Elisabeth Kübler-Ross: The rise and fall of the five stages of grief [Archive.org URL]

In 1969, Elisabeth Kubler-Ross wrote the book On Death and Dying. In it, she began by describing how patients talk about dying, and went on to discuss how end-of-life care could be improved.

The part of it that stuck in the public imagination was the idea that when a person is diagnosed with a terminal illness they go through a series of emotional stages.

Kübler-Ross described five of them in detail:

1. denial — “No, not me, it cannot be true”
2. anger — “Why me?”
3. bargaining — attempting to postpone death with “good behaviour”
4. depression — when reacting to their illness, and preparing for their death
5. acceptance — “The final rest before the long journey”

She described them as “defence mechanisms… coping mechanisms to deal with extremely difficult situations”.

There were never just five stages, though. While each of these gets a chapter heading, a graphic in the book describes as many 10 or 13 stages, including shock, preparatory grief – and hope.

And her son, Ken Ross, says she wasn’t wedded to the idea that you have to go through them in order.

“The five stages are meant to be a loose framework – they’re not some sort of recipe or a ladder for conquering grief. If people wanted to use different theories or different models, she didn’t care. She just wanted to begin the conversation.”

[…]

“When people are hurting, they want to know, ‘How long is this going to last? What will happen to me?’ They want something to hold on to. And the stages model gives them that.”

“They’re seductive,” agrees Charles A Corr, social psychologist and author of Death and Dying, Life and Living. “They offer you an easy way to categorise people who are in those situations, and they happen to fit with five fingers in a hand so you can tick them off.”

But George Bonanno says they can do more harm than good. “People who don’t go through these stages – and as far as I can tell that’s most people – can be led to believe that they are grieving incorrectly,” he argues.

[…]

And there’s very little concrete evidence for the existence of five stages of grief. The most extensive longitudinal study on the stages was published in 2007, based on a series of interviews with recently bereaved people. It concluded that although Elisabeth Kübler-Ross’s stages were present in different combinations, the most prevalent emotion reported at all stages was acceptance. Denial (or disbelief, as the study termed it) was very low, and the second strongest emotion reported was “yearning”, which was not one of the original five stages. The study has been criticised, though, for selective sampling and overstating its findings.

[…]

David Kessler believes that the key to grief is meaning – a sixth stage which he added to Elisabeth’s list, with the permission of the Kübler-Ross family.