaking volume clearly demonstrates that highly individual processes of meaning making are at the heart of grief dynamics." Published by the American Psychological Association in 2001, Neimeyer's book presents 26 academicians' and clinicians' non-stage methods for helping grieving people. 
               Neimeyer also addresses methodology in his introduction: "At the most obvious level, scientific studies have failed to support any discernible sequence of emotional phases of adaptation to loss or to identify any clear endpoint to grieving that would designate a state of 'recovery.' " Although Neimeyer's book's was published prior to the YBS, his contributors were familiar with earlier studies that attempted and failed to quantify stages.
          Dabbling in DABDA: A Stage by Any Other Name
          Prior to publication of her famous book, Kübler-Ross hypothesized the Five Stages of Receiving Catastrophic News, but in the text she renamed them the Five Stages of  Dying or Five Stages of Death. That led to the later, improper shift to stages of grief. Had she stuck with the phrase catastrophic news, perhaps the mythology of stages wouldn't have emerged and grievers wouldn't be encouraged to try to fit their emotions into non-existent stages.
               Adding irony to the stages debacle, Kübler-Ross' final book, On Grief and Grieving, is subtitled, Finding The Meaning Of Grief Through The Five Stages Of Loss. Confusingly, inside the book they're called the Five Stages of Grief. Stages of
          loss conveniently fit the new book on grief and confirmed the chameleon-like capacity of  the word stages to arbitrarily mean whatever Kübler-Ross or anyone else wants it to mean.
          Refuting The Alleged Stages
          Kübler-Ross may have been the first to advance a specific stage theory about dying, but others preceded her in the area of grief. John Bowlby, Colin Murray Parkes and several others advanced theories about grief based on stages or phases, using a variety of labels. Alternate terms for the stages they used include: Disbelief, Numbness, Yearning, Shock, and Guilt. As we refute the stages, we'll address the most commonly used stages and point out how they have the potential to harm grieving people.
           
          1. (a) Denial (b) Disbelief (c) Shock (d) Numbness
          (a) Denial. In our thousands of interactions withgrieving people we have never found one person who was in denial that a loss had occurred. We ask, "What happened?" They say, "My mother died." There's no denial that someone died. We've had a few people tell us someone died and then say, "I'm in denial." We ask, "Do you mean the person isn't dead?" They say, "No, but I've heard 'denial' is the first stage of grief."
               In the opening chapter of On Grief and Grieving, Kübler-Ross and Kessler state, "For a person who has lost a loved one, however, the denial is more symbolic than literal." We have to wonder: if denial is merely symbolic rather than literal, why call it a stage?
               (b) Disbelief. The YBS uses disbelief rather than denial. Disbelief, as expressed by most grievers, is rhetorical language, as in, "I still can't believe he's gone." Although disbelief may reflect the emotions of a broken heart, it is really a figure of speech rather than a  statement that a death didn't happen.
               (c) Shock. In cases of sudden, unexpected deaths, it's possible that upon receiving the news, a surviving family member may go into emotional shock, during which time they're in a suspended state, totally removed from events in the real world. This response is rare and doesn't last very long. Most deaths are at the end of a long-term illness or of old age, and don't produce shock in the survivors. However, there are books that maintain that shock is a standard stage of grief. There is no evidence to support that idea.
               (d) Numbness. Numbness is one of the most common physiological responses to a grief-producing event. We reference numbness because the YBS coupled it with disbelief as if both are stages. Grief related numbness is the result of an overload of emotional energy in reaction to a death. Many grievers report numbness as intermittent in the immediate aftermath of a death, which usually gives way to a lack of focus or limited concentration. However, numbness is not a stage, nor is the inability to concentrate.
                Potential Harm. Time can't heal emotional wounds, but the word "stage" implies that time is a component. The suggestion to grievers that they're in a stage of denial or disbelief can freeze them into inaction. They bury their feelings waiting for time to make that stage pass. Later they're liable to be diagnosed with "complicated bereavement" and put on psychotropic drugs, which make it difficult or impossible for them to access the emotions they've buried.
               Professionally Induced Harm. Many grievers tell us that a mental or medical health professional "strongly suggested" they were in the denial stage, when all they'd said was that they were having some difficulty since Mom died. Even after reiterating they were clear that Mom had died, the therapist insisted they were in denial, which created a breach of trust and safety. The grievers terminated therapy after one or two ineffective sessions, and left their grief unattended. We believe those professionals
          overlooked a cardinal rule of helping grievers, which is: "Hear what your client is telling
          you, as opposed to having your own agenda."
          2. Anger
          When an elderly loved one dies at the end of a long-term illness, there's usually no anger in those left behind. Along with feelings of sadness, there may be a sense of relief that the suffering is over. Things do happen relevant to a death that can make us angry: anger at a disease or God; anger at doctors or hospitals or the drunk driver who killed our loved one; even anger at loved ones who didn't take good care of themselves, or who took their own lives. But anger is not a universal feeling when someone important to us dies, and therefore is not a stage.
               Potential Harm. When anger is perceived as a stage, there are no actions the griever can take to end it. They must stay angry as long it lasts or as long as they're alive. As we said, stages imply that time is an element, so when time fails to end that stage, people re-create and re-live anger for years. Staying angry can have dangerous consequences, causing people to damage relationships, lose jobs, and worse, affect their health or restrict their will to live.
               Professionally Induced Harm. Grievers repeatedly tell us the same scenario about anger as about denial. They report that a mental or medical health professional "planted" the idea they were in a stage of anger, when nothing they'd said would indicate that this was true.
          3. (a) Bargaining and (b)Yearning
          (a) Bargaining. Kübler-Ross' bargaining stage may make sense for someone diagnosed with a terminal illness. "If you'll just give me another chance, I'll take better care of myself," is a plea someone might make to whichever deity they believe in. But, it doesn't relate to the grief people feel when someone important to them has died.
