Understanding The Emotional Stages Of Dying
Our contemporary awareness and honoring of the emotional stages of dying and grief are rooted in the work of Elisabeth Kübler-Ross, a Swiss-American psychiatrist. Made famous by her pioneering work in near-death studies, Kübler-Ross conceptualized five common emotional stages experienced by her clients facing terminal illness: denial, anger, bargaining, depression, and acceptance (DABDA).
Support Dying Loved Ones: Understand More About Their Emotional Journey
Her influential work has been highly misinterpreted, leading to undeserved criticism. Those of us who work in hospice understand how instrumental this awareness is when supporting those who are dying, their loved ones, and their caregivers. Understanding what people go through when facing a terminal illness, imminent death, or when grieving the loss of someone we love provides insight into their shifts in moods or potential reactive emotions and behaviors. Building on the work of Kübler-Ross, other mental health professionals (like Alan Wolfelt, John Bowlby, Colin Murray Parkes, David Kessler, and others have built on her work, identifying additional ways of expressing the emotional journey inherent in the dying process.The Famous Five Emotional Stages Of Dying And Grief
One of the biggest misconceptions people have about Kübler-Ross’s “Five Stages” is that they’re compartmentalized or that an individual goes through one of the stages, finishes with it, and then moves on to the next. This is not so. Instead, these are more like five emotional facets of dying and grief. Those experiencing them tend to move through them fluidly, rather than in a particular order, and can move back and forth – there may never be a “finishing” of them at all. Your hospice team is here to help you all remember and understand these stages so we can work together, providing whatever support the client needs.Denial
While most of us logically understand we’re going to die, another part of us thinks, “Everyone will die but me.” As a result, denying that we’re dying happens to most people who know they’re dying – whether they’re involved in a traumatic accident, facing a fresh terminal diagnosis, or experiencing the final stages of a chronic health condition. Denial may look like:- Questioning a doctor’s expertise.
- Blaming faulty testing or false diagnostic results.
- Refusing to talk about a diagnosis, prognosis, or anything related to dying.
- Depression
- Anger
- Shock
- Confusion
- Loneliness
Supporting the denial stage
First, it’s not always easy to know whether a person is in denial or if they don’t completely understand the diagnosis/prognosis. Once you’re confident they’ve received the information clearly and understand their new reality, the best thing you can do is give the person space to process their emotions.Anger
People frequently feel angry about dying, especially if they are younger, have unfinished business, or their diagnosis comes as a complete shock. When people are angry about dying, they’re likely to go into “why me?” mode or start to blame others for their situation. Clients may also exhibit signs of:- Frustration
- Rage
- Anxiety
- Fear (anger is almost always rooted in fear)
Supporting the anger stage
This can be very hard on caregivers as humans tend to be the most unkind, reactive, and downright mean to the ones they’re closest to. Let your hospice social worker know if anger is showing up in overwhelming or dangerous ways. If a client is stuck in anger or anger is manifesting via rage, hospice social workers and therapists are here to help.Bargaining
The Bargaining stage frequently overlaps with anger. The “why me?” question leads to trying to make things different. If only X would happen, then Y would/won’t. Or “I promise I’ll volunteer more in my community if this treatment can just let me live long enough to do so.” Someone in deep grief may bargain in ways like, “If I can just go back in time to redo that conversation/action…then this would be so much easier to bear.” Or, “God, if you spare my husband, I promise I’ll never snap at him again.” During the bargaining stage, loved ones may also feel:- Anger/rage.
- Frustration.
- Regret.
- Sadness/depression.
Supporting the bargaining stage
You’ll notice a theme here: the best way to support any strong emotional stage is to be a silent, attentive listener. Fixing or providing advice, placating – they don’t work. Your job is to be there as a quiet supporter and companion. It’s best to leave therapeutic-type work to the pros. That said, you may identify an underlying emotion under the bargain. For example, if a dying loved one bargains, “If God would just let me live, I would be so much more patient with the ones I love.” You now know they feel regret and sadness about their impatience. You can witness that and see if they have anything more to offer. “I hear that you’re sad and regretful that you were impatient with loved ones. That must feel hard right now.”Depression (profound sadness)
It’s a rare person that doesn’t have some amount of sadness around their death. Even people who are ready to die due to their pain, treatment fatigue, or a feeling their life is complete still feel sad about leaving loved ones behind or never seeing another beautiful sunset in this physical form. However, others may sink into a deep depression. This phase is grief at its most impactful. It can take people to very lonely, dark places that are almost a rite of passage, as it is only by moving through these strong emotions that they open up to experiencing joy, gratitude, and surrender. Depression may look like:- Not getting out of bed.
- Retreating from people and activities they love.
- Sleeping all the time.
- Not eating (or overeating).
- Self-pity