Kbler Ross, Elisabeth, Kessler, David, 2005, On Grief and Grieving, Scribner Publishing, Kbler Ross, Elisabeth, 1969, On Death and Dying, MacMillan Publishing, New YorkThe Kbler-Ross Model, commonly known as the The Five Stages Of Grief, was first introduced by Dr. Elisabeth Kbler-Ross in her 1969 book, On Death and Dying.[1]Included in the book was a model, The Model of Coping with Dying, which was based on her 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]It is now a widely accepted model of emotional and psychological responses that many people experience when faced with a life-threatening illness or a life-changing situation. These stages do not only apply to loss as a result of death but may also occur in someone who experience a different life-changing event, such as divorce or a breakdown of a relationship, or loss of a job.

Dr. Kbler-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-changing event feels all five of the responses nor will everyone who does experience them do so in the order that is 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 missed 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 commonly referred to as the Kbler-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.

Contents

[hide] 1 Stages 2 Cultural relevance 3 Criticism 4 Notes 5 Further reading 6 External links

[edit] StagesThe stages, popularly known in its abbreviated form DABDA, include:[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 possessions 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 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 her/his mortality or that of a loved one.

Kbler-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, the theft of a bike, an infertility diagnosis, as well many tragedies and disasters.

Kbler-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" effectswitching 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.

[edit] Cultural relevanceA dying individual's approach to death has been linked to the amount of meaning and purpose a person has found throughout their 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][edit] CriticismThe extensive work of George Bonanno has shown that the stages model of grief has no scientific basis.[3]

HYPERLINK "http://en.wikipedia.org/wiki/K%C3%BCbler-Ross_model" \l "cite_note-3" [4] A 20002003 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]After the release of her book and in response to criticism, Dr. Kbler-Ross later explained that the theory was not meant to be linear nor applied to all persons. The way a person goes through the stages is as unique as they are. They were not meant to describe a typical response to a loss, because there is no typical loss. Every person's reaction to a loss is unique, just as every loss is unique.

It's important to remember that some people will experience all of the stages, some in order and some not, and other people may only experience a few of the stages or even get stuck in one. It's also interesting to note that the way a person has handled adversity in the past will affect how a diagnosis of terminal illness is handled. For example, a man who always avoided adversity and used denial to cope with tragedy in the past may find himself stuck in the denial stage of coping for a long time. Similarly, a woman who uses anger to deal with difficult situations may find herself unable to move out of the anger stage of coping.Definition: The five stages of coping with dying were described by Elisabeth Kbler-Ross in her classic book On Death and Dying in 1969. The stages have been abbreviated as DABDA and stand for:

D - Denial

A - Anger

B - Bargaining

D - Depression

A - Acceptance