               (b) Yearning. The YBS substitutes yearning for bargaining. Since 83.8% of the participants in that study were widows or widowers, most over the age of 60, we're not surprised that many of them yearned for their lost partner. Talk to thousands of widows/widowers, as we have, and you are guaranteed to hear that most of them miss the person who died, including the surviving partners who were half of a 40-year relationship
          of constant bickering.
               Potential Harm. The death of a long-term spouse creates an incalculable amount of emotional energy. Those feelings are often accompanied by an overwhelming sense of missing the person and wanting the familiarity of their presence back. Missing someone who has been a constant part of your life for decades is normal and to be expected. Again, calling it a stage suggests a time frame, causing them to wait for that stage to end which adds exponentially to their grief.
          4. Depression
          We're going to address depression in greater detail than the other alleged stages because it carries with it a great deal of confusion and potential danger for grieving people. Here is a list of reactions common to grievers that are also symptoms of clinical depression:
          · inability to concentrate,
          · disturbance of sleeping patterns,
          · upheaval of eating patterns,
          · roller coaster of emotions,
          · lack of energy.
               One list fits both, and that's the problem. Are grievers clinically depressed? With very few exceptions, the answer is "no," and in those few cases only if they were clinically depressed before the death that affected them. Grief is the normal reaction to loss, but clinical depression is abnormal and requires different treatment. The line between grief-related depression and clinical depression has become hopelessly blurred, in part because the medical and mental health professions have adopted the non-existent stages of grief.
               Potential Harm. It is normal for grievers to experience a lowered level of emotional and physical energy, which is neither clinical depression nor a stage. But when people believe depression is a stage that defines their sad feelings, they become trapped  by the belief that after the passage of some time the stage will magically end. While waiting for the depression to lift, they take no actions that might help them. If and when they seek professional help, they use the self-diagnosis of depression to describe themselves.
               Professionally Induced Harm. When medical or psychological professionals hear grievers diagnose themselves as depressed, they often reflexively confirm that diagnosis and prescribe treatment with psychotropic drugs. The pharmaceutical companies which manufacture those drugs have a vested interest in sustaining the idea that grief-related depression is clinical, so their marketing supports the continuation of that belief.
               The question of drug treatment for grief was addressed in the National Comorbidity Survey (published in the Archives of General Psychiatry, Vol. 64, April, 2007). "Criteria For Depression Are Too Broad Researchers Say-Guidelines May
          Encompass Many Who Are Just Sad." That headline trumpeted the survey's results, which observed more than 8,000 subjects and revealed that as many as 25% of grieving people diagnosed as depressed and placed on antidepressant drugs, are not clinically depressed. The study indicated they would benefit far more from supportive therapies that could keep them from developing full-blown depression.
          5. Acceptance
          Acceptance, as it relates to psychology or emotions, is a vague and amorphous term. Since there is almost never denial or disbelief that a death occurred, the concept of acceptance is confusing, if not moot. The YBS asked grievers to assess the level of acceptance they'd achieved about the death of someone important to them. This is an odd question, because they had to have accepted that the death occurred or else they wouldn't have been in a bereavement study.
               Potential Harm. One definition of stages cannot fit all people, or all relationships-in fact we don't think they fit anybody. For example, an 85-year old woman whose spouse of 62 years has died reports a different emotional picture about her life and response to that death, than does a 62-year old woman whose 85-year old father has died. Both involve 62-year relationships, but the idea that there could be a stage of acceptance applicable to both is illogical.
          Another Non-Stage: Not Guilty As Charged
          Of all the incorrect ideas and feelings that are defined as stages of grief, guilt is undoubtedly the most unhelpful. We've seen it in dozens of books and heard it in hundreds of lectures. As those authors and speakers define it, guilt more accurately represents things the griever wishes had been different, better, or more in relation to the person who died; rather than a sense of having done something with intent to harm the person who died, for which the idea of guilt might make sense.
               Personal Danger. Grieving parents who have had a troubled child commit suicide after years of therapy and drug and alcohol rehab, are often told, "You shouldn't feel guilty, you did everything possible." The problem is that they weren't feeling guilty, they were probably feeling devastated and overwhelmed, among other  feelings. Planting the word guilt on them, like planting any of the stage words, induces them to feel what others suggest. Tragically, those ideas keep them stuck and limit their access to more helpful ideas about dealing with their broken hearts.
          Conclusion
          We understand that people engulfed in the aftermath of loss want to know what to expect and how long it will last. Such questions can never be satisfactorily answered. Since every griever is unique, there are no pat answers about grief.
               As much effort as we've put in to refuting the stages, Kübler-Ross herself rebuts them better than we can in the opening paragraph of On Grief and Grieving: "The stages have evolved since their
          introduction, and they have been very misunderstood over the past three decades. They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grief is as individual as our lives. Not everyone goes through all of them or goes in a prescribed order." 
               If there are no typical responses to loss and no typical losses, and not everyone goes through them or in order, how can there possibly be stages that universally represent people's reactions to loss? The fact is, no study has ever established that stages of grief actually exist, and what are defined as such can't be called stages. Grief is the normal and natural emotional response to loss. Stage theories put grieving people in conflict with their emotional reactions to losses that affect them.
          No matter how much people want to create simple, iron clad guidelines for the human emotions of grief, there are no stages of grief that fit every person or relationship.
          Russell Friedman and John W. James are the principals of The Grief Recovery Institute in Sherman Oaks, California. They are the co-authors of The Grief Recovery Handbook and When Children Grieve [both from HarperCollins], and Moving On [M. Evans]. For more information about recovery from loss, go to the Helpful Articles section at http://www.grief.net
           
