Kübler-Ross model

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.^[1]

Included in the book was a model, The Model of Coping with Dying, which she based on research and interviews with more than 500 dying patients. It describes, in five discrete stages, a process by which people cope and deal with grief and tragedy, especially when diagnosed with a terminal illness or experience a 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 or illness.^[2]

Kübler-Ross added that it's important to note that these stages are not meant to be complete or chronological. Not everyone who experiences a life-threatening or life-changing event feels all five of the responses nor will everyone who does experience them do so in the order in which they are written. Reactions to illness, death, and loss are as unique as the person experiencing them.

Not everyone goes through all of the steps or goes through them in a linear fashion. Some steps may be missed entirely, others may be experienced in a different order, some may be re-experienced again and again and some may get stuck in one.

These stages of coping with dying are now commonly referred to as the Kübler-Ross model, The Five Stages of Dying, The Five Stages of Grief, The Five Stages of Loss, The Five Stages of Coping with Dying, The Five Stages of Coping with Grief or The Five Stages of Coping with Loss.

Stages

The stages, popularly known by the acronym DABDA, include:^[2]

1. 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 possessions and individuals that will be left behind after death.
2. 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.
3. Bargaining — "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 do something to buy more time..."
4. Depression — "I'm so sad, why bother with anything?"; "I'm going to die soon so what's the point... 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 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.
5. 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 that of a loved one, or other tragic event.

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, major rejection, end of a relationship or divorce, drug addiction, incarceration, change in office environment, the onset of a disease or chronic illness, an infertility diagnosis, as well many tragedies and disasters.

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.^[2]

However, 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] 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 his 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.^[2]

Criticism

The extensive work of George Bonanno has shown that the Kubler-Ross stage theory of grief has no defined scientific basis.^[3][4] 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.^[5] 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.^[6]

Notes

1. ^ Broom, Sarah M. (Aug. 30, 2004). "Milestones". TIME. http://www.time.com/time/magazine/article/0,9171,689491,00.html. 
2. ^ ^{a b c d e} Santrock, J.W. (2007). A Topical Approach to Life-Span Development. New York: McGraw-Hill. ISBN 0073382647. 
3. ^ The Neuroscience of True Grit. Gary Stix, 15 February 2011. Scientific American.
4. ^ New Ways to Think About Grief. Ruth Davis Konigsberg, 29 January, 2011, Time Magazine.
5. ^ An Empirical Examination of the Stage Theory of Grief Maciejewski, P.K., JAMA (February 21, 2007). Retrieved April 14, 2009.
6. ^ Friedman and James. "The Myth of the Stages of Dying, Death and Grief", Skeptic Magazine (2008). Retrieved 2008, from http://www.grief.net/Articles/Myth%20of%20Stages.pdf

Further reading

• Kübler-Ross, E. (1969) On Death and Dying, Routledge, ISBN 0415040159
• Kübler-Ross, E. (2005) On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss, Simon & Schuster Ltd, ISBN 0743263448
• Scire, P. (2007). "Applying Grief Stages to Organizational Change"
• An Attributional Analysis of Kübler-Ross' Model of Dying, Mark R Brent. Harvard University, 1981.
• An Evaluation of the Relevance of the Kübler-Ross Model to the Post-injury Responses of Competitive Athletes, Johannes Hendrikus Van der Poel, University of the Free State. Published by s.n., 2000.

External links

• Elisabeth Kübler-Ross Homepage
• Elisabeth Kübler-Ross - Five Stages of Grief
• On Death and Dying - Interview with Elizabeth Kübler-Ross M.D.
• Beware the Five Stages of Grief - TLC Group Editorial
• Analysis of a Mozart string quintet using the Kübler-Ross model as a paradigm
• "Good News About Grief" - A different take on whether or not there are 5 stages. 1/24/11 by Ruth Davis Koningsberg