Kubler-Ross Model

Abstract

Psychology uses the Kubler-Ross model to outline the five stages of grief. The five stages are as follows: denial/isolation, anger, bargaining, depression, and acceptance. The model is the brain-child of Elisabeth Kubler-Ross, a Swiss-born psychiatrist, proposed in her 1969 book On Death and Dying. Initially, the model was used to educate medical students on how to interact with terminally ill patients, but it has since expanded in use to better understand grief in general. This paper will discuss the specifics of the model, including how it works, how it is used, and criticisms of it.

Kubler-Ross Model

Though there are five defined stages of the grief process in the Kubler-Ross model, the stages do not necessarily occur in sequential order, nor do they only necessarily occur only once (Elizabeth Kubler-Ross Foundation). For the sake of discussion, however, this paper will discuss the stages in order. Theoretically, the first stage of grief in the Kubler Ross model is denial/isolation. On first learning of the cause of grief, people will deny that the cause exists, preferring to cling to previous ideas of reality that did not incite pain. This is a temporary response that helps people normalize the initial pain of grief (Axelrod, 2006). Though the denial created by the shock of a loss is usually short-lived, this stage of grief can have significant impacts on productivity, as people find it hard to function in their normal routines once disrupted by a major change. Individuals who have not experienced grief or a major loss prior often have more difficulty in this stage than do others who are more familiar with the grieving process. In this stage, even normally confident individuals can have trouble maintaining composure and will seek out reassurance and guidance more readily than usual.

The second stage of grief is anger. As the effects of denial wear off, the emotion is replaced by anger--a reaction to the pain of grief as it begins to settle in as part of reality. Ideas of ‘unfairness’ and betrayal are common, and anger may be “aimed at inanimate objects, complete strangers, friends or family” (Axelrod, 2006). Anger may also be aimed at the person feeling the grief, as they know that anger at people and situations are not always justified, but the fact that the feeling persists can create even more anger. In this stage of grief, the griever often finds someone to use as a ‘scapegoat’ for their loss. It helps people rationalize things to believe that another person or persons intentionally caused their loss and subsequent grief instead of accepting that usually loss happens unintentionally and without motive. During this stage, though anger at external factors helps to perpetuate denial, people will begin to accept that the loss is part of reality.

Third, in the Kubler-Ross model of grief is bargaining. When grief occurs, it is rarely--if ever--asked for. Thus, grief is, for the most part, thrust upon us without our consent or desire, and this feeling of “helplessness and vulnerability” (Axelrod, 2006) is often responded to by bargaining attempts to right the confusion and pain brought on by grief. People often “[s]ecretly….make a deal with God or [a] higher power in an attempt to postpone the inevitable” (Axelrod, 2006). Bargaining helps people feel that they have some sort of control over the situation, or at least they are taking some action to prevent or reverse tragedy.

The fourth stage of grief is depression. Two types of depression can occur in the grief process. The first of the two is a sort of ‘practical sadness’ about the implications of whatever the cause of the grief is. This could be the funeral costs of a family member or the fact that time spent grieving could be spent with loved ones. Sadness and regret are the primary emotions in this type of depression. The second type of depression in this stage is the internal pain experienced with the preparation of letting the subject of grief go. For example, if the grief is caused by the death of a loved one, this type of depression would generally be directed at the sadness of letting them go and living without them.

The fifth and final stage of grief is acceptance. This stage is “marked by withdrawal and calm” (Axelrod, 2006). It is the assimilation of grief and its cause(s) into reality. It is not necessarily accompanied by happy emotions, but it can mean that the griever has found peace with said painful events in their life. It is usually “more optimistic and enthusiastic” (Kumudumali, 2011) than other stages of the grieving process, and is marked by “excitement [about] new opportunities, relief that the change has been survived, [and] impatience for the change to be complete” (Kumudumali, 2011). The stage of acceptance allows for progress towards a healthy life after loss to happen, allows for healing to occur, and gives space for the pain to fade and pass.