          • April 11, 2013 at 2:16 pm
          JC
          Participant
            The Myth of Stages of  Dying, Death and Grief
            By Russell Friedman and John W. James
             
                  In 1969 the psychiatrist Elizabeth Kubler-Ross wrote one of the most influential books in the history of psychology, On Death and Dying. It exposed the heartless treatment of terminally-ill patients prevalent at the time. On the positive side, it altered the care and treatment of dying people. On the negative side, it postulated the now-infamous five stages of dying-Denial, Anger, Bargaining, Depression, and Acceptance (DABDA), so annealed in culture that most people can recite them by heart. The stages allegedly represent what a dying person might experience upon learning he or she had a terminal illness. "Might" is the operative word, because Kübler-Ross repeatedly stipulated that a dying person might not go through all five stages, nor would they necessarily go through them in sequence. It would be reasonable to ask: if these conditions are this arbitrary, can they truly be called stages?
                 Many people have contested the validity of the stages of dying, but here we are more concerned with the supposed stages of grief which derived from the stages of dying. As professional grief recovery specialists, we contend that the theory of the stages of grief has done more harm than good to grieving people. Having co-authored three books on the impact of death, divorce, and other losses, and having worked directly with over 100,000 grieving people during the past 30 years, our reasons for disputing the stages of grief theory are predicated on the horror stories we've heard from thousands of grieving people who've told us how they'd been harmed by them.
            From Dying to Grief
            Elizabeth Kübler-Ross was a fearless pioneer who openly took the medical profession to task for its callous disregard for the feelings of dying people. The subtitle of On Death and Dying explains the book's primary focus: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families. The lessons Kübler-Ross learned from those dying people, coupled with her compassionate regard for them, became a focal point of the emergent Hospice movement. Somehow, over the years, the real virtues inspired by her work have been subordinated to the inaccurately named, largely imaginary stages.
                 During the 1970s, the DABDA model of stages of dying morphed into stages of grief, mostly because of their prominence in college-level sociology and psychology courses. The fact that Kübler-Ross' theory of stages was specific to dying became obscured. Students who eventually became therapists, social workers, or doctors carried what they learned about the stages into their careers. The media also played a role in disseminating the idea that specific, inexorable stages of grief exist. When a tragedy makes the news, newscasters and alleged experts recite the DABDA model of grieving. Medical and mental health professionals and the general public accepted the theory without ever investigating its provenance or validity.            
                 In fact, Kübler-Ross' stage theory was not the product of scientific research. In the second chapter of On Death and Dying she laments: "How do you do research on dying, when the data is so impossible to get? When you cannot verify your data and cannot set up experiments? We [she and her students] met for a while and decided that the best possible way we could study death and dying was by asking terminally ill patients to be our teachers." She then explains her methods: "I was to do the interview while they [her students] stood around the bed watching and observing. We would then retire to my office and discuss our own reactions and the patient's response. We believed that by doing many interviews like this we would get a feeling for the terminally ill and their needs which in turn we were ready to gratify if possible."
                 The phrase, "we would get a feeling" is especially revealing since Kübler-Ross' feelings were processed through the filter of her life-long unresolved grief and retained anger. We know that because she went public about the anguish of her past in her final book, On Grief and Grieving, coauthored with David Kessler and published shortly after her death in 2004. In the final chapter, titled My Own Grief, she tells the gruesome story about an episode involving her father and a cherished childhood pet that caused her to make an oath never to cry again. That event, along with a host of other personal grief incidents, resulted in her bottling up a lifetime of anger that she admitted she didn't deal with until very late in life.
                 When you read about Kübler-Ross' life, you sense how much her painful past may have colored her interpretation of her interviews with dying patients. Interestingly, anger is the only stage Kübler-Ross contends is absolute for everyone- in dying, or in grieving relationships with those who have died. It seems as if the palpable anger she carried for years caused her to insist we all must have anger about loss.
                 We're not sure why Kübler-Ross felt compelled to convert her observations from the interviews into stages. Possibly she believed that what she heard in her interviews with dying people was actually stages that needed to be quantified, or perhaps she simply attempted to put a scientific face on anecdotal evidence.
            When Does Wide Acceptance Equal Scientific Fact?
            On February 21, 2007, The Journal of the American Medical Association (JAMA) published the results of the Yale Bereavement Study (YBS): An Empirical Examination of the Stage Theory of Grief. The YBS evaluated a hodge-podge of alleged stages. It starts with the assumption that stages of grief exist, and then attempts to use that assumption to prove that they do. However, the existence of stages has never been established as fact. The results appeared to confirm some stages, negate others, and reposition their order and value. We cannot give any credence to the YBS because its premises and conclusions are flawed. But, since the study's own language perpetuates the myth that stages of grief even exist, we'll use it to make our case.
                 The YBS begins: "The notion that a natural psychological response to loss involves an orderly progression through distinct stages of bereavement has been widely accepted by clinicians and the general public." It concludes: "Identification of the normal stages of grief following a death from natural causes enhances understanding of how the average person cognitively and emotionally processes the loss of a family member." We are troubled by the assumption that stages of grief are normal and distinct and progress in a specific order. We also wonder, when does "wide acceptance" equal scientific fact?
                 Contrast the alleged wide acceptance of an "orderly progression of stages" with this from the inside cover of Meaning Reconstruction & the Experience of Loss, edited by Robert A. Neimeyer: "Debunking the notion that an invariant sequence of stages of grief occurs among all who experience the death of a loved one, this groundbreaking volume clearly demonstrates that highly individual processes of meaning making are at the heart of grief dynamics." Published by the American Psychological Association in 2001, Neimeyer's book presents 26 academicians' and clinicians' non-stage methods for helping grieving people. 
                 Neimeyer also addresses methodology in his introduction: "At the most obvious level, scientific studies have failed to support any discernible sequence of emotional phases of adaptation to loss or to identify any clear endpoint to grieving that would designate a state of 'recovery.' " Although Neimeyer's book's was published prior to the YBS, his contributors were familiar with earlier studies that attempted and failed to quantify stages.
            Dabbling in DABDA: A Stage by Any Other Name
            Prior to publication of her famous book, Kübler-Ross hypothesized the Five Stages of Receiving Catastrophic News, but in the text she renamed them the Five Stages of  Dying or Five Stages of Death. That led to the later, improper shift to stages of grief. Had she stuck with the phrase catastrophic news, perhaps the mythology of stages wouldn't have emerged and grievers wouldn't be encouraged to try to fit their emotions into non-existent stages.
                 Adding irony to the stages debacle, Kübler-Ross' final book, On Grief and Grieving, is subtitled, Finding The Meaning Of Grief Through The Five Stages Of Loss. Confusingly, inside the book they're called the Five Stages of Grief. Stages of
            loss conveniently fit the new book on grief and confirmed the chameleon-like capacity of  the word stages to arbitrarily mean whatever Kübler-Ross or anyone else wants it to mean.
            Refuting The Alleged Stages
            Kübler-Ross may have been the first to advance a specific stage theory about dying, but others preceded her in the area of grief. John Bowlby, Colin Murray Parkes and several others advanced theories about grief based on stages or phases, using a variety of labels. Alternate terms for the stages they used include: Disbelief, Numbness, Yearning, Shock, and Guilt. As we refute the stages, we'll address the most commonly used stages and point out how they have the potential to harm grieving people.
             
