Theories of Grieving

Theories of Grieving

Among well-known theories of grieving are those posed by Elizabeth Kubler-Ross, John Bowlby, George Engel, and Mardi Horowitz.

Kubler-Ross’s Stages of Grieving

Elisabeth Kubler-Ross (1969) established a basis for under-standing how loss affects human life. As she attended to clients with terminal illnesses, a process of dying became apparent to her. Through her observations and work with dying clients and their families, Kubler-Ross developed a model of five stages to explain what people experience as they grieve and mourn:

·    Denial is shock and disbelief regarding the loss.

·    Anger may be expressed toward God, relatives, friends, or health care providers.

·    Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss.

·    Depression results when awareness of the loss becomes acute.

·    Acceptance occurs when the person shows evidence of coming to terms with death.

This model became a prototype for care providers as they looked for ways to understand and assist their clients in the grieving process.

Bowlby’s Phases of Grieving

John Bowlby, a British psychoanalyst, proposed a theory that humans instinctively attain and retain affectional bonds with significant others through attachment behav-iors. These attachment behaviors are crucial to the development of a sense of security and survival. People experience the most intense emotions when forming a bond such as falling in love, maintaining a bond such as loving someone, disrupting a bond such as in a divorce, and renewing an attachment such as resolving a conflict or renewing a relationship (Bowlby, 1980). An attach-ment that is maintained is a source of security; an attach-ment that is renewed is a source of joy. When a bond is threatened or broken, however, the person responds with anxiety, protest, and anger.

Bowlby described the grieving process as having four phases:

·    Experiencing numbness and denying the loss

·    Emotionally yearning for the lost loved one and pro-testing the permanence of the loss

·    Experiencing cognitive disorganization and emotional despair with difficulty functioning in the everyday world

·    Reorganizing and reintegrating the sense of self to pull life back together.

Engel’s Stages of Grieving

George Engel (1964) described five stages of grieving as follows:

·    Shock and disbelief: The initial reaction to a loss is a stunned, numb feeling accompanied by refusal to ac-knowledge the reality of the loss in an attempt to pro-tect the self against overwhelming stress.

·    Developing awareness: As the individual begins to ac-knowledge the loss, there may be crying, feelings of helplessness, frustration, despair and anger that can be directed at self or others, including God or the deceased person.

·    Restitution: Participation in the rituals associated with death, such as a funeral, wake, family gathering, or religious ceremonies that help the individual accept the reality of the loss and begin the recovery process.

·    Resolution of the loss: The individual is preoccupied with the loss, the lost person or object is idealized, the mourner may even imitate the lost person. Eventually, the preoccupation decreases, usually in a year or per-haps more.

·    Recovery: The previous preoccupation and obsession ends, and the individual is able to go on with life in a way that encompasses the loss.

Horowitz’s Stages of Loss and Adaptation

Mardi Horowitz (2001) divides normal grief into four stages of loss and adaptation:

·    Outcry: First realization of the loss. Outcry may be out-ward, expressed by screaming, yelling, crying, or col-lapse. Outcry feeling can also be suppressed as the person appears stoic, trying to maintain emotional con-trol. Either way, outcry feelings take a great deal of energy to sustain and tend to be short-lived.

·    Denial and intrusion: People move back and forth dur-ing this stage between denial and intrusion. During de-nial, the person becomes so distracted or involved in activities that he or she sometimes isn’t thinking about the loss. At other times, the loss and all it represents intrudes into every moment and activity, and feelings are quite intense again.

Working through: As time passes, the person spends less time bouncing back and forth between denial andintrusion, and the emotions are not as intense and over-whelming. The person still thinks about the loss, but also begins to find new ways of managing life after loss.

·    Completion: Life begins to feel “normal” again, although life is different after the loss. Memories are less painful and don’t regularly interfere with day-to-day life. Epi-sodes of intense feelings may occur, especially around anniversary dates, but are transient in nature.

Table 12.1 compares the stages of grieving theories.