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the publication of On Death and Dying, prominent writers (including many with cautionary words) reported Ku¨bler-Ross’s stages of grief relating to bereavement. For example, already in 1975, Lopata referred to the existence of a ‘‘‘stages of grief’ ideology’’ (p. 50), describing: ‘‘the currently popular conception of stages of widowhood.’’ She went on to regret that: ‘‘However the stages of widowhood originated, it has become disseminated to at least the Chicago area women with great effectiveness. . . . Significant others . . . have an ideal typical sequence of stages in mind’’ (Lopata, 1975, p. 50). Other formulations of stages or phases appeared over the following decades (Bowlby, 1980; Horowitz, 1976; Jacobs, 1993; Sanders, 1989; Shuchter & Zisook, 1993), varying in labels (e.g., various combinations of disbelief, numbness, yearning, shock, and guilt), numbers of stages (e.g., 3, 4, and 7), and general guidelines (e.g., emphases on fluidity vs. rigidity). It is beyond our scope to review all, but our arguments can be considered in the context of these approaches. Stroebe et al. 457 It was Ku¨bler-Ross’s volume which became an international bestseller, even, according to Friedman and James (2008), reaching the status of ‘‘one of the most influential books in the history of psychology’’ (p. 37). Indeed, Ku¨bler-Ross succinctly both formulated and popularized stage theory, promoting it throughout her life. She was also a charismatic person, much admired and loved by her followers, even described as ‘‘legendary’’; in 1999, Time Magazine named Ku¨bler-Ross as one of the ‘‘100 Most Important Thinkers’’ of the past century (from her obituary); in 2007, she was posthumously inducted into the United States Women’s Hall of Fame. Already by 1982, Ku¨bler-Ross estimated that her stages had been taught in 125,000 courses in colleges, seminaries, medical schools, hospitals, and social work institutions (Rosenbaum, 1982; Wortman & Silver, 1987). By 2016, On Death and Dying reached a remarkable figure of well over 11,000 citations in Google Scholar. Contributions of both Parkes and Bowlby, around the time that Ku¨bler-Ross’s monograph was published, avoided some of the pitfalls of stage theory, going on to become major contributions to understanding of the course of grief and grieving.1 These researchers incorporated the notion of phases in a theory-based manner (following attachment theory principles; Bowlby, 1980; Parkes, 2006). More cautiously than Ku¨bler-Ross’s (1969) presentation of stages, Bowlby (1980) stated: ‘‘these phases are not clear cut, and any one individual may oscillate for a time back and forth between any two of them’’ (p. 85). Looking across the decades, a highly influential source of opposition to stage theory came from Wortman and Silver (Silver & Wortman, 1980; Wortman & Silver, 1987, 1989, 1992), who drew attention to the alarmingly widespread adoption of stages among health-care professionals, with disastrous consequences for the bereaved, despite lack of solid evidence. Their classic article of 1989, ‘‘The Myths of Coping With Loss,’’ criticized Ku¨bler-Ross’s expectation of recovery through to the final, acceptance stage of grieving, pointing to longer, varying courses of grieving among many bereaved people (without indications of pathology). Their conclusions were echoed in the Institute of Medicine’s authoritative review, which cautioned: The notion of stages might lead people to expect the bereaved to proceed from one clearly identifiable reaction to another in a more orderly fashion than usually occurs. It might also result in inappropriate behavior toward the bereaved, including hasty assessments of where individuals are or ought to be in the grieving process. (Osterweis & Green, 1984, p. 48) A strongly worded statement by Neimeyer (2000) extended the concerns to stage theory’s use as a conceptual model for underpinning counseling, denouncing use of suspiciously simplistic models, such as stage theories of grieving that have been largely repudiated by contemporary theorists and researchers... grief 458 OMEGA—Journal of Death and Dying 74(4) counseling ...rarely draws on the best available theories regarding the nature of bereavement and its facilitation. (p. 547) Many other researchers and clinicians have taken issue with stage theory. For example, Shuchter and Zisook (1993), describing the course of normal grief (in three flexible phases), too cautioned against the literal use of stages: ‘‘Grief is not a linear process with concrete boundaries but, rather, a composite of overlapping, fluid phases that vary from person to person’’ (p. 23). Similarly, Jacobs (1993) drew attention to oversimplification: Although it is sometimes instructive to conceptualize the manifestations of grief in this manner, it is important to emphasize that the idea that grief unfolds inexorably in regular phases is an oversimplification of the highly complex, personal waxing and waning of the emotional process. (p. 18) Since the early 1990s, Corr (1993, 2011) has become a major opponent of the stage theory approach for dying patients and for the bereaved (Corr, 2015), reviewing earlier criticisms (e.g., lack of scientific corroboration, conceptual inadequacies, and inappropriateness of the language of stages leading to prescriptive use by practitioners). Neither these nor other criticisms impacted on Ku¨bler-Ross’s adherence to stages.
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