Loss is something that happens to us all whether it’s through death of a loved one, a relationship breakdown, ill health, changing jobs, moving house, or a myriad of other changes in life. Even simply growing older can feel like a loss. Hello grey hair and good-bye youth! Sometimes we can feel loss coming our way, and at other times it can hit us out of the blue. Loss has a knack of shaking up everything that has been taken for granted. It can disrupt the meaning of our lives and give way to a time of confusion and chaos.
Meet Jack* – a case in point
Jack is a man in his forties. His wife and mother of their three children died 12 months ago after a battle with breast cancer. Amid the anguish, his own mother drowned recently, caught in a beach rip, and all this within four years of his father having a heart attack. Understandably his world has been shaken. There are so many stressors and balls in the air as he tries to keep some sense of family for their children and maintain a job. Everything inside him hurts. Not that it’s easy to share or let people know. He is after all, a private man.
The five stages of grief
Like so many people, Jack had heard of the five stages of grief. Type ‘stages of’ into Dr Google and it is likely to suggest ‘stages of grief’ as a search term. There is even a Simpsons’ episode featuring the five stages of grief. Homer was sick and facing the prospect of his own death. As a doctor explained the stages to Homer he predictably reacted to disprove each stage, and so, illustrated them beautifully – denial, anger, bargaining, depression and acceptance just as Elizabeth Kubler-Ross proposed them way back in 1969.
Ground breaking in its day, the stage model grew out of Kubler-Ross’s work with people who experienced life-threatening illness and struggled to come to terms with their mortality. However, the media heard of the model and it was also applied to people who were grieving a loss after a death, so the notion of stages was widely adopted in Western culture. Later, Kubler-Ross said the stages were not meant to be sequential, but by then, the horse had bolted and media of the day had found a captivating headline.
Letting Go and Moving On
The idea that grief progresses through sequential stages has been widely adopted. Kubler-Ross provides just one of a number of similar models. Broadly speaking, models that propose grief as a sequential process that can be universally applied to everyone tend to belong to a paradigm that believes in letting go and moving on.
Freud believed in the idea of letting go after loss and reinvesting energy into new relationships, though he found it harder to do in his own life. Bowlby drew attention to the importance of our attachment to the person who is lost and how this shapes grief that follows. Others, such as Rando argued that grief moves in three phases and has six steps; whereas, Wordern subscribed to the idea that grief is an active process that requires working through four tasks of mourning.
The advantage of these models is that they are primarily sequential, predictable and can help people see if their grief is normal, on track, or perhaps more complicated or prolonged and possibly stuck in any one stage, phase or task. By having stages and tasks we can see what needs to be done to guide our way back to accommodate our grief. The down side is that it can be easy to pathologise grief too. A couple of Jack’s mates thought he was angry and most certainly depressed. Robert Niemeyer is among the worlds’ most esteemed researchers and clinicians when it comes to loss and grief. (I am fortunate to have met Bob several times on his numerous visits to Australia). Niemeyer notes there is virtually no research to support the universal passage of grief through sequential stages.
Back in the mid 90’s, Klass, Silverman and Nickman critiqued the idea of letting go as a goal of grief. Instead they observed that many Eastern cultures and for that matter, many Western people, maintain a continuing bond with the person they have lost. Put another way, as it has been so eloquently said, death ends a life but it does not end a relationship. Instead we maintain an inner representation of the deceased. In his head, Jack still has conversations with his wife, mother and father that influence how he approaches life.
What is really lost?
Jack experienced three primary losses represented by the deaths of his wife, mother and father. These were physical losses. However, there were numerous ongoing secondary losses that followed as a consequence of primary loss. Whereas Jack and his wife shared work and parenting responsibilities reasonably evenly, these roles now fall to him as he contends with all the little shifts in his day that used to be taken for granted when his partner was alive. Furthermore, he’s lost hope for an imagined future, financial security and a faith in knowing his place in the world. These secondary losses are not physical. Rather they are psychosocial or symbolic in nature and laden with meaning.
Contemporary approaches to grief
Researchers Stroebe and Schut propose that grief is an active dual process. Our challenge is to cope with all the stresses that follow the loss. They group stressors into two orientations. The loss orientation contains all our thoughts, actions, behaviour and ruminations to contend with remembering the loss. The restoration orientation contains all the things to do with secondary and symbolic losses, such as figuring out how to get the dinner on, do the washing, be home from work in time to oversee the kids’ homework, whether to move house, find a new job, begin to socialise or eventually find a new partner. Stroebe and Schut suggest we oscillate between loss and restoration orientations, and at times it can even be useful to take time out from either orientation. That is where getting lost in music or a movie comes in.
The loss of Jack’s wife, and both his parents has also disrupted his life story, and how he imagined it continuing beyond this point. Jack faces the challenge of making sense of his multiple losses – not just the deaths, but also all the secondary symbolic losses that follow on. Neimeyer’s own research points to what is termed meaning reconstruction which happens over time to make sense of loss, and possibly find life-lessons and benefits that also shape who we are becoming. With sound research behind both dual process and meaning reconstruction approaches, it’s apparent they are very different to stage based models, which seem more prescriptive by comparison. Jack might become a better parent, live more in the moment, be more philosophical, or even understanding and empathetic towards others in a similar position. We can end up ‘sadder but wiser’ as Janoff-Bulman puts it.
Finding support with grief
All of us will face loss at some time in our life. It can take time, but most of us will learn to live with the loss and accommodate it into our life story. Not everyone needs to come for counselling or therapy. However, there are some times when counselling or therapy can be really important when grief goes unacknowledged or unsupported, especially if the loss is:
- unexpected (sudden death, or unforseen end of a relationship),
- traumatic (accidents),
- occurs out of the normal sequence expected in life (death of a child),
- disenfranchised because it goes unseen (miscarriage) and unacknowledged because of social stigma (suicide, same sex relationships, gender diversity, or loss of a lover from an unknown affair) so that the griever is cut off from social support,
- multiple difficult losses over time (like Jack),
- or, the griever has an insecure attachment style as a result of difficult childhood experiences.
These losses are harder to grieve and contacting a counsellor or therapist who is conversant with a wide range of approaches to loss can be useful. So in our example, it is unlikely that Jack would benefit from being ushered through the five stages of grief as there are multiple physical and secondary psychosocial losses to consider. He might resonate with the dual process model as he faces the losses and the challenges of rebuilding his life, and certainly he has a story to tell as he reconstructs his self and life over time.
*Jack is an entirely made up but plausible case developed to illustrate differing types of grief for the purpose of this blog post.
Graeme James uses an integrative approach to counselling and therapy, drawing from significant experience and research to tailor the therapeutic relationship. Graeme James has taught counselling through university, managed Lifeline Sydney and worked with Medibank Health for Beyondblue. He supervises a range of health professionals including counsellors, psychotherapists, psychologists, nurses, educators and students. His research investigated therapists’ sense and use of self during life-threatening illness.