Rethinking the ‘Stages of Grief’: From Descriptive to Dangerously Prescriptive 

Long-term care leaders and caregivers play a critical role in navigating grief, whether it’s the grief of the older adult, the older adult’s family, or their own. It’s essential, then, to address the narrative surrounding grief, and the often-cited ‘Stages of Grief’ that has deeply embedded itself into the fabric of our understanding of loss. 

Elisabeth Kübler-Ross, MD, revolutionized the field of thanatology with her groundbreaking work on the five stages of grief: denial, anger, bargaining, depression, and acceptance. Over time, her work was expanded upon; with professionals like David Kessler adding a sixth stage of finding meaning, while others integrated sub-stages or alternative perspectives. 

However, Rebecca S. Morse, PhD, MA, in her illuminating article recently published in MEDPAGE Today, points out two predominant concerns about this stage theory in the context of grief: 

  1. A Lack of Scientific Rigor: The ‘stages’ remain largely descriptive and don’t quite advance to the explanatory, predictive, or controlling objectives that define scientific inquiry. While these stages might offer insights into what individuals are experiencing, they don’t provide universal or consistent patterns that can be applied to everyone. 
  1. Prescriptive Application: Perhaps more concerning is the shift from using the stages as a descriptive tool to viewing them as a prescriptive path. Grief is profoundly individualistic. The danger lies in forcing individuals into a mold, potentially alienating them from the support they need, and stigmatizing their unique grieving process. 

Morse explains the allure of stage theories, especially in the realm of developmental psychology. Stages offer simplified frameworks, giving us cognitive shortcuts, or heuristics, to understand complex phenomena. But these very heuristics can be a double-edged sword. By relying on them, we risk succumbing to stereotypes, inadvertently diminishing the profound, multifaceted experiences of grief that individuals undergo. 

The emphasis on these stages often pushes individuals into a box. If someone doesn’t grieve “by the book,” they, or those around them, might mistakenly believe they’re grieving “incorrectly.” This perception can further isolate those in pain, particularly if they belong to historically marginalized groups. Such a limited focus can obstruct cultural humility and more nuanced understandings of grief. 

Morse’s call to retire the stages is a timely reminder for all caregivers and leaders in long-term . While Kübler-Ross’s work was pioneering and remains crucial in understanding grief, it’s vital to ensure that these stages don’t become a restrictive prescription. 

By broadening our perspective, we can offer more comprehensive, compassionate care to those grappling with loss. This is especially crucial in older adult care, where both older adults and caregivers confront grief in multifarious forms. 

In the poignant words of Morse, it’s time to transition from something “wonderfully descriptive” to avoiding that which has become “dangerously prescriptive.” 

[Author’s Note: Special thanks to Rebecca S. Morse, PhD, MA, for her insights and expertise.] 

Sources: 

Morse, R. (2023, August 20). Opinion: Why the “stages of grief” need to be retired. Medical News. https://www.medpagetoday.com/opinion/second-opinions/105952  

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