Understanding the Emotional Journey of Dying: The Kubler-Ross Model

Death is one of the few certainties in life, yet confronting it – whether our own or a loved one’s – remains one of the most emotionally overwhelming experiences we face. In 1969, Swiss-American psychiatrist Elisabeth Kübler-Ross published her landmark book On Death and Dying, in which she proposed a framework for understanding the emotional responses of terminally ill patients. This framework, known as the Kübler-Ross model, identifies five stages: denial, anger, bargaining, depression, and acceptance – often abbreviated as DABDA. While the model has become deeply embedded in popular culture, it was never meant to be a rigid, step-by-step prescription. Rather, it offers a lens through which we can better understand the complex emotional landscape of dying and loss.

The origins of the Kübler-Ross model 🔗

Elisabeth Kübler-Ross was motivated by a glaring gap in medical education. At the time, medical schools offered little instruction on the psychological aspects of death and dying. While working at the University of Chicago’s medical school, she began interviewing terminally ill patients to understand their inner emotional experiences. Before her work, death was something hospitals and medical professionals often avoided discussing openly. Dying patients were rarely given a voice in their own care, and some were not even informed about the severity of their diagnosis.

Her interviews with over 200 dying patients formed the basis of On Death and Dying, which not only introduced the five-stage model but also sparked a broader cultural shift. Conversations about mortality became more open, and the needs and emotional experiences of dying patients gained recognition in both clinical and public spheres. The model was later extended beyond terminal illness to other forms of significant personal loss, including bereavement, divorce, job loss, and major life transitions.

Stage 1: Denial – the mind’s first shield 🔗

When a person receives devastating news – a terminal diagnosis, the sudden death of a loved one – the first reaction is often denial. This is not about ignorance or a failure to understand. It is a defense mechanism that protects us from the full emotional impact of the situation. The mind essentially buys itself time to absorb the reality in manageable doses.

A patient who has just been told they have a terminal illness might insist the lab results are wrong or that there has been a mix-up. A person who has just lost a spouse might feel numb, unable to process the fact that life has fundamentally changed. Denial creates a temporary psychological buffer. It allows people to continue functioning while their mind slowly begins to process the painful truth.

Kübler-Ross noted that this stage is usually temporary. As the initial shock fades, the person begins to confront the reality they have been shielding themselves from – and with that confrontation, other emotions begin to surface.

Stage 2: Anger – the eruption of helplessness 🔗

Once denial can no longer hold, anger often takes its place. This is the stage where the reality of the situation starts to sink in, and the emotional response is frustration, resentment, and sometimes outright rage. A dying patient might direct their anger at doctors for not catching the illness earlier, at family members for perceived inadequacies, or even at a higher power for allowing such suffering.

The anger is not always rational or targeted. It can manifest as a generally shorter temper, irritability toward anyone nearby, or a deep sense of injustice – “Why me?” According to Kübler-Ross, recognizing anger as a natural response can help caregivers and loved ones tolerate what might otherwise feel like hurtful accusations. The key for those surrounding a dying or grieving person is to not take this anger personally. Underneath it lies pain, vulnerability, and a profound sense of loss of control.

David Kessler, who co-authored books with Kübler-Ross, has written that anger can actually serve as an anchor during a time when everything feels untethered. It provides a temporary structure – something concrete to feel – in the midst of overwhelming emotional chaos.

Stage 3: Bargaining – searching for control 🔗

Bargaining is the stage where people attempt to regain some sense of control over a situation that feels entirely out of their hands. It often involves negotiations – with God, with fate, with the universe – and takes the form of “if only” or “what if” statements. A terminally ill person might promise to live a reformed lifestyle in exchange for more time. A grieving person might replay events endlessly, wondering what could have been done differently.

This stage frequently involves guilt. People look back at their actions and wonder whether different choices could have prevented the outcome. “If only I had insisted on that second opinion.” “What if we had caught it sooner?” These thoughts represent an attempt to make sense of something that often has no satisfying explanation.

From a psychological perspective, bargaining reflects the human need to find meaning and order in suffering. Kübler-Ross described these emotional patterns not as neat packages but as common human responses to loss – messy, overlapping, and deeply personal. Bargaining, though it may seem irrational, serves an important function: it helps people transition from the raw shock of denial and anger toward a deeper confrontation with their loss.

Stage 4: Depression – confronting the weight of loss 🔗

After the outward-facing emotions of anger and the mental gymnastics of bargaining, depression draws a person inward. This is the stage where the full gravity of the loss becomes undeniable. The dying patient recognizes the certainty of death. The bereaved person feels the permanent absence of their loved one.

Symptoms during this stage are what one might expect: deep sadness, fatigue, withdrawal from social interaction, tearfulness, and a sense of emptiness. A person may ask, “What is the point of going on?” Kübler-Ross considered depression in this context not as a sign of mental illness, but as an appropriate and natural response to a painful reality. It would be unusual, she argued, to not feel depressed in the face of death or deep loss.

This is also the stage where caregivers may struggle the most. The first three stages – denial, anger, bargaining – can be emotionally taxing for those providing support. By the time depression arrives, compassion fatigue may set in. Yet this is precisely when empathy and patient presence are most needed. The person in this stage does not need to be “fixed” or cheered up. They need space to feel their grief.

