Throughout life’s, we experience many incidences and instances of grief. Grief is a result of factors such as relationships, substance abuse, death and break of friendship. However, of all the causes of grief, death is one of the most emotional and heartbreaking situations. Many scientists have spent the time to study the process that one undergoes until death occurs. According to Kubler-Ross model, death occurs in five stages commencing with denial, rage, bargaining, depression and, lastly acceptance. This research paper examines various scholarly materials to present and examine the five stages of death as proposed by Elizabeth Kubler-Ross.
The Stages of Grief
Denial and Isolation Stage
The first reaction to the possibility of death is denial. During this stage, persons believe that the diagnosis indicating that they are facing imminent death is mistaken. Consequently, they stick to a deceptive but preferable reality (Jokoby, 2012). Denial occurs not only to patients but also to the loved ones of the person facing imminent death. Denial is a psychological defense mechanism that helps buffer emotions. Hence, persons end up hiding from the facts, which is a temporary response to go through the initial waves of pain. Isolation is a mental process that involves the establishment of a gap between a threatening cognition and feelings or thoughts (Chapman et al., 2013). When an individual minimizes associative connection and thoughts, the chances of remembering the threatening cognition reduces (Jokoby, 2012).
Several studies conclude that persons defend themselves from threats through mental isolation (McAlearney et al., 2015). When presented with adverse information such as the possibility of death, persons will generate spontaneous happy feelings to minimize its impact (APA, 2018). Evidence from animal and human research depicts that the isolation process triggers sensitivity to social threats such as death hence motivating renewal of social relations. Denial and isolation may then advance to Anger stage (Francis et al., 2015).
Anger Stage
Anger is an emotional event that is characterized by the presence of antagonistic tendencies towards something or someone. Anger is a necessary healing process (APA, 2018). When an individual realizes that denial is not sustainable, they become frustrated. Usually, a person gets angry he/she realizes that they are living in actual reality and not in the preferable reality. A person will regret why the event is happening to him/her and find it incomprehensible of how it is unfair (Jokoby, 2012). While anger can help someone to find solutions to problems, it can expedite the process of death due to the adverse psychological effects. According to Chapman et al., (2013), suppression of anger significantly increases all causes of mortality. However, depending on the cultural association of an individual anger is presented and perceived differently from person to person. If an individual believes in God, he may end up questioning his/her beliefs (Jokoby, 2012).
Bargaining Stage
After anger phase, an individual will switch to the bargaining stage (McAlearney et al. 2015). The bargaining phase is a normal reaction to the feeling of vulnerability and hopelessness with the aim of regaining control of the situation (Francis et al., 2015). In most instances, during bargaining, a person’s would wish for or negotiates for an extended life in exchange for reforming his/her lifestyle or avoiding the causes of death (Chapman et al., 2013). Individuals with the relatively less serious traumatic event can seek for compromise. Religious persons may secretly make deal with God to attempt to defer the inevitable death and the associated pain. During bargaining, a person negotiates and tries to establish trade-offs to avert legitimate contingency (McAlearney et al. 2015). When the outcomes or bargaining are not desirable to the grieving or dying person, one may plunge into depression.
Depression Stage
After the process of bargaining, our attention may move squarely into the present reality and depression. Depression result in the lack of interest, loss of energy, worthlessness, inability to concentrate, recurrent thoughts of deaths and excessive guilt (APA, 2018).There are two types of depression that may relate to grieving. The first stage is dominated by regrets, sadness, and worry while the second type is more subtle and private (Francis et al., 2015). Depression is usually accepted as a form of grief. It relates to the emptiness that a person feels when experiencing reality and realizing that a person or situation is over (APA, 2018). Establishing the difference between normal grieving and depression phase can be complicated.
Studies show that factors such feeling of guilt, “unfinished business,” and personality of the person grieving can inform the coping strategies (McAlearney et al., 2015). A person withdraws from life, suffers intense sadness and worry. It is imperative to understand the difference between depression and normal grieving so that we can seek professional help. When studying the emotional outcomes of bereaved caregivers, Francis et al found out a strong connection between grief and depression. Various factors such as personality, culture, religion, and caregiving may influence the depressive outcomes. However, while grief severity is determined by caregiving circumstances, bereavement depression is largely unrelated to caregiving (Francis et al., 2015). After undergoing the depressive stage, an individual is forced to accept his/her condition or grief.
Acceptance Stage
The last stage of grieving according to Kubler-Ross model is acceptance. While acceptance stage is not a “happy” phase, it is often “void” of feelings. Thus it is often tangled with the notion that a person is “OK” with what is happening (McAlearney et al., 2015). However, most persons do not feel alright about the loss of loved ones or the near-death events. Persons undergoing this stage accept the reality that death is happening or has occurred and they recognize that it an irreversible reality. It is a difficult reality but eventually, we accept it after the emotions begin to stabilize. Acceptance is an individual’s assent to the existing reality of a condition, often an uncomfortable or negative situation without trying to protest or changing. However, the challenge is to find the pathway to accepting death (Jokoby, 2012).
Criticism of Elizabeth Kubler’s Model
Some scholars argue that there is no real pragmatic evidence to prove the existence of the stages or set the order of death. Such arguments are valid since any person may experience the phases in a different order and it may not be true that everyone passes through the stages. As such, the model prescribes rather than describe the dying process. The process of dying is affected by other factors such as attitudes, beliefs, cultural practices, religion and nature of care (Francis et al., 2015).
Conclusion
In conclusion, death is not only an emotional process but also a psychological happening. When a person is faced with a possibility of death, the first reaction will be denial. The denial process may elicit psychological reactions such as anger bargaining and depression. Due to the hopelessness that an individual may feel in near-death situations, and inability to get the help needed, one is forced to accept to die. However, not all persons will go through the five stages as proposed by Kubler-Ross. However, the model present necessary foundation for understanding how to cope with death and for further research.
References
APA. (2018). Depression. Retrieved 2018, from American Psychological Association: http://www.apa.org/topics/depression/index.aspx
Chapman, B. F. (2013). Emotion Suppression and Mortality Risk Over a 12-Year Follow-up. Journal of Psychosom Res, 75(4), 381-385.
Francis, L. K. (2015). Grief and Risk of Depression in Context The Emotional Outcomes of Bereaved Cancer Caregivers. OMEGA-Journal of death and dying, 70(4), 351-379.
Jokoby, N. (2012). Grief as a Social Emotion: Theoretical Perspectives. Death Studies, 36(8), 679-711.
McAlearney, A. H. (2015). The Journey through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation. Health Services Research, 50(2), 462–488.
