The Kübler-Ross model, or the five stages of grief, postulates a series of emotions experienced by terminally ill patients prior to death, or people who have lost a loved one, wherein the five stages are denial, anger, bargaining, depression and acceptance.
The model was first introduced by Swiss psychiatrist Elisabeth Kübler-Ross in her 1969 book On Death and Dying, and was inspired by her work with terminally ill patients. Motivated by the lack of instruction in medical schools on the subject of death and dying, Kübler-Ross examined death and those faced with it at the University of Chicago medical school. Kübler-Ross' project evolved into a series of seminars which, along with patient interviews and previous research, became the foundation for her book. Since the publication of On Death and Dying, the Kübler-Ross model has become accepted by the general public; however, its validity is not consistently supported by the majority of research.
Kübler-Ross noted later in life that the stages are not a linear and predictable progression and that she regretted writing them in a way that was misunderstood. Rather, they are a collation of five common experiences for the bereaved that can occur in any order, if at all.
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Stages of grief
The stages, popularly known by the acronym DABDA, include:
- Denial - The first reaction is denial. In this stage individuals believe the diagnosis is somehow mistaken, and cling to a false, preferable reality.
- Anger - When the individual recognizes that denial cannot continue, they become frustrated, especially at proximate individuals. Certain psychological responses of a person undergoing this phase would be: "Why me? It's not fair!"; "How can this happen to me?"; "Who is to blame?"; "Why would this happen?".
- Bargaining - The third stage involves the hope that the individual can avoid a cause of grief. Usually, the negotiation for an extended life is made in exchange for a reformed lifestyle. People facing less serious trauma can bargain or seek compromise. For instance: "I'd give anything to have him back." Or: "If only he'd come back to life, I'd promise to be a better person!"
- Depression - "I'm so sad, why bother with anything?"; "I'm going to die soon, so what's the point?"; "I miss my loved one, why go on?"
During the fourth stage, the individual despairs at the recognition of their mortality. In this state, the individual may become silent, refuse visitors and spend much of the time mournful and sullen. - Acceptance - "It's going to be okay."; "I can't fight it; I may as well prepare for it."
In this last stage, individuals embrace mortality or inevitable future, or that of a loved one, or other tragic event. People dying may precede the survivors in this state, which typically comes with a calm, retrospective view for the individual, and a stable condition of emotions.
Kübler-Ross later expanded her model to include any form of personal loss, such as the death of a loved one, the loss of a job or income, major rejection, the end of a relationship or divorce, drug addiction, incarceration, the onset of a disease or an infertility diagnosis, and even minor losses, such as a loss of insurance coverage. Even sports fans go through such a process if their favorite team loses an important game, and also supporters of a losing candidate in an election.
Both sufferers and therapists have reported the usefulness of the Kübler-Ross model in a wide variety of situations. The subsections below give a few specific examples of how the model can be applied in different situations:
Examples
Children grieving in divorce
Grieving a lost serious relationship
Grieving in substance abuse
As stated above, Kübler-Ross claimed these stages do not necessarily come in order, nor are all stages experienced by all patients. She stated, however, that a person always experiences at least two of the stages. Often, people experience several stages in a "roller coaster" effect--switching between two or more stages, returning to one or more several times before working through it. Women are more likely than men to experience all five stages.
However, the Kübler-Ross hypothesis holds that 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.
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Criticism
Criticisms of this five-stage model of grief center mainly on a lack of empirical research and empirical evidence supporting the stages as described by Kübler-Ross and, to the contrary, empirical support for other modes of the expression of grief. Moreover, Kübler-Ross' model is the product of a particular culture at a particular time and might not be applicable to people of other cultures. These points have been made by many experts, most notably by Professor Robert J. Kastenbaum (1932-2013) who was a recognized expert in gerontology, aging, and death; founder and editor of two academic journals in this area (International Journal of Aging and Human Development and Omega: Journal of Death and Dying); founder of the first university-based educational and research center on death and dying (Wayne State University, 1966); and author of several relevant books (e.g., The Psychology of Death (1972); Death, Society and Human Experience (1977); and On Our Way: The Final Passage Through Life and Death (2004)). In his writings, Kastenbaum raised the following points:
- The existence of these stages as such has not been demonstrated.
- No evidence has been presented that people actually do move from Stage 1 through Stage 5.
- The limitations of the method have not been acknowledged.
- The line is blurred between description and prescription.
- The resources, pressures, and characteristics of the immediate environment, which can make a tremendous difference, are not taken into account.
A 2003 study of bereaved individuals conducted by Maciejewski at Yale University obtained some findings consistent with the five-stage hypothesis but others inconsistent with it. Several letters were also published in the same journal criticizing this research and arguing against the stage idea.
George Bonanno, Professor of Clinical Psychology at Columbia University, in his book The Other Side of Sadness: What the New Science of Bereavement Tells Us About Life After a Loss, summarizes peer-reviewed research based on thousands of subjects over two decades and concludes that a natural psychological resilience is a principal component of grief and that there are no stages of grief to pass. Bonanno's work has also demonstrated that absence of grief or trauma symptoms is a healthy outcome.
The lack of support in the academic psychology literature has led to the popular and special interest press applying the labels of myth and fallacy to the notion that there are stages of grief, in publications ranging from Time magazine to Scientific American to Skeptic Magazine, the latter publishing findings of the Grief Recovery Institute that contested the concept of stages of grief as they relate to people who are dealing with the deaths of people important to them.
Grief communication
Grief communication occurs in grief-stricken people, through their emotions, actions, and words. Kübler-Ross placed much emphasis on communication. When a person is approaching death and is going through the five stages of her model she believed that person wanted to review their life, the illness they have, and their imminent death. When a patient and physician could discuss this courageously and candidly a good death would be possible. This model and her thoughts are influential to health care providers; it provides guidance to approaching and interacting with people experiencing grief.
Source of the article : Wikipedia
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