            1. (a) Denial (b) Disbelief (c) Shock (d) Numbness
            (a) Denial. In our thousands of interactions withgrieving people we have never found one person who was in denial that a loss had occurred. We ask, "What happened?" They say, "My mother died." There's no denial that someone died. We've had a few people tell us someone died and then say, "I'm in denial." We ask, "Do you mean the person isn't dead?" They say, "No, but I've heard 'denial' is the first stage of grief."
                 In the opening chapter of On Grief and Grieving, Kübler-Ross and Kessler state, "For a person who has lost a loved one, however, the denial is more symbolic than literal." We have to wonder: if denial is merely symbolic rather than literal, why call it a stage?
                 (b) Disbelief. The YBS uses disbelief rather than denial. Disbelief, as expressed by most grievers, is rhetorical language, as in, "I still can't believe he's gone." Although disbelief may reflect the emotions of a broken heart, it is really a figure of speech rather than a  statement that a death didn't happen.
                 (c) Shock. In cases of sudden, unexpected deaths, it's possible that upon receiving the news, a surviving family member may go into emotional shock, during which time they're in a suspended state, totally removed from events in the real world. This response is rare and doesn't last very long. Most deaths are at the end of a long-term illness or of old age, and don't produce shock in the survivors. However, there are books that maintain that shock is a standard stage of grief. There is no evidence to support that idea.
                 (d) Numbness. Numbness is one of the most common physiological responses to a grief-producing event. We reference numbness because the YBS coupled it with disbelief as if both are stages. Grief related numbness is the result of an overload of emotional energy in reaction to a death. Many grievers report numbness as intermittent in the immediate aftermath of a death, which usually gives way to a lack of focus or limited concentration. However, numbness is not a stage, nor is the inability to concentrate.
                  Potential Harm. Time can't heal emotional wounds, but the word "stage" implies that time is a component. The suggestion to grievers that they're in a stage of denial or disbelief can freeze them into inaction. They bury their feelings waiting for time to make that stage pass. Later they're liable to be diagnosed with "complicated bereavement" and put on psychotropic drugs, which make it difficult or impossible for them to access the emotions they've buried.
                 Professionally Induced Harm. Many grievers tell us that a mental or medical health professional "strongly suggested" they were in the denial stage, when all they'd said was that they were having some difficulty since Mom died. Even after reiterating they were clear that Mom had died, the therapist insisted they were in denial, which created a breach of trust and safety. The grievers terminated therapy after one or two ineffective sessions, and left their grief unattended. We believe those professionals
            overlooked a cardinal rule of helping grievers, which is: "Hear what your client is telling
            you, as opposed to having your own agenda."
            2. Anger
            When an elderly loved one dies at the end of a long-term illness, there's usually no anger in those left behind. Along with feelings of sadness, there may be a sense of relief that the suffering is over. Things do happen relevant to a death that can make us angry: anger at a disease or God; anger at doctors or hospitals or the drunk driver who killed our loved one; even anger at loved ones who didn't take good care of themselves, or who took their own lives. But anger is not a universal feeling when someone important to us dies, and therefore is not a stage.
                 Potential Harm. When anger is perceived as a stage, there are no actions the griever can take to end it. They must stay angry as long it lasts or as long as they're alive. As we said, stages imply that time is an element, so when time fails to end that stage, people re-create and re-live anger for years. Staying angry can have dangerous consequences, causing people to damage relationships, lose jobs, and worse, affect their health or restrict their will to live.
                 Professionally Induced Harm. Grievers repeatedly tell us the same scenario about anger as about denial. They report that a mental or medical health professional "planted" the idea they were in a stage of anger, when nothing they'd said would indicate that this was true.
            3. (a) Bargaining and (b)Yearning
            (a) Bargaining. Kübler-Ross' bargaining stage may make sense for someone diagnosed with a terminal illness. "If you'll just give me another chance, I'll take better care of myself," is a plea someone might make to whichever deity they believe in. But, it doesn't relate to the grief people feel when someone important to them has died.
                 (b) Yearning. The YBS substitutes yearning for bargaining. Since 83.8% of the participants in that study were widows or widowers, most over the age of 60, we're not surprised that many of them yearned for their lost partner. Talk to thousands of widows/widowers, as we have, and you are guaranteed to hear that most of them miss the person who died, including the surviving partners who were half of a 40-year relationship
            of constant bickering.
                 Potential Harm. The death of a long-term spouse creates an incalculable amount of emotional energy. Those feelings are often accompanied by an overwhelming sense of missing the person and wanting the familiarity of their presence back. Missing someone who has been a constant part of your life for decades is normal and to be expected. Again, calling it a stage suggests a time frame, causing them to wait for that stage to end which adds exponentially to their grief.
            4. Depression
            We're going to address depression in greater detail than the other alleged stages because it carries with it a great deal of confusion and potential danger for grieving people. Here is a list of reactions common to grievers that are also symptoms of clinical depression:
            · inability to concentrate,
            · disturbance of sleeping patterns,
            · upheaval of eating patterns,
            · roller coaster of emotions,
            · lack of energy.
                 One list fits both, and that's the problem. Are grievers clinically depressed? With very few exceptions, the answer is "no," and in those few cases only if they were clinically depressed before the death that affected them. Grief is the normal reaction to loss, but clinical depression is abnormal and requires different treatment. The line between grief-related depression and clinical depression has become hopelessly blurred, in part because the medical and mental health professions have adopted the non-existent stages of grief.
                 Potential Harm. It is normal for grievers to experience a lowered level of emotional and physical energy, which is neither clinical depression nor a stage. But when people believe depression is a stage that defines their sad feelings, they become trapped  by the belief that after the passage of some time the stage will magically end. While waiting for the depression to lift, they take no actions that might help them. If and when they seek professional help, they use the self-diagnosis of depression to describe themselves.
                 Professionally Induced Harm. When medical or psychological professionals hear grievers diagnose themselves as depressed, they often reflexively confirm that diagnosis and prescribe treatment with psychotropic drugs. The pharmaceutical companies which manufacture those drugs have a vested interest in sustaining the idea that grief-related depression is clinical, so their marketing supports the continuation of that belief.
                 The question of drug treatment for grief was addressed in the National Comorbidity Survey (published in the Archives of General Psychiatry, Vol. 64, April, 2007). "Criteria For Depression Are Too Broad Researchers Say-Guidelines May
            Encompass Many Who Are Just Sad." That headline trumpeted the survey's results, which observed more than 8,000 subjects and revealed that as many as 25% of grieving people diagnosed as depressed and placed on antidepressant drugs, are not clinically depressed. The study indicated they would benefit far more from supportive therapies that could keep them from developing full-blown depression.
            5. Acceptance
            Acceptance, as it relates to psychology or emotions, is a vague and amorphous term. Since there is almost never denial or disbelief that a death occurred, the concept of acceptance is confusing, if not moot. The YBS asked grievers to assess the level of acceptance they'd achieved about the death of someone important to them. This is an odd question, because they had to have accepted that the death occurred or else they wouldn't have been in a bereavement study.
                 Potential Harm. One definition of stages cannot fit all people, or all relationships-in fact we don't think they fit anybody. For example, an 85-year old woman whose spouse of 62 years has died reports a different emotional picture about her life and response to that death, than does a 62-year old woman whose 85-year old father has died. Both involve 62-year relationships, but the idea that there could be a stage of acceptance applicable to both is illogical.
            Another Non-Stage: Not Guilty As Charged
            Of all the incorrect ideas and feelings that are defined as stages of grief, guilt is undoubtedly the most unhelpful. We've seen it in dozens of books and heard it in hundreds of lectures. As those authors and speakers define it, guilt more accurately represents things the griever wishes had been different, better, or more in relation to the person who died; rather than a sense of having done something with intent to harm the person who died, for which the idea of guilt might make sense.
                 Personal Danger. Grieving parents who have had a troubled child commit suicide after years of therapy and drug and alcohol rehab, are often told, "You shouldn't feel guilty, you did everything possible." The problem is that they weren't feeling guilty, they were probably feeling devastated and overwhelmed, among other  feelings. Planting the word guilt on them, like planting any of the stage words, induces them to feel what others suggest. Tragically, those ideas keep them stuck and limit their access to more helpful ideas about dealing with their broken hearts.
            Conclusion
            We understand that people engulfed in the aftermath of loss want to know what to expect and how long it will last. Such questions can never be satisfactorily answered. Since every griever is unique, there are no pat answers about grief.
                 As much effort as we've put in to refuting the stages, Kübler-Ross herself rebuts them better than we can in the opening paragraph of On Grief and Grieving: "The stages have evolved since their
            introduction, and they have been very misunderstood over the past three decades. They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grief is as individual as our lives. Not everyone goes through all of them or goes in a prescribed order." 
                 If there are no typical responses to loss and no typical losses, and not everyone goes through them or in order, how can there possibly be stages that universally represent people's reactions to loss? The fact is, no study has ever established that stages of grief actually exist, and what are defined as such can't be called stages. Grief is the normal and natural emotional response to loss. Stage theories put grieving people in conflict with their emotional reactions to losses that affect them.
            No matter how much people want to create simple, iron clad guidelines for the human emotions of grief, there are no stages of grief that fit every person or relationship.
            Russell Friedman and John W. James are the principals of The Grief Recovery Institute in Sherman Oaks, California. They are the co-authors of The Grief Recovery Handbook and When Children Grieve [both from HarperCollins], and Moving On [M. Evans]. For more information about recovery from loss, go to the Helpful Articles section at http://www.grief.net
             
            • April 11, 2013 at 2:16 pm
            JC
            Participant
              The Myth of Stages of  Dying, Death and Grief
              By Russell Friedman and John W. James
               
