Five Stages of Grief
The Kübler-Ross model, or the five stages of grief, is a series of emotional stages experienced when faced with impending death or death of someone. The five stages are denial, anger, bargaining, depression and acceptance.
The model was first introduced by American Psychiatrist Elisabeth Kübler-Ross in her 1969 book, On Death and Dying, and was inspired by her work with terminally ill patients.[1] Motivated by the lack of curriculum in medical schools on the subject of death and dying, Kübler-Ross began a project which examined death and those faced with it while working as an instructor at the University of Chicago's medical school. Kübler-Ross' project evolved into a series of seminars which, along with patient interviews and previous research became the foundation for her book, and revolutionized how the U.S. medical field takes care of the terminally ill. In the decades since the publication of "On Death and Dying", the Kübler-Ross concept has become largely accepted by the general public; however, its validity has yet to be consistently supported by the majority of research studies that have examined it.[citation needed]
Elisabeth Kübler-Ross noted that the stages are not meant to be a complete list of all possible emotions that could be felt, and they can occur in any order. Her hypothesis holds that not everyone who experiences a life-threatening or life-altering event feels all five of the responses, due to reactions of personal losses differing between people.
Stages
The stages, popularly known by the acronym DABDA, include:[2]
- Denial — As the reality of loss is hard to face, one of the first reactions to follow the loss is Denial. The person is trying to shut out the reality or magnitude of his/her situation, and begins to develop a false, preferable reality.
- Anger — 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. The person in question can be angry with himself, or with others, or at a higher power, and especially those who are close to them. Certain psychological responses of a person undergoing this phase would be: "Why me? It's not fair!"; "How can this happen to me?"; '"Who is to blame?"; "Why would God let this happen?"
- Bargaining — The third stage involves the hope that the individual can somehow undo or avoid a cause of grief. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Other times, they will use anything valuable as a bargaining chip against another human agency to extend or prolong the life they live. In essence, the individual cannot totally move into acceptance yet acknowledges the fact that what has happened cannot be undone. People facing less serious trauma can bargain or seek to negotiate a compromise. For example, one may say "Can we still be friends?" when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it is a matter of life or death.
- Depression — "I'm so sad, why bother with anything?"; "I'm going to die soon so what's the point?"; "I miss my loved one, why go on?"
During the fourth stage, the grieving person begins to understand the certainty of death. Much like the existential concept of The Void, the idea of living becomes pointless. Things begin to lose meaning to the griever. Because of this, the individual may become silent, refuse visitors and spend much of the time crying and sullen. This process allows the grieving person to disconnect from things of love and affection, possibly in an attempt to avoid further trauma. Depression could be referred to as the dress rehearsal for the 'aftermath'. It is a kind of acceptance with emotional attachment. It is natural to feel sadness, regret, fear, and uncertainty when going through this stage. Feeling those emotions shows that the person has begun to accept the situation. Oftentimes, this is the ideal path to take, to find closure and make their ways to the fifth step, Acceptance. - Acceptance — "It's going to be okay."; "I can't fight it, I may as well prepare for it."
In this last stage, individuals begin to come to terms with their mortality or inevitable future, or that of a loved one, or other tragic event. This stage varies according to the person's situation. People dying can enter this stage a long time before the people they leave behind, who must pass through their own individual stages of dealing with the grief. This typically comes with a calm, retrospective view for the individual, and a stable mindset.
Kübler-Ross originally developed this model based on her observations of people suffering from terminal illness. She later expanded her theory to apply to any form of catastrophic personal loss, such as the death of a loved one, the loss of a job or income, major rejection, the end of a relationship or divorce, drug addiction, incarceration, the onset of a disease or chronic illness, an infertility diagnosis, as well as many tragedies and disasters (and even minor losses).
