Burkett-Caraway1

Phyllis Burkett-Caraway

Professor Dean Leonard

English 1201

April 22, 2020

Why the Five Stages of Grief Does Not Exist:
Complex Grief in a Quick Fix Culture
How do you describe what grief feels like to someone who has not experienced a

significant loss? Upon the death of his wife, author C.S. Lewis, began keeping a journal of his

grief experience. Published originally under a pseudonym, he began A Grief Observed with this

simple entry, “No one ever told me that grief felt so much like fear”[ CITATION Lew68 \l 1033 ].

This passage resonated with me in a way that nothing else had after my husband’s death. I

learned, quickly, that our culture is uncomfortable with the topic of grief and with those grieving.

Unless one has experienced a death that weaves through and alters every aspect of your life, it is

impossible to understand. Unless, within an hour of waking up, a funeral director is in your home

asking if you want an open or closed casket and if you want your loved one embalmed, it is not

possible to comprehend the destruction that can be wreaked within moments. We try to support

the griever by sending flowers, offering platitudes and not mentioning the death at all to prevent

upsetting the bereaved. We offer various words of wisdom: the deceased is watching over us;

they are in a better place; you’re so strong; it was their time; God knew better; time to move on;

this is like the time my cat died; at least you’re not divorced. The societal expectation that grief

has linear stages discounts the lifelong behavioral, physical and social impact on the bereaved.
 Burkett-Caraway_2

[ CITATION Fig20 \l 1033 ]

This essay will explore the societal expectations placed on those grieving and the

differences between grief and complex or complicated grief. For the purpose of this paper, I am

interested in grief as it pertains to the loss of a partner, child or parent. As a culture, grief makes

us uncomfortable. Once we have sent flowers, sent a card, forced ourselves to go to the visitation

or funeral, and expressed how sad we are on social media, our culture simply does not know how

to support or understand the grieving process. Complex grief is even less recognized. Society

tends to look at grief as linear accompanied by tasks, defined as emotions, to be completed and

checked off in a neat and tidy way. Non-grievers then become experts in how someone should be

grieving and feel compelled to direct, discuss and judge. The griever feels pressured and under a

random timeframe to move through the accepted and assumed stages of denial, anger,

bargaining, depression, and acceptance[ CITATION Kub69 \l 1033 ]. Once that timeframe is

exceeded by the griever, the tolerance, empathy and acknowledgement can turn into judgment,

advice and avoidance by their support system.

 Burkett-Caraway_3

Fig 2. The Complexity of Grief (Cartography of Grief)

The theory for the five stages of grief was put forth by Elisabeth Kübler-Ross, a Swiss-

American psychologist, in her book On Death and Dying[ CITATION Kub69 \l 1033 ]. The Kübler-

Ross model was conceived as a framework for the stages that terminally ill patients

experience[ CITATION Bio19 \l 1033 ]. Along the way, Kübler-Ross’ theory was culturally adapted

as a checklist for stages of the grieving process. Now disputed, this theory has made its way into

our society as a cultural norm, defining the expectations that society places on the bereaved to

move through grief as if they are ticking boxes off on a to-do list.[ CITATION Car20 \l 1033 ]

Referencing the Kübler-Ross model, newer research has cautioned health care

professionals against placing grievers in this model, “Major concerns include the absence of

sound empirical evidence, conceptual clarity, or explanatory potential. It lacks practical utility

for the design or allocation of treatment services, and it does not help identification of those at

risk or with complications in the grieving process. Most disturbingly, the expectation that

bereaved persons will, even should, go through stages of grieving can be harmful to those who

do not” (Stroebe, Margaret, et al.). This model is so firmly ingrained in our culture that during

the first visit to a doctor six months after my loss, my own primary care physician said, “You
 Burkett-Caraway_4

should be coming out of this by now.” He was unaware of the impact that filling out paperwork

that required me to face that unexpected and dreaded question, “Who is your emergency

contact?” brought the full weight of the loss down upon me.

