Do the Five Stages of Grief Still Hold Up?

The well-known, five-stage model of grieving is a remnant from an era when people's behavior seemed to be dictated by theories, not the other way around

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“Death in the Sickroom” by Edvard Munch (1893).
“Death in the Sickroom” by Edvard Munch (1893).
Shirley Avrami
Shirley Avrami

For more than 50 years, since Elisabeth Kübler-Ross conceived of a five-stage model of the grieving process, it has seemed that mourners are expected to pass through the stages of the process in order, experiencing successively denial, anger, bargaining, depression and acceptance. According to this model, grieving begins with loss, continues for a certain period – and concludes with acceptance. The model was of great importance in understanding the process of grief, its stages and its character; it shaped generations of therapists, patients and modes of treatment, rehabilitation and recovery. However, today there is place to question it.

According to Kübler-Ross, a Swiss-American psychiatrist (1926-2004), the process of grief and grieving has an expiry date. At its conclusion, the grieving person will stop bargaining with the past, as Kübler-Ross puts it, and so will be able to take leave of the deceased. However, an examination of grieving processes – their onset, duration, flow and termination – in theory and in practice, in the professional literature and in life itself, reveals a very broad range of grieving processes. Those that begin after a death, those that begin beforehand, those that never begin, those that stop at one of the stages, those in which the grieving process never concludes.

Grieving for a first-degree relative or for anyone with whom one was very close, never ends. It changes form, is transformed into processes of growing, or of withering and stagnation, perhaps it fades into distant memories, but it does not disappear. Under the influence of Kübler-Ross’ model, some therapists expect their patients – and some people expect of themselves – to “come out of it,” that “it will pass.” But it won’t pass, nor does it need to: Grief is, and should be, part of life.

The thought that grief is a process that is supposed to terminate and disappear, and vanish from the life of the psyche, reflects not acceptance of death, rather fear of it: its perception as a kind of short-term hitch whose impact, if we wait, will dissipate and disappear. This approach sees grief as something that distances us both from the deceased and from the death of that person. The deceased, however, will remain in the world of the living person who was close to them or connected with them. Their place and memories of them will change, will perhaps become dulled and blurred, but will not vanish, nor should they.

Grief can assume multiple forms. It can be a wound or a healing and forgiving. The expectation that there is an end to grief, and for the person who is mourning to return to what they used to be, creates a need to dissociate from the deceased and from the grieving for them as well. But grief is not meant to come to an end, but rather to change shape.

Israeli author Amos Oz, when asked by Shira Hadad – who edited some of his books – what is writing made of, replied, “What’s an apple made of?” According to his reply, which became the title of a book containing conversations between the two of them, just as sun, water and air create the apple in a process of magical transformation, so, too, experience, memory, talent and skill can create the written work. It’s the same with grief. It is a process of transformation, which we should not suppose will have an end in which the dead will be made to disappear and become separate from the living, but the opposite: one in which the dead will be transformed and enshrined in the living person’s memories and experiences, and will continue to be part of them.

Kübler-Ross defined the conclusion of the grieving process as a state of acceptance and the end of the process of bargaining with the past. However, the concept of transformation and of enfolding the memory within one’s self means that the subject of the grief is not only part of the griever’s past but also part of their present and their future.

Elisabeth Kübler-Ross.

The never-dead past

Grief gives rise to many questions, and few answers. One question is who the grief belongs to. Is it the preserve of the nuclear family, or are more distant relatives, or friends, permitted to experience it in full force? Israeli writer Iris Leal floated this question, too, among other silenced subjects, in her trenchant 2019 book about grief in the family, “We Didn’t Dare to Know” (Hebrew). Beyond the hierarchy of bereavement, at the top of which are those who fall in battle and at the bottom the suicides, an additional hierarchy exists – one even more transparent. This is the question of one’s closeness to the deceased, from which derives the legitimacy to grieve for them, as well as the duration and intensity of the grief.

