Kubler-Ross published her seminal work On Death and Dying in 1969. This described her work with terminally ill patients and the different psychological stages that they went through in coming to terms with their condition. Clearly this research was considered to have major implications for people experiencing other types of profound change.
Kubler-Ross realized that patients – given the necessary conditions – would typically go through five stages as they came to terms with their prognosis. The stages were denial, anger, bargaining, depression and finally acceptance.
Denial
People faced with such potentially catastrophic change would often not be able to accept the communication. They would deny it to themselves. That is, they would not actually take it in, but would become emotionally numb and have a sense of disbelief. Some would argue that this is the body’s way of allowing people to prepare themselves for what is to follow. On a more trivial scale, some of us have experienced the numbness and disbelief when our favourite sports team is defeated. There is little that we can do but in a sense ‘shut down’. We do not want to accept the news and expose ourselves to the heartache that that would bring.
Anger
When people allow themselves to acknowledge what is happening they enter the second stage, typically that of anger. They begin to ask themselves questions like, ‘Why me?’, ‘How could such a thing happen to someone like me? If only it had been someone else’, ‘Surely it’s the doctors who are to blame – perhaps they’ve misdiagnosed’ (back into denial). ‘Why didn’t they catch it in time?’
Anger and frustration can be focused externally, but for some of us it is ourselves we blame. Why did we not see it coming, give up smoking? ‘It’s always me who gets into trouble.’
In some ways we can see this process as a continuation of our not wanting to accept the change and of wanting to do something, anything, other than fully believe in it. Anger is yet another way of displacing our real feelings about the situation.
Bargaining
When they have exhausted themselves by attacking others (or themselves) people may still want to wrest back some control of the situation or of their fate. Kubler-Ross saw bargaining as a stage that people would enter now.
For those who themselves are dying, and also for those facing the death of a loved one, this stage can be typified by a conversation with themselves. Or if they are religious, this may be a conversation with God, which asks for an extension of time. ‘If I promise to be good from now on, if I accept some remorse for any ills I have committed, if I could just be allowed to live to see my daughter’s wedding, I’ll take back all the nasty things I said about that person if you’ll only let them live.’
Once again we can see this stage as a deflection of the true gravity of the situation. This is bargaining, perhaps verging on panic. The person is desperately looking around for something, anything, to remedy the situation. ‘If only I could get it fixed or sorted everything would be all right.’
Depression
When it becomes clear that no amount of bargaining is going to provide an escape from the situation, perhaps the true momentousness of it kicks in. How might we react? Kubler-Ross saw her patients enter a depression at this stage. By depression we mean a mourning or grieving for loss, because in this situation we will be losing all that we have ever had and all those we have ever known. We shall be losing our future, we shall be losing our very selves. We are at a stage where we are ready to give up on everything. We are grieving for the loss that we are about to endure.
For some, this depression can take the form of apathy or a sense of pointlessness. For others it can take the form of sadness, and for some a mixture of intense emotions and disassociated states.
Acceptance
Kubler-Ross saw many people move out of their depression and enter a fifth stage of acceptance. Perhaps we might add the word ‘quiet’ to acceptance, because this is not necessarily a happy stage, but it is a stage where people can in some ways come to terms with the reality of their situation and the inevitability of what is happening to them. People have a sense of being fully in touch with their feeling about the situation, their hopes and fears, their anxieties. They are prepared.
Further clinical and management researchers have added to Kubler-Ross’s five stages, in particular Adams.
- Relief: ‘At least I now know what’s happening now, I had my suspicions, I wasn’t just being paranoid.’
- Shock and/or surprise: really a subset of denial but characterized by a sense of disbelief.
- Denial: total non-acceptance of the change and maybe ‘proving’ to oneself that it is not happening and hoping that it will go away.
- Anger: experiencing anger and frustration but really in an unaware sort of way, that is, taking no responsibility for your emotions.
- Bargaining: the attempt to avoid the inevitable.
- Depression: hitting the lows and responding (or being unresponsive) with apathy or sadness.
- Acceptance: the reality of the situation is accepted.
- Experimentation: after having been very inward looking with acceptance, the idea arrives that perhaps there are things ‘out there’. ‘Perhaps some of these changes might be worth at least thinking about. Perhaps I might just ask to see the job description of that new job.’
- Discovery: as you enter this new world that has changed there may be the discovery that things are not as bad as you imagined. Perhaps the company was telling the truth when it said there would be new opportunities and a better way of working.