Archive for January 3rd, 2012
Dr. Elisabeth Kübler-Ross developed a frequently cited model of bereavement, the “stages of grief,” in her landmark book On Death and Dying. She described a linear five-step process — consisting of denial, anger, bargaining, depression, and acceptance — as terminally ill patients became aware of impending death. Dr. Kübler-Ross’ work helped legitimize the wide variety of emotions in people who are dying. The five-stage theory was later altered and adapted to cover the reaction to other losses, such as divorce or the death of a loved one.
Today, however, many experts no longer embrace the concept of sequential stages of grief and have proposed a number of alternatives.
For example, Dr. Colin Murray Parkes, who has written extensively on bereavement, proposed that people who have experienced a loss undergo several prolonged and overlapping phases — numb disbelief, yearning for the deceased, disorganization and despair, and finally reorganization — during which they carve out a new life. The road to this new life may be long. According to Dr. Parkes, people must go through a painful period of searching for what has been lost before they can release their attachment to the person who died and move forward. When enmeshed in disorganization and despair, people find themselves repeatedly going over the events preceding the death as if to set them right.
Dr. J. William Worden suggested a model of grieving that includes certain tasks. The first three tasks are to accept the loss, to experience the resulting pain, and to put the loss in some perspective and adjust to a changed world without the person who has died. The fourth and final task is for people to alter ties with the deceased enough that they are able to invest their love and energy in others. People may shuttle back and forth among these tasks. However, Dr. Worden suggests that leaving some of the tasks undone is like healing only partially from a wound.
Some experts combine elements of several grief models. Dr. Margaret Stroebe and Dr. Henk Schut note that early in grieving, the emphasis is on “loss-oriented coping,” such as focusing on the person who died, the circumstances of the death, and painful feelings like yearning and despair. Later, people invest more in “restoration-oriented coping,” focusing on managing practical issues that arise, such as loneliness or challenging new circumstances. Rather than grieving continually, people seek occasional periods of respite. Time away from grief might take the form of a weekend with friends or a day of social activities.
A new way of grieving
Most recently, two psychologists make the case that advances in diagnosis and treatment — which have enabled people to live longer with life-threatening illnesses, such as cancers and heart disease — have significantly changed the grieving process.
In their book Saying Goodbye: How Families Can Find Renewal Through Loss, Dr. Barbara Okun and Dr. Joseph Nowinski identify a pattern of grief commonly encountered by families who face the loss of a loved one to protracted illness. The book includes the following stages, which begin long before a person actually dies.
Crisis. Family life is disrupted by the diagnosis. People are upset, saddened, and anxious. Other, unexpected feelings — resentment, anger, or guilt — may also emerge but often go unexpressed in the interest of rallying around the patient.
Unity. The patient’s needs are paramount. Activities include managing medical treatment, lining up social and support services, gathering insurance and other information, and attending to legal matters such as wills.
Upheaval. The patient may be in remission or doing relatively well. But for others, unity and patience may have worn thin as protracted illness buffets their lives, relationships, and routines. At this stage, it’s important — though often difficult — for family members to communicate honestly about the upheaval they’re experiencing.
Resolution. As the patient’s health deteriorates, everyone comes to accept that the end is near. Decisions about hospice and other end-of-life matters have been made. Now is the chance for resolving old issues, healing wounds, and addressing resentments and jealousies — factors that can undermine family members’ ability to come together and support one another.
Renewal. This final stage begins with the funeral and continues for a long time, as individuals adjust to the loss and to their changed roles.
Navigating the process
Every person — and every family — grieves differently. Some people may feel anxious, or others worry on their behalf, if they don’t follow a particular path. However, grief is not a tidy, orderly process, and there is no single “right” way to grieve. It’s normal for emotions to collide and overlap. Each person grieves uniquely, taking as much time as necessary, finding a meaningful way to come to terms with a loss.Read Full Post | Make a Comment ( None so far )