Five stages of grief

by Elisabeth Kbler-Ross

Kubler-Ross model for death and bereavement counselling, personal change and trauma
Elisabeth Kbler-Ross (which is the correct spelling; Elizabeth Kubler Ross is a common incorrect form and used above for search-engine visibility). Incidentally, 'counselling' is UK English and 'counseling' is US English. Dr Elisabeth Kbler-Ross pioneered methods in the support and counselling of personal trauma, grief and grieving, associated with death and dying. She also dramatically improved the understanding and practices in relation to bereavement and hospice care. Her ideas, notably the five stages of grief model (denial, anger, bargaining, depression, acceptance), are also transferable to personal change and emotional upset resulting from factors other than death and dying.

We can clearly observe similar reactions to those explained by Kbler-Ross's grief model in people confronted with far less serious traumas than death and bereavement, such as by work redundancy, enforced relocation, crime and punishment, disability and injury, relationship break-up, financial despair and bankruptcy, etc. This makes the model worthy of study and reference far outside of death and bereavement. The 'grief cycle' is actually a 'change model' for helping to understand and deal with (and counsel) personal reaction to trauma. It's not just for death and dying. This is because trauma and emotional shock are relative in terms of effect on people. While death and dying are for many people the ultimate trauma, people can experience similar emotional upsets when dealing with many of life's challenges, especially if confronting something difficult for the first time, and/or if the challenge happens to threaten an area of psychological weakness, which we all possess in different ways. One person's despair (a jobchange, or exposure to risk or phobia, etc) is to another person not threatening at all. Some people love snakes and climbing mountains, whereas to others these are intensely scary

things. Emotional response, and trauma, must be seen in relative not absolute terms. The model helps remind us that the other person's perspective is different to our own, whether we are the one in shock, or the one helping another to deal with their upset. The study of death and dying is actually known as thanatology (from the Greek word 'thanatos' meaning death). Elisabeth Kbler-Ross is accordingly sometimes referred to as a thanatologist, and she is considered to have contributed significantly to the creation of the genre of thanatology itself. Elisabeth Kbler-Ross's seminal book was On Death & Dying, published in 1969, in which she explained her now classically regarded 'five stages of grief'. The book and its ideas were quite revolutionary at the time, reflecting Kbler-Ross's outspoken and bold approach, which is paradoxical given the sensitivity and compassion of her concepts. Kbler-Ross was a catalyst. She opened up and challenged previously conservative (sweep it under the carpet, don't discuss it, etc) theories and practices relating to death and bereavement, and received an enormously favourable response among carers, the dying and the bereaved, which perhaps indicates the level of denial and suppression that had earlier characterised conventional views about the subject - particularly in the western world, where death is more of a taboo than in certain other cultures. As stated, and important to emphasise, Kbler-Ross's five stages of grief model was developed initially as a model for helping dying patients to cope with death and bereavement, however the concept also provides insight and guidance for coming to terms with personal trauma and change, and for helping others with emotional adjustment and coping, whatever the cause. This has probably helped her ideas to spread and to enter 'mainstream' thinking. Elisabeth Kbler-Ross and her ideas have now become synonymous with emotional response to trauma, and to grief support and counselling, much like Maslow is fundamentally associated with motivational theory; Kolb with learning styles, and Gardner with multiple intelligence. As with much other brilliant pioneering work, the Kbler-Ross model is elegantly simple. The five stages of grief model is summarised and interpreted below. This Kbler-Ross five stages and terminology are featured here with permission from the Elisabeth Kbler Ross Foundation, which is gratefully acknowledged. Please look at the two websites www.ekrfoundation.org, and www.elisabthkublerross.com, both of which enable and sustain Dr Kbler-Ross's values and mission, and extend help to those who need it. Please be aware that the interpretation and contextual material on this webpage represents my own thoughts on the subject. I would encourage you to develop your own ideas too - this is a deeply significant area and one that can be interpreted in many ways. My interpretation and associations are not an attempt to reproduce Kbler-Ross's thinking, they seek to provide a modern context, and to relate the basic model to the philosophies of this website. Use of and reference to the Elisabeth Kbler-Ross five stages for commercial purposes, and publication of EKR quotations, require permission from the EKR Foundation. You can use freely the other aspects of this page subject to the normal terms for using this website, briefly summarised at the foot of this page.

Elisabeth Kbler-Ross - Five stages of grief

Also known as the 'grief cycle', it is important to bear in mind that Kbler-Ross did not intend this to be a rigid series of sequential or uniformly timed steps. It's not a process as such, it's a model or a framework. There is a subtle difference: a process implies something quite fixed and consistent; a model is less specific - more of a shape or guide. By way of example, people do not always experience all of the five 'grief cycle' stages. Some stages might be revisited. Some stages might not be experienced at all. Transition between stages can be more of an ebb and flow, rather than a progression. The five stages are not linear; neither are they equal in their experience. People's grief, and other reactions to emotional trauma, are as individual as a fingerprint. In this sense you might wonder what the purpose of the model is if it can vary so much from person to person. An answer is that the model acknowledges there to be an individual pattern of reactive emotional responses which people feel when coming to terms with death, bereavement, and great loss or trauma, etc. The model recognises that people have to pass through their own individual journey of coming to terms with death and bereavement, etc., after which there is generally an acceptance of reality, which then enables the person to cope. The model is perhaps a way of explaining how and why 'time heals', or how 'life goes on'. And as with any aspect of our own or other people's emotions, when we know more about what is happening, then dealing with it is usually made a little easier. Again, while Kbler-Ross's focus was on death and bereavement, the grief cycle model is a useful perspective for understanding our own and other people's emotional reaction to personal trauma and change, irrespective of cause.

