November 01, 2018


Anxiety: The Missing Stage of Grief—A Revolutionary Approach to Understanding and Healing the Impact of Loss. By Claire Bidwell Smith, L.C.P.C. Da Capo. $26.

     Licensed Clinical Professional Counselor Claire Bidwell Smith, a specialist in helping people deal with loss and the grieving that comes with and after it, offers in Anxiety: The Missing Stage of Grief a series of stories, including personal ones from her own life, plus clinical notes on the cases she discusses, and exercises for the reader to help him or her get in touch with his or her feelings about the various circumstances. Essentially that is the whole book: a series of stories, notes and exercises. Smith uses the format to indicate how widespread anxiety is after a deep personal loss. Indeed, she suggests that the five stages of grief, enumerated by Elizabeth Kübler-Ross, M.D., in a book intended for the terminally ill rather than for survivors, do not tell the whole story. Those stages are denial, anger, bargaining, depression, and acceptance – and to Kübler-Ross’ credit, she correctly observes that there is nothing linear about the stages: individuals may experience one, then another, then go back to the earlier one, then onward, and so forth. The goal of counseling, then, is to help people find their way, in their own fashion, to the final stage of acceptance. In counseling for survivors of loss, this means people can get on with their refashioned lives.

     Smith acknowledges, and even emphasizes, the ways in which life changes when a loved one dies, and suggests that society’s current preoccupation with speed in so many things creates a “get over it” mentality and pressure that in turn produce anxiety when people find they cannot “get past” a major loss easily or completely. Certainly there is considerable truth to this: external societal pressures are often incompatible with inward feelings, and our current move-on-to-the-next-thing-quickly attitude, so prevalent in so many areas, affects loss and grieving as well. Whether this, in and of itself, leads to anxiety, is not quite so clear-cut, however, and whether anxiety is a separate stage of grief or a response to another stage is not clear-cut, either.

     What mattes, though, is not whether Smith has made a significant “stage discovery” but whether her descriptive approach generates prescriptive behavior that can help readers of her book handle loss-caused stressors in their own lives. The answer to this question is: it depends. The basic notion that anxiety is a normal, natural and to-be-expected response to a deeply felt loss is certainly reassuring, and that alone carries benefits for people experiencing the death of a loved one – or, for that matter, deep grief of another sort, such as the descent of a parent or spouse into advanced Alzheimer’s disease, although Smith does not acknowledge this. But Smith’s approach to handling the anxiety is very much a New Age-y, California-ish one (her counseling practice is in Los Angeles): mindfulness, meditation and yoga. As a generalized prescription, this is, not to put too fine a point on it, nonsense. Some people, those predisposed to engage in meditation and other guided forms of inward-looking behavior, will surely benefit from what Smith suggests. But turning these rarefied, distinctly leisure-class pursuits into a panacea for the deep anxiety associated with loss of a loved family member is at best naïve, at worst disingenuous. Of course, Smith draws her clients from the geographical area where she lives and the societal class to which she belongs, so the fact that she wears blinders regarding alternative possibilities is scarcely surprising, however disappointing it may be.

     What is valuable in Smith’s book is her acknowledgment that the death of a loved one leads to permanent changes in a survivor’s life and worldview, and that this is normal; and, furthermore, that the anxiety provoked by the death itself and by the disconnect between societal expectations and internal feelings is real, understandable and, again, normal. The ultimate goal of moving through grief is learning to live with it, since the alternative is not living with it, which means either not living at all (therapists are well aware of the frequency with which long-married couples die within months of each other) or repressing the elements of grief in a way that creates long-term negative emotional and behavioral effects. To the extent that Smith’s book explores an element of grieving that is not always clearly identified as such, it does a considerable service for readers striving to cope with the losses in their lives. On the other hand, to the extent that Smith’s approach involves example after example, story after story, exercise after exercise, it is dull to read and difficult to get through from start to finish. And her one-size-fits-all lifestyle-modification approach to overcoming anxiety is presented in a way that is irritatingly self-assured. Smith comes across as a genuinely empathetic and concerned grief counselor, no doubt thanks in part to her own experiences after the deaths of her parents. But for readers who do not have direct, personal access to her office and her treatment, Anxiety: The Missing Stage of Grief is likely to seem both repetitious and facile.

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