By Patrick Wright for ABC
Photo: 123RF
Most people have heard of the "five stages of grief".
The idea is that as we grieve, we progress through different stages: denial, anger, bargaining, depression and acceptance.
This popular concept was introduced by Swiss-American psychiatrist Elisabeth Kübler-Ross in her 1969 book, On Death and Dying.
What might surprise you is that, despite its popularity, there is no scientific basis for the model and experts say it can be more harmful than helpful.
"There is no evidence that people move through these stages - or that the stages even exist," says Chris Hall, a psychologist and chief executive of Grief Australia.
How the five stages model came about
Kübler-Ross developed the five stages model while working with terminally ill people in US hospitals in the 1960s. Her original intention was to describe the experiences of people coming to terms with their own deaths, Hall said.
"Really, it was a model of anticipatory grief: how people receiving a terminal diagnosis adjust to that," he said.
"It then mutated into the five stages of grief, and has been applied to lots of different issues."
Why grief doesn't follow certain steps or stages
Lisa Burke is a clinical psychologist based in Geelong/Djilang who works with people who are grieving. She says grief is often complex and messy and doesn't follow orderly stages or steps.
"People interpret the five stages as a road map," Dr Burke said.
"But when they inevitably become lost in the messiness of grief, that becomes distressing, because they don't feel like [their experience] fits the known way of grieving."
The problem with the idea of 'acceptance'
The fifth stage of the model, acceptance, can be particularly problematic, Dr Burke said.
"[What] I see often in clinical practice is this idea of the fifth stage being desirable to reach. People can become distressed … that they haven't attained this state of higher being that the model portrays," Dr Burke said.
When we lose someone we love, our relationship with the loss may change over time. But that doesn't mean that one day we'll suddenly wake up and accept it, Hall said.
He notes that the five stages model also doesn't account for cultural and social differences in how we grieve.
The importance of 'continuing bonds' with lost loved ones
Hall said many grief practitioners were moving away from the idea of acceptance and embracing the concept of "continuing bonds".
"It's about moving from a relationship of physical presence to a relationship of memory," Hall said.
"You don't relegate [a dead loved one] to history. In fact, that person still lives in your heart and your mind. There is no sense of reaching completion or conclusion.
"This is a very healthy and adaptive way that people deal with their loss."
There was also a popular belief in the past that severing ties was the best way to shield people from grief, Dr Burke said.
But Dr Burke said this approach - which was not something Kübler-Ross advocated - caused enormous harm to some people, such as parents who had stillborn children taken away immediately after birth.
"There have been a number of clients I've worked with over the years - women in particular but also men - who never met their baby. I've worked with people with religious beliefs who are very distressed at the idea that they won't recognise their baby in heaven," she said.
A different way to understand grief
When she's with clients, Dr Burke said she often introduces what's known as the "dual process" model of grief.
The idea is that instead of moving through stages, we are cycling between the dual processes of confronting our loss and rebuilding our lives.
"There's one whole group of experiences that we would label loss-oriented experiences; they're all the things that focus on the loss itself and the emotions," Dr Burke said.
"Then, at the same time, [you're] also … dealing with all the adjustments that your life now requires because you've lost someone so important to you."
The benefit of this model is that it frames grief as an active process we are involved with rather than something that simply happens to us, Dr Burke said.
Why Kübler-Ross helped us understand grief and dying
While the five stages model may be problematic, both Hall and Dr Burke said that Kübler-Ross's work was an important step in our understanding of death and grief.
"I want to always acknowledge that she was someone who really brought the experience of dying people to public attention," Hall said.
"In her lectures or workshops, she'd bring a dying person on stage and talk to them. That was kind of unheard of. So, in that sense, she was a ground breaker."
Dr Burke said Kübler-Ross herself was disappointed by how the five stages model was being used.
"She felt that it was being interpreted too rigidly herself; she felt it was too prescriptive," she said.
"[Kübler-Ross] wanted to bring humanity to dying. But it seems to have gone too far; we've stopped appreciating the individual human experience [of grieving]."
- This story was first published by ABC