Elisabeth Kubler Ross, in her studies of dying patients, found they had similar responses to facing terminal illness. Although Dr. Kubler-Ross termed these reactions the five stages of grief in her classic book, "On Death and Dying," they are not a rigid formula for human processes. Stages may overlap, be revisited or dispensed with, require minutes or months and occur out of order. The five stages of grief simply demonstrate a common way that people cope with loss.
Denial and Isolation
Patients may meet the shock of a terminal diagnosis by deciding that it can't be happening to them. Disbelief may fuel certainty that the lab made a mistake and the results are wrong. They point to having survived other dangerous situations as proof that they are somehow protected. Kubler-Ross sees denial as a healthy coping mechanism to relieve intensity. Isolation accompanies denial until the person is able to admit and discuss the truth.
Anger
According to Helpguide.org, anger may be used to mask fear and loss of control. An angry person asks why me, why now and why not someone else? Blaming God and feeling envious of those who are healthy stem from anger at the loss of plans, hopes and dreams. Displaced anger can be a concern for caregivers and loved ones, who may take it personally or wonder where it is coming from.
Bargaining
Extra good behavior often worked In childhood to manipulate favors from parents. In grieving, bargaining may consist of agonizing over what should or could have been done to prevent the current situation. Although painful, expressing every what-if can help people eventually come to terms with loss. Dying patients described by Kubler-Ross naturally filled their prayers for recovery with promises, usually kept secret. Many divulged a wish to do one last thing one more time, before all things became impossible. Some of these desires could be met once they were expressed and understood by others.
Depression
According to the American Cancer Society, going through crying spells in the face of uncertainty and loss is a healthy reaction to serious concerns. Kubler-Ross writes that this type of depression is a necessary step to finding peace. Persistent feelings of worthlessness and inability to function may be signs of a more serious clinical depression.
Acceptance
A person can find acceptance without being completely all right with what is happening. The difference lies in having learned to live with a harsh reality and being ready to deal with the changes it brings. In this stage, the person is no longer entirely controlled and defined by loss. For some, acceptance comes early; for others it comes late or not at all.
References
- Helpguide: Anger Management
- "On Death and Dying", Elisabeth Kubler-Ross, M.D., 1997
- ACS: How Do I Cope?
