See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/264310506

Elisabeth Kübler-Ross

Chapter · February 2014

DOI: 10.13140/RG.2.1.3863.2401

CITATION READS
1 32,742

1 author:

Jason M Holland
TNWellnessCenter.com LifeSparkWeekly.com
88 PUBLICATIONS   2,240 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Examination of Life Satisfaction, Child Maltreatment Potential and Substance Use in Mothers Referred for Treatment by Child Protective Services for Child Neglect and
Substance Abuse: Implications for Intervention Planning View project

Performance of Appointment Tasks Scale (PATS) View project

All content following this page was uploaded by Jason M Holland on 29 July 2014.

The user has requested enhancement of the downloaded file.

Kϋbler-Ross, Elisabeth

Elisabeth Kϋbler-Ross, a Swiss-born psychiatrist and advocate for

compassionate care in the end-of-life, was a pioneering figure in bringing awareness to

issues of death and dying in the medical profession and encouraging improved

treatment for dying patients. Born one of three triplets in 1926, Kϋbler-Ross was highly

influenced by her early experiences as a relief worker in Poland following World War II.

In particular, during a visit to Maidanek, a concentration camp, she was struck by

carved butterflies on the camp walls left by children there. As she commented in a 1995

interview with Dr. Daniel Redwood, “It was incomprehensible to me. Thousands of

children going into the gas chamber, and this is the message they leave behind—a

butterfly. That was really the beginning.”

Committed to a career path that would allow her to examine issues of life, death,

and the human spirit, Kϋbler-Ross began her medical training in 1951 at the University

of Zurich. It was there that she met her American-born husband, Emanuel Ross, and

she eventually moved to the United States with him, where she completed her

internship and residency training in psychiatry. In 1965, she secured a teaching position

at the University of Chicago Medical School and taught seminars there on death and

dying, which involved extensive interviews with terminally ill patients. Based on these

interviews, Kϋbler-Ross wrote her seminal work, On Death and Dying, and introduced

her now famous 5-stage model of approaching death. Although her first book is the

most widely read, Kϋbler-Ross was a prolific writer, authoring more than 20 books

dealing with subjects related to death, grief, and the afterlife.

 Using the proceeds from her books, workshops, and talks, in 1977 Kϋbler-Ross

left academia and founded Shanti Nilaya (Final Home of Peace) in Escondido, CA,

which was intended as a healing center for terminally ill patients and their families.

Shortly afterward, she and her husband divorced. Kϋbler-Ross eventually moved her

healing center to a farm in Head Waters, Virginia in 1990 and attempted to create a

hospice for children with AIDS there. However, progress was stifled by opposition in the

community, which ultimately prevented her vision from being fully realized.

After suffering a series of strokes in the mid-1990’s, her Virginia-based center

was closed. Following a long period of being partially paralyzed and wheel-chair bound,

Kϋbler-Ross died in 2004 in her home in Scottsdale, AZ and was survived by her two

children and two grandchildren.

Stage Theory

According to Kϋbler-Ross’s 5-stage model, terminally ill patients tend to

experience five reactions to their impending loss, often proceeding through denial,

anger, bargaining, depression, and then ultimately acceptance. In the denial phase,

patients may feel shocked or stunned and have a difficult time grasping the reality of

their situation. As the reality of their impending death begins to sink in, disbelief can

sometimes be replaced by feelings of anger, characterized by bitterness, feeling that life

is unfair, or questioning God. In the subsequent bargaining stage, patients long to

postpone death, in some cases attempting to “make a deal” with God for more time,

often in exchange for a reformed lifestyle. This stage may also involve a desire to

change the past (e.g., “If only I had taken better care of myself”), which is accompanied

by feelings of guilt and regret. Realizing the certainty of death, dying patients’ may also
go through a period of depression and experience feelings of despair, hopelessness,

and isolation. In the final stage of acceptance, individuals acknowledge their mortality

and are better able to make preparations for their death, perhaps by attending to any

perceived “unfinished business” in their life.

Although Kϋbler-Ross’s stage model was initially intended for patients with a

terminal illness, she later broadened her focus and suggested that it has applicability for

anyone who has experienced a catastrophic loss (e.g., following bereavement, job loss,

divorce). Since the birth of Kϋbler-Ross’s theory, the notion of stages of grief has, to a

significant extent, become ingrained in our cultural beliefs about loss, and these models

of grieving are still routinely taught as part of the curriculum in medical schools and

nursing programs.

Criticism and Controversy

A number of end-of-life theorists and researchers have sharply criticized Kϋbler-

Ross’s model, noting that individuals who experience a loss do not proceed through a

linear set of stages and that reactions to loss are as diverse as the people who

experience them. Others have also pointed out the inconsistency between stage theory

and more contemporary research that suggests that most individuals who experience

the loss of a loved one are fairly resilient and report minimal depressive and grief

symptomatology.

In her final book, On Grief and Grieving coauthored with David Kessler, Kϋbler-

Ross responded to these criticisms:

The stages…have been very misunderstood over the past three decades. They

were never meant to help tuck messy emotions into neat packages. They are
 responses to loss that many people have, but there is not a typical response to

loss, as there is no typical loss. Our grief is as individual as our lives. (p. 7)

Although stage theories of loss continue to permeate popular culture, in

academic settings alternative models have largely replaced stage theory. For example,

Margaret Stroebe and Henk Schut’s Dual Process Model as well as meaning-oriented

models (largely popularized by Robert Neimeyer), have been researched extensively

and enjoy a strong base of empirical support.

Empirical Findings

Although Kϋbler-Ross’s model has not been researched as extensively as some

other models, two recent studies have been conducted that yielded findings that were

both consistent and inconsistent with stage theory. In a 2007 study conducted by Paul

Maciejewski and his colleagues, the grief experiences of bereaved individuals were

found to reach peak levels in a sequence that was consistent with Kϋbler-Ross’s model.

However, acceptance was found to be the dominant response throughout the first two

years of loss. In another study of stage theory conducted by Jason Holland and Robert

Neimeyer in 2010, sharp differences were found for individuals who experienced losses

by natural and violent causes. Specifically, acceptance was found to be the dominant

response for those bereaved by natural causes regardless of time since loss. In

contrast, in the early aftermath of loss by violent means, disbelief and depression were

most prominent, which then seemed to be largely replaced by acceptance for those

bereaved for 10 months or longer—a finding somewhat more consistent with Kϋbler-

Ross’s model.

Jason M. Holland, Ph.D.

University of Nevada, Las Vegas
 Further Reading

Holland, J. M., & Neimeyer, R. A. (2010). An examination of stage theory of grief among

individuals bereaved by natural and violent causes: A meaning-oriented

contribution. Omega: Journal of Death and Dying, 61, 103-120.

Kübler-Ross, E. (1969). On death and dying. New York, NY: Macmillan Publishing.

Kübler-Ross, E., & Kessler, D. (2005). On grief and grieving: Finding the meaning of

grief through the five stages of loss. New York, NY: Scribner.

Maciejewski, P. K., Zhang, B., Block, S. D., & Prigerson, H. G. (2007). An empirical

examination of the stage theory of grief. JAMA, 297, 716-723.

Redwood, D. (Interviewer). (1995). On Death and Dying: Interview with Elisabeth

Kübler-Ross [Interview transcript]. Retrieved from Health.net Web site:

http://www.healthy.net/scr/interview.aspx?Id=205

View publication stats