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Death, dying and the emotional responses one feels toward these topics are particularly challenging issues to address.

Psychiatrist Dr. Elisabeth Kubler-Ross proposed stages of emotional responses to death and dying. This lesson will present those five stages and also discuss common criticisms of Kubler-Ross’s theory.

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Approach to Death and Dying

The emotional response to death and the knowledge that one is dying is a complex situation to process, from the perspective of the individual dealing with the knowledge of death to the loved one or caregiver associated with that person.

Before the late 1960s, when one found out they were dying, the focus was on the cure, not necessarily the care. Doctors and caregivers were not sensitized to the emotional needs of dying people. It was the work of psychiatrist Elisabeth Kubler-Ross that changed this perspective of death from an approach of curing to an approach of caring for the person dying.Kubler-Ross wrote On Death and Dying, a work that was said to have revolutionized the care of dying people by making society and doctors aware and more sensitive to the emotional needs of dying people. Kubler-Ross identified emotional responses which resulted in five stages of grief. She and her colleagues conducted interviews with terminally ill patients.

Through these interviews, she identified a common set of emotional responses to how one deals with death and the knowledge of dying. Those stages are denial, anger, bargaining, depression and acceptance.

Kubler-Ross’s 5 Stages

The first stage in the Kubler-Ross model is denial .

During this stage, the initial (and most common) emotional response to the knowledge of impending death is denial. People in this stage say, ‘No, not me. It can’t be!’ According to Kubler-Ross, denial serves as a defense mechanism. Denying the inevitable helps ease anxiety and fearful thoughts. For example, a man diagnosed with cancer may be adamant that the test results are incorrect or feels invincible and thinks he can beat the odds of survival. Denial can be a positive coping method, allowing one to come to terms with the knowledge of dying on their own until they are ready to cope constructively. Close family members and friends may also experience denial.

The second stage is anger. Once the dying person accepts that the diagnosis is correct he or she may become very angry. Feelings of rage or resentment may overcome this person and the anger may be directed at others as well. The person may ask, ‘Why me?’ The identification of this stage has aided the care of dying patients, as Kubler-Ross recommended that doctors and loved ones should not respond to the anger of the dying person with avoidance or returned anger, but instead through support.

The third stage is bargaining. During this stage the dying person may try to barter with doctors, family or even God. Saying, ‘Okay, but please.

..’ The person may try to bargain for a cure, extra time with family or less pain.The fourth stage is depression. As the dying person realizes death is impending and has nothing left to bargain, he or she may become depressed. The individual may grieve what they have already lost (for example the ability to walk or have independence) and grieve the impending separation from loved ones.

The final stage is acceptance. Kubler-Ross described this time period as a period of calm and peace. If the dying person was able to work through previous emotional stages, they may be at a point of reflectance and embrace the end of their battle.Kubler-Ross points out that in addition to the five stages, a sixth emotional responses runs throughout, and that is hope. Kubler-Ross stated that hope is critical for dying patients, even if it is just the hope of dying with dignity.

Criticism of Kubler-Ross’s Theory

While Kubler-Ross’s theory greatly improved the practice of caregivers and doctors when treating and caring for dying patients, there are several criticisms of the theory to be familiar with. One common critique of the theory is the fact that dying does not happen in a stage-like progression. The emotional responses identified by Kubler-Ross may or may not occur in the order outlined in her theory.Additionally, all dying patients are unique. Depending on the type of disease or cause of impending death, people may experience different emotional responses to the particular event happening at that time point.

Finally, critics have pointed out that every person has a unique personality, and these personalities play a big role on their emotional responses to death. Depending on the existing support, coping mechanisms and social competencies, one person may be in denial until death, and another may accept the fatal diagnosis right away.

Lesson Summary

In summary, Kubler-Ross and colleagues developed a five stage model of death and dying. These stages have different emotional responses that people go through in response to the knowledge of death. They are commonly referred to by an acronym of DABDA and are denial, anger, bargaining, depression and acceptance.

While her theory helped to revolutionize the approach and care provided by doctors in dealing with dying patients, critics have pointed out a few areas concerning the generalizability of the theory. First, dying does not occur in a stage-like progression as indicated by Kubler-Ross. Second, all dying patients are unique and thus their responses to death will be different. Third, unique personalities play a role in the emotional responses of each dying person.

Learning Outcome

Once you’ve completed the video, you should have the ability to:

  • Identify Elisabeth Kubler-Ross and her seminal work On Death and Dying
  • Explain the five stages of death that she proposed
  • Discuss the criticisms towards her five-stage model

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