Kübler-Ross model
Encyclopedia
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.
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.
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-altering 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 bypassed 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 frequently 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.
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. Women are more likely than men to experience all five stages.
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. Those who experience problems working through the stages should consider professional grief counseling or support groups.
has brought the scientific basis of the Kübler-Ross stage theory of grief into question. 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. 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.
Elisabeth Kübler-Ross
Elisabeth Kübler-Ross, M.D. was a Swiss American psychiatrist, a pioneer in Near-death studies and the author of the groundbreaking book On Death and Dying , where she first discussed what is now known as the Kübler-Ross model.She is a 2007 inductee into the American National Women's Hall of Fame...
in her 1969 book, On Death and Dying.
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
Coping (psychology)
Coping has been defined in psychological terms by Susan Folkman and Richard Lazarus as "constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing" or "exceeding the resources of the person".Coping is thus expending...
and deal with grief
Grief
Grief is a multi-faceted response to loss, particularly to the loss of someone or something to which a bond was formed. Although conventionally focused on the emotional response to loss, it also has physical, cognitive, behavioral, social, and philosophical dimensions...
and tragedy
Tragedy (event)
A tragedy is an event in which one or more losses, usually of human life, occurs that is viewed as mournful. Such an event is said to be tragic....
, especially when diagnosed with a terminal illness
Terminal illness
Terminal illness is a medical term popularized in the 20th century to describe a disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient within a short period of time. This term is more commonly used for progressive diseases such as...
or experience a catastrophic loss
Loss
Loss may refer to:*A negative difference between retail price and cost of production**Loss leader a deliberate commercial loss made in the expectation of recouping it by profitable sales of other lines...
. In addition to this, her book brought mainstream
Mainstream
Mainstream is, generally, the common current thought of the majority. However, the mainstream is far from cohesive; rather the concept is often considered a cultural construct....
awareness to the sensitivity required for better treatment of individuals who are dealing with a fatal disease or illness.
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-altering 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
Emotion
Emotion is a complex psychophysiological experience of an individual's state of mind as interacting with biochemical and environmental influences. In humans, emotion fundamentally involves "physiological arousal, expressive behaviors, and conscious experience." Emotion is associated with mood,...
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
Linear
In mathematics, a linear map or function f is a function which satisfies the following two properties:* Additivity : f = f + f...
fashion. Some steps may be bypassed 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
Coping (psychology)
Coping has been defined in psychological terms by Susan Folkman and Richard Lazarus as "constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing" or "exceeding the resources of the person".Coping is thus expending...
with dying are now frequently 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:- DenialDenialDenial is a defense mechanism postulated by Sigmund Freud, in which a person is faced with a fact that is too uncomfortable to accept and rejects it instead, insisting that it is not true despite what may be overwhelming evidence.The subject may use:* simple denial: deny the reality of the...
— "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. - AngerAngerAnger is an automatic response to ill treatment. It is the way a person indicates he or she will not tolerate certain types of behaviour. It is a feedback mechanism in which an unpleasant stimulus is met with an unpleasant response....
— "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. - BargainingBargainingBargaining or haggling is a type of negotiation in which the buyer and seller of a good or service dispute the price which will be paid and the exact nature of the transaction that will take place, and eventually come to an agreement. Bargaining is an alternative pricing strategy to fixed prices...
— "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..." - DepressionDepression (mood)Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...
— "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. - AcceptanceAcceptanceAcceptance is a person's agreement to experience a situation, to follow a process or condition without attempting to change it, protest, or exit....
— "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
Social rejection
Social rejection occurs when an individual is deliberately excluded from a social relationship or social interaction. The topic includes both interpersonal rejection and romantic rejection. A person can be rejected on an individual basis or by an entire group of people...
, end of a relationship or divorce
Divorce
Divorce is the final termination of a marital union, canceling the legal duties and responsibilities of marriage and dissolving the bonds of matrimony between the parties...
, drug addiction, incarceration
Incarceration
Incarceration is the detention of a person in prison, typically as punishment for a crime .People are most commonly incarcerated upon suspicion or conviction of committing a crime, and different jurisdictions have differing laws governing the function of incarceration within a larger system of...
, change in office environment, the onset of a disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
or chronic illness, an infertility
Infertility
Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term...
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. Women are more likely than men to experience all five stages.
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. 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.Criticism
The extensive work of George BonannoGeorge Bonanno
George A. Bonanno is a professor of clinical psychology at Columbia University, Teachers College. He is known as a pioneering researcher in the field of bereavement and trauma. The New York Times on February 15, 2011, stated that the current science of bereavement has been "driven primarily" by...
has brought the scientific basis of the Kübler-Ross stage theory of grief into question. A 2000–2003 study of bereaved individuals conducted by Yale University
Yale University
Yale University is a private, Ivy League university located in New Haven, Connecticut, United States. Founded in 1701 in the Colony of Connecticut, the university is the third-oldest institution of higher education in the United States...
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. 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.
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