[INTRO ♪]
There are a lot of ways to mark the passing of a loved one.
But in many modern cultures, once the funeral's over,
all that's left are too many flowers and that well-meant
soggy casserole your neighbor made for you.
Those black mourning dresses Scarlett O'Hara hated so much
have gone out of style, but grief doesn't stop
just because the public ceremony of saying goodbye is over.
Grief can be hard and lonely, and sometimes it can feel like it'll never end.
Psychologists have been trying to figure this out for over a century.
And the only good answers they've got are that
it's a totally normal process, and that it's different for everyone.
Bereavement is the technical term that psychologists use
to talk about the loss of a loved one by death.
Grief is what they call the distress caused by that loss.
And when you think about grief in a psychological sense,
the first thing that probably comes to mind is the Kübler-Ross model.
You might not recognize that name,
but it gets talked about a lot in pop culture.
You might, for instance, know it from
that Robot Chicken video of a giraffe stuck in quicksand.
Basically, the Kübler-Ross model says
we all go through five stages as we process our grief.
We start off by denying that whatever happened is real,
which helps us temporarily deal with it.
Next, we get angry.
And then, we try to bargain our way out of it,
by making a deal with God, or the universe,
or whatever we believe has the power to change what has happened.
When that doesn't work, we experience depression.
And finally, we get to acceptance.
Everything might not be okay, but we've learn to live with it.
Even if you haven't taken a psychology class,
you're probably familiar with this idea.
But you might not know where the model comes from.
Elisabeth Kübler-Ross was a psychiatrist who worked with terminally ill patients.
She helped change attitudes about dying
and encouraged people to actually talk about death.
And rather than just worrying about the salvation of the soul,
she was a strong supporter of hospice care,
which focuses on making the patients' final days comfortable
and keeping them involved in the decisions that affect them.
This is all super important stuff that has affected
how we think about people who are dying.
But she also wrote a book called On Death and Dying.
Published in 1969, it was based on interviews with over 200 dying patients.
Kübler-Ross was influenced by the work of two psychiatrists
who proposed that, after a separation or a loss,
grief was a process that involved four sequential stages.
So in her book, she proposed five stages we all go through
as we come to terms with dying.
Not while grieving for someone else, but while dying ourselves.
The book sold really well, and the five stages took off in the public's imagination.
People started applying the stages to grief even though they weren't meant to describe it.
And so, Kübler-Ross and her coauthor eventually went back
and adapted the same five stages so that they made sense for grieving, too.
But! There wasn't really any scientific basis for that adaptation.
Of course, we didn't always think of grieving as a pattern of psychological responses.
Since death is inevitable, people have been studying grief for a while.
In the 17th century, it was believed that too much grieving could be deadly.
And in the 19th century, Charles Darwin wrote about grief
and noted that monkeys and apes also seemed capable of feeling it.
Freud had something to say about it too.
In 1917, he proposed that the living had to detach their emotional energy
from the dead person and channel it into some other aspect of their lives.
He called this grief work.
And if people didn't do grief work?
He believed they had a much higher risk of developing a psychological illness
because of their supposedly pathological grief.
Yeah, Freud had… a lot of ideas, and they weren't always great.
But, of all these ideas, the Kübler-Ross model is the one that really stuck around.
Some psychologists think that its staying power
comes from the fact that it's such a good narrative.
Our brains like to organize things, and this model offers
a nice, neat progression through five well-defined stages—
and ultimately, has a happy ending.
But even though we might like the way it sounds,
psychologists nowadays have a few big issues with these five stages.
First of all, there's a lack of empirical evidence.
Many researchers argue that the interviews it's based on
weren't conducted with enough scientific rigor.
In the years since the book was published,
some studies have attempted to replicate and verify the findings.
For instance, one study published in 2007 followed 233 people over three years.
And a 2010 study looked at 614 undergraduates and surveyed them once,
all at different points in their grief.
Both studies asked the subjects to assess their grief on a scale
for disbelief, yearning, anger, depression, and acceptance.
And they all had mixed results.
The 2007 study found that acceptance was the most common reaction,
even right after death.
But after averaging all the data over time
the different stages did peak in the order that Kübler-Ross had suggested.
The 2010 study found that their results didn't support Kübler-Ross's stage theory,
but they didn't completely disprove it either.
And how much people were thinking about the loss
seemed to influence what they were experiencing more than the passing of time.
A second criticism is that the stages don't really have an underlying explanation.
There's no hypothesis for why grief would be organized
into sequential stages, what function they serve,
or how people move from one stage to the next.
On top of that, the stages are kind of random, psychologically speaking.
Some of them are emotional states, like anger and depression,
while others are cognitive processes, like acceptance and denial.
And lastly, researchers have noted that the Kübler-Ross model
seems to create problematic expectations for how grief should be dealt with.
The five stages can make people expect
to experience certain things in a certain order.
