Five Stages

During a recent conversation, the question of the stages of grief came up. I wasn’t sure if there were supposed to seven stages or five. The five stages of grief are Denial, Anger, Bargaining, Depression and Acceptance, in the system suggested by the Swiss psychiatrist Elizabeth Kubler-Ross, in her 1969 book On Death and Dying. I read it many years ago. I remembered her effort to find a pattern of meaning in the emotions of terminally ill hospital patients. I remembered the theory sounded a bit fuzzy. The stages had been the central theme of the 1979 movie, All that Jazz, which I had seen when it was released in theaters. (The movie has attracted mixed reviews).

Kubler-Ross claimed to have described a general process of grieving for one’s own death by terminal illness, or for grieving the death of a loved one. Her idea has been extended and generalized to other kinds of losses by some counsellors and writers who appear to accept the stages as a universal human process. The idea of a staged process has become part of the stock of modern cultural information and so widely accepted that it forms part of the conventional wisdom.
Kubler-Ross’s theory has been widely criticized. < a href="http://www.uky.edu/Classes/PHI/350/kr.htm">This link to the online course notes of Dr. Christian Perring of the University of Kentucky’s Department of Philosophy provides some general criticisms of the theory. Howard Gorle has published an online E-book at www.bereavement.org which goes into more detail.
One of the pages at bereavement.org – Beware the 5 Stage Theory – reminds us that the theory of 5 stages was originally a description of how critically ill patients receive catastrophic news and that it was not a general theory of grief. The Canadian journalist Heather Robertson published an article in Elm Street Magazine which indicates that Kubler-Ross had borrowed her theory from a chaplain and from other writers without attribution and dressed it up as a (Freudian-oriented) psychiatric theory.
Gorle’s summary of the criticism of Kubler-Ross is succinct:

The ‘Stage Theory’ and Kubler-Ross have been the subject of often cynical questioning in recent years. Difficulties with the research method have not been addressed in over 25 years. Nor is there any verification of the existence of the Five Stages or that if they exist, people progress through them in any orderly fashion.
The supposed universality of the stages sometimes results in patients being herded along to ‘the next stage’ by family, support and medical personnel. In other words, the ‘description’ has become the ‘prescription’. The theory denies the individuality of human beings and other needs of the dying such as having some control in their own treatment and destiny, the role of culture, religion, personality, family dynamics and so on.

Other pages at bereavement.org, stemming from a theories page, explore many other literary, religious and cultural theories of grief. I recommend these pages to readers of my age who will be confronting their own illnesses and the illnesses and deaths of elderly parents. I have been there myself in 2001 around a (fortunately incorrect) diagnosis of colon cancer. I wish I had had this information for my own support at that time.
Kubler-Ross describes the process of learning about imminent death, and dying as a journey from denial to acceptance. That’s a romantic vision, with overtones of Eastern religious wisdom – a journey from ignorance and pain to enlightenment and release. It is obviously a more attractive package than the journey from immobilized shock through anxiety and depression to painful resignation.
She presents her work as a scientific analysis of the case studies of a large number of patients. What she presents is her selective interpretation of what some people told her they were feeling. The 5 stage theory is her rough model of the grief process for the doomed and the bereaved. It isn’t science – it’s metaphor. Her five stages are named for a confusing combination of states, processes and basic emotions. She starts and ends with judgmental statements about denial and acceptance. People who don’t like the idea of dying are in denial which is unenlightened and bad. People who learn they have no choice are enlightened and good.
Her concept of Denial seems to legitimize one of the great all-purpose insults of the late 20th century. When someone does not agree with your interpretation of facts, events or emotions, he is not merely mistaken or wrong, but “in denial”. A person in denial is ignorant, unenlightened and sick. When one person describes someone else as being in denial, she claims the moral and spiritual high ground, and the therapeutic high ground. I doubt that she was the first person to misuse the word “denial” this way. This demeaning pseudo-therapeutic usage comes out of the addiction/recovery movement and humanistic psychology, and Kubler-Ross has only further popularized it.