Five stages of grief (Kübler-Ross)

What drives it

The stages give a frightened person a map and names for feelings that seem to have no order. For identification the useful question runs the other way: when someone measures their grief against the five stages and feels behind, out of order or broken, the model itself may be adding to the distress.

How it shows

Work

An HR leaflet with the five stages printed on it, handed out the week of the funeral. A manager says ‘he’s in the anger stage’ about a colleague who snapped in a meeting. The change curve on a slide during a restructure, drawn from the same five words.

Relationships

A sister is told she must still be ‘in denial’ because she hasn’t cried. A friend asks, eight months on, whether someone has ‘reached acceptance yet’. Two relatives argue over who is grieving properly.

Self

Notice whether you check your feelings against a list. Anger after a calm month, or yearning on a good day, can feel like going backwards when it may be how grief usually moves.

What tells it apart

Dual process model of coping with bereavement (Stroebe and Schut): The dual process model describes moving back and forth between the loss and daily life, with no fixed order. Grief that swings between days of tears and days of admin and plans is more likely that back-and-forth than a stage left unfinished.

Change curve: The change curve is a management tool for organizational change, borrowed from the stages. When the five words turn up at work about a restructure, the curve may be in use, and it carries the same lack of evidence.

Grief trajectories and resilience (Bonanno): Trajectory research follows people over time and finds several paths, the most common being steady functioning with brief waves of pain. A person with no clear ‘depression stage’ may be on that path and has skipped nothing.

A test

Ask the person to list the feelings of the last two weeks in the order they came. Feelings that arrive together, repeat or jump around may suggest the stages are a poor fit, and a worry about doing grief wrong may come from the model more than from the grief.

Go deeper

One book, one talk and one study, each on another site.

• Read: The Other Side of Sadness, George A. Bonanno, 2009, revised 2019. Written for readers by a psychologist who has followed bereaved people for years. He questions the idea that grief moves through set stages and argues that most people come through a loss with more resilience than expected. Much of it rests on his own group's studies.
• Watch: 3 secrets of resilient people, Lucy Hone, TEDxChristchurch, 2019. A resilience researcher on the months after her 12-year-old daughter Abi was killed in a car crash, and the three habits she leaned on. She describes the five-stage leaflets she was handed. One family's account, free to watch.

How strong the research is

weak. The stages came from Kübler-Ross’s work with dying patients and were later applied to bereavement without testing. In the Yale Bereavement Study (Maciejewski, Zhang, Block and Prigerson, JAMA, 2007), 233 people bereaved by natural causes were followed from 1 to 24 months: acceptance was the most endorsed item, and yearning outweighed disbelief, anger and depression throughout. Disbelief, yearning, anger and depression peaked in that order within six months, which the authors read as partial support, but critics pointed out that these were group averages with acceptance ahead from the start, so they show no person passing from one stage to the next. Stroebe, Schut and Boerner (Omega, 2017) called the stages unsupported and warned they can leave bereaved people feeling they are grieving wrongly.

Where it comes from

Elisabeth Kübler-Ross, On Death and Dying, 1969 (how dying patients came to terms with their own death). In Questions and Answers on Death and Dying, 1974, she wrote that patients often showed several stages at once and out of order. Extended to bereavement with David Kessler in On Grief and Grieving, 2005

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