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5/4/12   stages/steps of   Grief / Addiction / Accepting new ideas

By Steve Draper,   Department of Psychology,   University of Glasgow.

5 stages (of grieving)

Kübler-Ross model (1969). [Kübler-Ross, E. (1969) On Death and Dying (Routledge)]
  1. Denial
  2. Anger
  3. Bargaining
  4. Despair (/ Depression)
  5. Acceptance

  6. Reconstruction – A missing stage?

For more on grieving see the longer section below.
For pointers to Michael White's Narrative Therapy see here.

4 stages (of accepting a new idea)

This comes from J.B.S. Haldane. [(Review of "The Truth About Death" in: Journal of Genetics 1963, Vol. 58, no.3 p.464)
Also "Evolutionary genetics are not simple, and the obvious in it is often untrue." p.450
]

When a person hears of a new idea, they go through the following responses (often over some years):

  1. This is worthless nonsense.
  2. This is an interesting, but perverse, point of view.
  3. This is true but quite unimportant.
  4. I have always said so.

12 steps (of overcoming addiction)

The 12 steps (APA version):
  1. Admitting that one cannot control one's addiction or compulsion;
  2. Recognizing a greater power that can give strength;
  3. Examining past errors with the help of a sponsor (experienced member);
  4. Making amends for these errors;
  5. Learning to live a new life with a new code of behavior;
  6. Helping others that suffer from the same addictions or compulsions.

See here for more / the original 12 steps.

Grieving (expanded discussion)

Steps, stages, or just dispositions?

Steps pretty much have to be a sequence, in a fixed order.

Stages may just sound like they are.
The 5 stages above are often thought of as sequential but:

  • They aren't experienced in the same order for everybody.
  • They may be iterative: one person re-experiencing a stage, and/or oscillating between stages.

    But perhaps in looking over extended grieving for someone who is in the process of dying (rather than in recovering from grief for an unexpected death), a common thing is to see either Denial or Acceptance, but sometimes to see both in the one person, depending on whom they are talking to. The underlying issue is not being able to bear to acknowledge to someone else that the death is going to occur: and that can depend on who that other is.

    So a) One person can be in two stages at once, depending upon their co-locutor; b) The problems come from two people not being at the same stage; not having the same attitude to the situation. There is no rule as to whether it is the survivor or the dying who exhibit one or the other, and many problems around such dying is the mismatch in attitude between the two involved.

    Sudden death: Inadequacies of the 5-stage model

    [This is from the first Albia novel by Lindsey Davis.] A young wife's husband suddenly dies. Her main apparent emotion is bewilderment: not overt grief, nor denial, nor .... The nearest official stage is "Despair": not knowing what to do, all plans destroyed as void; but no overwhelming passion. Like denial in that it's first, and dysfunctional; but not denying the fact, just paralysing. This character wasn't deeply in love with her husband, but was getting along fine: so perhaps no-emotion yet paralysis is right. The death was very destructive of her life plans; but not perhaps destructive of her inner life goals/needs.

    Perhaps people whose employer suddenly goes bust may often be like this (unless they are financially very threatened already).

    Reconstruction. Being constructive.

    One of the biggest issues to improve on, in the 5 stage model, may be around being constructive. The 5th stage is "Acceptance", but a lot of people get stuck in a kind of Acceptance that is little different from Despair – so that accepting the fact has not led to reconstructing a worthwhile life.

    What needs to be constructed? Firstly: grief is most disabling in the first instance to the extent that previous habits, ways of living, are disrupted by the death of someone else. So all those habits must be re-planned: invented differently, practised, adapted; and this is independent of whether the dead person was emotionally important.

    We can approach this from another angle. Stage 5 "Acceptance" sounds completely passive, yet reconstruction must be active. So there seem to be two quite different final stages: (1) passive acceptance, which is perhaps little different to Despair or Bewilderment; and (2) active acceptance which means moving into a new re-planned way of living, which requires the person to be active and creative: "Reconstructed". This isn't just about stages of reaction to grief, but also to other kinds of changed circumstances.

    I am writing this paragraph on 31 May 2020, just as the UK is making the first steps out of lockdown from Covid. This issue of passive acceptance vs. active acceptance can be seen in how different groups have responded to the lockdown.

    Type I: Highly active reconstruction The documentaries and news pieces on life in intensive care units during the peak pandemic show high stress, but also a very high rate of adaptation as organisations and units invent the necessary procedures and rapidly improve them as they learn more about what does and doesn't work. In my university, Teachers have similarly had to invent, agree, and carry out a completely new way of doing examinations with large numbers of anxious students at very short notice, and managed to pull this off with no significant breakdowns. This too, is doing one's regular job under suddenly very different conditions, and managing the innovations necessary: change at perhaps ten times the normal pace of change.

    Type II: Business more or less as usual: work hours similar to before; distancing, but the nature of the job not different. This has been true of the jobs deemed necessary like opening food shops, waste disposal. In my university, Researchers have continued their work from home with little dramatic change. A similar amount of accomplishment in similar time scales, although many small adaptations (shooing the kids out of the room while having a work Zoom; getting used to planning participation in academic conferences as remote live events rather than face to face ones).