In Leal’s book, the sister of a dead soldier says to Leal’s daughter – the cousin of the fallen soldier – “What are you doing here? This isn’t your grief.” Grief appears in works by many authors as a years-long process whose impact does not end. Thus author Haim Gouri wrote in his eclectic work “The Crazy Book” about “Berenice” – as he and his friends nicknamed a striking teenage girl in their class – from a perspective of a great many years. In his memories he does not part from her or from his love for her; the same goes for his friends who were killed in the War of Independence whom he mourned in his poetry even seven decades after their death. In his penultimate book of poetry, “Eyval,” which appeared 60 years after his first book, “Flowers of Fire,” Gouri revisits the presence of the dead in his poems, where they will never die: “A poem goes on longer than we supposed. Like the dead who lives from the poems.”

In my encounters with people whose families suffered a suicide, it was clear that their process of grieving can go on for many years. Sometimes, because of the stigma, the secret, the shame and the concealment which shroud suicides, the grieving never actually begins. The process includes parting, separation from the dead and sending them on their way; but that requires the ability to speak to the deceased, and about them. Without these, separation is not possible.

Another – and different – type of grieving process that I found among those who have lost someone to suicide is one that stopped at a certain stage and did not continue beyond it. Thus, one person I interviewed for my book on this subject told me that she hadn’t visited the grave of her father, who had killed himself, for 20 years: “He doesn’t deserve it!,” she said, still angry. Twenty years, I noted to myself, and her process of grief is still in the anger stage, light-years away from understanding, reception and acceptance.

Another individual, whom I interviewed 10 years after his father’s suicide, said his father had left a letter “that didn’t explain anything.” It sounds to me like you’re angry at him, I remarked, and he replied, “Of course I’m angry! Because he left me without a father. Me, my younger siblings and my mother. What will become of us – didn’t you think about what would become of us? To leave us just like that with all the problems!?”

In the therapeutic context of processing loss, Yossi Levi-Belz, a clinical psychologist, speaks of post-traumatic growth that becomes possible given the ability to bare oneself to others, to be helped and to share. This is a process whose course in many cases differs from the hyper-ordered model proposed by Kübler-Ross. One reason is that in some cases the onset of the grieving process is delayed; and also because the progression of the stages might change accordingly. In an article by Prof. Levi-Belz and psychologist Mor Vinter, entitled “Your days that have passed are hanging on my doorstep” (a line from a poem written by the authors’ friend Daphne Assaf, for her daughter, a suicide), the two refer to “prolonged grief disorder” – complex grief, lasting years, but also one that allows growth to spring from it, precisely in cases in which mourning is indeed allowed to occur and is not silenced or repressed. The authors note that one of the conditions for this growth to occur is the ability to recognize grief and pain and to share them with others.

Parting in real time

Amos Oz, in his autobiographical novel, “A Tale of Love and Darkness,” wrote how, “I have hardly ever spoken about my mother till now, till I came to write these pages. Not with my father, or my wife, or my children or with anybody else.” When we remember that Fania Klausner committed suicide when her son Amos was just 12, and that he published “A Tale of Love and Darkness” only 51 years later, when he was 63, it is expected that the other stages of grief would not have been precisely consecutive, even if they appeared. So it is not surprising that Oz continues to speak also about his guilt feelings in the wake of his mother’s death, and the feeing that he could have prevented the act; but all these appear in the book as part of a process that occurred simultaneously with the steps of grieving, which he began to talk about half a century and more after his mother’s death.

Sharon Arik Cohen writes about a suicide in his family – in this case it was a grandmother – in his recently published book of poetry “Moroccan Rashomon,” again 51 years after the fact, exactly like the case of Oz. The book’s epigraph is from William Faulkner: “The past is never dead. It’s not even past.” That recalls a line by the Israeli poet Zelda: “The past trembles within the present”; for his part, Cohen writes, “My grandmother’s suicide: recalculate route / for four generations.”

In their articles about what they term “the two-track mode of bereavement,” Simon Shimshon Rubin, Alex Manevitch and Israel Doron refer to processes of grief in families in which someone is suffering from dementia or Alzheimer’s. In such cases, they write, grieving accompanies the disease – it does not begin with its termination. The manifestations of grief surface before the death has come to pass in reality: This is grief for the person who existed and no longer exists, though still alive, for the loss of the identity of the person who was; it is complex bereavement, and in many cases also silenced.

