What Does Research Say About the Five Stages of Grief?

Almost everyone has heard of the five stages of grief. Many people are told, or tell themselves, that they should be in one stage or another. But where did the stages come from, and does the research support them? The short answer: they are a useful idea, but grief does not follow a schedule.

Where did the five stages come from?

From a book about dying, not about mourning. Elisabeth Kübler-Ross, a psychiatrist, introduced the five stages in her 1969 book On Death and Dying. They were denial, anger, bargaining, depression, and acceptance. JAMA reports that she adapted earlier work to describe how terminally ill patients respond to knowing that they are going to die. The stages were later applied to people grieving a death too. Researchers note that she drew them from clinical work with dying patients, and that she never meant them as a rigid sequence for everyone.

What did the 2007 study find?

It was one of the first careful tests. Researchers at Yale studied 233 grieving adults in Connecticut who had recently lost a loved one (violent and complicated deaths were left out), and followed them from 1 to 24 months after the loss. They tracked five feelings: disbelief, yearning, anger, depression, and acceptance. The main findings, published in JAMA, were:

• Acceptance was the most commonly reported feeling from the very start, not just at the end.
• Yearning, a longing for the person, was the strongest negative feeling throughout, even though it is missing from the famous five stages.
• The feelings did peak in the expected order (disbelief, yearning, anger, depression, acceptance), and the negative ones peaked by about six months and then faded.

One of the lead researchers said that yearning, not sadness, is what bereavement is really about.

So are the stages right or wrong?

A bit of both. The study found some support for a pattern in the average, but averages hide differences between people. The researchers said that results from other cultures might differ. Other research has found different paths through grief. A large JAMA paper describes Bonanno’s findings of five trajectories from before a loss to 18 months afterward: common grief, chronic grief, chronic depression, improvement during bereavement, and resilience. A review of grief research reports that about 46 percent of the widowed people in one of his studies were resilient.

What does this mean for me?

It means there is no checklist. Some people never feel anger. Some feel acceptance one day and deep sadness the next. Some feel several things in a single hour. A grief counselor quoted by The Washington Diplomat said that there are no predictable or prescribable stages, and that people worry they are “doing it wrong” when they do not follow them. You are not.

When should I seek help?

If you feel stuck, or your grief is not easing over a long time. The researchers behind the 2007 study found that for most people, painful feelings eased after about six months, but that 10 to 15 percent of the bereaved in the study had prolonged grief. That is a condition that can be treated. See Complicated Grief for the signs and where to find help.

Where can I read more?

What Is Grief? Understanding What’s Normal describes the wide range of normal reactions. If you are grieving a death before it happens, see Anticipatory Grief. And if the loss was a homicide, Grief After a Homicide addresses what makes that loss different.