Elisabeth Kubler-Ross M.D. did a study in the mid to late 1960’s of patients and family of patients who were diagnosed with life-threating illness’s that would end in death. She was “trying to outline the changes that have taken place in the last few decades, [1950’s and 1960’s] changes that are ultimately responsible for the increase fear of death, the rising number of emotional problems, and the greater need for understanding of and coping with the problems of death and dying.”  Since the mid 1900’s, there has been advancements of medical procedures, medicine, and better access to hospitals and medical care. With more people dying and holding the funeral outside their home it has generally changed people reaction to death and dying.
Kubler-Ross’s study identified five stages of dying: denial, anger, bargaining, depression, and acceptance. You can look at this from a linear progression, moving from denial, then to anger, then to bargaining, and so on. I learned that another way to look at this is we move from one stage to any of the other stages in no prescribed order. We could be experiencing anger this morning, acceptance this evening, and depression the next day. Someone said, it’s like popcorn popping. Our mind, heart, body, and soul are trying to make sense of our loss as we experience many, if not all, of these stages of grief. We also experience many other types of thoughts, feelings, awareness’s, and emotions.
The first stage is “Denial and Isolation.” “This is when the patient may say, “No, not me, it cannot be true.” The patient may look to another doctor(s) for other opinions. Being in denial allows the patient a “buffer after unexpected news…to collect himself (herself) and, with time mobilize other, less radical defenses…The patient will decide when the time is to speak of their diagnosis. Denial is usually temporary and usually moves to partial acceptance.”
The second stage is “Anger.” “When people acknowledge that the diagnosis is true they usually turn to “feelings of anger, rage, envy, and resentment…‘Why me.’” “This is hard for the families, friends and caregivers as the anger is pointed in all directions. This is the time to put yourself in the patient’s position to get a sense of where the anger is coming from…Loss of their dreams, retirement, raising a family, work, and church involvement, etc.”
The third stage is “Bargaining.” “As a way to postpone the inevitable, the patient may ask God for a little more time so for example they can attend their child’s upcoming wedding. They may bargain with God that if they are spared they will do this or that in return. ‘Most bargains are made with God and are usually kept a secret’ or quietly said to a chaplain.”
The fourth stage is “Depression.” “When the patient ‘cannot smile it off anymore’… his numbness or stoicism, his anger and rage will soon be replaced with a sense of great loss… Financial burdens, loss of a job loss of being the breadwinner, child care changes and other things will cause depression to help alleviate ‘some of the unrealistic guilt and shame’…Kuber-Ross talks about the first depression as reactive and the second as preparatory in “taking into account pending losses…In order to facilitate acceptance…the patient should not be encouraged to look at the sunny side of things” at this time.”
The fifth stage is “Acceptance.” Acceptance “is almost void of feelings…The final rest before the long journey…While the dying patient has found some peace and acceptance, his circle of interest diminishes. He (she) wishes to be left alone…The family usually needs more help, understanding, and support than the patient himself…This may be a time for the patient to be in silence, where holding a hand is better than talking.”
 Elisabeth Kubler-Ross, M.D., On Death and Dying – What the dying have to teach doctors, nurses, clergy, and their own families (New York: Scribner, 1969), 51-124.
Researched and written by David Tillman, December 2013