No Neat Stages

There’s a widespread belief that people should work through their feelings of shock or disappoint before they can move forward emotionally in their fertility journey. Many more believe there are neat stages of recovery from loss and worry.

Well, research finds that life doesn’t work that way—and neither does fertility treatment!

The original idea of “neat stages” of adjustment to a shock or loss was described by Swiss psychiatrist Elisabeth Kübler-Ross. She wrote that we go through the following emotional steps in this order:  

• Denial of the shock or loss
• Anger about the shock loss
• Bargaining, with yourself or God, to undo the shock or loss
• Depression about the shock or loss
• Acceptance of the shock or loss

However, research has found that the notion of neat stages is a myth. Instead, we each work through our recovery from stress or grief at different rates and we can experience and deal with more than one symptom and feeling at the same time. That means we can be sad, worried, or frightened about past fertility results and yet hopeful and excited about the next steps.

The research is interesting:

• A review of grief research in Scientific American by Michael Shermer finds that no scientific study has ever demonstrated that stages of grief exist.
• Yale research in the Journal of the American Medical followed 233 recently bereaved people and found that most accepted a major loss from the very beginning.
• The same study found that anger was the least experienced emotion after a loss. Yearning or sadness is more frequent.
• The Washington Center for Advancing Health report concluded that latest research shows grief is more of a grab bag of symptoms that come and go and, eventually lift.  
• Even if you are experiencing stress symptoms during fertility treatment, current research reported in Psychology Today finds that resilience is natural to humans, and even tragedies like September 11 or a pregnancy loss, often do not disrupt relatively stable daily-life.

This is good news for two reasons. First, the theory can put guilt and pressure on people who are not feeling the stages they think they ‘should’. Second, believing that we have to work through disappointment about a fertility failure before we can move on to a new or different option may delay treatment for months or years, and that means sadness and stress are prolonged.

So why does the theory of neat stages persist? Probably because the more our sense of control goes down, the more stress goes up and the idea of ‘neat stages’ may give us a feeling that there is still some predictability in our world, even when our fertility journey feels unpredictable.  It’s as if the “stages” notion is telling us that we may feel bad now, but we will eventually arrive at acceptance. 

We usually do arrive at acceptance, but for a different reason than because we marched through stages. We are built for daily life, so most symptoms of stress gradually dissipate after a time and moments of joy, and even laughter, can re-emerge after losses and co-exist with disappointment and stress.

The bottom line is this: you will only know that you are ready to move on if you try moving on. So, try and then try again. Moving forward is the real next stage. 

ABOUT AUTHOR

 Georgia Witkin, Ph.D., is the Director of Patient Services Development for Progyny and an Assistant Professor of Psychiatry and Ob/Gyn and Reproductive Sciences at Mt. Sinai School of Medicine.