Lea Michele, shattered by the unexpected death of her boyfriend Cory Monteith, issued a statement through a representative, asking that others respect her privacy.

Michele's 31-year-old long-term boyfriend and co-star was found dead in a luxury hotel room in Vancouver, Canada on Saturday. The night before, Monteith and friends had gone out after spending time in his hotel room. Although there are no implications of foul play, medical examiners will conduct an autopsy today, the results of which are expected to be released shortly. No cause of death has been confirmed as of yet.

Michele, 26, was in Mexico when news of his death reached her. "She is absolutely hysterical and completely inconsolable. She is devastated beyond belief," a source reputedly told the press. In well-documented psychological terms, Michele may be said to have entered the first phase of grief.

Five Stages

When Elisabeth Kübler-Ross published On Death and Dying in 1969, only very elementary models outlining how most people grieve existed. Although she derived her theory from countless interviews with terminally ill patients, she probably drew inspiration from the earlier theories of Bowlby and Parkes. According to their outline of grief, shock and protest comprise the initial phase, followed by preoccupation, disorganization, and resolution.

Trained in psychiatry, Kübler-Ross' desire was to create a systematic approach when talking with patients about dying, death, and grieving. She derived her 'five stages' model from the process she witnessed again and again in her patients at the University of Chicago Pritzker School of Medicine as they faced a diagnosis of terminal illness. Although later she would expand the model, her original sketch consisted of these five stages of grief:

  • Denial, when we cannot believe what is happening
  • Anger, when we search for blame, and lash out
  • Bargaining, when we believe that magical cures and Faustian deals can be made
  • Depression, when the weight of reality crushes the will to do anything
  • Acceptance, when we determine to come to terms with what faces us

Although some have questioned whether Kübler-Ross' research was 'valid' medical research (as she conducted her research via personal interviews), her stage theory of grief was widely accepted almost immediately, and today it is still taught in medical schools, espoused by physicians, and discussed as pop psychology in the media. Recently, though, researchers at Yale University, the Dana-Farber Cancer Institute, and other institutions questioned whether a natural psychological response to loss involves such an orderly progression through distinct stages of bereavement.

In an effort to gain a greater understanding of grief, they decided to put Kubler-Ross' theory to the test.


In search of empirical evidence, the researchers examined the Yale Bereavement Study for patterns of change over time post-loss to determine if any consistency existed with the stage theory of grief. The study included 233 bereaved participants living in Connecticut, with data collected during a three-year period. The researchers assessed disbelief, yearning, anger, depression, and acceptance of death from one to 24 months post-loss.

In models that take into account the rise and fall of psychological responses, disbelief decreased from an initial high at one month post-loss, yearning peaked at four months post-loss, anger peaked at five months post-loss, and depression peaked at six months post-loss. Acceptance increased throughout the study observation period.

"The results of this study provide what appears to be the first empirical examination of the stage theory of grief. They indicate that in the circumstance of natural death, the normal response involves primarily acceptance and yearning for the deceased. Each grief indicator appears to peak in the sequence proposed by the stage theory," wrote the authors.

Significantly, all of the negative grief indicators were in decline by approximately six months post-loss. "Once the normal patterns of grief are known, individuals with abnormal bereavement adjustment can be identified," concluded the authors, suggesting that those who continue to experience the four earliest stages of grief — denial, anger, bargaining, or depression — beyond six months be recommended for treatment.

The psychological ramifications of grief, then, may be said to have been defined and encoded so that the normal grieving process is documented and understood. A pathological response to grief, then, has also been defined as the converse experience to what is 'normal.' The question remains as to whether there are any physical implications of grief.

Physical Response To Death

The relationship between bereavement and increased risk of morbidity and mortality has been well-documented, yet the biological mechanism(s) by which grief leads to increased risk for medical illness is not clear. Some individuals may be more vulnerable to bereavement, and this vulnerability may be due to some unidentified psychological, neuroendocrine, or immunologic factor that places them at increased risk.

The root theory underlying psychoneuroimmunology suggests that relationships exist among behavior, psychosocial environment, experience, and the immune system. No other group of people so clearly exhibits this intertwining of the immune system with the environment and experience than those who have recently been bereaved. Simply put, the death of an elderly spouse increases depressive symptoms, and depression increases the risk of death.

Death of a spouse is consistently rated as the most stressful of common experiences. In a study conducted in Iceland, researchers sought to assess whether widowers had an increased mortality rate during the first six to nine years after the death of their wife, compared initially to an age-matched control group and also compared to the general population of Iceland. The population base of the study comprised 371 men who were widowed in 1999-2001 and 357 controls, married men, who were matched by age and residence. The widowers and controls were followed, and mortality rates were compared between the groups as well as with the general population. "Being a widower was related to an increased risk of death for at least 9 years after the death of their wife," concluded the authors, observing a statistically significant increase in mortality among the widowers.

Another study, which attempted to pin down a link between bereavement and cause of death, used data obtained from the National Heart, Lung, and Blood Institute. Of the 5,795 older men and women aged 65 years and older in the Cardiovascular Health Study, 3,820 were married and 1,436 were widows or widowers. The researchers assembled a cohort of 819 pairs of widowed and married participants who were balanced on 74 baseline characteristics, such as gender, age, and ethnicity. Among the paired participants, 46 percent of those who were married died during roughly 11 years of follow-up, while five percent more (51 percent) of the widowed participants met their death. The causes of mortality encompassed all manner of death; the researchers concluded that cardiovascular events did not contribute to a greater number of either hospitalizations or incident among those widowed.

The vast majority (94 percent) of deaths in the U.S. are the result of natural causes and so the 'normal' stages of psychologically processing death is both relevant and of concern to most. After completing her work on the five stages of grief, Kübler-Ross turned to more controversial investigations: life after death, out-of-body experiences, and spiritual mediums. She then worked extensively with AIDS patients. The 1994 arson fire, in which she lost her house and possession, is suspected to have been set by opponents of her work in this area.

Having publicly stated that she was ready for her own death, Kübler-Ross died in 2004 at her home in Arizona.

Sources: Skulason B, Jonsdottir LS, Sigurdardottir V, Helgason AR. Assessing survival in widowers, and controls - a nationwide, six- to nine-year follow-up. BMC Public Health. 2012.

Williams BR, Zhang Y, Sawyer P, et al. Intrinsic association of widowhood with mortality in community-dwelling older women and men: findings from a prospective propensity-matched population study. The Journals of Gerontology. 2011.

Maciejewski PK, Zhang B, Block SD, Prigerson HG. An Empirical Examination of the Stage Theory of Grief. JAMA. 2007.