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The five stages of grief bargaining


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Five stages of grief. The Rise and Fall of Kübler-Ross

  • Lucy Burns
  • BBC

Image copyright Getty Images

Denial. Anger. Finding a compromise. Despair. Adoption. Many people know the theory according to which grief, when receiving unbearable information for a person, goes through these steps. The scope of its application is wide: from hospices to boards of directors of companies.

A recent interview with a psychologist in English on the Internet proves that the perception of the current quarantine is subject to the same rules. But do we all experience the same?

When Swiss psychiatrist Elisabeth Kübler-Ross began working in American hospitals in 1958, she was struck by the lack of methods of psychological care for dying patients.

  • A method that can predict your death

"Everything was impersonal, the attention was paid exclusively to the technical side of things," she told the BBC at 1983 year. “Terminally ill patients were left to their own devices, no one talked to them.”

She started a workshop with Colorado State University medical students based on her conversations with cancer patients about what they thought and felt.

Author photo, LIFE/Getty Images

Photo caption,

Elisabeth Kübler-Ross talks to a woman with leukemia in Chicago, 1969. Seminar participants observe through a special mirror glass

Despite the misunderstanding and resistance of a number of colleagues, soon there was nowhere for an apple to fall at the Kübler-Ross seminars.

In 1969 she published a book, On Death and Dying, in which she quoted typical statements from her patients and then moved on to discuss how to help doomed people pass from life as free of fear and pain as possible.

Kübler-Ross described in detail the five emotional states that a person goes through after being diagnosed with a terminal diagnosis:

  • Denial: "No, that can't be true"
  • Anger: "Why me? Why? It's not fair!!!"
  • Bargaining: "There must be a way to save myself, or at least improve my situation! I'll think of something, I'll behave properly and do whatever is necessary!"
  • Depression: "There is no way out, everything is indifferent"
  • Acceptance: "Well, we must somehow live with this and prepare for the last journey"

difficult situation.

A separate chapter of the book is devoted to each of the stages. In addition to the five main ones, the author identified intermediate states - the first shock, preliminary grief, hope - from 10 to 13 types in total.

Image copyright Getty Images

Elisabeth Kübler-Ross died in 2004. Her son, Ken Ross, says she never insisted that every person must go through these five stages in sequence.

"It was a flexible framework, not a panacea for dealing with grief. If people wanted to use other theories and models, the mother did not object. She wanted to start a discussion of the topic first," he says.

  • Last will: how did the photo of a dying American touch the world?
  • "You hear everything, Fernando." How was the evening in honor of the terminally ill football player

The book "On Death and Dying" became a bestseller, and Elisabeth Kübler-Ross was soon inundated with letters from patients and doctors from all over the world.

"The phone kept ringing, and the postman started visiting us twice a day," recalls Ken Ross.

The notorious five steps took on a life of their own. Following the doctors, patients and their relatives learned about them. They were mentioned by the characters of the series "Star Trek" and "Sesame Street". They were parodied in cartoons, they gave food for creativity to the mass of musicians and artists and gave rise to many successful memes.

Literally thousands of scientific papers have been written that have applied the theory of the five steps to a wide variety of people and situations, from athletes suffering career-incompatible injuries to Apple fans' worries about the release of the 5th iPhone.

Image copyright, Getty Images

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Kübler-Ross's legacy has found its way into corporate governance: Big companies from Boeing to IBM (including the BBC) have used her "change curve" to help employees at times of great business change.

And during the coronavirus pandemic, it applies, says psychologist David Kessler.

Kessler worked with Elisabeth Kübler-Ross and co-authored her latest book, Grief and How We Grieve. His interview with the Harvard Business Review at the start of the pandemic garnered a lot of attention online as people everywhere searched for solutions to their emotional problems.

"And here, first comes denial: the virus is not terrible, nothing will happen to me. Then anger: who dares to deprive me of my usual life and force me to stay at home?! Then an attempt to find a compromise: okay, if after two weeks of social distancing it gets better, then why not? Followed by sadness: no one knows when it will end. And, finally, acceptance: the world is now like this, you have to somehow live with it, "describes David Kessler.

