What are the Kübler-Ross Stages of Grief?

Elisabeth Kübler-Ross, MD, is widely recognized as the foremost authority in the field of death and dying. Her book, "On Death and Dying," is a classic and required reading in many medical and nursing schools and graduate schools of psychology, psychiatry and theology. In it, she describes five stages of grief: denial, anger, bargaining, depression and acceptance.

Denial

• Denial is the first of Kübler-Ross' five stages of grief. It is the conscious or unconscious refusal to accept the reality of dying or of death. Denial is a natural defense mechanism to cope with the shock of a traumatic change. In this stage, the world is overwhelming and meaningless. Some people can become stuck in this stage and not progress to the other stages for a long time. Denial helps people pace their feelings of grief. According to Kübler-Ross, it is nature's way of letting in only as much as a person can handle. As denial fades, the feelings that were denied rise to the surface.

Anger

• Kübler-Ross claims that anger is a necessary next step in the healing process. In this second stage of grief, anger has no limits. A person becomes angry with himself, with the person who dies, with doctors, with family, with life, with nature and with God. Beneath this anger is pain, which is why the anger in grieving is feared and often not faced or expressed. Kübler-Ross says that only if it is expressed can it become an anchor or temporary structure to cling to in the nothingness of the loss. Also, anger gives a person the strength to continue with the healing process.

Bargaining

• Bargaining is the stage when a grieving person imagines that a temporary truce can be achieved in which the reality of the dying or the death can be reversed. Stemming from an intense desire to return life to the way it was before, the grieving person becomes lost in a series of "what if's" and "if only's." Coupled with this is bargaining with the loss by promising to behave differently or more seriously. The person who grieves remains stuck in the past while trying to negotiate a way around or out of the loss.

Depression

• In this stage, the aggrieved is thrown into the present. The depressing grief is felt deeply and seems as if it will last forever. The person who is grieving withdraws from life and stews in a fog of intense sadness, wondering if life is worth going on alone without the lost loved one. As difficult as this stage is, it is necessary, according to Kübler-Ross, in dealing with grief.

Acceptance

• Acceptance, the last stage of grieving, is not feeling it is OK to be without the loved one. It is, instead, finally living in the present reality and accepting it as the permanent reality. Detachment and emotional objectivity characterize this stage. Acceptance is the adjustment to the radical change in life circumstances. When this stage is complete, the aggrieved person feels alive again, willing to go on with life and capable of feeling joy once again.