                    In 1969 the psychiatrist Elizabeth Kubler-Ross wrote one of the most influential books in the history of psychology, On Death and Dying. It exposed the heartless treatment of terminally-ill patients prevalent at the time. On the positive side, it altered the care and treatment of dying people. On the negative side, it postulated the now-infamous five stages of dying-Denial, Anger, Bargaining, Depression, and Acceptance (DABDA), so annealed in culture that most people can recite them by heart. The stages allegedly represent what a dying person might experience upon learning he or she had a terminal illness. "Might" is the operative word, because Kübler-Ross repeatedly stipulated that a dying person might not go through all five stages, nor would they necessarily go through them in sequence. It would be reasonable to ask: if these conditions are this arbitrary, can they truly be called stages?
                   Many people have contested the validity of the stages of dying, but here we are more concerned with the supposed stages of grief which derived from the stages of dying. As professional grief recovery specialists, we contend that the theory of the stages of grief has done more harm than good to grieving people. Having co-authored three books on the impact of death, divorce, and other losses, and having worked directly with over 100,000 grieving people during the past 30 years, our reasons for disputing the stages of grief theory are predicated on the horror stories we've heard from thousands of grieving people who've told us how they'd been harmed by them.
              From Dying to Grief
              Elizabeth Kübler-Ross was a fearless pioneer who openly took the medical profession to task for its callous disregard for the feelings of dying people. The subtitle of On Death and Dying explains the book's primary focus: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families. The lessons Kübler-Ross learned from those dying people, coupled with her compassionate regard for them, became a focal point of the emergent Hospice movement. Somehow, over the years, the real virtues inspired by her work have been subordinated to the inaccurately named, largely imaginary stages.
                   During the 1970s, the DABDA model of stages of dying morphed into stages of grief, mostly because of their prominence in college-level sociology and psychology courses. The fact that Kübler-Ross' theory of stages was specific to dying became obscured. Students who eventually became therapists, social workers, or doctors carried what they learned about the stages into their careers. The media also played a role in disseminating the idea that specific, inexorable stages of grief exist. When a tragedy makes the news, newscasters and alleged experts recite the DABDA model of grieving. Medical and mental health professionals and the general public accepted the theory without ever investigating its provenance or validity.            
                   In fact, Kübler-Ross' stage theory was not the product of scientific research. In the second chapter of On Death and Dying she laments: "How do you do research on dying, when the data is so impossible to get? When you cannot verify your data and cannot set up experiments? We [she and her students] met for a while and decided that the best possible way we could study death and dying was by asking terminally ill patients to be our teachers." She then explains her methods: "I was to do the interview while they [her students] stood around the bed watching and observing. We would then retire to my office and discuss our own reactions and the patient's response. We believed that by doing many interviews like this we would get a feeling for the terminally ill and their needs which in turn we were ready to gratify if possible."
                   The phrase, "we would get a feeling" is especially revealing since Kübler-Ross' feelings were processed through the filter of her life-long unresolved grief and retained anger. We know that because she went public about the anguish of her past in her final book, On Grief and Grieving, coauthored with David Kessler and published shortly after her death in 2004. In the final chapter, titled My Own Grief, she tells the gruesome story about an episode involving her father and a cherished childhood pet that caused her to make an oath never to cry again. That event, along with a host of other personal grief incidents, resulted in her bottling up a lifetime of anger that she admitted she didn't deal with until very late in life.
                   When you read about Kübler-Ross' life, you sense how much her painful past may have colored her interpretation of her interviews with dying patients. Interestingly, anger is the only stage Kübler-Ross contends is absolute for everyone- in dying, or in grieving relationships with those who have died. It seems as if the palpable anger she carried for years caused her to insist we all must have anger about loss.
                   We're not sure why Kübler-Ross felt compelled to convert her observations from the interviews into stages. Possibly she believed that what she heard in her interviews with dying people was actually stages that needed to be quantified, or perhaps she simply attempted to put a scientific face on anecdotal evidence.
              When Does Wide Acceptance Equal Scientific Fact?
              On February 21, 2007, The Journal of the American Medical Association (JAMA) published the results of the Yale Bereavement Study (YBS): An Empirical Examination of the Stage Theory of Grief. The YBS evaluated a hodge-podge of alleged stages. It starts with the assumption that stages of grief exist, and then attempts to use that assumption to prove that they do. However, the existence of stages has never been established as fact. The results appeared to confirm some stages, negate others, and reposition their order and value. We cannot give any credence to the YBS because its premises and conclusions are flawed. But, since the study's own language perpetuates the myth that stages of grief even exist, we'll use it to make our case.
                   The YBS begins: "The notion that a natural psychological response to loss involves an orderly progression through distinct stages of bereavement has been widely accepted by clinicians and the general public." It concludes: "Identification of the normal stages of grief following a death from natural causes enhances understanding of how the average person cognitively and emotionally processes the loss of a family member." We are troubled by the assumption that stages of grief are normal and distinct and progress in a specific order. We also wonder, when does "wide acceptance" equal scientific fact?
                   Contrast the alleged wide acceptance of an "orderly progression of stages" with this from the inside cover of Meaning Reconstruction & the Experience of Loss, edited by Robert A. Neimeyer: "Debunking the notion that an invariant sequence of stages of grief occurs among all who experience the death of a loved one, this groundbreaking volume clearly demonstrates that highly individual processes of meaning making are at the heart of grief dynamics." Published by the American Psychological Association in 2001, Neimeyer's book presents 26 academicians' and clinicians' non-stage methods for helping grieving people. 
                   Neimeyer also addresses methodology in his introduction: "At the most obvious level, scientific studies have failed to support any discernible sequence of emotional phases of adaptation to loss or to identify any clear endpoint to grieving that would designate a state of 'recovery.' " Although Neimeyer's book's was published prior to the YBS, his contributors were familiar with earlier studies that attempted and failed to quantify stages.
              Dabbling in DABDA: A Stage by Any Other Name
              Prior to publication of her famous book, Kübler-Ross hypothesized the Five Stages of Receiving Catastrophic News, but in the text she renamed them the Five Stages of  Dying or Five Stages of Death. That led to the later, improper shift to stages of grief. Had she stuck with the phrase catastrophic news, perhaps the mythology of stages wouldn't have emerged and grievers wouldn't be encouraged to try to fit their emotions into non-existent stages.
                   Adding irony to the stages debacle, Kübler-Ross' final book, On Grief and Grieving, is subtitled, Finding The Meaning Of Grief Through The Five Stages Of Loss. Confusingly, inside the book they're called the Five Stages of Grief. Stages of
              loss conveniently fit the new book on grief and confirmed the chameleon-like capacity of  the word stages to arbitrarily mean whatever Kübler-Ross or anyone else wants it to mean.
              Refuting The Alleged Stages
              Kübler-Ross may have been the first to advance a specific stage theory about dying, but others preceded her in the area of grief. John Bowlby, Colin Murray Parkes and several others advanced theories about grief based on stages or phases, using a variety of labels. Alternate terms for the stages they used include: Disbelief, Numbness, Yearning, Shock, and Guilt. As we refute the stages, we'll address the most commonly used stages and point out how they have the potential to harm grieving people.
               
