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Grief · 7 min read

Grief is not a straight line

Why the “five stages” are misunderstood, and what healthy grieving can actually look like.

Ask most people how grief works and they will recite the stages: denial, anger, bargaining, depression, acceptance. The list is so familiar that grieving people often worry they are doing it wrong: “I never felt angry. Why am I back to crying in month eight? Shouldn’t I be at acceptance by now?” Here is the part that rarely gets said: the five stages were never a map anyone was required to follow.

Where the stages came from

Elisabeth Kübler-Ross introduced the stages in her 1969 book On Death and Dying, based on interviews with terminally ill patients confronting their own deaths, not with bereaved families[1]. The model was later applied to bereavement and took on a life of its own. Kübler-Ross herself wrote late in her career that the stages were never meant to be a tidy, linear package.

When researchers actually tested stage theory in bereaved people, the data did not cooperate. A study in JAMA following bereaved adults over two years found that yearning, not anger or depression, was the dominant painful experience, and that acceptance was present early and grew steadily rather than arriving at the end of a sequence[2].

What grief usually looks like instead

Psychologist George Bonanno’s research, following thousands of bereaved people over time, found something quietly hopeful: the most common pattern after loss is resilience. Most people experience acute pain that comes in waves and gradually softens, while they continue to function, love, and even laugh[3]. Laughing at a funeral story does not mean you loved the person less. It appears to be part of how humans survive loss.

Researchers Margaret Stroebe and Henk Schut describe healthy grieving as an oscillation. In their Dual Process Model, people swing between loss-oriented moments (crying, missing, remembering) and restoration-oriented ones (handling paperwork, returning to work, building a changed life)[4]. Both are grief. The back-and-forth is not avoidance; it is the mechanism.

When grief needs more support

For most people, grief remains painful but livable and slowly integrates. For roughly one in ten bereaved adults, it does not: the yearning and preoccupation stay at full intensity, and life stops restarting[5]. When that picture persists for a year or more and impairs daily functioning, clinicians now call it prolonged grief disorder, added to the DSM-5-TR in 2022[6]. This is not grieving “too much” or loving “too long.” It is a treatable condition, and targeted therapies developed for prolonged grief have performed well in trials[5].

If someone you love is grieving, you do not need perfect words. Show up, say the person’s name, tolerate the tears you cannot fix, and keep showing up after the casseroles stop. And if your own grief feels frozen at full volume long after the loss, asking for help is not a betrayal of the person you lost. It is a way of carrying them forward.

A note from HEALS: this article is educational and is not medical advice, diagnosis, or treatment. If you are struggling, please talk with a licensed clinician. If you are in crisis, call or text 988 (Suicide and Crisis Lifeline), available 24/7.

References

  1. Kübler-Ross E. On Death and Dying. Macmillan; 1969.
  2. Maciejewski PK, Zhang B, Block SD, Prigerson HG. An empirical examination of the stage theory of grief. JAMA. 2007;297(7):716-723.
  3. Bonanno GA. Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist. 2004;59(1):20-28.
  4. Stroebe M, Schut H. The dual process model of coping with bereavement: rationale and description. Death Studies. 1999;23(3):197-224.
  5. Lundorff M, Holmgren H, Zachariae R, Farver-Vestergaard I, O’Connor M. Prevalence of prolonged grief disorder in adult bereavement: a systematic review and meta-analysis. Journal of Affective Disorders. 2017;212:138-149.
  6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). 2022.
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