And if they don't do that, or they don't hit certain stages at all,
people might believe that they aren't coping properly.
That expectation could also lead to unhelpful support
from their social networks or health care professionals.
But psychologists aren't just critiquing the Kübler-Ross model,
they're also trying to figure out new ways to think about grief.
There's a ton of research to sift through, but there are a few prominent ideas.
The dual-process model of grief was proposed in 1999.
Developed from other studies on cognitive stress,
it suggests that the griever switches back and forth
between two patterns of behavior, called orientations.
In the loss orientation, someone spends time
thinking about the person they've lost and what life used to be like.
They might look at old pictures or tell stories,
and they'll express a lot of emotion about the loss.
In the restoration orientation, someone focuses on
the changes that need to be made.
It's more of a problem-solving state of mind.
They might work on establishing a new identity for themselves
or adjusting to do things that the deceased used to do,
like doing the dishes after you cooked.
What's unique about the dual-process model is that it suggests that
a person who's grieving switches back and forth between these two orientations
until eventually, they don't need to think about certain aspects of the loss anymore.
It's a more flexible model, with room for individual and cultural differences.
One of the best known task-based models of grief was proposed in 2008 by a
clinical psychologist with a lot of experience treating people dealing with grief.
While this one also doesn't have a ton of empirical evidence,
unlike stage-based models, it tries to account more for
people going through grief differently.
The model says that grieving is a process of engaging in four tasks—
all in no particular order.
Essentially, they include: accepting the reality of the loss,
processing the pain of the grief, adjusting to the world without the loved one,
and finding a lasting connection with them somehow.
The task-based model also points out seven factors
that can affect the individual experience of each griever,
which may help healthcare professionals understand what someone's going through.
These factors are things like their relationship to the deceased,
how the person died, or other stress that they're under.
Another prominent way of thinking about grief
identifies multiple possible grieving processes,
reinforcing that it can be very different for different people.
This idea started with a 2002 study on 205 people who lost their spouses.
The researchers tracked subjects for several years before the death until 18 months afterward.
And they used this information to identify five common trajectories of grief.
The trajectories include common grief,
in which the subjects experience a lot of depression at six months,
but not before the death or at 18 months.
There's also depressed-improved,
in which the subject experienced depression before the death,
but had largely returned to normal by six months.
In chronic grief and chronic depression trajectories,
the subject experienced many grief symptoms
and high levels of depression at six months and 18 months.
These were both associated with higher dependence on the spouse before death.
But they were distinguishable.
In the case of chronic depression,
the subject experienced depression before the death as well,
and it was associated with marital strife.
The most common trajectory was actually resilience,
in which a person experiences relatively low and stable levels of depression
before and following the loss.
Nearly half the subjects experienced this pattern.
Now, all these ideas suggest that grief can be different
depending on the circumstances and the person—
which makes a lot of sense!
Grief is really complicated.
But there's just so much research out there.
And some psychologists worry that without a tidy, unified narrative,
it will be hard to dislodge the Kübler-Ross model in the general public's mind.
The other thing to know is that there can be complications
that make grief extra hard to deal with.
For example, there's disenfranchised grief,
which is what psychologists call grief that isn't generally acknowledged by society.
Like, when someone you didn't actually know dies
or when you experience a miscarriage.
It's not as socially acceptable to feel and talk about those kinds of grief,
which can make them harder to process.
But even typical grief can become a problem.
The DSM-5, an evolving guide that professionals use to diagnose mental illness,
includes proposed criteria for Persistent Complex Bereavement Disorder.
These criteria are things like: longing for the deceased, intense suffering,
and preoccupation with the death that causes distress and impairment lasting over a year.
So if grief is such a complicated, intense experience... can therapy help?
Unfortunately, a 2008 meta-analysis published in Psychological Bulletin
found that, most of the time, grief therapy didn't seem to
significantly help the average person.
It did somewhat help the people who were having the most trouble coping, though.
Like if they're experiencing some of the complications we just talked about.
But to be clear: we here at SciShow aren't health professionals,
and everyone processes grief differently.
So even though some research says therapy might help
certain people more than others, it's not worth writing off completely.
The good news, though, is that most people can move past their grief.
Or at least, they can move past the most difficult stage of it, known as acute grief.
That's the really sucky part with all of the physiological symptoms…
where you're exhausted, your stomach feels empty, or you have a lump in your throat.
Most people seem to be able to move beyond this in three to six months.
They still miss their loved one, but they can get on with living their lives.
And plenty of researchers see establishing a lasting relationship
with the deceased as part of coping.
The thing is… grief really is a normal process.
It can be really tough on the mind, but you'll get through it okay.
Thanks for watching this episode of SciShow!
If you want to learn more about brains and why humans act the way that we do,
you can come check out our other channel SciShow Psychology, at youtube.com/scishowpsych.
[OUTRO ♪]
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