Simone de Beauvoir, in her book “A Very Easy Death,” which she wrote while tending to her mother in the final, difficult month of her life, when she was diagnosed with cancer, noted, “When I said to myself, ‘She is of an age to die,’ the words were devoid of meaning, as so many words are. For the first time I saw her as a dead body under suspended sentence… Maman thought that we were with her, next to her; but we were already placing ourselves on the far side of her history.”

According to an analysis written by psycho-oncologists Michal Baron and Omer Berkovich, in the new Hebrew translation of de Beauvoir’s book, “the parting described in ‘A Very Easy Death’ does not occur only at the moment of the mother’s death, and the mourning does not begin only after her death. The processes of parting and grieving occur from the time that Simone and her sister learn about the diagnosis of cancer. Though the mother is alive, her daughters have already begun to grieve for her. This process, known as ‘anticipatory grief’ in the literature, prepares the family and other relatives of the dying person for the approaching parting. In this process the family treats the sick individual as though they were already gone, even though they are still living… Francoise de Beauvoir became, even in the eyes of her daughter, a cadaver.”

Breaching boundaries

One day, 50 years after the death of my father, I was on my way to the Jezreel Valley, when a glider I suddenly saw floating in the sky reminded me of a scene I’d depicted in a poem that appears in my book “Looking at the Light”:

Driving on the road, I saw a glider

And like-dad is sitting inside

Suddenly I was like a 6-year-old going to his flight

Together the two of us, father and child

He and Abraham Hacohen synchronize their watches

Taking off and soaring among the clouds

Years passed and they both crashed, each one differently

To the yawning mouth of earth

One very fast,

And the other one slowly, in a hush

And I continue staring at the light

Still waiting for him to be within my sight.

Not long afterward was the 50th anniversary of the death of Avraham Hacohen, who is mentioned in the poem. His daughter Smadar wrote in a Facebook post: “Today is the 50th anniversary of the death of my father in the crash of an Arava plane in one of its test flights. Fifty years of longing: the longing of a girl of 13 for her all-powerful, loving, strong and handsome father, who was so present and meaningful in my life, and disappeared in an instant… My father’s absence from my happy events and my sad times, from my achievements and from my failures, is painful almost daily… Only for 13 years was I your daughter, and another 50 years in which in some special way you continue to accompany me on every single day of my life.”

Kübler-Ross’ model is perhaps a vestige of an era in which people were expected to organize themselves psychologically according to theories, and not the opposite. It was published in 1969, the year of the Woodstock festival, the year of the first moon landing. However, the spirit of freedom that emanated from those events did not, it seems, make its way into her restrictive and limiting model. Accordingly, 50 years later the time has come to ask whether Kübler-Ross was right. It’s not people who need to behave according to theoretical models; it’s the models that need to define and explain behavior, with the very broad range, so diverse, so fascinating and so challenging, of behaviors and of responses to trauma. Clearly we need to create generalizations in order to understand phenomena, generate forecasts and draw distinctions. However, the generalizations need to be sensitive and open, both to behaviors that operate precisely according to the models, those that arise from variations on them, as well as those that have not the least connection to them.

Like Freud, in whose case the fact that the number of his opponents is no less than the legions of his supporters does not detract from his immense contribution to the study of the psyche, so too Kübler-Ross’ model needs to remain as a foundation for understanding grief and its processes. However, that is the essence of a foundation: It’s a launch pad from which numerous theories and modes of thought can grow and develop, some of which stem from the original while others take issue with it and contradict it. Grafting these onto one tree of knowledge will make possible a more complex approach to grief, to its understanding, to its treatment and to coping with its attributes.

Dr. Shirley Avrami’s book, “If Only He Had Died in the War: The Impact of Suicide on Surviving Family Members” was published last year (Kibbutz Hameuchad). An English version is available via Amazon.

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