              1. (a) Denial (b) Disbelief (c) Shock (d) Numbness
              (a) Denial. In our thousands of interactions withgrieving people we have never found one person who was in denial that a loss had occurred. We ask, "What happened?" They say, "My mother died." There's no denial that someone died. We've had a few people tell us someone died and then say, "I'm in denial." We ask, "Do you mean the person isn't dead?" They say, "No, but I've heard 'denial' is the first stage of grief."
                   In the opening chapter of On Grief and Grieving, Kübler-Ross and Kessler state, "For a person who has lost a loved one, however, the denial is more symbolic than literal." We have to wonder: if denial is merely symbolic rather than literal, why call it a stage?
                   (b) Disbelief. The YBS uses disbelief rather than denial. Disbelief, as expressed by most grievers, is rhetorical language, as in, "I still can't believe he's gone." Although disbelief may reflect the emotions of a broken heart, it is really a figure of speech rather than a  statement that a death didn't happen.
                   (c) Shock. In cases of sudden, unexpected deaths, it's possible that upon receiving the news, a surviving family member may go into emotional shock, during which time they're in a suspended state, totally removed from events in the real world. This response is rare and doesn't last very long. Most deaths are at the end of a long-term illness or of old age, and don't produce shock in the survivors. However, there are books that maintain that shock is a standard stage of grief. There is no evidence to support that idea.
                   (d) Numbness. Numbness is one of the most common physiological responses to a grief-producing event. We reference numbness because the YBS coupled it with disbelief as if both are stages. Grief related numbness is the result of an overload of emotional energy in reaction to a death. Many grievers report numbness as intermittent in the immediate aftermath of a death, which usually gives way to a lack of focus or limited concentration. However, numbness is not a stage, nor is the inability to concentrate.
                    Potential Harm. Time can't heal emotional wounds, but the word "stage" implies that time is a component. The suggestion to grievers that they're in a stage of denial or disbelief can freeze them into inaction. They bury their feelings waiting for time to make that stage pass. Later they're liable to be diagnosed with "complicated bereavement" and put on psychotropic drugs, which make it difficult or impossible for them to access the emotions they've buried.
                   Professionally Induced Harm. Many grievers tell us that a mental or medical health professional "strongly suggested" they were in the denial stage, when all they'd said was that they were having some difficulty since Mom died. Even after reiterating they were clear that Mom had died, the therapist insisted they were in denial, which created a breach of trust and safety. The grievers terminated therapy after one or two ineffective sessions, and left their grief unattended. We believe those professionals
              overlooked a cardinal rule of helping grievers, which is: "Hear what your client is telling
              you, as opposed to having your own agenda."
              2. Anger
              When an elderly loved one dies at the end of a long-term illness, there's usually no anger in those left behind. Along with feelings of sadness, there may be a sense of relief that the suffering is over. Things do happen relevant to a death that can make us angry: anger at a disease or God; anger at doctors or hospitals or the drunk driver who killed our loved one; even anger at loved ones who didn't take good care of themselves, or who took their own lives. But anger is not a universal feeling when someone important to us dies, and therefore is not a stage.
                   Potential Harm. When anger is perceived as a stage, there are no actions the griever can take to end it. They must stay angry as long it lasts or as long as they're alive. As we said, stages imply that time is an element, so when time fails to end that stage, people re-create and re-live anger for years. Staying angry can have dangerous consequences, causing people to damage relationships, lose jobs, and worse, affect their health or restrict their will to live.
                   Professionally Induced Harm. Grievers repeatedly tell us the same scenario about anger as about denial. They report that a mental or medical health professional "planted" the idea they were in a stage of anger, when nothing they'd said would indicate that this was true.
              3. (a) Bargaining and (b)Yearning
              (a) Bargaining. Kübler-Ross' bargaining stage may make sense for someone diagnosed with a terminal illness. "If you'll just give me another chance, I'll take better care of myself," is a plea someone might make to whichever deity they believe in. But, it doesn't relate to the grief people feel when someone important to them has died.
                   (b) Yearning. The YBS substitutes yearning for bargaining. Since 83.8% of the participants in that study were widows or widowers, most over the age of 60, we're not surprised that many of them yearned for their lost partner. Talk to thousands of widows/widowers, as we have, and you are guaranteed to hear that most of them miss the person who died, including the surviving partners who were half of a 40-year relationship
              of constant bickering.
                   Potential Harm. The death of a long-term spouse creates an incalculable amount of emotional energy. Those feelings are often accompanied by an overwhelming sense of missing the person and wanting the familiarity of their presence back. Missing someone who has been a constant part of your life for decades is normal and to be expected. Again, calling it a stage suggests a time frame, causing them to wait for that stage to end which adds exponentially to their grief.
              4. Depression
              We're going to address depression in greater detail than the other alleged stages because it carries with it a great deal of confusion and potential danger for grieving people. Here is a list of reactions common to grievers that are also symptoms of clinical depression:
              · inability to concentrate,
              · disturbance of sleeping patterns,
              · upheaval of eating patterns,
              · roller coaster of emotions,
              · lack of energy.
                   One list fits both, and that's the problem. Are grievers clinically depressed? With very few exceptions, the answer is "no," and in those few cases only if they were clinically depressed before the death that affected them. Grief is the normal reaction to loss, but clinical depression is abnormal and requires different treatment. The line between grief-related depression and clinical depression has become hopelessly blurred, in part because the medical and mental health professions have adopted the non-existent stages of grief.
                   Potential Harm. It is normal for grievers to experience a lowered level of emotional and physical energy, which is neither clinical depression nor a stage. But when people believe depression is a stage that defines their sad feelings, they become trapped  by the belief that after the passage of some time the stage will magically end. While waiting for the depression to lift, they take no actions that might help them. If and when they seek professional help, they use the self-diagnosis of depression to describe themselves.
                   Professionally Induced Harm. When medical or psychological professionals hear grievers diagnose themselves as depressed, they often reflexively confirm that diagnosis and prescribe treatment with psychotropic drugs. The pharmaceutical companies which manufacture those drugs have a vested interest in sustaining the idea that grief-related depression is clinical, so their marketing supports the continuation of that belief.
                   The question of drug treatment for grief was addressed in the National Comorbidity Survey (published in the Archives of General Psychiatry, Vol. 64, April, 2007). "Criteria For Depression Are Too Broad Researchers Say-Guidelines May
              Encompass Many Who Are Just Sad." That headline trumpeted the survey's results, which observed more than 8,000 subjects and revealed that as many as 25% of grieving people diagnosed as depressed and placed on antidepressant drugs, are not clinically depressed. The study indicated they would benefit far more from supportive therapies that could keep them from developing full-blown depression.
              5. Acceptance
              Acceptance, as it relates to psychology or emotions, is a vague and amorphous term. Since there is almost never denial or disbelief that a death occurred, the concept of acceptance is confusing, if not moot. The YBS asked grievers to assess the level of acceptance they'd achieved about the death of someone important to them. This is an odd question, because they had to have accepted that the death occurred or else they wouldn't have been in a bereavement study.
                   Potential Harm. One definition of stages cannot fit all people, or all relationships-in fact we don't think they fit anybody. For example, an 85-year old woman whose spouse of 62 years has died reports a different emotional picture about her life and response to that death, than does a 62-year old woman whose 85-year old father has died. Both involve 62-year relationships, but the idea that there could be a stage of acceptance applicable to both is illogical.
              Another Non-Stage: Not Guilty As Charged
              Of all the incorrect ideas and feelings that are defined as stages of grief, guilt is undoubtedly the most unhelpful. We've seen it in dozens of books and heard it in hundreds of lectures. As those authors and speakers define it, guilt more accurately represents things the griever wishes had been different, better, or more in relation to the person who died; rather than a sense of having done something with intent to harm the person who died, for which the idea of guilt might make sense.
                   Personal Danger. Grieving parents who have had a troubled child commit suicide after years of therapy and drug and alcohol rehab, are often told, "You shouldn't feel guilty, you did everything possible." The problem is that they weren't feeling guilty, they were probably feeling devastated and overwhelmed, among other  feelings. Planting the word guilt on them, like planting any of the stage words, induces them to feel what others suggest. Tragically, those ideas keep them stuck and limit their access to more helpful ideas about dealing with their broken hearts.
              Conclusion
              We understand that people engulfed in the aftermath of loss want to know what to expect and how long it will last. Such questions can never be satisfactorily answered. Since every griever is unique, there are no pat answers about grief.
                   As much effort as we've put in to refuting the stages, Kübler-Ross herself rebuts them better than we can in the opening paragraph of On Grief and Grieving: "The stages have evolved since their
              introduction, and they have been very misunderstood over the past three decades. They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grief is as individual as our lives. Not everyone goes through all of them or goes in a prescribed order." 
                   If there are no typical responses to loss and no typical losses, and not everyone goes through them or in order, how can there possibly be stages that universally represent people's reactions to loss? The fact is, no study has ever established that stages of grief actually exist, and what are defined as such can't be called stages. Grief is the normal and natural emotional response to loss. Stage theories put grieving people in conflict with their emotional reactions to losses that affect them.
              No matter how much people want to create simple, iron clad guidelines for the human emotions of grief, there are no stages of grief that fit every person or relationship.
              Russell Friedman and John W. James are the principals of The Grief Recovery Institute in Sherman Oaks, California. They are the co-authors of The Grief Recovery Handbook and When Children Grieve [both from HarperCollins], and Moving On [M. Evans]. For more information about recovery from loss, go to the Helpful Articles section at http://www.grief.net
               
                • April 11, 2013 at 3:17 pm
                POW
                Participant

                  Thank you for posting this excerpt. I read it and I checked out the source of the article– The Grief Recovery Institute (thanks for that link).

