There’s a nicely written piece over at Obit magazine, a review of a new book, The Truth About Grief: The Myth of Its Five Stages and the New Science of Loss (Simon & Schuster), by Ruth Davis Konigsberg. It’s probably worth reading.
It’s a demolition job on certain schools of bereavement counselling — those informed by Elisabeth Kubler-Ross’s On Death and Dying. I don’t know how prevalent it is in the UK now, the orthodoxy that bereaved people must, under the supervision of a well-meaning person who’s been on a course, be taken on a journey through the Famous Five Stages — possibly stage by stage to a strict timetable. Denial. Anger. Depression. Bargaining. Acceptance.
With acceptance, of course, comes closure, as the bereaved person finally ejects the dead person, wiggles her tail and swims happily away to join all the other carefree fishes. Something like that. (How I wish we could put WTF in tiny caps after a word, as we put TM after a brand name. Closure WTF)
If it misses the point bigtime, why should we be surprised? Kubler Ross was writing about the emotions a dying person might go through, not a bereaved one. And I don’t remember her prescribing the full five in the right order.
“When 233 people were interviewed [by Yale University researchers] between one to 24 months after the death of a spouse, most respondents accepted the death of a loved one from the very beginning.” I seem to recall that studies of those bereaved by the 911 attacks revealed that counselling had prolonged the grief of many of those unlucky enough to receive it; those who had none did best.
While I was researching my book I spoke to someone at Cruse who fielded this question: Have you done any research to discover whether a good funeral can be transformative of grief? (Ans: We’ve never thought of that.)
I am sure there are good things going on in the bereavement sector and I hope someone will tell us what they are. Counsellors take a bit of a bashing from sceptics (until they themselves need counselling).
Similarly, a group of battle-traumatised soldiers were quite recently studied (sorry Charles can’t remember the reference)and it was found that those who hadn’t had anti-PTSD counselling did rather better than those who had. Which doesn’t negate counselling, but makes me think how well it is or can be suited to each individual, ranging from “full job on this one” to “leave this one alone.” How could one know? Some people clearly benefit from it. What would be the diagnostic tools, as it were?
Someone from Cruse recently told me that the K-R stages were pretty generally replaced by a different model, that saw different elements, tasks, of grieving happening in no particular order, or indeed simultaneously.
It’s astonishing that Cruse people hadn’t considered the transformative possibilities of a “good” funeral. I’m sure some of them must have, especially any of them who do funerals as well as counselling.
Now I’ll shut up and leave it to people who know more about bereavement counselling than I do. Which wouldn’t be difficult.
This misunderstanding about Kubler Ross’s five stages is extraordinary, as is pointed out they are for the dying, not the bereaved. I’m sure I have mentioned this before, but the episode of The Simpsons when Homer thinks he has twenty four hours to live after ingesting poorly prepared ‘fugu’ fish in a Japanese restaurant and passes through the five stages in under five seconds is a classic.
GM, battle traumatised soldiers from Afghanistan and Iraq have just begun to be treated with MDMA, also known as Ecstasy for their symptoms with incredibly promising results. Therapists have been battling for years to open this study up, and have finally been granted permission. The organisation behind this is called MAPS. Good people doing a difficult thing.
I’m a Cruse counsellor and I conduct funerals. I’m relatively new to both (about a year) but my experience so far has been this… We learn about Kubler Ross’s five stages during our Cruse training, but the most important lesson we learnt about stages of grief was that no two people experience grief in the same way, and you see ‘clients’ with very much an open mind. At its most simplistic level you represent a safe environment where they can just say what they really feel to someone who will listen without judging them in any way. Of course, they are ‘signs’ and ‘stages’ that you recognise, but there is no formula, as such, that people are forced through. Everyone is unique and they are treated as such. Counselling shouldn’t prolong grief. That’s certainly not what Cruse is about, in my experience anyway.
With regards to the transformative effects of a good funeral, I don’t think there are any counsellors in my Cruse group who haven’t thought about the positive effects of a good funeral. Both out of interest and because they have had clients who have experienced good and bad funerals.
In fact, this very night, I have been invited by my Cruse group to be the speaker at our monthly meeting and tell everyone about my work as a civil celebrant, and my experiences of how a good funeral can help grieving families.
So a very timely post! Thanks Charles!
