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Five stages of grief

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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.[1]

It describes, in 5 discrete stages, a process by which people deal with grief and tragedy, especially when diagnosed with a terminal illness or 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.[2]

Stages

The progression of states is:[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 positions 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 his mortality or that of his loved one.

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, divorce, drug addiction, 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.[2]

Significantly, people experiencing (or caretakers observing) the stages should not force the process. The grief process is highly personal and should not be rushed, nor lengthened, on the basis of 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.

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.[2] 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.[2]

Criticism

According to a book by Professor George Bonanno at Columbia University, as well as several rigorous scientific studies which he and others have carried out over 20-plus-year period and which were supported by major research organizations, such as NIH, NIMH, and the National Science Foundation, the preponderance of evidence shows that no stages of grief exist and that the Kubler-Ross theory of stages theory is invalid. Resilience, as first postulated by Bonanno, is the accurate description of the human grief experience and grief can take any of four trajectories. [3]

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.[4] 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.[5]

The phenomenon was illustrated in a number of episodes of the popular 1990s TV series, The Simpsons.[6]

Notes

  1. ^ Broom, Sarah M. (Aug. 30, 2004). "Milestones". TIME. {{cite news}}: Check date values in: |date= (help)
  2. ^ a b c d e Santrock, J.W. (2007). A Topical Approach to Life-Span Development. New York: McGraw-Hill. ISBN 0073382647. {{cite book}}: Cite has empty unknown parameter: |coauthors= (help)
  3. ^ Bonanno, George (2009). The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After a Loss. Basic Books. ISBN 9780465013609. {{cite book}}: Cite has empty unknown parameter: |coauthors= (help)
  4. ^ An Empirical Examination of the Stage Theory of Grief Maciejewski, P.K., JAMA (February 21, 2007). Retrieved April 14, 2009.
  5. ^ 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
  6. ^ eg "One Fish, Two Fish, Blowfish, Blue Fish", Season 2, episode 11.

Further reading

  • Kübler-Ross, E. (1973) 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.
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