The Kubler-Ross model for grieving was a catalyst for change in the medical field. Before it, medical schools had virtually nothing in their curriculums regarding how to interact with terminally ill patients. The Kubler-Ross model not only revolutionized the way terminally ill patients and their loved ones were treated by healthcare professionals but has also revolutionized the way people are guided by mental healthcare professionals in dealing with grief. The theory has since been expanded to include grief in general, instead of simply grief regarding the death of a loved one or ones’ self. The model can also be used in circumstances such as job loss, incarceration, income loss, addiction, significant rejection, the end of a relationship, divorce, sickness, abortion, infertility, or any other loss of something important. The model intends to allow sufferers of grief to become more aware that the emotions they deal with in the grieving process are normal and necessary to move on and have a happy, fulfilling life. With the Kubler-Ross model in mind, individuals can develop coping strategies, healthcare professionals can help to empower their patients by educating them on how to take control of the grieving process when they cannot take control of actual events, and caregivers can be more prepared in how they deal with the needs of a grieving person.

As said before, these stages set out by the Kubler-Ross model do not necessarily occur in sequential order and can occur multiple times. Some argue however that stages might not occur at all. Kathleen Gilbert, an expert on grief and bereavement in families, says that the “stage models for grief are wrong” (Bryant, 2006). She says that the model developed by Kubler-Ross and advanced by others is fundamentally flawed as it asserts that the stages of grief ultimately culminate in closure. Gilbert says closure means that "basically means you stop acting sad. You're supposed to be done” (Bryant, 2006). Despite the appeal of having an endpoint to look forward to at the end of the grieving process, Gilbert asserts that grief is too complex to have a defined completion. Throughout her work, she has also noticed that grief can often recur or worsen with time, and says that[g]rief is like a river, not a ladder…. When you suffer a loss and experience grief, you enter that river for good. It's not a steady stream: There are raging rapids of boulder-sized heartbreak and shallow pools of peace, where you get a chance to enjoy what's around you. But you are always on the river; there is no going ashore to return to a life without loss (Bryant, 2006). Gilbert’s main criticism of the Kubler-Ross model of grieving is that it depicts grief to be a process that can be finished, when in fact it is a lifelong effort (Bryant, 2006).

In recent years, the Kubler-Ross model of grief has come under much criticism from social psychologists because of its rigidity and tendency to be interpreted as a linear model. For example, researchers Richard Schulz and David Aderman tested the model’s claim that dying people pass through five predictable psychological stages when confronted with their mortalities. Their “data show the process of dying to be less rigid and even stageless”. They also found that, though terminally ill patients often experience depression before death, “there is no consistent evidence that other affect dimensions characterize the dying patient” (Schulz, Richard, and David Aderman). Additionally, George Bonanno--Columbia University professor of clinical psychology--has done extensive research on the practicality of the Kubler-Ross model, and has found evidence that the stages of grief do not exist, or, at least, sometimes do not occur at all after a loss. His research shows that many people, after experiencing loss, will not grieve at all, therefore excluding the possibility of any stages of grief (Konigsberg, 2011).

Though there are criticisms from the community of the science of psychology, the Kubler-Ross model is held as true by the general public. Though its assertions might not hold across the board for every person after a loss or change, the model can be useful in helping people build a framework for returning to their lives and creating a new ‘normal’ after the pain of grief has passed. Because it is still useful to many, the psychological community still puts its teachings to work in helping people to cope with grief.

References

Axelrod, J. (2006). The 5 stages of loss and grief. Psych Central. Retrieved from http://psychcentral.com/lib/the-5-stages-of-loss-and-grief/000617

Bryant, L. J. (2003). The story of grief. Research & Creative Activity, 25(2), 35-38. Retrieved from http://www.indiana.edu/~rcapub/v25n2/gilbert.shtml

Elisabeth Kubler-Ross Foundation. (2014). On death and dying. Retrieved from http://www.ekrfoundation.org

Konigsberg, R. D. (2011, January 29). New ways to think about grief. Time. Retrieved from http://content.time.com/time/magazine/article/0,9171,2042372,00.html

Kumudumali. (2011). Change curve. StudyMode. Retrieved from http://www.studymode.com/essays/Change-Curve-588116.html

Schulz, Richard, &Aderman, D. (1974). Clinical research and the stages of dying. OMEGA: Journal of Death and Dying, 5(2), 137-43. Retrieved from http://baywood.metapress.com