Earlier, Stroebe, Schut and Boerner challenged the dominant grief models and proposed

the Dual Process model which studied various coping mechanisms and identified two dynamics

that change and fluctuate, loss orientation and restoration oriented. Whereby a grieving person at

times confronts their grief, and at other times avoids their grief (Stroebe, Margaret, et al.).

The Kübler-Ross model defines acceptance as, “accepting the reality that our loved one is

physically gone and recognizing that this new reality is a permanent reality….final healing and

adjustment can take a firm hold, despite the fact that healing often looks and feels like an

unattainable state. Healing looks like remembering, recollecting, and reorganizing… we must try

to live now in a world where our loved one is missing.”[ CITATION Kub69 \l 1033 ].

In opposition, The Continuing Bonds theory first came to light in 1996 (Klass, Dennis, et

al.) and proposed that the “dominant twentieth-century model holds that the function of grief and

mourning is to cut bonds with the deceased, thereby freeing the survivor to reinvest in new

relationships in the present….Close examination reveals that this model is based more on the

cultural values of modernity than on any substantial data of what people actually do.” This

theory refutes that ties to the deceased need to end. Further, staying connected to a loved one and

not detaching, erasing or leaving them behind is a valid response. This theory recognizes that

grief is ongoing. The Common Bonds model hypothesizes that the Kübler-Ross theory of

acceptance is an unrealistic expectation of detachment from the deceased.

The most recent update to the Diagnostic and Statistical Manual of Mental Disorders

(DSM–5)[ CITATION Ame131 \l 1033 ] included a change that has been as widely criticized as it has
 Burkett-Caraway_5

been lauded, the removal of the Bereavement Exclusion. Language has been inserted to “caution

clinicians to differentiate between normal grieving associated with a significant loss and a

diagnosis of a mental disorder.” [ CITATION Ame13 \l 1033 ]. This exclusion creates a clear line

between grief and major depressive disorder and allows a patient to be considered for a

depression diagnosis even in the early stages of grief. Advocates claim that this will allow

patients to get treatment earlier, even if the depression is a result of grief.

Additionally, the DSM-5 has officially recognized Prolonged Grief Disorder as a clinical

diagnosis (The Center for Complicated Grief). Identified by several names: complicated grief;

complex grief; and prolonged grief; this disorder is generally undiagnosed without formal

cognitive behavioral therapy (CBT). Complex grief occurs most frequently in the cases of

sudden death, out of order death or traumatic death. Grief at this stage is accompanied by the

griever becoming triggered and manifests as: PTSD; anxiety; panic attacks; insomnia; and a host

of other physical and emotional responses. According to the Center, “Complicated grief occurs

when something interferes with adaptation…. A person with complicated grief feels intense

emotional pain…they don’t see a pathway forward. A future without their loved one seems

forever dismal and unappealing.” This is a significant inclusion in the DSM-5 as historically,

grief has been considered a non-medical and personal struggle by health-care providers.

Speaking from experience, a widow/er will move forward as they begin to heal. The

phrase, “move on” is triggering and upsetting. This is particularly true if the individual

suggesting this has not experienced this type of loss. This is a frequent topic on private widow/er

groups on social media channels. Nora McInerny, a widow, discusses the difference between

moving forward and moving on in her Ted talk.

 Burkett-Caraway_6

But grief is kind of one of those things…where you don't get it until

you get it, until you do it. And once you do, once it's your love or your

baby, once it's your grief and your front row at the funeral, you get it. You

understand what you're experiencing is not a moment in time, it's not a bone

that will reset, but that you've been touched by something chronic.

Something incurable. It's not fatal, but sometimes grief feels like it could be.

[ CITATION McI19 \l 1033 ]

Grief and complex grief are poorly understood by our culture and by grievers themselves.

