Deacon Mike Steele, Ph.D., on the need to be there to understand

New Doesn’t Mean It Is Accurate!

By now most of us have probably read or heard about the longitudinal cohort study, “An Empirical Examination of the Stage Grief Theory.” I finally took time to read this article that appeared in The Journal of American Medical Association.[1]

The researchers concluded that the familiar death-related stages of grief are more accurately defined as: disbelief, yearning, anger, depression, and acceptance. The newly defined stages are in disagreement with the Kubler-Ross stages of denial-disassociation-isolation, anger, bargaining, depression, and acceptance that most of us learned as CPE students. Equally important is the assertion that grief stages reach their climax by the end of twenty-four months.

I find fault with the studies conclusions. The findings are proven statistically; however, the cohort is not representative of the people who were in attendance at the majority of deaths that I experienced during the past decade as a chaplain. Additionally, the new grief stage theory only confirms what I already knew experientially: that is, older surviving family members who experience the natural death of an approximate similarly aged loved one, are more accepting and resolve their grief in a shorter period of time than younger family members who have suffered the loss of a younger loved one, especially someone whose death was medically unexpected or the result of trauma.

The researchers did not contact grieving survivors until more than six months after the death. They refined the cohort by excluding anyone meeting the definition of a complicated grief disorder, and anyone whose family members’ death was related to a traumatic event. They also excluded family members who said they were too upset to participate. These disclosures place the study’s conclusion outside of the cohort I would construct – the very people I encountered on a daily basis when most of my time was spent in the ER trauma rooms – those loud and demonstrative survivors whose loved one was about to die from an event other than a natural death.

I was disappointed by the researcher’s lack of attention to the sociological, psychological, and theological dynamics of families caught up in the reality of a moribund death: the family who moves in-tandem with their loved to an ICU for the last hours or days of their life. Like so many comparative experiences of life, the researchers “would have to have been there to understand it.”

I believe these omissions and oversights disqualify the assertions of the study. The episodic memory of survivors after six-months is often a tainted expression of what has been suppressed or repressed immediately following the emotional moments of death – so much so that memory is no longer declarative, but non-declarative. This is the result of habit, not conscious thought, consequently putting “yes and no” responses to the testing instrument in doubt.

It would be harmful for me to generalize or suggest to family members in any imminent death situation that they will be accepting of their loved one’s death when it occurs and that they will only grieve for about twenty-four months.

This study shows that those who have been there and understand what is going on are the ones who should be writing these articles – we chaplains need to claim our knowledge and experiences so that we can ensure that the cohorts that we know will accurately reflect what these researchers were trying to prove, are included and count. However, most pastoral care departments are incapable of initiating or completing the long-term research that would have to be done. Not because the individual chaplains are unqualified; but because their "plate is already full."

On the other hand, there are pastoral service departments at Level One trauma centers at major university hospitals with ample medical and psych residents who are connected to on-campus seminaries that offer masters and doctoral degrees: that is where the human capital to see a project of this kind through might be found. The students and their department heads who might already be interacting with staff chaplains could assist in the design and completion of the longitudinal study. Furthermore, the students might be easily enticed by the possibility of graduate credit for their participation.

Foremost in all of this is that the creation-design process would begin with "us:" the chaplains who live the experience and bring it into the life of the design research.

Footnote

[1] Maciejewski PK et al. "An empirical examination of the stage theory of grief." JAMA 2007 Feb 21; 297:716-23.

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