The five stages of grief: what they are and what they miss

Where did the five stages come from?

Kubler-Ross's work began with seminars and conversations with people who were dying. On Death and Dying, published in 1969, described the responses she heard from them. According to the Elisabeth Kubler-Ross Foundation, her own chart in that book shows overlapping bands rather than a fixed staircase of steps. She later applied the same responses to other big losses and changes, which is part of why they became the best-known description of grief.

So the stages did not start as a map for people who are bereaved. They started from listening to people facing their own deaths, and the neat, ordered list of five is the version that spread.

Do you have to go through the stages in order?

Not necessarily, and you may not recognise all five in yourself. You might feel several at once, skip one, return to one months later, or feel something that isn't on the list: yearning for the person, guilt, relief, anxiety, or numbness. None of that means you are grieving wrongly.

Researchers have tested the idea. In 2007, Paul Maciejewski, Holly Prigerson and colleagues published a study in the Journal of the American Medical Association called 'An empirical examination of the stage theory of grief'. They followed bereaved people in Connecticut and rated five feelings (disbelief, yearning, anger, depression and acceptance) at points from 1 to 24 months after the death. The results were mixed. Contrary to stage theory, disbelief was not the first or strongest feeling. Acceptance was the most frequently reported, and yearning (missing the person) was the strongest negative feeling. Yet the authors also found that the five feelings reached their peaks in the order stage theory predicts: disbelief, then yearning, anger, depression, acceptance. The people in the study had lost someone to natural causes, so a different path after a sudden or violent death is not abnormal.

The study looked at group averages. It cannot tell you what your grief will do.

Other ways to understand grief

The stages are one way of describing grief. Two others have research and thinking behind them, and some people find them closer to their own experience.

• The dual process model. Margaret Stroebe and Henk Schut described it in a 1999 paper in the journal Death Studies. It suggests there are two kinds of stress after a loss: ones about the loss itself, such as sadness and missing the person, and ones about rebuilding life, such as new roles, tasks and routines. Rather than moving through steps, you swing back and forth between facing the loss and taking a break from it, and the authors treat those breaks as a normal part of coping, not avoidance.
• Continuing bonds. In a 1996 book edited by Dennis Klass, Phyllis Silverman and Steven Nickman, contributors challenged the idea that grief is about cutting ties with the person who died. They argue that healthy grieving can include an ongoing relationship with them: talking to them, keeping their things, or carrying their values forward.

Neither is a rulebook. If one of them fits what you are feeling, it might make it feel less strange. If you feel pulled to talk about the person or to write to them, the grief journal prompts and the grief worksheet are gentle places to begin. If you are also holding on to something that happened before the loss, the letting go of the past worksheet can help.

There is no right way or timetable to grieve

You may cry a lot, or not at all. You may want company, or silence. You may feel fine for a week and flattened the next. Grief can come back around birthdays, anniversaries or a smell or a song, long after you thought it was behind you. None of this is failing at grief.

Some things that may help, without any guarantee. Be as gentle with yourself as you would be with a friend in your position.

1. 1Let the feelings come when they come, rather than trying to schedule them.
2. 2Keep a little routine: regular food, some sleep, a short walk.
3. 3Talk about the person you lost, to someone you trust or out loud on your own.
4. 4Accept help with practical things, and say yes to specific offers.
5. 5Take breaks from the grief without guilt: a film, a meal out, an hour with a friend.

When to get more support

Grief is not an illness, and it doesn't need treating. But you don't have to carry it alone. Consider talking to a GP or family doctor if your grief feels like it is getting worse rather than easing, if it keeps getting in the way of sleep, eating, work or looking after yourself or others, or if you stay overwhelmed and can't see a way through. A GP can listen, check how you are, and point you to support. You don't need to wait for it to be bad enough.

In the UK, Cruse Bereavement Support has a free helpline on 0808 808 1677 (check their website, cruse.org.uk, for opening times), plus local support. In the US, your doctor, a local hospice or your faith community can point you to bereavement support nearby. Our helplines and support page lists more routes.

If your grief comes with hopelessness, or thoughts of harming yourself or not wanting to be alive, please reach out now. Those thoughts can be serious, and you deserve support from a real person. In the UK and Ireland, call Samaritans free on 116 123, any time. In the US, call or text 988. Elsewhere, findahelpline.com lists free, confidential lines by country. If you are in immediate danger, call your local emergency number.