There Are No Seven Stages of Grief

On an otherwise ordinary afternoon, college student Julia Martinez heard her mother answer the phone and then cry out in distress: Julia's father had been hit by a car. The two women rushed to the hospital, but Julia's father died within minutes of their arrival. It was a shocking, untimely death, and, as Julia told George Bonanno, professor of clinical psychology at Columbia University, the following weeks were full of sadness, anxiety, and just "crying a lot." Eventually, she returned to college. She had bad days, but she tried not to think too much about her father's death. Over the summer, she got an exciting newspaper internship and felt herself looking forward to the future. Julia’s upbeat attitude made her mother really anxious. Was Julia grieving enough? Would it hit her at some point in the future? Had Julia forgotten her father?

The idea that grief is work that we must do began with Freud. He believed that if you didn't labor at it, you would never recover the psychic energy you had invested in a person who was no longer there. Over time, psychologists developed ways to describe the various stages of this “work.” Elizabeth Kübler-Ross’ stages are the most familiar: Stage 1, denial—“This cannot be!” Stage 2, anger, followed by bargaining, then depression, then acceptance. The stages have great intuitive appeal, but, according to Bonanno, both Freud and Kübler-Ross were wrong. The way that grief unfolds for most people is almost nothing like the old model says it should. It is not work, and it doesn't occur in stages. It can be short-lived for some people and never-ending for others. Like breathing and consciousness and almost everything else about us, grief fluctuates. Our biggest mistake when describing grief, Bonanno writes in his deep and intelligent book, The Other Side of Sadness [2], is that we underestimate the resilience of the bereaved.

Modern scientists have by now thoroughly picked apart Freud and his idiosyncracies, but Bonanno says that Freud's pronouncements about grief were particularly incomplete. The father of psychoanalysis never really explained how “work” turned “grief” into “recovery.” His statements were brief and preliminary, and he himself qualified them as pretty speculative. Kubler-Ross' stages of grief have been similarly accepted without any rigorous testing. It’s also crucial to note that Kubler-Ross came up with her stages after observing people's reactions to the news that they themselves were going to die—not to the news that someone else had. Only later did she and colleagues apply “the five steps” to grief resulting from another person's death or to some other great disappointment.

Bonanno’s innovation is to apply more rigorous scientific methods/tools to understanding grief. For more than 15 years, he has given thousands of mourning people standard psychological tests in order to better understand how they feel. As Bonanno interviewed the grief-stricken, he counted the number of times they referenced their loss. He recorded their facial expressions and monitored the activity of their autonomic nervous system (which controls things like heart rate, digestion, breathing, sweating), and crucially, he submitted his results for peer review.

Bonanno and his colleagues found that there are at least three common patterns of grief. Some people find the experience deeply distressing and disorienting but then slowly heal. Some become completely dominated by their sadness, perhaps never to recover. This type is extremely rare. Then there are people who experience some initial shock and distress but who pretty quickly bounce back into the competent execution of their daily lives. Most people, says Bonanno, fit into the third category.

The resilient bereaved tend to have some key characteristics. Many of them testify to an ongoing bond with the person who died, experiencing the connection almost as if their loved one were still real. We might normally consider behavior like this to be dysfunctional, and, unsurprisingly, the bereaved are usually very private about this experience. But Bonanno observes that it is generally a good coping mechanism. Sometimes, the bond has religious significance, and sometimes not. Bonanno himself used to talk to his deceased father in the privacy of an empty elevator. There are important distinctions here. If the experience happens too soon after the death, or takes too much time, it might not be so helpful, says Bonanno. The same goes for holding on to the deceased's belongings. Keeping some things can be of great comfort, but clinging to everything—insisting that a room always stay the same—does not help recovery.

Another important trait is the ability to smile or laugh with other people even in the midst of sorrow. Bonanno and a colleague measured the facial expression of widows and widowers talking about their loss and found that the ones who laughed or smiled the most in the months after their loss were also the ones who were better off a few years down the track. Grieving people who smiled or laughed were viewed with more positivity and less frustration by those around them than people who didn’t smile or laugh at all. Those who are very depressed, by contrast, evoke feelings of hostility and anxiety in those around them, even in as little as 15 minutes of conversation. This suggests that grief-stricken people who are incapable of fleeting positive interactions may get caught in a negative spiral. Because they don’t smile, they may be treated with less kindness and receive much less support than people who can.

Grieving people who are capable of positive interactions are often surprised by the way that almost overwhelming pain will suddenly lift, leaving them lighter, Bonanno found. They can even joke with others—until the next time it comes around again. These fluctuations, notes Bonanno, are the opposite of “stages”: You don’t make it through one feeling—whether it’s anger, sorrow or depression—neatly wrap it up, and then move on to the next.

One of Bonanno’s most counterintuitive observations is that friends and family of the bereaved often find resilience deeply unsettling. “Countless” people interviewed by Bonanno describe being pushed by concerned loved ones to try to “get in touch” with their lurking, hidden grief. This was Julia Martinez’s experience. At her mother's insistence, Julia went to see a grief counselor. She didn’t want to do it, she felt manipulated by it, and she found all eight sessions boring and irritating. Finally, her mother agreed that she could stop.

A similar style of resilience was shown by Karen Everly, whose daughter died in the South Tower of the World Trade Center on Sept. 11, 2001. Bonanno discovered that Karen's initial feelings included a profoundly disorienting anguish that almost caused her to leap from a friend's 18th floor balcony. Yet her equilibrium quickly returned. She slept at night, she ate normally during the day, she maintained relationships with family and friends, and she returned to work within a week. She found purpose in the way people at her work still needed her. Was Karen using work to avoid her true feelings? All of Bonanno's psychological tools told him that Karen and Julia were well-adjusted people. The problem, he says, lies with the idea of delayed grief. In studies that have followed people up years after they’d lost someone, there is no evidence of it. What looks like strength, in Bonanno's book, is almost always strength.

The real problem with “delayed grief,” says Bonanno, is that there is tyranny in the idea that people who are coping aren't really coping. Even the most well-intentioned encouragement to delve into feelings—when there are no hidden caches of sorrow—may be haranguing someone who has already been dealt a blow. But it can be much worse than that. The neural connections underlying memories are strengthened when we pay particular attention to those memories. So if grieving people are encouraged to dwell on their dead loved ones or to dissect their relationship with them, this could increase the sense of loss and longing—in a cruelly artificial way.

Our culture tends to believe that healthy recovery from trauma involves expressing our emotions, and, in fact, in “letting it all out” as soon as possible. Historically, this idea was given great support by a study of emergency workers who took part in debriefing sessions shortly after experiencing difficult situations in their work. In this case, the debriefing discussions were shown to be helpful, and accordingly people reasoned that the principles of debriefing would help anyone who had experienced trauma.

But Bonanno points out that just because debriefing works for a subset of people—in this case a group of highly trained and hardened individuals—doesn’t mean that it works for all people. Indeed, some studies show that debriefing harms people. One group of people who were “debriefed” for an hour within 24 hours of a car accident were found to be struggling much more three years later than people in car accidents who were not debriefed. If grief-stricken people are otherwise left alone and not forced to discuss and express their distress, Bonanno suggests, their feelings would ebb more naturally.

It’s heartening to discover that grieving is not “work,” we don’t have to be successful at it, and we’re stronger than we know. Still, not even Bonanno’s brilliant methods can take away the fundamental strangeness of the idea that if someone we love dies, we could just be OK.