A Messy Grieving Process Is Still a Healthy One

The stages of grief are well known: denial, anger, bargaining, depression, and acceptance. It is commonly assumed that we move through these stages one by one as we mourn the death of someone we love.

But therapists and other experts in bereavement have long suspected it's not quite so simple. New research published in The Journal of the American Medical Association investigates the process of grief.

Holly Prigerson and Paul Maciejewski are a husband-wife research team. Prigerson teaches at Harvard Medical School, Maciejewski teaches at Yale.

For their latest research, Prigerson and Maciejewski wanted to test the common conception of grief: That when people mourn, they go through a series of stages. Prigerson, who also works at the Dana-Farber Cancer Institute, says the stage grief theory is something that has been accepted but not closely studied.

"Some people say, 'You mean, that hasn't been tested yet?' And it even struck us as odd. It's just been out there so long," Prigerson says.

For two years the couple followed 233 people who were mourning the death of a loved one — a spouse, a parent, a child or a sibling. The deaths were all by natural causes, and many were expected deaths from cancer or a long illness.

The research confirmed parts of the stage theory of grief, but it also found big differences.

Counter to the current stage theory of grief, Prigerson and Maciejewski found that acceptance was the most common feeling. And it often came early in the grieving process.

Also surprising was the finding that the main negative feeling wasn't sadness or anger, as previously thought. Yearning, Maciejewski says, is a more dominant characteristic after a loss than sadness.

"Grief is really about yearning and not sadness," Prigerson says. "That sense of heartache. It's been called pangs of grief."

The idea that different people grieve in different ways is no surprise to many who counsel the bereaved.

"When we consider stages, then we place expectations upon people that there's a certain way they should behave or be," says Marcia Lattanzi-Licht, a nurse and psychotherapist who has written about grief.

She notes that some people go through all the stages, and some don't. Often, people will be in more than one stage at the same time. They can be both accepting and yearning, for example.

Lattanzi-Licht welcomes research that goes beyond the stage theory, and hopes that the new research will be reassuring to those mourning the loss of a loved one.

"What it does is normalize some parts of the experience," she says. "People want to know that they're sort of on track."