The concept of death is abstract until it impacts someone on a deeply personal level. Celebrity

deaths have almost made a mockery of the grieving process. Fans and media outlets alike

magnify the death in shock and despair of the loss - until the next news cycle. Everyone wants in

on the grief, over a loss that does not change anything in their life. This is highlighted by the

comparison of military deaths. An article in Havok Journal delves into this phenomenon, “But

what shouts perhaps even more loudly is the silence. The missing reactions of those who can’t

even muster the interest in the loss of a fallen soldier to click Like. Our pictures of the fallen will

become some of our most unliked posts” (Atalanta). Written shortly after Kobe Bryant’s

sensationalized death, the author further states, “every American who now mourns Kobe Bryant

is, on some level, morally accountable for the deaths they choose not to mourn. The deaths that

don’t register. The deaths that are important, but not important enough”[ CITATION Ata20 \l 1033 ].

Institutionalizing the death experience where the dying do not pass away at home and

choosing extreme or continuing medical measures that provide false hope sterilize the dying

process and rob the deceased of a dignified good death. (Meier, Emily, et al.). One component of

processing grief is rumination over how the deceased died. Pertaining to mourning and rituals,
 Burkett-Caraway_7

the manner of death, and the questions that repeat in a grievers mind ask: could more have been

done; was something missed; did I miss something; were they in pain; was dignity preserved? As

latent memories surface, learning the answers to these sometimes unanswerable questions

become of utmost importance to the griever.

Social media has complicated this experience. Grief is inherently private while death has

become public. Often, individuals who are not close to the deceased or significantly impacted by

the loss report the news through social media. This can alert those who are close to the deceased,

before the family has had the opportunity. A quick search of Google easily illustrates how this

topic has required popular sources to address and discuss social media death etiquette. Johnson,

referencing the Hierarchy of Grief, states, “Consider your role and relationship to the newly

deceased. Remember, hierarchy refers to your status and your relative importance to the

deceased”[ CITATION Joh16 \l 1033 ].

Those grieving often find themselves feeling as if they are moving too quickly, or not

quickly enough and surrounded by individuals who have not been in this situation. Individuals

from all aspects of life from co-workers, family, friends and even strangers try to help by

providing their version of expert advice and judgment that can range from intrusive to insensitive

to well-intentioned. Simply put, the griever is overwhelmed and is experiencing decision

paralysis. As is the case with many widow/ers, the grief pendulum can create behaviors that

swing back and forth and demonstrate various levels of behavior, from risk adverse to risky.

These behaviors can range from excessive spending, withdrawal, new relationships and over

socialization to putting on a brave face, denial and counseling. Unbeknownst to the griever,

healing occurs with each swing of the pendulum. Healing and forward motion happens in

hindsight and slowly. On one day healing may look like getting out of bed. The next day, healing
 Burkett-Caraway_8

may look like going grocery shopping. But what should be recognized is that grief is not constant

forward motion. The pendulum swings back and inexplicably, the griever may spend the entire

day in bed unable to find any motivation. The support received during these varying and

repetitive periods is critical. Intrusive or well-intentioned comments and advice can be harmful

to the griever.

The experience of secondary loss for a griever is profound, although a search for

scholarly sources on this topic did not yield significant results. Within the widowed community,

secondary losses are well documented and well-known. Frequent posts and discussions about a

breakdown in a grocery store after realizing you no longer know how to shop, then walking out,

leaving a full cart in the aisle is completely normal in a widowed world. Experiences like this are

are considered a rite of passage. Simple activities such as not being able to reach the lightbulb

that your husband always took care of, father-daughter dances, or yard maintenance can trigger

overwhelming feelings of loss and fear. Secondary losses are the ones no one thinks about and

that the griever never sees coming: Loss of income, identity, the future, friends, confidence,

faith, relationships, security, health, hopes, plans and intimacy[ CITATION LaM13 \l 1033 ].