"As you can see, strength comes with acceptance. It gives you control: I can wash my hands, I can keep a safe distance, I can work from home," he says.

"It's a roadmap," says George Bonanno, professor of clinical psychology and head of the Loss, Trauma, and Emotion Laboratory at Columbia University. "When people are in pain, they want to know: how long will it last? What will happen to me? something to grab on to. And the five-step model gives them that opportunity."

"This scheme is seductive," notes Charles Corr, social psychologist and author of Death and Dying, Life and Being. "It offers an easy solution: sort everyone, and it takes no more than the fingers of one hand to label each one." .

George Bonanno sees this as a possible harm.

"People who don't fit exactly into these stages - and I've seen the majority of them - may decide they're grieving the wrong way, so to speak," he explains.

According to him, over the years he has seen many cases when people themselves inspired that they must certainly experience this and that, or they were convinced of this by friends and relatives, but they did not feel it and decided, that they need a doctor.

Experimental evidence of the existence of the five stages of grief is not enough. The longest and most extensive bereavement interview was conducted in 2007.

According to him, the most common state at any time is acceptance, only a few go through the stage of denial, and the second most common emotion is longing.

However, according to David Kessler, while scientists debate the nuances and terms, people who experience grief continue to find meaning in the Kübler-Ross scheme.

"I meet people who tell me, 'I don't know what's wrong with me. Now I'm angry, and a minute later I'm sad. I must be crazy.” And I say, “It has names. These are called the stages of grief. ” The person says, “Oh, so there is a special stage called 'anger'? It's about me!" And feels more normal."

Image copyright, Getty Images

"People need catchy statements. If Kübler-Ross hadn't called it stages and stated that there are exactly five of them, then she probably would have been closer to the truth. But then she would not have attracted to attention," says Charles Corr.

He believes that talking about the five stages distracts from the main scientific legacy of Elisabeth Kübler-Ross.

"She wanted to take on the topic of death and dying in the broadest sense: how to help terminally ill people come to terms with their diagnosis, how to help those who care for them, support these patients and cope with their own emotions, how to help everyone live a full life, realizing that we are not eternal,” says Charles Corr.

"The terminally ill can teach us everything: not only how to die, but also how to live," said Elisabeth Kübler-Ross at 1983 year.

During the 1970s and 1980s, she traveled the world, giving lectures and giving workshops to thousands of people. She was a passionate supporter of the hospice idea pioneered by British nurse Cecily Saunders.

Kübler-Ross has established hospices in many countries, the first in the Netherlands in 1999. Time magazine named her one of the 100 most important thinkers of the 20th century.

Professor Kübler-Ross' scientific reputation was shaken after she became fascinated with theories about the afterlife and began to experiment with mediums.

One of them, a certain Jay Barham, practiced non-standard religious-erotic therapy, in particular, he persuaded women to have sex, assuring that he was possessed by a person close to them from the afterlife. In 1979, because of this, a loud scandal arose.

In the late 1980s, she tried to set up a hospice for children with AIDS in rural Virginia, but faced strong local opposition to the idea.

In 1995, her house caught fire under suspicious circumstances. The next day Kübler-Ross had her first stroke.

She spent the last nine years of her life with her son in Arizona, moving around in a wheelchair.

In her last interview with the famous TV presenter Oprah Winfrey, she said that at the thought of her own death she feels only anger.

"The public wanted the famed expert on death and dying to be some kind of angelic personality and quickly get to the stage of acceptance," says Ken Ross. "But we all deal with grief and loss as best we can."

The theory of the five stages of grief is not widely taught in medical schools these days. It is more popular at corporate trainings under the name "Curve of Change".

Since then, there have been many theories about how to deal with your grief.

David Kessler, with the consent of Kübler-Ross's family, added a sixth stage to the five: the understanding that everything that is done makes sense.

