About Elisabeth Kübler-Ross 

Elisabeth Kübler-Ross, M.D. (1926 – 2004) was a Swiss-born psychiatrist, a pioneer in Near-death studies, and the author of the groundbreaking book On Death and Dying (1969), where she first discussed what is now known as the Kübler-Ross model. In this research, she proposed the now famous Five Stages of Grief as a pattern of adjustment. These five stages of grief are denial, anger, bargaining, depression, and acceptance.

In general, individuals experience most of these stages, though in no defined sequence, after being faced with the reality of their impending death. The five stages have since been adopted by many as applying to the survivors of a loved one’s death, as well. She is a 2007 inductee into the National Women’s Hall of Fame. She was the recipient of twenty honorary degrees and by July 1982 had taught, in her estimation, 125,000 students in death and dying courses in colleges, seminaries, medical schools, hospitals, and social-work institutions.

–Elisabeth Kübler-Ross Foundation

Stages of Grief

According to Dr. Kübler-Ross, grief is a progression of states (popularly known by the acronym DABDA):

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 a heightened awareness of situations 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 oneself 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 their mortality or that of
   their loved ones.

Later in her life, Kübler-Ross noted that the stages are not a linear and predictable progression and that she regretted writing them in a way that was misunderstood.” Kübler-Ross originally saw these stages as reflecting how people cope with illness and dying,” observed grief researcher Kenneth J. Doka, “not as reflections of how people grieve.”

–Wiki

The Stages of Grief and Implications 

Kübler-Ross originally applied these stages to people suffering from a 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, an infertility diagnosis, as well as 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.

Significantly, people experiencing the stages should not force the process. The grief process is highly personal and should not be rushed, nor lengthened, based on 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.

Criticisms and Assessment of Stage Theory

Five main categories of criticism emerge:

• Lack of theoretical explanation…fails to address the question: What is the function of grief? Bonanno and Boerner (2007) expressed their doubts as follows:

Grief stages tell us little about how people might cope with the loss; why they might experience varying degrees and kinds of distress at different times; and how, over time, they adjust to a life without their loved one. Considering the evidence from other studies that contradict the idea of an “average” normal response to loss, this is a misguiding message. (p. 2693)

The aforementioned shortcomings have a further, major implication: Stage theory does not help us identify those at high risk or with complications in the grieving process of great importance for diagnostic systems such as Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and International Statistical Classification of Diseases and Related Health Problems (ICD-11).

• Conceptual confusion and misrepresentation of grief and grieving: Among this class of critical comments, the following stands out: It is unclear what the sequential stages (i.e., denial, anger, bargaining, depression, and acceptance) really are and what they represent. Some denote affective states, other cognitive processes. So there is a mixture of different types of constructs that do not fit coherently or sequentially together. There is no theoretical rationale for this particular arbitrary use of dividing lines between states.
• Lack of empirical evidence: Kübler-Ross’s (1969) knowledge was not derived from a systematic, empirical investigation (of bereaved persons) but through the contact of “over two hundred dying patients” (p. 38). Despite this number, in Parkes’ (2013) view, there was a lack of scientific rigor: On Death and Dying was simply “a collection of case studies in the form of conversations with dying patients” (p. 94). Surprisingly little empirical testing of stage theory has been subsequently undertaken—as Archer (1999) pointed out, this is difficult to do.
• The availability of alternative models: The stages approach has been supplanted by finer-grained, sometimes theoretically based, more-representative-of-the-grieving-process models of grief and grieving These alternative perspectives, developed over the years, are well known but received no acknowledgment or discussion by Kübler-Ross and Kessler (2005).
• The devastating consequences of using stage theory: Last, but certainly not least, it is important to recognize that using the stages approach as a guideline in supporting bereaved persons may raise undue expectations, even presumptions about the course that grief should take. Naturally, some bereaved people may feel affirmation from reading about the incorporation of emotions such as anger or despair in stage theory: If they fit one’s personal experience, they provide verification. Kübler-Ross received a large fan mail confirming this. However, such positive appraisal does not provide evidence for the sequence of stages in general, nor does it follow that the stages should be taught or used in therapy. Silver and Wortman (2007) stated:

A mistaken belief in the stage model . . . can have devastating consequences. Not only can it lead bereaved persons to feel that they are not coping appropriately, but it also can result in ineffective support provision by members of their social network as well as unhelpful and potentially harmful responses by healthcare professionals. (p. 2692)

Such fears were endorsed by Friedman and James (2008) who expressed concern about the “horror stories . . . heard from thousands of grieving people who’ve told us how they’d been harmed by them.”

Many writers have also drawn attention to the dangers of bereaved people of prescriptive interpretation. The stages, it was often said, were meant to be descriptive. However, they have been taken to be prescriptive (browsing the Internet provides ample evidence). Caregivers mention clients worrying because they are not experiencing the stages in “the right order” (and that a not-uncommon reason for seeking professional help is a failure to experience one or more of the stages of grief).

–Cautioning Health-Care Professionals

I was not going to discuss The Stages of Grief until I took my boards. One of the questions was like someone has lost their job and the answer suggested providing grief services. It was the only logical answer but before the exam, some people (like myself) would commonly associate grief only with death.  However, if you’re supporting a family or your job is the only means of income… a job loss can be heart-wrenching and can cause profound saddness.  Therefore, looking at a theory about grief can hopefully offer some insight and guidance when someone is dealing with a tragic situation but it’s not considered standard.

Additional Information & References 

• 5 Stages of Grief by Very Well Mind
• The Extraordinary Ordinary Life and Death of Elisabeth Kübler-Ross by Huffington Post 
• More information and resources about grief by Elisabeth Kübler-Ross Foundation
• Stroebe, M., Schut, H., & Boerner, K. (2017). Cautioning Health-Care Professionals. Omega, 74(4), 455–473. doi:10.1177/0030222817691870

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The International Neuro-Linguistic Programming Center has a great article about grief and living a resourceful life.