When Elizabeth Kubler-Ross formulated five stages of reaction to dying she did not intend that they be taken as rigidly sequential steps that would follow one another. Her stages of denial, anger, depression, 
bargaining and acceptance were formulated about the act of dying. Clearly this is a loss with grief from the awareness that one is dying. Ross acknowledged that her stages were not rigid and there are other emotions associated with dying.  

But do the stages of reaction to dying translate to the grief and bereavement experienced by the relative and friends of the person dying? 

In my own formulation based on work with the bereaved as well as on the academic work of Lindemann (1944) and Parkes (1972) I believe grief can be likened to a pot of soup. Initially there is probably for most people shock and disbelief. Following that however are numerous behaviors and feelings such as searching, pining, yearning, anger, guilt, anxiety, sadness, jealousy, loneliness, accommodation and many others. We are the pot and our own history determines the heat that will bring out certain feelings and behaviors much as cooking soup is determined by what is in the pot and the heat. 

Depending on the connection to the bereaved and what roles they played in our lives as well as our own personal history of life experience and current circumstance various emotions and behaviors will show themselves in each individual. Probably for most people early on there will be shock or disbelief. At the end there will be some accommodation. Each individual is unique and the myriad of emotions described above will manifest themselves in many varied ways among the bereaved.

More recent work from studies done at Yale (2007) have led Parkes and Prigerson (2009) to posit that there may be some pattern of numbness, followed by pining, then disorganization and despair ending in acceptance. They note that people move back and forth and that there are considerable differences in duration and form from one person to another.

For those working with the bereaved the idea of stages can be used as a loose formulation of a process of adjustment that has common emotions and behaviors that occur in most people. However, they are not rigid, will not happen to everyone and will not happen in the same way depending on the person.

As helpers, counselors, family members  we can understand that we are dealing with people who have their own reactions to loss. By paying attention to those individual reactions we can deal with the emotions and behaviors at hand. The stages, processes or pot of soup can be used as guidelines to  reassure the bereaved they are not alone and to foster understanding without rigidity.

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    As part of my doctoral studies at the University of Wisconsin, Madison, when information on grief, bereavement, death and dying was scarce, some colleagues and I began group work with the bereaved. Out of that work grew interviews with widowers, training with funeral workers, clergy, social workers, hospice and medical personnel. 

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    Copyright 2013, Dr. Donald Steele, Ph.D.
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