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The Kübler-Ross model, commonly known as the five stages of grief, was first introduced by Elisabeth Kübler-Ross in her 1969 book, On Death and Dying.
It describes, in five discrete stages, a process by which people deal with grief and tragedy, especially when diagnosed with a terminal illness or catastrophic loss. In addition to this, her book brought mainstream awareness to the sensitivity required for better treatment of individuals who are dealing with a fatal disease.
Stages
- Denial — “I feel fine.”; “This can’t be happening, not to me.”
Denial is usually only a temporary defense for the individual. This feeling is generally replaced with heightened awareness of situations and individuals that will be left behind after death.[1]
- Anger — “Why me? It’s not fair!”; “How can this happen to me?”; “Who is to blame?”
Once in the second stage, the individual recognizes that denial cannot continue. Because of anger, the person is very difficult to care for due to misplaced feelings of rage and envy. Any individual that symbolizes life or energy is subject to projected resentment and jealousy.[1]
- Bargaining — “Just let me live to see my children graduate.”; “I’ll do anything for a few more years.”; “I will give my life savings if…”
The third stage involves the hope that the individual can somehow postpone or delay death. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Psychologically, the individual is saying, “I understand I will die, but if I could just have more time…”[1]
- Depression — “I’m so sad, why bother with anything?”; “I’m going to die . . . What’s the point?”; “I miss my loved one, why go on?”
During the fourth stage, the dying person begins to understand the certainty of death. Because of this, the individual may become silent, refuse visitors and spend much of the time crying and grieving. This process allows the dying person to disconnect oneself from things of love and affection. It is not recommended to attempt to cheer up an individual who is in this stage. It is an important time for grieving that must be processed.[1]
- Acceptance — “It’s going to be okay.”; “I can’t fight it, I may as well prepare for it.”
This final stage comes with peace and understanding of the death that is approaching. Generally, the person in the fifth stage will want to be left alone. Additionally, feelings and physical pain may be non-existent. This stage has also been described as the end of the dying struggle.[1]
Kübler-Ross originally applied these stages to people suffering from terminal illness, later to any form of catastrophic personal loss (job, income, freedom). This may also include significant life events such as the death of a loved one, divorce, drug addiction, an infertility diagnosis. Kübler-Ross claimed these steps do not necessarily come in the order noted above, nor are all steps experienced by all patients, though she stated a person will always experience at least two. Often, people will experience several stages in a “roller coaster” effect – switching between two or more stages, returning to one or more several times before working through it.[1]
Significantly, people experiencing the stages should not force the process. The grief process is highly personal and should not be rushed, nor lengthened, on the basis of an individual’s imposed time frame or opinion. One should merely be aware that the stages will be worked through and the ultimate stage of “Acceptance” will be reached.
However, there are individuals that struggle with death until the end. Some psychologists believe that the harder a person fights death, the more likely they are to stay in the denial stage. If this is the case, it is possible the ill person will have more difficulty dying in a dignified way. Other psychologists state that not confronting death until the end is adaptive for some people.[1] Those who experience problems working through the stages should consider professional grief counseling or support groups.
Cultural relevance
A dying individual’s approach to death has been linked to the amount of meaning and purpose a person has found throughout their lifetime. A study of 160 people with less than three months to live showed that those who felt they understood their purpose in life, or found special meaning, faced less fear and despair, in the final weeks of their lives than those who had not. In this and similar studies, spirituality helped dying individuals deal with the depression stage more aggressively than those who were not spiritual. [1]
Criticism
According to George Bonanno[2], professor of clinical psychology of Columbia University, in his book “The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After a Loss,” based on two decades of rigorous scientific studies that follow people who have suffered losses in the U.S. and in other cultures, there is no evidence to support the Kübler-Ross theory[3]
A 2000-2003 study of bereaved individuals conducted by Yale University obtained some findings that were consistent with the five-stage theory and others that were inconsistent with it. Several letters were also published in the same journal criticizing this research and arguing against the stage idea. [4] Skeptic Magazine published the findings of the Grief Recovery Institute, which contested the concept of stages of grief as they relate to people who are dealing with the deaths of people important to them.[5]