                  The message that I took away from what I read is that, yes, people should talk about their grief. But they should talk about it using The Grief Recovery Institute's "7-Steps" instead of Kubler Ross' "5-Stages". H-m-m-m. Sounds more like academic (and profit-driven) opinion than first hand experience to me. 

                  I would like to know whether real people feel that they have benefitted more from talking it out or from keeping it to yourself.

                  • April 11, 2013 at 3:17 pm
                  POW
                  Participant

                    Thank you for posting this excerpt. I read it and I checked out the source of the article– The Grief Recovery Institute (thanks for that link).

                    The message that I took away from what I read is that, yes, people should talk about their grief. But they should talk about it using The Grief Recovery Institute's "7-Steps" instead of Kubler Ross' "5-Stages". H-m-m-m. Sounds more like academic (and profit-driven) opinion than first hand experience to me. 

                    I would like to know whether real people feel that they have benefitted more from talking it out or from keeping it to yourself.

                    • April 11, 2013 at 3:17 pm
                    POW
                    Participant

                      Thank you for posting this excerpt. I read it and I checked out the source of the article– The Grief Recovery Institute (thanks for that link).

                      The message that I took away from what I read is that, yes, people should talk about their grief. But they should talk about it using The Grief Recovery Institute's "7-Steps" instead of Kubler Ross' "5-Stages". H-m-m-m. Sounds more like academic (and profit-driven) opinion than first hand experience to me. 

                      I would like to know whether real people feel that they have benefitted more from talking it out or from keeping it to yourself.

                    • April 11, 2013 at 4:54 pm
                    BillMFl
                    Participant

                      Dump the grief  counselor. She was unbelievably insensitive. This is not a cookie cutter "one size fits all" situation.  She is so full of s… that it makes me angry! There is nothing wrong for feeling monments of grief even years later. An old photo or a memory of a special time/place can retrigger grief for my sister and there is nothing wrong at all with a natural emotion like that. What can be bad is someone who cannot get over their grief over a reasonable period of time and instead dwells on the grief to the point that it interferes with their every day normal activities. I think yousound like a very reasonable person who is getting on with your life (and thats what your brother would want for you). To sometimes revisit the emotions and pain of your loss is absolutely normal and there is no exact lenght of time for the healing process. My dear sister passed away about 4 years ago. I am not ashamed to still feel the loss. Nor should you!

                      • April 11, 2013 at 4:54 pm
                      BillMFl
                      Participant

                        Dump the grief  counselor. She was unbelievably insensitive. This is not a cookie cutter "one size fits all" situation.  She is so full of s… that it makes me angry! There is nothing wrong for feeling monments of grief even years later. An old photo or a memory of a special time/place can retrigger grief for my sister and there is nothing wrong at all with a natural emotion like that. What can be bad is someone who cannot get over their grief over a reasonable period of time and instead dwells on the grief to the point that it interferes with their every day normal activities. I think yousound like a very reasonable person who is getting on with your life (and thats what your brother would want for you). To sometimes revisit the emotions and pain of your loss is absolutely normal and there is no exact lenght of time for the healing process. My dear sister passed away about 4 years ago. I am not ashamed to still feel the loss. Nor should you!

                        • April 11, 2013 at 4:54 pm
                        BillMFl
                        Participant

                          Dump the grief  counselor. She was unbelievably insensitive. This is not a cookie cutter "one size fits all" situation.  She is so full of s… that it makes me angry! There is nothing wrong for feeling monments of grief even years later. An old photo or a memory of a special time/place can retrigger grief for my sister and there is nothing wrong at all with a natural emotion like that. What can be bad is someone who cannot get over their grief over a reasonable period of time and instead dwells on the grief to the point that it interferes with their every day normal activities. I think yousound like a very reasonable person who is getting on with your life (and thats what your brother would want for you). To sometimes revisit the emotions and pain of your loss is absolutely normal and there is no exact lenght of time for the healing process. My dear sister passed away about 4 years ago. I am not ashamed to still feel the loss. Nor should you!

                          • April 11, 2013 at 4:54 pm
                          BillMFl
                          Participant

                            Dump the grief  counselor. She was unbelievably insensitive. This is not a cookie cutter "one size fits all" situation.  She is so full of s… that it makes me angry! There is nothing wrong for feeling monments of grief even years later. An old photo or a memory of a special time/place can retrigger grief for my sister and there is nothing wrong at all with a natural emotion like that. What can be bad is someone who cannot get over their grief over a reasonable period of time and instead dwells on the grief to the point that it interferes with their every day normal activities. I think yousound like a very reasonable person who is getting on with your life (and thats what your brother would want for you). To sometimes revisit the emotions and pain of your loss is absolutely normal and there is no exact lenght of time for the healing process. My dear sister passed away about 4 years ago. I am not ashamed to still feel the loss. Nor should you!

                            • April 11, 2013 at 4:54 pm
                            BillMFl
                            Participant

                              Dump the grief  counselor. She was unbelievably insensitive. This is not a cookie cutter "one size fits all" situation.  She is so full of s… that it makes me angry! There is nothing wrong for feeling monments of grief even years later. An old photo or a memory of a special time/place can retrigger grief for my sister and there is nothing wrong at all with a natural emotion like that. What can be bad is someone who cannot get over their grief over a reasonable period of time and instead dwells on the grief to the point that it interferes with their every day normal activities. I think yousound like a very reasonable person who is getting on with your life (and thats what your brother would want for you). To sometimes revisit the emotions and pain of your loss is absolutely normal and there is no exact lenght of time for the healing process. My dear sister passed away about 4 years ago. I am not ashamed to still feel the loss. Nor should you!

                              • April 11, 2013 at 4:54 pm
                              BillMFl
                              Participant

                                Dump the grief  counselor. She was unbelievably insensitive. This is not a cookie cutter "one size fits all" situation.  She is so full of s… that it makes me angry! There is nothing wrong for feeling monments of grief even years later. An old photo or a memory of a special time/place can retrigger grief for my sister and there is nothing wrong at all with a natural emotion like that. What can be bad is someone who cannot get over their grief over a reasonable period of time and instead dwells on the grief to the point that it interferes with their every day normal activities. I think yousound like a very reasonable person who is getting on with your life (and thats what your brother would want for you). To sometimes revisit the emotions and pain of your loss is absolutely normal and there is no exact lenght of time for the healing process. My dear sister passed away about 4 years ago. I am not ashamed to still feel the loss. Nor should you!

                                • April 12, 2013 at 12:29 am
                                JuleFL
                                Participant
                                  My husband passed away September 2010 and my grief has been very deep. I have learned that there are no “right” ways or guarantees in grieving. It is unique to each one of us and can be formed by our upbringing and culture as well as previous experiences with loss. I have not read Anonymous’ article yet, but I have heard and believe that there are no set “stages” of grief. Most of my “colleagues” refer to it as a roller coaster – and we are aboard for an unpredictable ride. And we do ride.

                                  I think that your counselor might be encouraging you to “work on your grief”. In other words, try to recognize it and allow yourself to feel the grief. The phrase “not doing OK” is unfortunate as it is normal to have confusing emotions during this time and there is no “Ok” or “not Ok”. You do what feels right for you.

