Kübler-Ross model

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The Kübler-Ross model, commonly known as The Five Stages of Grief, is a theory first introduced by Elisabeth Kübler-Ross in her 1969 book, On Death and Dying.[1]

Included in her book was 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.[2]

Kübler-Ross added that these stages are not meant to be complete or chronological. Her theory also holds that 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 any particular order. The theory is that the reactions to illness, death, and loss are as unique as the person experiencing them. Some people may get stuck in one stage.

These theoretical 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.

Contents

[edit] Stages

The stages, popularly known by the acronym 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.
  3. Bargaining — "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..."
  4. Depression — "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.
  5. Acceptance — "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. She later expanded this theoretical model to apply to any form of catastrophic personal loss (job, income, freedom). Such losses 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.

As stated above, according to her theory, Kübler-Ross claimed these stages do not necessarily come in order, nor are all stages experienced by all patients. She stated, however, that a person will always experience at least two of the stages. 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.[2] Women are more likely than men to experience all five stages.[2]

However, the Kübler-Ross theory holds that 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]

[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 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.[2]

[edit] Epistemological relevance

Studies of epistemology, the process of learning, suggest that the patterns of grief are one way of describing the basic patterns of integrating new information that conflicts with previous beliefs.

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident." said Arthur Schopenhauer of the learning process, which corresponds to the five stages of grief with denial being ridicule, opposition being anger and bargaining, and acceptance being depression and acceptance.

There is also a theory which suggests that this learning process is the same pattern seen in the back-and-forth looping movement of a particle being disturbed by a wave.[3] Emotional intensity moves up and down and up again, while knowledge moves backward, forward, back, and then forward again, until the individual is happy with the way they have integrated the new information with the old.

[edit] Criticism

The extensive scientific studies of George Bonanno show that the Kübler-Ross stages of grief do not exist. Bonanno's research shows that most people who experience a loss do not grieve, but are resilient. If there is no grief, there can be no stages of grief.[4][5] In Bonanno's book, "The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After a Loss,"[6] he summarizes his rigorously peer-reviewed research based on thousands of subjects and conducted over more than two decades. His findings conclude that a natural resilience is the main component of grief and trauma reactions.[7] The logic is that if there is no grief, there are no stages to pass through.[8] Bonanno's work has also demonstrated that absence of grief or trauma symptoms is a healthy outcome, rather than something to be feared as has been the thought and practice until his research.[9][10]

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.[11] 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.[12]

[edit] Notes

  1. ^ Broom, Sarah M. (Aug. 30, 2004). "Milestones". TIME. http://www.time.com/time/magazine/article/0,9171,689491,00.html. 
  2. ^ a b c d e f Santrock, J.W. (2007). A Topical Approach to Life-Span Development. New York: McGraw-Hill. ISBN 0073382647. 
  3. ^ "Stages of Grief" - The normal learning process, diagram. May, 2011
  4. ^ The Neuroscience of True Grit. Gary Stix, 15 February 2011. Scientific American.
  5. ^ New Ways to Think About Grief. Ruth Davis Konigsberg, 29 January, 2011, Time Magazine.
  6. ^ http://www.perseusbooksgroup.com/basic/book_detail.jsp?isbn=0465013600 The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After a Loss
  7. ^ http://faculty.tc.columbia.edu/upload/gab38/americanPsychologist.pdf
  8. ^ "New Ways to Think About Grief". Time. 29 January 2011. http://www.time.com/time/magazine/article/0,9171,2042372.html. 
  9. ^ The Neuroscience of True Grit. Gary Stix, 15 February 2011. Scientific American.
  10. ^ New Ways to Think About Grief. Ruth Davis Konigsberg, 29 January, 2011, Time Magazine.
  11. ^ An Empirical Examination of the Stage Theory of Grief Maciejewski, P.K., JAMA (February 21, 2007). Retrieved April 14, 2009.
  12. ^ Friedman and James. "The Myth of the Stages of Dying, Death and Grief", Skeptic Magazine (2008). Retrieved 2008, from http://www.grief.net/Articles/Myth%20of%20Stages.pdf

[edit] 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.

[edit] External links

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