Grief

Five Stages of Grief

The Kübler-Ross model describes, in five discrete stages, the process by which people deal with grief and tragedy. Terminally ill patients are said to experience these stages. The model was introduced by Elisabeth Kübler-Ross in her 1969 book On Death and Dying. The stages have become well known, and are called the Five Stages of Grief.

Enumeration of stages
The stages are:

• Denial : The initial stage: "It can't be happening."
• Anger : "Why ME? It's not fair?!" (either referring to God, oneself, or anybody perceived, rightly or wrongly, as "responsible")
• Bargaining : "Just let me live to see my son graduate."
• Depression : "I'm so sad, why bother with anything?"
• Acceptance : "It's going to be OK."

Kübler-Ross originally applied these stages to any form of catastrophic personal loss (job, income, freedom). This also includes the death of a loved one and divorce. Kübler-Ross also claimed these steps do not necessarily come in order, nor are they all experienced by all patients, though she stated a person will always experience at least two.

Others have noticed that any significant personal change can follow these stages. For example, experienced criminal defense attorneys are aware that defendants who are facing stiff sentences, yet have no defenses or mitigating factors to lessen their sentences, often experience the stages. Accordingly, they must get to the acceptance stage before they are prepared to plead guilty. 

Additionally, the change in circumstances does not always have to be a negative one, just significant enough to cause a grief response to the loss (Scire, 2007). Accepting a new work position, for example, causes one to lose their routine, workplace friendships, familiar drive to work, even customary lunch sources.

Grief

In popular culture these stages are almost exclusively applied only to news of one's own impending death. The notion that to resolve grief they must all be followed, in order, is also common.

Although, in 1974, "The Handbook of Psychiatry" defined grief as "...the normal response to the loss of a loved one by death," and response to other kinds of losses were labeled "Pathological Depressive Reactions," this has become the predominant way for counselors and professionals to approach grief, loss, tragedy and traumatic experiences.[1]

Further, many psychiatrists believe real grieving begins after the stages are over, and that "grief work", involving its own set of stages, begins with acceptance, where the Kubler-Ross stages end.

Research on the theory

A February 2007 study of bereaved individuals, from Yale University obtained some findings that were consistent with the five-stage theory and others that were inconsistent with it .

Criticism

The original Kübler-Ross model did not identify five stages of grief. It identified what Kubler-Ross called "the Five Stages of Receiving Catastrophic News". There exists no real evidence that stages are present in coping with death: Using the terms stages implies that there is a set order of set conditions, meaning that everyone will go through each stage at the same time while confronting impending death. The order of the stages, as well as the amount of time each stage lasts can vary. Also, the definition of each stage is not clear, and some stages can be combined.

More specifically, there is no real evidence that people coping with their impending death move through all of the five stages. The path through the stages is not a one-way street: they can repeat, occur out of order or not at all. It is highly dependent on other qualities, such as emotional ties to family, and other relationships. These stages can also occur in a repetitive, spiral-like fashion where the individual is re-working and re-experiencing various grief stages over time. "Real events", such as moving, getting rid of the loved ones clothing or objects, etc. tend to trigger a grief regression in which the grieving individual may re-experience anger or shock or depression.

The way in which the particular loss is experienced may strongly influence how grief is played out. A sudden loss or violent loss in which one is "blind-sided", caught unaware and unprepared, may create a traumatic loss which is probably more difficult to process and work through.