The process of grieving can be compared to the workings of a pinball machine, where mourners' movement between different stages of grief such as shock and depression may be unpredictable, according to authors writing in September's issue of Mental Health Practice journal.

Margaret Baier of Baylor University, Waco, Texas and Ruth Buechsel of Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas, say they are not trying to suggest grief is a game or downplay the experience, but that the metaphor can help people understand that grieving is not a linear process.

As on a pinball machine, there are triggers which can prolong or even restart the process. For the mourner these could be the anniversary of a death or a special event they used to share with their loved one. This model can be used in therapy by healthcare professionals to help people understand that their responses are normal. It may also be adaptable to help those coping with separation, divorce, loss of employment or financial loss, say the authors.

They identify numerous models and factors for understanding grief in the literature as helpful in predicting coping and adjustment in bereavement. However, they say, many of the models are misinterpreted as linear. Grieving patients often speak of feeling as though they are 'bouncing' from one stage to another, which elicited the image of a pinball.

They say their model contains elements of the seminal work by Kubler-Ross (1969) but illustrates the process in a way that helps bereaved people see and understand their emotional processes, which helps them normalise and move through the experience of grief. This normalisation may help people to relax and better process grief, make sense of a seemingly chaotic experience, and be prepared when grief is triggered by other events or prolonged, as in the process of complicated grief.