Supporting her theory, many (both sufferers and therapists) have reported the usefulness of the Kübler-Ross Model in a wide variety of situations where people were experiencing a significant loss. The application of the theory is intended to help the sufferer to fully resolve each stage, then help them transition to the next – at the appropriate time – rather than getting stuck in a particular phase or continually bouncing around from one unresolved phase to another. The subsections below give a few specific examples of how the model can be applied in different situations. These are just some of the many benefits that Kübler-Ross hoped her model would provide.
Children grieving in divorce
Denial
Children feel the need to believe that their parents will get back together, or will change their mind about the divorce. Example: “Mom and Dad will stay together.”
Anger
Children feel the need to blame someone for their sadness and loss. Example: “I hate Mom for leaving us.”
Bargaining
In this stage, children feel as if they have some say in the situation if they bring a bargain to the table. This helps them keep focused on the positive that the situation might change, and less focused on the negative, the sadness they’ll experience after the divorce. Example: “If I do all of my chores maybe Mom won’t leave Dad.”
Depression
This involves the child experiencing sadness when they know there is nothing else to be done, and they realize they cannot stop the divorce. The parents need to let the child experience this process of grieving because if they do not, it only shows their inability to cope with the situation. Example: “I’m sorry that I cannot fix this situation for you.”
Acceptance
This does not necessarily mean that the child will be completely happy again. The acceptance is just moving past the depression and starting to accept the divorce. The sooner the parents start to move on from the situation, the sooner the children can begin to accept the reality of it.[3]
Grieving a break-up
Denial
The person left behind is unable to admit that the relationship is really over. They may continue to call the former partner even though that person wants to be left alone. Instead they may deny their feelings and not admit that they are upset about it at all.
Anger
The partner left behind may feel angry for the pain the leaving partner causes them. The partner left also might blame himself/herself.
Bargaining
After the anger stage, the one left behind may plead with their former partner by promising that whatever caused the breakup will never happen again. Example: “I can change. Please give me a chance."
Depression
Next, the person might feel discouraged that his or her bargaining plea did not convince the former partner to stay. This may send the person into depression causing disruption to life functions.
Acceptance
Moving on from the situation and the person is the last stage. The partner left behind accepts that the relationship is over and begins to move forward with his or her life. She or he may not be completely over the situation but is weary of going back and forth, so much so that they can accept the separation as reality.[4]
Grieving in substance abuse
Denial
People feel that they do not have a problem concerning alcohol or substances. Even if they do feel as if they might have a small problem they believe that they have complete control over the situation and can stop drinking or doing drugs whenever they want. Example: “I don’t have to drink all of the time. I can stop whenever I want.”
Anger
The anger stage of abusers relates to how they get upset because they have an addiction or are angry that they can no longer use drugs. Some of these examples include “I don’t want to have this addiction anymore.” “This isn’t fair, I’m too young to have this problem.”
Bargaining
This is the stage that drug and alcohol abusers go through when they are trying to convince themselves or someone else that they are going to stop abusing in order to get something out of it or get themselves out of trouble. Example: “God, I promise I’ll never use again if you just get me out of trouble.”
Depression
Sadness and hopelessness are important parts of the depression stage when dealing with a drug abuser. Most abusers experience this when they are going through the withdrawal stage quitting their addiction. It is important to communicate these feelings as a process of the healing.
Acceptance
With substance abusers, admitting the existence of a problem is different from accepting the problem. When a substance abuser admits that he/she has a problem, this is more likely to occur in the bargaining stage. Accepting that he/she has a problem is when you realise that you have a problem and start the process to resolve the issue.[5]
As stated above, according to her hypothesis, Kübler-Ross claimed these stages do not necessarily come in order, nor are all stages experienced by all patients. She stated, however, that a person always experiences at least two of the stages. Often, people 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.[2] Women are more likely than men to experience all five stages.[2]
However, the Kübler-Ross hypothesis holds that there are individuals who struggle with death until the end. Some psychologists believe that the harder a person fights death, the more likely they will be 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.[2]