Illustration by Clara Wright
CW: This article talks openly about death.
When we start to grieve, we know how our body will react. We know that when someone dies, our body interprets this as stress. We know that the pituitary gland in the brain will produce adrenocorticotropic (ACTH) which then sends a signal to the gut to produce cortisone, a stress hormone. We also know that a consistently high amount of cortisone can lead to a weakened immune system and that in the first few weeks of grief you are more likely to suffer a heart attack or develop high blood pressure. These are things that we can measure. What is not so easy to measure is your mental health and how we process this grief.
You may already be aware of the five stages of grief. The theory, that people who are grieving experience denial, anger, bargaining, depression and acceptance, has become so widespread that it can be found across popular culture including Grey’s Anatomy and Sesame Street. Developed by psychiatrist Elizabeth Kübler-Ross, the process was originally designed to learn more about terminally ill patients’ wellbeing. Originally published in 1969, it was not until 2005 in her book ‘On Death and Dying’ that Kübler-Ross stated the theory could also be applied to those grieving.
At first, this sounds logical. Both those that are dying and those that are becoming bereaved are experiencing a monumental emotional upheaval. It stands that both would go through the same, if not similar, process. The problem is Kübler-Ross had no evidence to support her theory; it was based entirely on anecdotal evidence. Since then, several studies have found that while those grieving do go through similar emotions, most did not go through the five stages exactly, with some studies finding new stages such as yearning to be far more important.
The five stages of grief is no longer taught in medicine, for good reason. The theory assumes that everyone goes through grief the same way. Not only that, it assumes that there is an endpoint to people’s grief. Whilst Kübler-Ross was ahead of her time in discussing mental health, the idea that grief is a tick box exercise is outdated. Its linear, target driven goals don’t allow for the myriad of situations that people find themselves bereaved. It creates an unhealthy standard people feel that they have to meet whilst also experiencing a tremendously difficult situation. Even if there was scientific evidence to support the theory, it does not encourage good grief.
So if the five stages of grief don’t exist how do we process grief? There is no definitive answer from academics, with several theories currently circulating. However, of all the theories out there perhaps the kindest one is the dual process model. Devised by Professor Margaret Stroebe and Dr Henk Schut of Utrecht University, the dual process model focuses on two sets of actions: those that focus on loss and those that focus on rebuilding one’s life. As you grieve, you alternate between these two states and learn how to cope with each state. There is no limitation on how many times or how quickly you can alternate between these two states. Instead, the dual process model is a living theory. It allows for humanity.
The idea that grief is a seesaw is perhaps closest to reality. Grief is devastating but it’s also punctuated by these strange practicalities such as funeral arrangements, informing family and friends and trying to understand how the timer on the boiler works. On the day my gran died there was this confusing string of events my mum and I went through that included going to the care home, the funeral directors, picking up a pint of milk and going to the GP because I’d somehow managed to get an ear infection. A week later I was on a professional development course and halfway through one day my mum and I had to meet the reverend to discuss the funeral arrangements before I had to return to deliver a pitch. Not dealing with reality is not a choice for many people. There are things that need to be done. You have to go on living but at the same time, it feels so disconcerting to have it together one minute and the next feel utterly lost.
If I’d measured my grief on the five stages I’d have totally failed. Knowing that it was ok to have this back and forth of emotions made grieving much more manageable. Our mental health is just as important as our physical health, especially when grieving. And whilst knowing what’s happening to your mind and body doesn’t solve your grief, it does help make it just that little bit easier.
Just a Note: Bereavement services are available for all. Each article in this column will be accompanied by a charity, database or service that may be of help. The Good Grief Trust brings together all bereavement services under one umbrella to offer help and hope in one place.