The Stages of Dying and Death

Perhaps the best‐known pioneer in thanatology is Elisabeth Kubler‐Ross, who after interviewing 200 terminally ill people proposed five stages of coming to terms with death. Upon learning of their own impending death, dying people's first reaction is often denial, in which they refuse to acknowledge the inevitable, perhaps believing a mistake has been made. They may seek other medical opinions and diagnoses or pretend that the situation will simply go away on its own. Gradually, as they realize that they are going to die, the terminally ill experience anger at having their lives end prematurely. They may become envious and resentful of those who will continue on, especially if they feel that their own life plans and dreams will go unfulfilled. Individuals who are dying will then attempt to bargain, often with God or another religious figure, and will promise to change or make amends or atone for their wrongdoings. When bargaining fails, they experience depression and hopelessness. During this stage, the terminally ill may mourn the loss of health that has already occurred, as well as the impending losses of family and plans. Finally, those dying learn to accept the inevitable, paving the way for a smoother transition both for themselves and loved ones.

Kubler‐Ross pointed out that although the above five stages are typical, they are not absolute. Not all people progress predictably through all the stages, nor do people experience the stages in one particular order. Additionally, these stages do not necessarily represent the healthiest pattern for all individuals under all circumstances. Kubler‐Ross and others also have noted that people whose loved ones are dying may progress through the same five stages as the dying person.

An individual who is not facing an immediate death has more time to adjust to the idea. In fact, dying can be a time of increased personal growth. The life review, or process of reminiscing, can help people examine the significance of their lives and prepare for death by making changes and finishing uncompleted tasks. Many dying individuals report that they are finally able to sort out who and what is the most important to them and are able to enjoy to the fullest what time remains. Many also report that dying is a time of religious awakening and transcendence.

Following the death of a loved one, survivors normally experience bereavement, or a change in status, as in the case of a spouse becoming a widow or widower. The behavioral response of the bereaved person is termed mourning; the emotional response is termed grief. People vary in their patterns of mourning and grief, both within and across cultures. People may also experience anticipatory grief, or feelings of loss and guilt, while the dying person is still alive.

Grieving typically begins with shock or disbelief, and is quickly followed by intense and frequent memories of the dead person. When those who are grieving finally attain resolution, or acceptance of the person's passing, they resume everyday activities and are able to move on with their lives.

People grieve in considerably different ways. Some adults are very vocal in their expressions of grief, while others prefer to be alone to quietly gather their thoughts and reflect on the loss of the loved one. Of course, cultural groups around the world handle grief according to their own customs. Egyptian mourners, for example, may cry loudly in public as a sign of grief, while Japanese mourners may talk quietly to the deceased person while kneeling in front of a home altar.