Much as I admire many of the FDs I work with round here, I wonder if it would be possible for Rupert to nip up to these parts and bite them – maybe they would be infected with his enquiring mind, depth of thought and range of interest and knowledge.(That’s OK Rupert, a G&T will cover it…)
And CB’s response too is informative and reassuring. Hope the talk goes well – I’m sure it will.
Homer and the fugu fish sadly unavailable on YouTube etc. I’d love to see that.
Thanks for your comments, everyone. I woke up feeling guilty about the simplisticalness of this post.
Let’s go MAPS, Rupert? Do you want to write about it or shall I? There’s a wonderful account of a dying man and his partner using MDMA to help them come to terms with what’s happening. And more besides…
Re CB above — Inasmuch as so many people regard a funeral as an invidious social obligation rather than an event which can be transformative of grief (they can’t wait to get it over with so that they can start grieving), I’d really like to see Cruse campaigning alongside other funeral reformers to raise consciousness and re-vision funerals. In child care it’s called early intervention. I hope you will carry that rallying cry to your Cruse colleagues.
I will indeed Charles. We’re a small branch in a little market town but we’re a plucky bunch and we’ll do our best. As activist and campaigner Anita Roddick said: If you think you’re too small to make a difference, you’ve obviously never been in bed with a mosquito…
“When 233 people were interviewed…most respondents accepted the death of a loved one from the very beginning.”
Firstly let me explain that, like Comfort Blanket, I’m a celebrant and Cruse bereavement support worker (we’re not supposed to call it ‘counselling’ because we don’t have to have a counselling qualification). Kubler-Ross doesn’t get that much of a look-in in the training; it’s Worden with his ‘four TASKS’, not stages, ‘of grieving’, not dying (I only even remember them by an acronym – AWARe: Accept reality of loss, Work through to the pain, Adjust to new circumstances without deceased, and Re-locate deceased in your head so you can move on) who informs a very loose understanding of how a client MIGHT be working through their own ‘grieving process’. A thermometer rather than a scalpel, to a counsellor. With you completely on that one, CB.
So the 233 need to have been chosen carefully before quoting their responses to a tick-box. Cruse exists for the tiny minority of bereaved people who are experiencing complicated grief, not just for anybody who happens to be bereaved; if you looked deeply into those of the 233 who actually asked for help, you may find less than a majority claiming to have no trouble accepting the death of a loved one. And who’s to say which of the 911 lot asked for counselling, and which merely agreed to it? Possibly, those who had no counselling did best because they didn’t need it anyway. Whatever; but in my experience, those referred to Cruse (by an overworked GP for instance) are far less open to, often less in need of, support than are those coming from their own initiative – unsurprisingly.
I hope your talk with your group of volunteers went well last night, CB. I’ve given a few such talks, with such a good response that I’m now an element in two of the local Cruse training courses; with, in turn, such an enthusiastic response that I was almost unanimously quoted on one feedback form as ‘the best part of the course’ – not blowing my own trumpet, just pointing up the starvation of information and discussion of funerals generally, and people’s hunger to learn about them. So work at it, you may find yourself in greater demand; I’d be happy to communicate on the subject if you get asked again (Charles has my email address).
Finally, I find a less enquiring attitude into funerals in my local Cruse lot, at least until I come along and stir it up. And I mentioned recently on this blog that I intend writing to Cruse head office to enquire about its policy of gaining financially by selling Funeral Planning Services’ pre-paid funeral packages… so far, I can’t even get a response out of them about who I should address my enquiry to. Apathetic lot, they should indeed be right behind us in the matter of researching the funeral as a grieving ritual, and I shan’t give up. Mind you, Bereavement Celebrities such as Neimeyer or Parkes tend to talk about ‘Grieving Outcome Indicator Scores’ and such, so don’t hold your breath.
Even more finally:
Accepting the reality of the loss could be seen as witnessing the coffin arriving;
Working through to the pain may be associated with the committal moment;
Adjusting to the changed circumstances without the deceased is required when everyone is saying how sorry they are about your loss, if there’s anything I can do etc; experiencing your beliefs either strengthening or abandoning you; being regarded suddenly as the widow or the orphan;
and what could be more evocative of Re-locating the deceased than putting him in a hole in the ground or in a fire, and walking away?
A grieving ritual indeed? Just a thought.
I have written a response to the book and ensuing public commentary here:
http://drjoanne.blogspot.com/
Thank you so much for this discussion!