I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.
Maya Angelou

The most familiar model of how people react to their own dying is the 5-stage model proposed in 1969 by psychiatrist Dr. Elisabeth Kübler-Ross in her book On Death and Dying. The basis of her model was a series of interviews she conducted in her attempt to determine how people react to their own imminent death.  From their responses, she developed a list of five predominant “defense mechanisms” these people used to face the stress of their situation.

Dr. Kübler-Ross’s five stages (also known as DABDA) and how they are typically expressed are:

  • Denial - “Not me!”
  • Anger - “Why me?”
  • Bargaining - “Yes, it is me, but…”
  • Depression - both Reactive (responding to past and present losses) and Prepatory (anticipating and responding to losses yet to occur),
  • Acceptance - “almost void of feeling”
While Dr. Kübler-Ross’s book and model helped bring the issues related to death and dying out into the open, both public and professional, and she highlighted the importance of “unfinished business,” there are some serious flaws with her model, many of which are the same ones associated with using stages and phases as a model for mourning.

  • The actual existence of these, or any other set of stages, has not been shown to exist.
  • There there is no evidence that people move from one stage to another.
  • The model does not differentiate between describing what happens or prescribing what should happen?
  • There is no consideration of the whole of a person’s life.
  • There is no consideration of the immediate environment of the person such as resources, pressures, etc. The stage names are used loosely.  For example, the meaning for the word denial can range from “I am not ill.” to “I am dying and death will come shortly."
  • The term “stages” carries with it the implication that coping is a series of linear progressions.
  • As with its use in describing mourning, “stages” also infers that coping with dying is a passive event.
  • In misapplications of Kübler-Ross’s model, dying people can become objectified into a “case of denial,” “stuck in anger,” etc. The person is pathologized, and the uniqueness of his/her own particular situation is ignored.
For these reasons, I do not use a stage-based approach to describe coping with dying.  I prefer the more active, individualistic task-based model.