Kbler Ross, Elisabeth, Kessler, David, 2005, On Grief and Grieving, Scribner

Publishing,
Kbler Ross, Elisabeth, 1969, On Death and Dying, MacMillan Publishing, New York
The Kbler-Ross Model, commonly known as the The Five Stages Of Grief, was first
introduced by Dr. Elisabeth Kbler-Ross in her 1969 book, On Death and Dying.[1]
Included in the book was a model, The Model of Coping with Dying, which was based
on her 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]
It is now a widely accepted model of emotional and psychological responses that many
people experience when faced with a life-threatening illness or a life-changing situation.
These stages do not only apply to loss as a result of death but may also occur in someone
who experience a different life-changing event, such as divorce or a breakdown of a
relationship, or loss of a job.
Dr. Kbler-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 lifechanging event feels all five of the responses nor will everyone who does experience
them do so in the order that is 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 Kbler-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.

Contents
[hide]

1 Stages
2 Cultural relevance
3 Criticism
4 Notes
5 Further reading

6 External links

[edit] Stages
The stages, popularly known in its abbreviated form 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. Any individual that symbolizes life or energy is subject to
projected resentment and jealousy.
3. 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..."
4. 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 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, the individual begins to come to terms with her/his mortality or
that of a loved one.
Kbler-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,
the onset of a disease or chronic illness, the theft of a bike, an infertility diagnosis, as well
many tragedies and disasters.
Kbler-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"
effectswitching between two or more stages, returning to one or more several times
before working through it.[2]

Significantly, people experiencing (or caretakers observing) 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 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.

[edit] 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.[2]

[edit] Criticism
The extensive work of George Bonanno has shown that the stages model of grief has no
scientific basis.[3][4] A 20002003 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]
After the release of her book and in response to criticism, Dr. Kbler-Ross later explained
that the theory was not meant to be linear nor applied to all persons. The way a person
goes through the stages is as unique as they are. They were not meant to describe a
typical response to a loss, because there is no typical loss. Every person's reaction to a
loss is unique, just as every loss is unique.
It's important to remember that some people will experience all of the stages, some in
order and some not, and other people may only experience a few of the stages or even get
stuck in one. It's also interesting to note that the way a person has handled adversity in
the past will affect how a diagnosis of terminal illness is handled. For example, a man
who always avoided adversity and used denial to cope with tragedy in the past may find
himself stuck in the denial stage of coping for a long time. Similarly, a woman who uses

anger to deal with difficult situations may find herself unable to move out of the anger
stage of coping.
Definition: The five stages of coping with dying were described by Elisabeth KblerRoss in her classic book On Death and Dying in 1969. The stages have been abbreviated
as DABDA and stand for:
D - Denial
A - Anger
B - Bargaining
D - Depression
A - Acceptance