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bereaved persons) but through the contact of ‘‘over two hundred dying patients’’ (p. 38). Despite this number, in Parkes’ (2013) view, there was lack of scientific rigor: On Death and Dying was simply ‘‘a collection of case studies in the form of conversations with dying patients’’ (p. 94). Surprisingly little empirical testing of stage theory has been subsequently undertaken—as Archer (1999) pointed out, this is difficult to do. Table 2 reviews relevant studies, indicating little support and quite some refutation of the stages. In conclusion: While there is empirical evidence that people experience (some of) the emotional and cognitive reactions some of the time, there is little to support the sequential development of these in stages. 4. The availability of alternative models. The stages approach has been supplanted by finer grained, sometimes theoretically based, more-representative-of-the-grieving-process models of grief and grieving (see Table 3; for reviews, see Boerner, Stroebe, Schut, & Wortman, 2015; Doka & Tucci, 2011; Stroebe & Schut, 2001). These alternative perspectives, developed over the years, are well known but received no acknowledgment or discussion by Ku¨bler-Ross and Kessler (2005). 5. The devastating consequences of using stage theory. Last, but certainly not least, it is important to recognize that using the stages approach as a guideline in supporting bereaved persons may raise undue expectations, even presumptions about the course that grief should take. Naturally, some bereaved people may feel affirmation from reading about incorporation of emotions such as anger or despair in stage theory: If they fit one’s personal experience, they provide verification. Ku¨bler-Ross received a large fan mail confirming this. However, such positive appraisal does not Stroebe et al. 461 provide evidence for the sequence of stages in general, nor does it follow that the stages should be taught or used in therapy. Silver and Wortman (2007) stated: A mistaken belief in the stage model . . . can have devastating consequences. Not only can it lead bereaved persons to feel that they are not coping appropriately, but Table 1. Misrepresentation of Grief and Grieving in Stage Theories: Major Concerns. Oversimplicity Approach does not account for enormous diversity in grief reactions either between individuals or across time. Theoretical models should at least attempt to explain variability. Passive model Describes what a bereaved person is put through; the effortful struggle of coming to terms with loss is not represented. Complex nature of coping with loss Takes no account of recuperative purpose of avoiding reality of death at times of doing other things to regain strength to cope. Inclusion of poorly defined concepts Stage formulations incorporate broad, imprecise terms (some stages are emotions, some cognitive processes; e.g., ‘‘depression’’ could range from clinical depression to sadness). Implication of smooth progression Notion of replacement of one stage by another poorly represents all we know about the course of grief over time, particularly regarding the fluctuations between emotions and cognitions that typify grief and grieving. Prescriptive statements/ interpretations ‘‘Anger is a necessary stage of the healing process. Be willing to feel your anger, even though it may seem endless. The more you truly feel it, the more it will begin to dissipate and the more you will heal’’ (Ku¨bler-Ross & Kessler, 2005, p. 12). While anger is a common grief symptom (Archer, 1999), evidence shows it is not a universally experienced emotion (Bonanno & Keltner, 1997; Shuchter & Zisook, 1993). Failure to account for secondary stressors Lack of attention to other stressors not related to grief that needs to be taken into account in assessing adaptation (e.g., ongoing life changes, new roles, and identities). Neglect of the social/cultural context of grieving Neglects broader social context of grief and grieving. No account of interpersonal factors (e.g., processes relating to family members coping together; Stroebe & Schut, 2015), culturally shared meanings (Rosenblatt, 1983, 2013), social relations and power dimensions (Thompson, 2002), and historical and cross-cultural As early-career researchers studying the end of life, we recognise that scholarly activity in the field of death studies - an umbrella term for research spanning all aspects of death, dying and bereavement, including end of life care - is growing in popularity. Since we completed our PhDs (less than 7 years ago), the number of U.K. universities offering courses on deathrelated topics has increased, mailing lists and online chat groups have multiplied, and the range of international seminars and conferences addressing topics in the field is expanding. This mounting interest in death studies makes this an opportune time to consider the methodological issues that doing research on death, dying, and bereavement present. Mortality is a flagship journal in this interdisciplinary field. Read by both academics and practitioners, and with an increasingly international authorship and audience, it is an ideal space to consider contemporary methodological issues and challenges. As editors of this special issue we have brought together a range of articles written by researchers which foreground and explore in detail matters pertaining to the study of death. As a collection, the articles seek to generate
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