Despite the problems with the Kübler-Ross model discussed below in this
section, it has enough truth in it to be worth thinking about.
The biggest complement, arguably, is that Cicely Saunders was impressed by it.
(Cicely Saunders:
Steps pretty much have to be a sequence, in a fixed order.
Stages may just sound like they are.
The 5 stages above are often thought of as sequential but:
They may be iterative: one person re-experiencing a stage, and/or
oscillating between stages.
But perhaps in looking over extended grieving for someone who is in the
process of dying (rather than in recovering from grief for an unexpected
death), a common thing is to see either Denial or Acceptance, but sometimes to
see both in the one person, depending on whom they are talking to.
The underlying issue is not being able to bear to acknowledge to someone else
that the death is going to occur: and that can depend on who that other is.
So a) One person can be in two stages at once, depending upon their co-locutor;
b) The problems come from two people not being at the same stage; not having
the same attitude to the situation.
There is no rule as to whether it is the survivor or the dying who exhibit
one or the other, and many problems around such dying is the mismatch in
attitude between the two involved.
Sudden death: Inadequacies of the 5-stage model
[This is from the first Albia novel by Lindsey Davis.]
A young wife's husband suddenly dies. Her main apparent emotion is
bewilderment: not overt grief, nor denial, nor .... The nearest official
stage is "Despair": not knowing what to do, all plans destroyed as void; but
no overwhelming passion. Like denial in that it's first, and dysfunctional;
but not denying the fact, just paralysing. This character wasn't deeply in
love with her husband, but was getting along fine: so perhaps no-emotion yet
paralysis is right. The death was very destructive of her life plans; but not
perhaps destructive of her inner life goals/needs.
Perhaps people whose employer suddenly goes bust may often be like this (unless
they are financially very threatened already).
Reconstruction. Being constructive.
One of the biggest issues to improve on, in the 5 stage model, may be around
being constructive. The 5th stage is "Acceptance", but a lot of people get
stuck in a kind of Acceptance that is little different from Despair –
so that accepting the fact has not led to reconstructing a worthwhile life.
What needs to be constructed? Firstly: grief is most disabling in the first
instance to the extent that previous habits, ways of living, are disrupted by
the death of someone else. So all those habits must be re-planned: invented
differently, practised, adapted; and this is independent of whether the dead
person was emotionally important.
We can approach this from another angle. Stage 5 "Acceptance" sounds
completely passive, yet reconstruction must be active. So there seem to be
two quite different final stages: (1) passive acceptance, which is perhaps
little different to Despair or Bewilderment; and (2) active acceptance which
means moving into a new re-planned way of living, which requires the person to
be active and creative: "Reconstructed". This isn't just about stages of
reaction to grief, but also to other kinds of changed circumstances.
I am writing this paragraph on 31 May 2020, just as the UK is making the first
steps out of lockdown from Covid. This issue of passive acceptance vs. active
acceptance can be seen in how different groups have responded to the lockdown.
Type I: Highly active reconstruction
The documentaries and news pieces on life in intensive care units during the
peak pandemic show high stress, but also a very high rate of adaptation as
organisations and units invent the necessary procedures and rapidly improve
them as they learn more about what does and doesn't work.
In my university, Teachers have similarly had to invent, agree, and carry out a
completely new way of doing examinations with large numbers of anxious
students at very short notice, and managed to pull this off with no
significant breakdowns. This too, is doing one's regular job under suddenly
very different conditions, and managing the innovations necessary: change at
perhaps ten times the normal pace of change.
Type II: Business more or less as usual: work hours similar to before;
distancing, but the nature of the job not different. This has been true of
the jobs deemed necessary like opening food shops, waste disposal.
In my university, Researchers have continued their work from home with little
dramatic change. A similar amount of accomplishment in similar time scales,
although many small adaptations (shooing the kids out of the room while having
a work Zoom; getting used to planning participation in academic conferences
as remote live events rather than face to face ones).
Type III: No work, just enduring life at home day and night.
Basically waiting for things to "return to normal", but generally not
expecting that their life will be changed: just suspended then resumed.
This tactic is often useful in real life, even if on a shorter timescale. I
climb a mountain not by savouring every moment, but by plodding on trying to
think of something else until the reward of arriving at the top.
If a train breaks down or is blocked for several hours, that may ruin the
whole day with missed meetings and connections, but the next day things are
back to normal: not usually a cause for radically changing my way of travelling.
However this is not creative and constructive, just passive endurance.
As a senior doctor in a covid documentary said, his family hasn't considered
that there may not be a normal they will soon return to.
Assuming that there will be may be a weakness. If that turns out to be how it
is, then those of us in endurance mode will have missed a chance to start
inventing and implementing new ways of living and working.
Thus the modes and categories thrown up for grief seem more general than just
that specific case; and suggest a general structure of comparable
alternatives.
Yet a third angle is that of Michael White's Narrative Therapy
(see below), which addressed
grieving not by interpreting "Acceptance" as forgetting the dead person as if
they "had been disappeared", but on the contrary "saying hallo to them" and
actively constructing a narrative about their role and continuing influence on
the bereaved. This is obviously related to hero worship (often a one-sided
relationship), and to gratitude exercises about past events, and is realistic in
not confusing physical death with the cessation of their meaning for the lives
of those to whom they were important, and whose effect in shaping them remains.
It implies that "acceptance" should not be equated with amnesia and the
"Despair" stage, but again with active reconstruction: this time a
reconstruction of personal meanings rather than of new plans of action.
Major disasters
There has been work on how humans actually respond in big disasters /
emergencies e.g. big earthquakes; but presumably also air crashes etc.
The Manchester ground fire: an air disaster where the plane landed intact but
immediately a big fire started that killed about 40% of the people.
Quite a lot of people just don't focus on the urgency of helping themselves.
Does it need pain? Is it just that we don't have much fear in our lives; don't
think about the imminent need for self-preservation? Or is it social: thinking
it is up to someone else to help us or order us about?
One big feature missing from the five stages above is "Dissociation": a bit like
denial, a bit like despair; but really characterised by a surprising lack of
feeling but also of engagement: likely to hardly do anything. In another way,
though, this is the opposite of the five stages above which ARE all emotions.
This sixth is its absence: the absence of both feeling and of disposition to
act.
"I just want to go back to how it was before that date".
Not actually denying the change factually, but not able to think of the future
or of any goal to work towards. I.e. not deny the fact; but deny the need to
re-plan. Denial of planning rather than of facts.
Scapegoating: Another point, exemplified by scapegoating of Korean immigrants
after the great Kanto earthquake, is perhaps
a kind of "Anger" directed to an inappropriate target, just like anger in the
face of a cancer diagnosis.
Thus it is not just about grieving: the same stages may apply more
widely; and not only to situations that require a long adaptation, but also
to those that require an immediate response,
Theory?
- Grief is about having your daily plans destroyed: so you look OK for
stretches, but are continually reminded and disrupted as old habits don't work
or don't make sense any more.
- Keith Oatley and emotions
as reactions to a change in status of life-goals.
- So if your life was currently somewhat neutral with respect to
life-goals, you may show bewilderment rather than emotion and distress.
- But if your life was in a high-value (or high risk) phase,
i.e. the disrupted plans were about crucial life-goals,
then big emotion.
