The Kübler-Ross model, commonly referred to as the "five stages of grief", is a hypothesis introduced by Elisabeth Kübler-Ross and says that when a person is faced with the reality of impending death or other extreme, awful fate, he or she will experience a series of emotional stages: denial, anger, bargaining, depression and acceptance. This hypothesis was introduced in Kübler-Ross' 1969 book On Death and Dying, which was inspired by her work with terminally ill patients. Motivated by the lack of curriculum in medical schools, at the time, addressing the subject of death and dying, Kübler-Ross started a project about death when she became an instructor at the University of Chicago's medical school. This evolved into a series of seminars; those interviews, along with her previous research, led to her book. Her work revolutionized how the U.S. medical field took care of the terminally ill. In the decades since her book's publication, 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
Kübler-Ross noted that these 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/-altering event feels all five of the responses, as reactions to personal losses of any kind are as unique as the person experiencing them.
The stages, popularly known by the acronym DABDA, include:
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. Denial can be conscious or unconscious refusal to accept facts, information, or the reality of the situation. Denial is a defense mechanism and some people can become locked in this stage.
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. Anger can manifest itself in different ways. People can be angry with themselves, or with others, and especially those who are close to them. It is important to remain detached and nonjudgmental when dealing with a person experiencing anger from grief.
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…" People facing less serious trauma can bargain or seek to negotiate a compromise. For example "Can we still be friends?.." when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death.
4. 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 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. Depression could be referred to as the dress rehearsal for the 'aftermath'. It is a kind of acceptance with emotional attachment. It's 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.
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. 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.
Kübler-Ross originally applied these stages to people suffering from terminal illness. She later expanded this theoretical model to apply to any form of catastrophic personal loss (job, income, freedom). Such losses 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, the onset of a disease or chronic illness, an infertility diagnosis, as well as many tragedies and disasters.
As stated before, the Kübler-Ross Model can be used for multiple situations where people are experiencing a significant loss. The subsections below explain how the model is applied differently in a few specific situations. These are just some of the many examples that Kübler-Ross wanted her model to be used for.
Children grieving in divorce.
Denial – Children feel the need to believe that their parents will get back together, or they will change their mind about the divorce. Example: “Mom or Dad will change their mind.”
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 will only show 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.
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.
Anger – The partner left behind may feel angry for the pain the leaving partner causes them.
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 such as sleeping, eating and even daily bowel movements.
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.
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 you have a problem is different than accepting you have a problem. When you admit you have a problem this is more likely to occur in the bargaining stage. Accepting that you have a problem is when you realise that you have a problem and start the process to resolve the issue.
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 will always experience at least two of the stages. 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. Women are more likely than men to experience all five stages.
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