The 5 Stages of Grief

The first reaction to learning of terminal illness or death of a cherished loved one is to deny the reality of the situation. It is a normal reaction to rationalize overwhelming emotions. It is a defense mechanism that buffers the immediate shock. We block out the words and hide from the facts. This is a temporary response that carries us through the first wave of pain.

As the masking effects of denial and isolation begin to wear, reality and its pain re-emerge. We are not ready. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends or family. Anger may be directed at our dying or deceased loved one. Rationally, we know the person is not to be blamed. Emotionally, however, we may resent the person for causing us pain or for leaving us. We feel guilty for being angry, and this makes us more angry.

Two types of depression are associated with mourning. The first one is a reaction to practical implications relating to the loss. Sadness and regret predominate this type of depression. We worry about the costs and burial. We worry that, in our grief, we have spent less time with others that depend on us. This phase may be eased by simple clarification and reassurance. We may need a bit of helpful cooperation and a few kind words. The second type of depression is more subtle and, in a sense, perhaps more private. It is our quiet preparation to separate and to bid our loved one farewell.

Reaching this stage of mourning is a gift not afforded to everyone. Death may be sudden and unexpected or we may never see beyond our anger or denial. It is not necessarily a mark of bravery to resist the inevitable and to deny ourselves the opportunity to make our peace. This phase is marked by withdrawal and calm. This is not a period of happiness and must be distinguished from depression.

The stages, popularly known by the acronym DABDA, is a series of emotional stages experienced when faced with impending death or death of someone.

The model was first introduced by American Psychiatrist Elisabeth Kubler-Ross in her 1969 book, On Death and Dying, and was inspired by her work with terminally ill patients. Motivated by the lack of curriculum in medical schools on the subject of death and dying, Kubler-Ross began a project which examined death and those faced with it while working as an instructor at the University of Chicago's medical school. Kubler-Ross' project evolved into a series of seminars which, along with patient interviews and previous research, became the foundation for her book, and revolutionized how the U.S. medical field takes care of the terminally ill. In the decades since the publication of "On Death and Dying", the Kubler-Ross concept has become largely accepted by the general public; however, its validity has yet to be consistently supported by the majority of research studies that have examined it.

Elisabeth Kubler-Ross noted that the stages are not meant to be a complete list of all possible emotions that could be felt, and they can occur in any order. Her hypothesis holds that not everyone who experiences a life-threatening or life-altering event feels all five of the responses, due to reactions of personal losses differing between people.