Stage 5: Acceptance – finding peace, not happiness 🔗

Acceptance is often misunderstood. It does not mean being “okay” with death or loss. It does not imply happiness or resolution. Instead, acceptance describes a state in which the person acknowledges the reality of what has happened and begins to find a way to live with it.

For a dying patient, acceptance might involve preparing practically for death – arranging finances, writing letters to loved ones, or focusing on enjoying the time they have left and reflecting on their memories. For a grieving person, it could mean slowly re-engaging with daily life – not because the sadness is gone, but because they have found a way to carry it. There are still bad days, but they become less frequent over time.

It is worth noting that not everyone reaches this stage. Some people struggle against death until the very end, and some psychologists have pointed out that this is not necessarily unhealthy – it can be an equally valid way of coping. Acceptance is not the “goal” of grief. It is simply one possible outcome in a complex, deeply individual process.

The stages are not a linear path 🔗

One of the most common misconceptions about the Kübler-Ross model is that the five stages occur in a fixed, sequential order. They do not. Kübler-Ross herself repeatedly emphasized this point. In her later work, she acknowledged that most patients exhibit two or three stages simultaneously, and the stages do not always occur in the same order. She even placed the word “stages” in quotation marks in her book’s diagrams to signal that these were not rigid categories.

A person might move from denial directly to depression, skip bargaining entirely, or oscillate between anger and acceptance over weeks or months. Some people experience all five stages multiple times. Others may only experience two. The model was always intended to be descriptive – a way of naming common emotional responses – rather than prescriptive.

Grief researcher Kenneth J. Doka made an important distinction: Kübler-Ross originally viewed these stages as reflections of how people cope with illness and dying, not as reflections of how people grieve. The extension of the model to bereaved individuals – those mourning the death of someone else – happened later and was not part of her original research.

Criticisms and limitations of the model 🔗

Despite its widespread popularity, the Kübler-Ross model has faced substantial criticism from the scientific community. The primary concern is the absence of sound empirical evidence supporting the stages as described. The model was based on qualitative interviews and clinical observations – not controlled studies or systematic research. It was, in essence, a collection of case studies drawn from conversations with dying patients.

Several research efforts have attempted to test the model empirically, and most have found it lacking. A study by Bonnano in 2002 that examined 205 individuals before and after their spouses’ deaths found that only about 11% followed the grief trajectory assumed to be “normal.” The Yale Bereavement Study (2000-2003) found that acceptance was actually the most commonly reported reaction from the very start, not something that emerged only at the end. Yearning, not denial or anger, was the most common negative experience in the first two years.

Critics also argue that treating the stages as a universal framework can cause harm. When people believe they should be experiencing certain emotions in a certain order, they may feel that they are “grieving wrong” if their experience does not match the model. This can lead to unnecessary distress and can also influence how caregivers and healthcare providers interact with grieving individuals – sometimes pushing them through stages rather than supporting their unique process.

Alternative models of grief 🔗

In response to these criticisms, several alternative approaches to understanding grief have emerged. Bowlby and Parkes proposed a four-phase model in the 1980s that replaced “denial” with “numbness” to avoid negative connotations and emphasized that grief is not a linear process. Their phases – numbness, yearning and searching, disorganization and despair, and reorganization – drew on attachment theory and offered a more fluid understanding of loss.

The Dual Process Model of Coping with Bereavement, developed by Stroebe and Schut, suggests that grieving individuals oscillate between “loss-oriented” coping (processing the pain of loss) and “restoration-oriented” coping (adjusting to life changes). This model accounts for the fact that grief is not a constant state – people move in and out of it as they navigate daily life.

David Kessler, Kübler-Ross’s co-author, has also proposed a sixth stage: meaning. In his 2019 book Finding Meaning, Kessler argues that the journey through grief does not end with acceptance but continues into a phase where people find ways to honour their loved ones and create purpose from their loss.

Why the Kübler-Ross model still matters 🔗

Despite its limitations, the Kübler-Ross model has enduring value – not as a scientific law, but as a vocabulary for emotional experience. Before On Death and Dying, Western culture largely avoided frank conversations about death. Kübler-Ross gave people – patients, families, doctors, and the general public – a language to talk about something that had been treated as taboo.

The model remains widely taught in medical and nursing programs, psychology courses, and counselling training – not because it is empirically airtight, but because it offers a starting point for understanding the emotional complexity of dying. It reminds healthcare professionals that patients are not simply bodies to be treated but human beings grappling with fear, loss, and the search for meaning.

The key is to use the model the way Kübler-Ross intended: as a flexible framework, not a checklist. Every person’s experience with death – their own or someone else’s – is unique. The stages provide a map of common emotional terrain, but they do not dictate the path anyone must walk.

What do you think? Have you found the five-stage model helpful in understanding your own experiences with loss, or does it feel too structured for something as personal as grief? How might recognising that grief is non-linear change the way we support those around us who are mourning?

References

1. https://www.ekrfoundation.org/5-stages-of-grief/change-curve/
2. https://www.ncbi.nlm.nih.gov/books/NBK507885/
3. https://www.health.harvard.edu/mind-and-mood/5-stages-of-grief-coping-with-the-loss-of-a-loved-one
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC8675126/
5. https://en.wikipedia.org/wiki/Five_stages_of_grief
6. https://encyclopedia.pub/entry/32709
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC5375020/
8. https://courses.lumenlearning.com/suny-lifespandevelopment/chapter/models-of-grief/