Dr. Elisabeth Kübler-Ross was a psychiatrist who was greatly interested in the field of death and dying. She believed that medical students and doctors should be aware of how important the topic was. One of her major contributions to the field of medicine was a theory inspired by her work with terminally ill patients. Dr. Kübler-Ross discovered that patients who were given bad news often reacted in a rather predictable pattern of five “stages”. She also found that these theoretical stages of coping with dying also applied to other grieving processes, such as a child going through a divorce or grieving a break-up. It is important to note that these stages are not absolutely complete or chronological, but only a general theory of how people react to grief.
- Denial: A person’s initial response to any bad news or trauma is usually denial. Denial is a hardwired defence mechanism of the brain to protect the mind from trauma. However, it may hinder the process of coping, with some people being perpetually stuck in this stage while never fully coping with their grief. An example thought during this stage is “This can’t be happening to me”.
- Anger: Once the person overcomes their denial and recognises reality, they respond with anger. This is an externalisation response where the mind tries to deal with the bad news by lashing out. It can be seen as the mind’s response to the confusion that arises from receiving the bad news, which may be caused by cognitive dissonance arising from the conflict between denial and reality. Because people at this stage often lash out with rage and verbal abuse (sometimes even physical), they may be difficult to deal with. Thus, it is important to recognise that this is a natural response to grief and try to support them even though they are acting abusive. An example thought during this stage is “It’s unfair that this is happening to me”.
- Bargaining: When the anger settles down, a person attempts to deal with the grief with logic instead of emotions. They will try to negotiate with a higher power to delay their death, such as through praying. This stage shows how desperate and vulnerable the person is while trying to deal with the bad news. They will try to do anything to make the grief go away, or at least reduce it. However, this stage rarely produces any viable solutions. An example thought during this stage is “If I can have a few more years, I will do anything”.
- Depression: With both emotions and logic failing to protect them from the grief, the person will fall into a state of depression. Hope is lost and the person understands that resistance is futile (an example of learned helplessness). By this stage, the person has become quiet and withdrawn, often detaching themselves from family and friends. Ironically, trying to cheer a person up during this stage is ill-advised. It is more beneficial if the person can pull through the depression and process it to make it to the last stage of grief. An example thought during this stage is “Why bother, I’m going to die anyway”.
- Acceptance: The last stage of grief is not only accepting that death is unavoidable, but also recognising that there is still time before that. The person reaches a state of clarity and comes to term with the grief, achieving some inner peace. The time taken to reach this state varies and some people may never reach it at all. It is also important to note that just because the person receiving the bad news has accepted it, others around them may not have processed the grief. An example thought during this stage is “Everything is going to be okay”.