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Understanding the Five Stages of Grief

The stages of grief are not linear; they could meander

by Terre Mirsch

“Those who learned to know death, rather than to fear and fight it, become our teachers about life.”

Dr. Elisabeth Kubler-Ross

A few weeks ago, I had the privilege of meeting Ken Ross, son of the late Dr. Elisabeth Kubler-Ross. As the keynote speaker at a state hospice conference, Ken shared the story of his mother’s pioneering journey- one of trials and tribulations as she devoted her life to listening to and caring for the dying. Her work, consisting of joys and hardship, transformed the manner in which the dying are cared for and treated within our healthcare system. She was certainly instrumental in bringing hospice into mainstream medicine within the United States. And today, because of her courage and tenacity, we are able to have honest and intimate conversations with our loved ones and with each other about the experience of dying and of grief.

You are likely familiar with her groundbreaking book On Death and Dying (1969) where Kubler-Ross described the popular—but often misunderstood—Five Stages of Grief: denial, anger, bargaining, depression, and acceptance. Sometimes referred to as Stage Theory or the Psychological Stages of Dying, Kubler-Ross described a framework for understanding the emotional experience of the dying, as well as those who experience trauma or grief. Knowing more about what is happening often helps us to cope with less uncertainty and apprehension.

It is important to realize that Kubler-Ross did not intend for others to view these stages as sequential or linear in fashion. In fact, understanding that dying is an individual journey and that some people may not experience all stages while others may revisit some stages was critical to her work. In my experiences with the dying and their families, people may demonstrate many different aspects of these stages- sometimes all within the same conversation! I like to think of the stages as a model for understanding, not as goals to be accomplished. Doing so allows me to be present with the emotions, without feeling that I need to ‘fix it’ or change it.

Consider how these stages might apply to the experiences of you and your loved one:

  • Denial: “This can’t be true.” Denial is used by almost all people in some form and sometimes functions as a buffer. For many, denial is a strong coping or defense mechanism.
  • Anger: When the reality of the situation becomes clear, emotions of anger, rage, or resentment are not uncommon. People have many different ways of asking the question “Why me?” Anger may be expressed through anger at God or envy of others. It may also be projected at the environment and those that they love. It is important to understand that the anger is not directed at you personally, but at the situation.
  • Bargaining: Bargaining usually involves a specific wish that has a deadline and a promise that there will be no more requests if the wish is granted. I often hear “I just want to make it to the wedding”… “or the graduation”… “or to the birth of my grandchild”… “or ____(fill in the blank)”.
  • Depression: A profound sense of sadness might be present for the losses already experienced (loss of a job, hobbies, independence) or losses yet to come. It is important to allow your loved one to express their sadness and regrets while you listen.
  • Acceptance: Acceptance is the realization of the inevitable. Some may be accepting of the reality of their illness soon after diagnosis. For others, it may take some time. Some may never experience this acceptance.

Glimpses of hope usually persist throughout all stages and may help to sustain you and your loved one throughout the journey. Understanding the true meaning of the Five Stages provides important perspectives that can benefit you in your caregiving journey—whether you are currently caring for a loved one or are in the midst of grief following a loss. Just as Kubler-Ross spent her career listening carefully while seeking to understand the experience of others, we can do the same as we care for and listen to our loved ones. This was her ultimate goal.

Have you experienced or witnessed any of the emotions described by Kubler-Ross in Stage Theory? Share with us the stories or experiences of you and your loved one. 

2 Comments Post a comment
  1. Paul Johnson #

    When, oh when, are we going to finally put Dr. Kubler-Ross’ stages to rest. Every time they get brought up–even in good articles like this one where you re-state what her ultimate goal for them was–it gets reinforced in readers’ minds that this is still the way we think about grief. Whenever grief is referred to in the popular press it is the stages that are shared. Even licensure exams for doctors, nurses, and social workers continue to have the stages be the only thing asked about grief.
    Let’s move on to some of the more current philosophies/perspectives which help us understand how the grief process works. Kubler-Ross was extremely important at the time she helped bring the study/discussion of death out of the closet, but let’s not contribute to inadvertently keeping these stages alive when so many more helpful perspectives are available.

    June 18, 2012
    • Terre Mirsch #

      Hello Paul,

      I certainly agree with you that there are many current philosophies and perspectives that help us understand how the grief process works that are invaluable for caregivers to understand. Over time, we will continue to share them with our readers as every perspective provides an opportunity to better understand our individual and collective experiences. Even Dr. Kubler-Ross, herself, encouraged us to move forward and not remain ‘stuck’ with the belief that Stage Theory is the only perspective! And she certainly did not see it as the end point in our understanding of the experience of the dying. Because the stages are so well known to caregivers, I thought it essential to discuss them in order to provide some clarity and as always, to emphasize the importance of listening.

      I welcome your input regarding philosophies and perspectives that you find beneficial for caregivers. We would love to discuss them in future posts. Thank you for following Caring with Confidence.

      Terre

      June 18, 2012

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