                                  I have been very fortunate to meet a group of women who have lost loved ones. It took me a while before I met them, but we have become committed to listening and supporting each other. Everyone’s situation is different , but we have some things in common and can empathise with each other. We take time out to do “normal” and fun things. I feel blessed. I know (and have heard from others) that it is difficult to find friends like this – and we do have our disagreement at times 🙂

                                  I guess my point of the above paragraph is to allow yourself – even if you are by yourself – to express your feelings. During my most troubling times, I wrote in a journal. I wrote some terrible things and poured out my guilt and anger on paper – in my situation I had plenty of both. It actually helped calm me down and get me through to the next time when I needed to write again.

                                  Losing someone causes us emotional “trauma”. Our emotions are not prepared to deal with it even though we might have known for a while that the loss was pending. Sometimes when people are traumatized, their counselors suggest that they “relive” the experience in order to understand it – perhaps to see it from an outside point of view. This is difficult to do, but over time I have gained a different perspective. I am still grieving, but it is getting better and I am gaining clarity and confidence. I am beginning to feel that I am ready to move on with my life (although I hold my husband in my heart always).

                                  I know that I have the need to talk about my feelings so please feel free to contact me if you wish to talk. My email is [email protected].

                                  • April 12, 2013 at 12:29 am
                                  JuleFL
                                  Participant
                                    My husband passed away September 2010 and my grief has been very deep. I have learned that there are no “right” ways or guarantees in grieving. It is unique to each one of us and can be formed by our upbringing and culture as well as previous experiences with loss. I have not read Anonymous’ article yet, but I have heard and believe that there are no set “stages” of grief. Most of my “colleagues” refer to it as a roller coaster – and we are aboard for an unpredictable ride. And we do ride.

                                    I think that your counselor might be encouraging you to “work on your grief”. In other words, try to recognize it and allow yourself to feel the grief. The phrase “not doing OK” is unfortunate as it is normal to have confusing emotions during this time and there is no “Ok” or “not Ok”. You do what feels right for you.

                                    I have been very fortunate to meet a group of women who have lost loved ones. It took me a while before I met them, but we have become committed to listening and supporting each other. Everyone’s situation is different , but we have some things in common and can empathise with each other. We take time out to do “normal” and fun things. I feel blessed. I know (and have heard from others) that it is difficult to find friends like this – and we do have our disagreement at times 🙂

                                    I guess my point of the above paragraph is to allow yourself – even if you are by yourself – to express your feelings. During my most troubling times, I wrote in a journal. I wrote some terrible things and poured out my guilt and anger on paper – in my situation I had plenty of both. It actually helped calm me down and get me through to the next time when I needed to write again.

                                    Losing someone causes us emotional “trauma”. Our emotions are not prepared to deal with it even though we might have known for a while that the loss was pending. Sometimes when people are traumatized, their counselors suggest that they “relive” the experience in order to understand it – perhaps to see it from an outside point of view. This is difficult to do, but over time I have gained a different perspective. I am still grieving, but it is getting better and I am gaining clarity and confidence. I am beginning to feel that I am ready to move on with my life (although I hold my husband in my heart always).

                                    I know that I have the need to talk about my feelings so please feel free to contact me if you wish to talk. My email is [email protected].

                                    • April 12, 2013 at 12:29 am
                                    JuleFL
                                    Participant
                                      My husband passed away September 2010 and my grief has been very deep. I have learned that there are no “right” ways or guarantees in grieving. It is unique to each one of us and can be formed by our upbringing and culture as well as previous experiences with loss. I have not read Anonymous’ article yet, but I have heard and believe that there are no set “stages” of grief. Most of my “colleagues” refer to it as a roller coaster – and we are aboard for an unpredictable ride. And we do ride.

                                      I think that your counselor might be encouraging you to “work on your grief”. In other words, try to recognize it and allow yourself to feel the grief. The phrase “not doing OK” is unfortunate as it is normal to have confusing emotions during this time and there is no “Ok” or “not Ok”. You do what feels right for you.

                                      I have been very fortunate to meet a group of women who have lost loved ones. It took me a while before I met them, but we have become committed to listening and supporting each other. Everyone’s situation is different , but we have some things in common and can empathise with each other. We take time out to do “normal” and fun things. I feel blessed. I know (and have heard from others) that it is difficult to find friends like this – and we do have our disagreement at times 🙂

                                      I guess my point of the above paragraph is to allow yourself – even if you are by yourself – to express your feelings. During my most troubling times, I wrote in a journal. I wrote some terrible things and poured out my guilt and anger on paper – in my situation I had plenty of both. It actually helped calm me down and get me through to the next time when I needed to write again.

                                      Losing someone causes us emotional “trauma”. Our emotions are not prepared to deal with it even though we might have known for a while that the loss was pending. Sometimes when people are traumatized, their counselors suggest that they “relive” the experience in order to understand it – perhaps to see it from an outside point of view. This is difficult to do, but over time I have gained a different perspective. I am still grieving, but it is getting better and I am gaining clarity and confidence. I am beginning to feel that I am ready to move on with my life (although I hold my husband in my heart always).

                                      I know that I have the need to talk about my feelings so please feel free to contact me if you wish to talk. My email is [email protected].

                                      • April 12, 2013 at 7:44 pm
                                      jag
                                      Participant

                                        Next time you see her, bring in a sample of dog poo, put it on her desk and telll her she has to smell it until she doesn't wrinkle her nose anymore.

                                        Oh and ask for the name of a better therapist.

                                        • April 12, 2013 at 7:44 pm
                                        jag
                                        Participant

                                          Next time you see her, bring in a sample of dog poo, put it on her desk and telll her she has to smell it until she doesn't wrinkle her nose anymore.

                                          Oh and ask for the name of a better therapist.

                                            • April 14, 2013 at 2:13 am
                                            NYKaren
                                            Participant
                                              Well-said, John.
                                              I think there’s got to be a medium between being stoic and not talking about your emotions and re-hashing the same painful memory over and over again. If you want to talk about it, fine, but if it were me, I wouldn’t want someone telling me I HAVE to!
                                              And from what it sounds like to me, you’re doing just fine. Good days and bad; good moments and bad.
                                              It’s good to hear you’re able to so some freelancing.
                                              You’re in my thoughts,
                                              Karen
                                              • April 14, 2013 at 2:13 am
                                              NYKaren
                                              Participant
                                                Well-said, John.
                                                I think there’s got to be a medium between being stoic and not talking about your emotions and re-hashing the same painful memory over and over again. If you want to talk about it, fine, but if it were me, I wouldn’t want someone telling me I HAVE to!
                                                And from what it sounds like to me, you’re doing just fine. Good days and bad; good moments and bad.
                                                It’s good to hear you’re able to so some freelancing.
                                                You’re in my thoughts,
                                                Karen
                                                • April 14, 2013 at 2:13 am
                                                NYKaren
                                                Participant
                                                  Well-said, John.
                                                  I think there’s got to be a medium between being stoic and not talking about your emotions and re-hashing the same painful memory over and over again. If you want to talk about it, fine, but if it were me, I wouldn’t want someone telling me I HAVE to!
                                                  And from what it sounds like to me, you’re doing just fine. Good days and bad; good moments and bad.
                                                  It’s good to hear you’re able to so some freelancing.
                                                  You’re in my thoughts,
                                                  Karen
                                                • April 12, 2013 at 7:44 pm
                                                jag
                                                Participant

                                                  Next time you see her, bring in a sample of dog poo, put it on her desk and telll her she has to smell it until she doesn't wrinkle her nose anymore.

                                                  Oh and ask for the name of a better therapist.

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