An Empirical Examination of Grief

We received an interesting e-mail not long ago from a gentleman asking if there had been much empirical work done on grief and mourning. His wife had died and he found that he recovered quite readily, but that many others in his situation were severely affected by their grief, to the point that they couldn’t really function in their jobs.

I had previously poked around in this subject a bit but hadn’t come up with anything very interesting. There was this Wall Street Journal article called “Putting a Price Tag on Workplace Grief,” which included a reference to the Grief Recovery Institute, both of which left a lot of interesting questions unasked.

So I was interested to see that the Journal of the American Medical Association has just published a paper called “An Empirical Examination of the Stage Theory of Grief” (link is to the abstract only), a longitudinal study of 233 bereaved people in Connecticut. The stage theory of grief was pioneered by the psychiatrist Elisabeth Kubler-Ross, most famous for writing On Death and Dying. There has been considerable controversy and confusion over the application of Kubler-Ross’s stage theory: e.g., does it apply to a bereaved person as well as a person who is dying himself/herself? Does it apply in the case of, say, divorce as well as death?

Anyway … a commonly accepted premise is that there are five sequential stages of grief: denial, anger, bargaining, depression, acceptance. Here is a summary of the JAMA study, which supports some of the stage theory while contradicting perhaps the most essential argument:

Counter to stage theory, disbelief was not the initial, dominant grief indicator. Acceptance was the most frequently endorsed item and yearning was the dominant negative grief indicator from 1 to 24 months postloss. In models that take into account the rise and fall of psychological responses, once rescaled, disbelief decreased from an initial high at 1 month postloss, yearning peaked at 4 months postloss, anger peaked at 5 months postloss, and depression peaked at 6 months postloss. Acceptance increased throughout the study observation period. The 5 grief indicators achieved their respective maximum values in the sequence (disbelief, yearning, anger, depression, and acceptance) predicted by the stage theory of grief.

Even though there isn’t much meat here, I am happy to see that a subject as essential as grief is being put to some empirical testing. I would like to think that we are on our way to a less childish, or child-like, view of death in this country, although there isn’t yet much evidence to support my hope. At the very least, the hospice movement continues to grow, with roughly one-third of all U.S. deaths now within a hospice program. As someone whose mother died under hospice care — as good a death as any of us could have imagined — I consider this a hopeful sign.