"Understanding can come in a million different ways. Let's say I've become a better person after losing a loved one. Maybe my loved one passed away in a different way than it should have happened, and I can try to make the world a better place to this has not happened to others," says David Kessler.

Charles Corr recommends the "double process model". It was developed by Dutch researchers Margaret Stroebe and Nenk Schut and suggests that a person in grief is simultaneously experiencing a loss and preparing himself for new things and life challenges.

George Bonanno talks about four trajectories of grief. Some people have great stamina and do not fall into depression, or it is weakly expressed in them, others remain morally broken for many years, others recover relatively close, but then a second wave of grief rolls over them, and finally, the fourth becomes stronger from the loss.

Over time, one way or another, the vast majority of people get better.

But Professor Bonanno admits that his approach is less clear-cut than the five-stage theory.

"I can say to a person: 'Time heals.' But that doesn't sound so convincing," he says.

Grief is difficult to control and hard to endure. The thought that there is some kind of road map that suggests a way out is comforting, even if it is an illusion.

Elisabeth Kübler-Ross, in her latest book, Grief and How We Grieve, wrote that she did not expect to sort out the tangled human emotions.

Everyone experiences grief in their own way, even if some patterns can sometimes be deduced. Everyone goes their own way.

Lavrov advised to take Putin's phrase about negotiations seriously - RBC

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“Those who refuse should understand that the longer they delay, the more difficult it will be to negotiate,” Lavrov recalled Putin’s words. Earlier, the President of Russia called on Kyiv to "immediately cease fire and return to the negotiating table"

Sergei Lavrov (Photo: Pavel Bednyakov / Sputnik / AP)

Russian President Vladimir Putin's words that Ukraine's delay in the resumption of negotiations will make it more difficult to negotiate should be taken seriously, Foreign Minister Sergei Lavrov told Zvezda TV channel.

The head of the Foreign Ministry noted that Moscow "never refused" negotiations with Kyiv, about which "the president has repeatedly spoken in his speeches over the past months."

“And let me remind you of his phrase: we do not refuse negotiations, but those who refuse must understand that the longer they delay, the more difficult it will be to negotiate. I am sure that this is the phrase that needs to be taken seriously,” Lavrov said.

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The Russian and Ukrainian delegations began negotiations a few days after the start of the special operation. At the end of March, they met in Istanbul, where Kyiv handed over proposals to resolve the conflict.

However, in May, both sides reported that the dialogue had been frozen. Ukraine announced a change in its "emotional state" after the events in Bucha (Russia considers what happened there a provocation and insists that the data on dead civilians appeared after Russian troops were withdrawn from the Kyiv region) and its intention to return to the negotiating table after how to return the lost territories. The Russian authorities, in turn, have repeatedly stressed their readiness to resume dialogue, but at the same time noted that Kyiv has departed from the agreements reached in Istanbul. As Putin explained, Ukraine wanted to decide the fate of Crimea and Donbass at the summit, while Russia insisted on resolving this issue even at the drafting stage of the agreement.

In early July, Putin reiterated that Russia "is not giving up on peace talks" with Ukraine, "but those who refuse should know that the longer it takes, the more difficult it will be to negotiate." And in September, referendums were held in the territories lost by Ukraine. And earlier on September 30, the president signed agreements on the entry of the DPR, LPR, Zaporozhye and Kherson regions into Russia.

At an event marking the signing of these treaties, Putin called on Ukraine to "immediately cease fire" and "return to the negotiating table." President of Ukraine Volodymyr Zelenskyy replied that the Ukrainian side took initiatives in the negotiation process, offered Russia "to agree on coexistence on equal, honest, worthy and fair terms. " However, “when Russia is headed by Putin, it is impossible to come to an agreement with it,” and therefore Kyiv is ready for a dialogue with Russia, “but with a different president,” he said. After Putin signed the treaties, Ukraine announced that it would apply for an accelerated entry into NATO.

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