Elisabeth Kübler-Ross (1973) studied reactions to death and dying by interviewing patients who were terminally ill. She broke down the reactions she witnessed into five stages, which are still used today to describe people’s reactions to loss, not just with dying, but with any type of loss. The five stages are denial and isolation, anger, bargaining, depression, and acceptance.
Although the stages are presented in a simplified manner, they are truly more complex as they might overlap, repeat, occur out of order, or not occur at all. Although every person may experience grief reactions to losses differently, the five stages as described by Kübler-Ross can help in understanding our own or others’ experiences with grief.
Stage 1: Denial and Isolation
This is the most common stage to occur first, and might be exemplified by thinking that test results got mixed up or trying to find a different doctor who can provide better news. This reaction acts as a buffer to deal with the shock before having to deal with other emotions and is usually temporary, although there may be partial denial later as well. This initial denial is usually replaced by at least partial acceptance.
Stage 2: Anger
This stage could be best described by the question “Why me?” This stage may also involve envy or resentment, and the griever may become a complainer or demanding. Compared to the denial stage, the anger stage may be more difficult for family or staff to handle. The important lesson for others dealing with people in this stage is to not take the anger personally when it is directed at them.
Stage 3: Bargaining
Many people may feel angry at God while grieving, but this anger can shift to trying to bargain with God. Bargaining with God, or with science (such as promising to give your body to science if the doctors can delay death), is an attempt to postpone an undesired outcome. Kübler-Ross further explained that bargaining includes a prize in return for a good behavior, a deadline, and an implicit promise that they will not ask for more if it is granted (although the promise is usually broken). Bargaining might be caused by feelings of guilt.
Stage 4: Depression
Numbness or anger may be replaced with feelings of loss. Loss may be many things: physical loss, financial loss, loss of a dream, loss of a job, loss of a role, or impending loss of life. Kübler-Ross described two types of depression that may occur: reactive depression (backwards looking), in which the causes of the depression should be addressed to alleviate depression; and preparatory depression (forwards looking), which is a result of impending loss. Encouragement and reassurance are not as helpful for preparatory depression as they are for reactive depression, but allowing the griever to express feelings are very important and providing nonverbal support is helpful.
Stage 5: Acceptance
The griever needs time to work through the other stages to reach acceptance, and some people never reach this last stage. Time allows the griever to mourn, contemplate impending loss, and work through their feelings. Acceptance is not happiness, but can be better described as a quiet expectation or an absence of painful feelings.
Although these five stages are simplistic to present, the reality is much more complex. Yet having even a basic understanding of what the five general stages of grief involve can help us to understand our own and others’ reactions to loss of many kinds. While everyone may experience grief differently, we can normalize the feelings that come and go and learn how to respond more effectively to the emotional needs of the griever.
Kübler-Ross, E. (1973). On Death and Dying. London: Taylor & Francis [CAM].