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]
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 it's important to note that these stages are not meant to be complete or chronological. 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 the order in which they are written. Reactions to illness, death, and loss are as unique as the person experiencing them.
Not everyone goes through all of the steps or goes through them in a linear fashion. Some steps may be bypassed entirely, others may be experienced in a different order, some may be re-experienced again and again and some may get stuck in one.
These 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.
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The stages, popularly known by the acronym DABDA, include:[2]
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, 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.
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] Women are more likely than men to experience all five stages.[2]
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.
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]
The extensive work of George Bonanno has brought the scientific basis of the Kübler-Ross stage theory of grief into question.[3][4] 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.[5] 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.[6]