Five stages of grief - Elisabeth Kbler Ross

EKR stage Interpretation Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. It's a defence mechanism and perfectly natural. Some people can become locked in this stage when dealing with a traumatic change that can be ignored. Death of course is not particularly easy to avoid or evade indefinitely. Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. Knowing this helps keep detached and nonjudgemental when experiencing the anger of someone who is very upset. Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in. People facing less serious trauma can bargain or seek to negotiate a compromise. For example "Can we still be friends?.." when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death. Also referred to as preparatory grieving. In a way it's the dress rehearsal or the practice run for the 'aftermath' although this stage means different things depending on whom it involves. It's a sort of acceptance with emotional attachment. It's natural to feel sadness and regret, fear, uncertainty, etc. It shows that the person has at least begun to accept the reality. Again this stage definitely varies according to the person's situation, although broadly it is an indication that there is some emotional detachment and objectivity. People dying can enter this stage a long time before the people they leave behind, who must necessarily pass through their own individual stages of dealing with the grief.

1 - Denial

2 - Anger

3 - Bargaining

4 - Depression

5 - Acceptance

(Based on the Grief Cycle model first published in On Death & Dying, Elisabeth KblerRoss, 1969. Interpretation by Alan Chapman 2006-08.)

Elisabeth Kbler Ross - short biography

Dr Elisabeth Kbler-Ross was born in Zurich, Switzerland, on July 8, 1926. She was one of triplet sisters. Kbler-Ross studied medicine against her father's wishes, at Zurich, later settling in the US in 1958 and becoming a US citizen in 1961. Her experiences at the end of the Second World War, including the aftermath of the Majdanek (Maidanek) concentration camp at Lublink (now Ukraine) as a member of the International Voluntary Service for Peace, reinforced her destiny to focus on the humanistic perspective of death and dying. According to some accounts the young Elisabeth's childhood treatment by her father was very harsh, which might explain additionally how she became so intensely concerned for people's worst suffering. Her seminal book On Death & Dying was published in 1969, in which she explained the process of dying in which she first described her now classically regarded Five Stages of Grief. The book, and the supporting publication of her ideas in Time magazine, achieved wide circulation, so that Elisabeth Kbler-Ross soon became known for her pioneering work with the terminally ill, and for her ideas in the counselling and support of those affected by death and bereavement. Kbler-Ross spent much of the 1970's running workshops and speaking to audiences about her ideas, which quickly gained popular appeal and general acceptance among the caring professions, and which had significant positive influence over the development of hospice care and attitudes towards death and the care of the dying. In the 1980's Kbler-Ross turned her attention to the plight of babies born with AIDS, and also founded a healing and workshop centre which she called Healing Waters, on a 300-acre farm in Virginia. Kbler-Ross's work has not always been universally applauded. Detractors tend to focus on the 'vagueness' of the grief cycle model (which reminds us of the need to appreciate it as a guide, rather than a rigid process), and her interest in the after-life linked to near-death experiences also attracted mixed response, as one might expect given her iconic status, and the understandable scientific caution of much of her audience. Whatever, Elisabeth Kbler-Ross was a remarkable woman who carved out unique reputation in her field - indeed she arguably defined the field itself. Later in her life she suffered personal tragedy: a fire destroyed her Virginia home, and a series of strokes left her in ill health. She moved to Scottsdale Arizona and retired soon afterwards in 1996. Other critically admired works include Living with Death and Dying (1981) and On Life After Death (1991) which are among more than 20 books that Kbler-Ross wrote or coauthored on subjects related to death and grieving, and caring for those affected by bereavement. Elisabeth Kbler-Ross died on 24 August 2004. The Elisabeth Kbler-Ross Foundation (EKR Foundation) was formed in to keep Elisabeth's spirit alive. The EKR Foundation seeks to continue Elisabeth's life work through the education of bereavement carers, and to promote and enable the compassionate support of families affected by death across the world.

Elisabeth Kbler-Ross was inducted into the The National Women's Hall of Fame in 2007, a national nonprofit organization that annually recognizes the contributions to civilization of American women in a variety of disciplines. "It's only when we truly know and understand that we have a limited time on earth - and that we have no way of knowing when our time is up, we will then begin to live each day to the fullest, as if it was the only one we had." (Dr Elisabeth Kbler-Ross, 1926-2004, psychiatrist, humanitarian, teacher, author, and pioneer of bereavement and hospice care. Used with permission, with thanks to www.ekrfoundation.org and www.elisabethkublerross.com.)

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