Was den Menschen zum Menschen macht

Kübler-Ross Model

4 Min. Lesezeit

🇩🇪 Deutsche Version: Kübler-Ross-Modell

In her book On Death and Dying (1969), Elisabeth Kübler-Ross formulated a model of five stages that became synonymous in popular discourse with “stages of grief”:

  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance

In the popular understanding, the stages are often perceived as a linear progression — an understanding that is scientifically untenable and that Kübler-Ross herself had not meant so strictly.

Important: originally for the dying, not for the bereaved

Kübler-Ross derived her stages from qualitative interviews with dying patients — not from research with the bereaved. The model describes the emotional reaction to one’s own impending death, not grief over a lost person.

The extension of the model to the bereaved (the surviving relatives) came later, popular since the 1980s, and was not part of the original research. This shift has led to considerable confusion: grief counselors and caregivers apply to the bereaved a model that was never validated for them.

Scientific critique

Several systematic studies have examined the model empirically and identified weaknesses:

Wortman, Camille B.; Silver, Roxane Cohen (1989): The myths of coping with loss. Journal of Consulting and Clinical Psychology 57(3): 349—357. An early systematic critique: not all bereaved persons reach a stage of acceptance; the absence of a phase of denial is not a pathological sign; emotional well-being oscillates rather than progressing linearly.

Stroebe, Margaret; Schut, Henk; Boerner, Kathrin (2017): Cautioning Health-Care Professionals: Bereaved Persons Are Misguided Through the Stages of Grief. OMEGA — Journal of Death and Dying 74(4): 455—473. A systematic finding: the Kübler-Ross model is not sufficiently supported empirically — neither for the dying nor for the bereaved. In application it is frequently misunderstood prescriptively.

Maciejewski, Paul K.; Zhang, Baohui; Block, Susan D.; Prigerson, Holly G. (2007): An empirical examination of the stage theory of grief. JAMA 297(7): 716—723. An empirical study that did find some correspondences with the stages but could not confirm their sequence.

Harm in application

The prescriptive application of the model can harm the bereaved:

  • Pressure of expectation: the bereaved feel pressured to “go through the stages correctly.” Whoever feels no anger or never denies wonders whether he is “grieving wrongly.”
  • Pathologization: caregivers and therapists interpret deviations from the stage model as pathology — although deviation is the normal case.
  • Failure to recognize individuality: every grief is the response to a unique loss of a unique person. Models that suggest a uniform course fail to recognize the uniqueness of the reality of grief.

What remains

Historically, the model opened up medical and social discourse — dying and grief became legitimate topics that were no longer suppressed. This opening is Kübler-Ross’s enduring merit.

Scientifically, the model is today supplemented or replaced by theoretically grounded models (Bowlby-Parkes, cf. grief models) and task-oriented models (Worden). These models respect the individual reality of grief and avoid the prescriptive character.

Position of the ontology

The ontology classifies the Kübler-Ross model as a historically important but scientifically criticized conception: it is problematic under the precautionary principle.

The precautionary principle thus applies not only to the determination of death (cf. organ donation after circulatory arrest), but analogously also to grief counseling: where scientific certainty is lacking, restraint applies in determining what the bereaved “ought” to go through. Models with a theoretical foundation are to be preferred over the popular stage model.

Ontological classification

Superordinate concept: state of affairs (psychological model)

Ontological relations:

Chapter assignment: Chapter 4: What Is Human Personhood? (German)

Sources

Primary source

  • Kübler-Ross, Elisabeth (1969): On Death and Dying. New York: Macmillan.

Scientific critique

  • Wortman, Camille B.; Silver, Roxane Cohen (1989): The myths of coping with loss. Journal of Consulting and Clinical Psychology 57(3): 349—357.
  • Maciejewski, Paul K.; Zhang, Baohui; Block, Susan D.; Prigerson, Holly G. (2007): An empirical examination of the stage theory of grief. JAMA 297(7): 716—723.
  • Stroebe, Margaret; Schut, Henk; Boerner, Kathrin (2017): Cautioning Health-Care Professionals: Bereaved Persons Are Misguided Through the Stages of Grief. OMEGA — Journal of Death and Dying 74(4): 455—473. https://pmc.ncbi.nlm.nih.gov/articles/PMC5375020/
  • Avis, Kerry A.; Stroebe, Margaret; Schut, Henk (2021): Stages of Grief Portrayed on the Internet: A Systematic Analysis and Critical Appraisal. Frontiers in Psychology 12: 772696.

Theoretically grounded alternative models

  • Bowlby, John (1980): Attachment and Loss, Vol. 3: Loss: Sadness and Depression. New York: Basic Books.
  • Worden, J. William (2009): Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner (4th ed.). New York: Springer.
  • Stroebe, Margaret S.; Schut, Henk (1999): The dual process model of coping with bereavement: Rationale and description. Death Studies 23(3): 197—224.

See also

Generated by querying the Personhood ontology.

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