These secondary losses are significantly expanded as the griever struggles to cope and

balance life as it should be and life as it is. The significance of waking up and realizing your

partner is not there versus waking up and knowing your partner is not there. Both realizations are

an everyday shock to the system. Envisioning life as how it will become is not immediately

possible. And, when this state of becoming starts to occur, the thoughts of “what if” are always

carried and ever present to the griever. The griever is always aware that they are living an

alternate life. Those experiencing the loss will struggle to navigate debilitating depression and to

preserve income, health and housing. “Death in the U.S. is complicated. Self-defined by
 Burkett-Caraway_9

youthfulness, longevity, positivity, and personal and professional triumph, Americans struggle to

accept and openly talk about mortality because it runs counter to our core cultural values. Public

policy ignores it, too: There’s no federal law that grants paid bereavement leave to individuals,

though some unpaid options, such as the U.S. Family Medical Leave Act (FMLA), are

available”[ CITATION Mur19 \l 1033 ] .

In on-going studies, it has been determined that the loss of a spouse or partner

significantly elevates the mortality rate for the bereaved and weakens the immune

system[ CITATION New19 \l 1033 ]. Additionally, the significance of food and widowhood is now

being studied. Traditions that surround food are culturally significant, worldwide. Food and

mealtimes bring people together whether through grocery shopping, preparing meals, eating

together or dining out. “The connection between food and mourning runs deep…for a spouse,

accustomed to sharing every meal with a partner, the grieving can go on long afterward, renewed

constantly by the rhythms of shopping, cooking and eating” (Nierenberg).

Emotional trauma leads to changes in the wiring of the brain. Often, panic attacks,

anxiety, loss of concentration, poor decisions, and an inability to begin or finish tasks will make

the griever wonder what is wrong with them. Particularly true if the griever had been previously

emotionally stable. Emotional trauma triggers the anxiety producing fight or flight response.

Past reality trumps alleged logic. Add in the fact that those of us who have

lost someone close are extra vigilant: We guard against more loss, more fear,

more helplessness in the face of the randomness of life. It’s a small, hard way to

live. Anxiety is exhausting [ CITATION Dev18 \l 1033 ].

The brain continually seeks to apply logic to a situation that is illogical.

 Burkett-Caraway_10

Grief and stress disrupt not only our patterns of behavior, but also how our brains work.

In addition to the signals it sends to our body, the brain seeks patterns, trying to link experiences

to create a causal relationship. With death, particularly a sudden or out-of-order death, there is no

pattern and the brain goes into overdrive trying to create one. This emotional trauma causes a

flood of “psychological grief responses…. The areas that manage attention and memory are

activated. The sections [of the brain] that focus on emotion and relationships are stimulated. The

zones that are dedicated to planning and language are triggered. Hormones reserved for

emergencies course through you.[ CITATION Fan16 \l 1033 ]” It is impossible for the griever to talk

themselves out of this cycle or to use calming techniques. Panic and anxiety are induced by what

might happen. In addition to the griever becomes hypervigilant about potential worst-case

scenarios. The griever has lived a worst-case scenario and their brain knows that not only can it

happen, it already has happened.

The societal expectation that grief has linear stages discounts the lifelong behavioral,

physical and social impact on the bereaved. There is no one right answer to this research

question, only information from a well-studied topic and personal experience. Opportunities to

communicate, inform and correct well-intentioned non-grievers can occur daily. The widowed

community has champions, authors, secret Facebook pages, and conferences to advance

understanding and messaging. It is significant that research is being devoted to this topic and the

DSM-5 have recently made great strides in categorizing and understanding the true grief process.
 Burkett-Caraway_11

Works Cited

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders:

DSM-5. Arlington, 2013.

Atalanta, Alice. “Celebrity Deaths Magnify the Silence on Our Nation’s Fallen.” Havok Journal,

27 January 2020. 9 April 2020. https://havokjournal.com/culture/celebrity-deaths-

magnify-the-silence-on-our-nations-fallen/

Biography.com Editors. Elisabeth Kubler-Ross Biography. 14 May 2019. 8 March 2020.

https://www.biography.com/scientist/elisabeth-kubler-ross.

