NEW THEORIES OF GRIEF

Perhaps the best known and most well established theory of grief is the stages-approach of Elizabeth Kübler-Ross (1969). The basic idea behind the theory is that, when we are grieving, we go through a set of stages; we follow a particular pattern:

• Denial. This refers to the sense of unreality that often arises when we come face to face with a major loss experience – the sense of ‘No, it can’t be. There must be a mistake.’ It can take us quite a while to work through this sense of unreality. It is as if our head knows that we have experienced a major loss, but our heart takes a while to catch up, for the idea to ‘sink in’ at an emotional level.

• Anger. This relates to situations where the intense feelings generated by the loss are directed outwards towards other people as anger or resentment. As we shall see in Chapter 4, such feelings can also be directed inwards as a strong sense of irrational guilt.

• Bargaining. Faced with significant changes brought about by loss, we may begin to negotiate, to enter into a process of bargaining.

• Depression. A sense of hopelessness and helplessness can lead to a depressed frame of mind and mood, a psychological state characterized by lethargy, low motivation, pessimism and negativity.

• Acceptance. This refers to the presumed end point of grief, the stage where we have ‘come to terms’ with our loss.

This theory has had a profound and far reaching influence in the public at large, and there is now evidence suggesting that people willfully try to grieve in stages, the model having become a prescriptive way of going through loss, rather than a description of how loss is experienced. 

The basic thrust of the counter-arguments against this stage model is that there is little to no academic, clinical or practice evidence to support the idea. 

So, if grief is not simply a matter of people going through a set of stages, how can we explain what happens in grief? There are various ways of doing this. One of them is what has come to be known as the ‘tasks approach’ to grieving. 

This is linked to the idea of developmental psychology whereby, in growing and developing over time, we face certain developmental tasks. For example, an adolescent faces the developmental task of making the transition from childhood to adulthood. So, it is in this sense that the term ‘tasks’ is being used. The work of William Worden in this regard has been very helpful and influential, and is here below organised in terms of 4 tasks that can be easily remembered through the TEAR anagram:

1. Accepting the reality of the loss. Getting used to the idea that the person (or thing) is no longer physically with us.

2. Working through the pain of grief. Dealing, as far as possible, with the pain involved in the loss.

3. Adjusting to a changed environment, externally, internally and spiritually. Getting used to the wider changes brought about by the loss.

4. Emotionally relocating the deceased and moving on with life. This means continuing to have a meaningful, loving relationship with the deceased, but in a new context.

This has proven to be a helpful model that has cast a lot of light on the complexities of grieving. However, it can be argued that it is not enough on its own.

Originally Worden's fourth task was characterized as ‘withdrawing emotional energy from the deceased and reinvesting it in another relationship’. This idea of ‘letting go’ and moving on after grief was challenged by the ‘continuing bonds thesis’. Behind this idea is research which strongly suggests that people may benefit from continuing their relationship with the deceased person and, in effect, transforming that relationship, rather than relinquishing it. As Attig (2011) puts it:

We need not break our bonds with the deceased but instead redefine those bonds and their places in our lives. Rather than challenging us to separate from the dead, their deaths challenge us to maintain meaningful connection. (p. 174)

Worden’s later work has supported this idea, and so its reformulation of the fourth task as "Reinvest in the new reality".

Another key development in our understanding of grief has been the idea of the dual process model of grief. 

This derives from the work of Stroebe and Schut who point to two co-existing processes: 1) ‘loss orientation’ to grief, which entails the way we look back on who or what we have lost and reflect on the significance of that loss. This process is characterized by sadness, anger and so on. 2) ‘restoration orientation’, which refers to the process of looking forward, of thinking about how life will be different now without the person or thing that has been lost, looking towards developing in a sense a new identity, a new approach to life based on the new transformed circumstances. What Stroebe and Schut put forward is the notion that we ‘oscillate’ between these two orientations. That is, a grieving person may be in loss orientation in the morning but, by the afternoon, may have moved to restoration orientation and back to loss orientation in the evening.

The basic idea is that, over time, the grieving individual will spend less time in loss orientation and more time in restoration orientation but will, nonetheless, continue to oscillate between the two. For example, even years after a significant loss when restoration-orientation has come to the fore, if the person concerned is reminded of their loss, for a few minutes, hours, days or even weeks, they may be back in loss-orientation temporarily before they return to restoration orientation. The scope of oscillation remains open to debate, and the model may be criticised for placing too much emphasis on the individual's ability to cope. Furthermore, there does not appear to be any scope for the role of interpersonal relationships in helping people cope with death. A major advantage of this model is that it takes into account the effect of cultural and religious beliefs on the grieving process thus emphasising the individuality of the experience of loss and grief.

Finally a third development in loss theory has come from the work of Neimeyer and his colleagues in the United States who have developed what has come to be known as meaning reconstruction theory. What this refers to is the idea that, when we lose someone (or something) very close to us, then we lose not only that person (or thing), but also what they meant to us. We then face the difficult and painful process of constructing a new meaning without the person (or thing) we have lost.

In effect, what we are doing when we are grieving is we are rewriting the story of our life. We are in a sense moving on to a new chapter in terms of what our life now means to us. In this way, what is happening is that we are developing new meanings that allow us to retain a relationship with the person (or thing) we have lost, but which recognizes that that relationship is a very different one as a result of the loss that has occurred – it has been transformed rather than destroyed. 

Meaning reconstruction theory is in line with the transformational grief view. This refers to the recognition that, while grief can be an extremely painful and difficult process, it is not necessarily entirely negative. Grief can lead to significant changes in a person’s life which turn out to be very positive. For example, Larry was a quiet, withdrawn and fairly unconfident individual with few friends and no real interests to speak of. He worked as a porter in a local hospital and made do with what he had. He was prone to depression from time to time. All this changed one day. Larry was working with two colleagues removing some boxes that had been dumped in the hospital parking lot, when two youths in a stolen car raced through at high speed killing Larry's colleagues in front of his eyes. He was shocked by this and found the intense feelings the incident generated extremely hard to deal with in the coming weeks and months. There were times when he wondered whether he might ‘crack up’ as he could not get the incident out of his mind. Over time, though, he managed to recover from the trauma and he decided to attend night classes to gain the entry qualifications that would allow him to commence nurse training. He now had a clear sense of wanting to do something positive with his life rather than just let it drift past. The trauma had turned out to be a point of growth for him – an intensely painful experience, but one that ultimately brought important positive benefits.

This is a classic example of transformational grief, the recognition that grief is not something that we should just ‘get over’. It is something that can have a silver lining, and from my professional point of view this is very significant, as it means that without a knowledge of transformational grief we may miss significant opportunities to grow and develop as a result of significant loss.

All in all what you need to remember here is that grief is a complex process that does not come in stages, and that the process of digesting a major loss is one that entails a reconstruction of meaning, as well as several tasks and phases of growth and fall back.

Wishing you Well,

Your Shrink in Bansko