    Type III: No work, just enduring life at home day and night. Basically waiting for things to "return to normal", but generally not expecting that their life will be changed: just suspended then resumed. This tactic is often useful in real life, even if on a shorter timescale. I climb a mountain not by savouring every moment, but by plodding on trying to think of something else until the reward of arriving at the top. If a train breaks down or is blocked for several hours, that may ruin the whole day with missed meetings and connections, but the next day things are back to normal: not usually a cause for radically changing my way of travelling. However this is not creative and constructive, just passive endurance. As a senior doctor in a covid documentary said, his family hasn't considered that there may not be a normal they will soon return to. Assuming that there will be may be a weakness. If that turns out to be how it is, then those of us in endurance mode will have missed a chance to start inventing and implementing new ways of living and working.

    Thus the modes and categories thrown up for grief seem more general than just that specific case; and suggest a general structure of comparable alternatives.

    Yet a third angle is that of Michael White's Narrative Therapy (see below), which addressed grieving not by interpreting "Acceptance" as forgetting the dead person as if they "had been disappeared", but on the contrary "saying hallo to them" and actively constructing a narrative about their role and continuing influence on the bereaved. This is obviously related to hero worship (often a one-sided relationship), and to gratitude exercises about past events, and is realistic in not confusing physical death with the cessation of their meaning for the lives of those to whom they were important, and whose effect in shaping them remains. It implies that "acceptance" should not be equated with amnesia and the "Despair" stage, but again with active reconstruction: this time a reconstruction of personal meanings rather than of new plans of action.

    Major disasters

    There has been work on how humans actually respond in big disasters / emergencies e.g. big earthquakes; but presumably also air crashes etc. The Manchester ground fire: an air disaster where the plane landed intact but immediately a big fire started that killed about 40% of the people. Quite a lot of people just don't focus on the urgency of helping themselves. Does it need pain? Is it just that we don't have much fear in our lives; don't think about the imminent need for self-preservation? Or is it social: thinking it is up to someone else to help us or order us about?

    One big feature missing from the five stages above is "Dissociation": a bit like denial, a bit like despair; but really characterised by a surprising lack of feeling but also of engagement: likely to hardly do anything. In another way, though, this is the opposite of the five stages above which ARE all emotions. This sixth is its absence: the absence of both feeling and of disposition to act.

    "I just want to go back to how it was before that date". Not actually denying the change factually, but not able to think of the future or of any goal to work towards. I.e. not deny the fact; but deny the need to re-plan. Denial of planning rather than of facts.

    Scapegoating: Another point, exemplified by scapegoating of Korean immigrants after the great Kanto earthquake, is perhaps a kind of "Anger" directed to an inappropriate target, just like anger in the face of a cancer diagnosis.

    Thus it is not just about grieving: the same stages may apply more widely; and not only to situations that require a long adaptation, but also to those that require an immediate response,

    Theory?

  • 3 Victim responses. Three faces of victimhood

    Informally, some observers classify how a victim of some serious assault or other disaster responds in the long term into three:

    Michael White's Narrative Therapy, and how to find out about his ideas

    Starting points:

      photo
    1. The first metaphor (1988): "Saying Hullo again" (meaning the incorporation of the lost relationship in the resolution of grief).

    2. A surprisingly good start (as of 1st June 2020, anyway) is White's wikiP page – very brief, but lists all the books he wrote. Furthermore, it lists (but doesn't define) many of the major terms and concepts he introduced (which could also be useful for googling to find people who used them).

      The list of books is useful because, although some of them are hard to get, most of his papers are very hard indeed to access.

    3. A three line characterisation of Narrative Therapy is as follows, and is in terms of the basic frame, or unit of analysis, that it adopts. Different kinds of therapy take different units as basic. E.g. behavioural therapy takes behaviour as the unit; cognitive takes thoughts as the unit; (CBT is unusual, and perhaps unusually effective, because it uses two frames in parallel – cognitions and behaviours).

      For Narrative Therapy, the unit is the story (or narrative). Generally this narrative is a partly social and partly individual construction.

      This definition of Narrative Therapy derives from this four page 1998 paper by Sween, where it is one of seven alternative three-line explanations of Narrative Therapy.

    4. A useful two page introduction to Narrative Therapy can be found by downloading the following paper, and then just reading the first untitled section (up to the section heading "Case study").
      Rothschild,P., Brownlee,K. and Gallant,P. (2000) "Narrative Interventions for Working with Persons with AIDS: A Case Study" Journal of Family Psychotherapy Vol.11 no.3 pp.1-13 doi: 10.1300/J085v11n03_01

    5. The Dulwich Centre is host to current and past materials on narrative therapy; including a section on some writings by Michael White. Within those, a former student of mine recommended the "Externalising conversations exercise" within the "Workshop notes".

    Lianna Champ

    Lianna Champ How to grieve like a Champ (2018) (RedDoor Publishing Limited). Champ is a Funeral Director based in Lancashire, and this book on grief offers advice for families and individuals addressing grief. In a radio interview she mentioned how the death of her own mother had a major impact on her, but she did work through it and said that now she talks to her every day in her own head. So, in other words, she sounds as if she is in accord with the "narrative therapy" views of Michael White, even though she probably arrived there by an independent (and perhaps earlier) route.

    Sherry Turkle

    The same idea appears in a sermon by a rabbi described in Sherry Turkle's book Alone together (2011) (NY: Basic Books) on almost the last page: pp.304-5. She mentions that in 2009, on Yom Kippur, in the service "Yiskor" of mourning for the dead; in her ?NYC district her rabbi gave a sermon saying we should talk to the dead.
    "His premise is that we want to, need to, talk to the dead. It is an important, not a maudlin, thing to do. The rabbi suggests that we have four things to say to them: I'm sorry. Thank you. I forgive you. I love you. This is what makes us human, over time, over distance."

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