“Cartography of Grief.” Electronic. 31 March 2020.

https://www.psychologytoday.com/us/blog/promoting-hope-preventing-

suicide/201908/grief-and-loss-the-long-view.

“The Center for Complicated Grief. Columbia School of Social Work.” 2020. 8 March 2020.

https://complicatedgrief.columbia.edu/for-the-public/complicated-grief-public/overview/

"Continuing Bonds in Adaptation to Bereavement: Toward Theoretical Integration." Clinical

Psychology Review March 2010: 259-268. Electronic. 9 March 2020.

https://www.sciencedirect.com/science/article/pii/S0272735809001627.

Devine, Meghan. “Grief & Anxiety: What To Do When the Worst Has Already Happened?”

Refuge in Grief, 15 January 2018. 8 April 2020.

https://www.refugeingrief.com/2018/01/15/grief-anxiety/.
 Burkett-Caraway_12

Fane, Barbara. Barbara Fane, LCSW, BCD, Monmouth County Therapy & Counseling. 13

January 2016. Electronic. 8 April 2020. https://barbarafane.com/grief-symptoms-how-

grief-affects-the-brain/#.Xo4jQ4hKjIV.

Fig. 1. Grief and Work. 8 April 2020. https://www.pinterest.com/shellnich/good-grief/.

Johnson, Taya Dunn. “Please Read This Before You Post Another RIP on Social Media.” 20 July

2016. Electronic. 9 March 2020. https://www.upworthy.com/please-read-this-before-you-

post-another-rip-on-social-media.

Klass, Dennis, Phyllis Silverman and Steven Nickman. Continuing Bonds: New Understandings

of Grief. Taylor & Francis, 1996.

Kübler-Ross, Elisabeth. On Death and Dying. 1969. Print.

LaMorie, Jill. “T*A*P*S, Tragedy Assistance Program for Survivors.” 21 March 2013. 9 March

2020. https://www.taps.org/articles/19-1/secondaryloss.

Lewis, C.S. A Grief Observed. London: Faber & Faber, 1968. Print.

McInerny, Nora. "We Don't Move on From Grief, We Move Forward." YouTube, uploaded by

TED. 25 April 2019. 8 March 2020. https://www.youtube.com/watch?v=khkJkR-ipfw.

"Major Depressive Disorder and the "Bereavement Exclusion"." 2013. 8 March 2020.

APA_DSM-5-Depression-Bereavement-Exclusion.pdf.

Meier, Emily, et al. "Defining a Good Death (Successful Dying): Literature Review and a Call

for Research and Public Dialogue." American Journal of Geriatric Psychiatry, April
 Burkett-Caraway_13

2016: 261-271. Electronic. 9 March 2020.

https://www.sciencedirect.com/science/article/pii/S106474811600138X.

Murphy, Clare. "Social Media is Changing the Way Americans Process Death." DAME (2019).

28 March 2020. https://www.damemagazine.com/2019/10/31/social-media-is-changing-

the-way-americans-process-death/.

Newman, Tim. "How Does Bereavement Impact the Immune System?" Medical News Today

(2019). Online. 28 March 2020. https://www.medicalnewstoday.com/articles/324970.

Nierenberg, Amelia. "Mourning with Every Meal." The New York Times 28 October 2019:

Section D, Page 1. 26 February 2020.

https://www.nytimes.com/2019/10/28/dining/widows-cooking-grief.html?

searchResultPosition=20.

Stroebe, Margaret, Henk Schut and Kathrin Boerner. "Cautioning Health-Care Professionals:

Bereaved Persons Are Misguided Through the Stages of Grief." OMEGA - Journal of

Death and Dying 74.4 (2017): 455-473. https://doi.org/10.1177/0030222817691870.