What are the common stages of grief?

G R. Smith, MD
Common stages of grief include denial/anger, persistent sadness, and finally, the reinvestment in relationships with other people besides the deceased. In this video, psychiatrist G. Richard Smith, MD, explains the typical stages of grieving. 
There are many emotions that are common in bereavement. But whether these emotions occur in a standard sequence is subject to much debate. A frequently cited model of bereavement, the "five stages of grief," was originally described in the book On Death and Dying by Elisabeth Kübler-Ross. These stages were used to describe a five-step response of terminally ill patients to awareness of their impending death: denial, anger, bargaining, depression, and acceptance. Kübler-Ross' work helped legitimize the wide variety of emotions in people who are dying. The five-stage theory was later altered and adapted to cover many forms of loss, from divorce to death of a loved one.

Today, the concept of stages of grief or the idea that grief follows a standard pattern is not widely embraced by experts. Colin Murray Parkes, a psychiatrist who has written extensively on bereavement, proposed a variation: that people who have experienced a loss undergo phases of numb disbelief, yearning for the deceased, disorganization and despair, and finally reorganization, during which they carve out a new life. The road to this new life may be long. According to Parkes, people must go through a painful period of searching for what has been lost before they can release their attachment to the person who died and move forward. When enmeshed in disorganization and despair, people find themselves repeatedly going over the events preceding the death as if to set them right.

J. William Worden, a psychologist who taught at Harvard Medical School, suggested a model of grieving that includes certain tasks. The first three tasks are to accept the loss, experience and work through the resulting pain, and adjust to a changed world without the person who has died. The fourth and final task is to alter ties with the deceased enough that you're able to invest your love and energy in others. People may shuttle back and forth among these tasks, but Worden warns that failing to complete all of them is like healing only partially from a wound.
The five stages of grieving have become a standard paradigm for the feelings and emotions that follow any major loss, such as the loss of a loved one, the breakup of a marriage, or the conceivable loss of one's health and former lifestyle to a chronic and unpredictable disease. The five stages of grief include:
  • Denial and isolation: The first reaction to any major loss. This stage involves avoidance, emotional numbing, blaming the doctors, doubting test results, and avoiding friends and family.
  • Anger: This stage can be difficult and frightening, and involves questioning one's religious beliefs, and asking, 'why me?' Anger can be harmful if it is not recognized and dealt with as an appropriate stage of the grieving process.
  • Bargaining: This stage may involve making promises to God or thinking that changing your life will somehow result in freedom from the disease.
  • Depression: A common response, but if it continues for an extended period of time and does not seem to improve, seek professional help.
  • Acceptance: When you find you are again living in the present, rather than trying to reclaim the past, you have reached some degree of acceptance.
The Kübler-Ross five stages of grieving are:
  • Denial: When a reality feels too overwhelming to accept, many people will -- to some degree or another -- deny that the reality exists. For example, upon hearing the news of a death it is not uncommon to deny the news or argue that the death could not have occurred.
  • Anger: Anger is a natural emotional response to feeling wronged or harmed. For many people, the death of a loved one can feel “unfair,” which can lead to feelings of anger, and can sometimes lead to searching for someone to blame for the death (and therefore someone to be angry at).
  • Bargaining: After experiencing a loss, it is common to wish things back to the way they were before the loss, which in turn can lead to thoughts of what could have been done differently before the loss occurred. These thoughts often take the form of imagining “What if...” or “If only...” in an attempt to negotiate an alternate reality.
  • Depression: When someone is fully present and engaged in the grief he or she is experiencing, it is common to feel sad, lonely and hopeless. The grieving person might ask, “Now that my loved one has died, what’s the point in continuing to live?” or feel that life is meaningless.
  • Acceptance: To reach acceptance is to fully understand that the person who has died is gone forever and that this new reality -- life without that person -- is the permanent reality.
Charles J. Sophy, MD
Adolescent Medicine

Denial-"this can't be happening to me", looking for the former spouse in familiar places, or if it is death, setting the table for the person or acting as if they are still in living there. No crying. Not accepting or even acknowledging the loss.

Anger-"why me?" feelings of wanting to fight back or get even with spouse, anger at the deceased, blaming them for leaving.

Bargaining-bargaining often takes place before the loss. Attempting to make deals with the spouse who is leaving, or attempting to make deals with God to stop or change the loss. Begging, wishing, and praying for them to come back.

Depression-overwhelming feelings of hopelessness, frustration, bitterness, self-pity, mourning loss of person. Feeling a lack of control, feeling numb, or feeling suicidal.

Acceptance-there is a difference between resignation and acceptance. You have to accept the loss, not just try to bear it quietly. Realization that it takes two to make or break a marriage. Realization that the person is gone (in death) that it is not their fault; they didn't leave you on purpose. Finding the good that can come out of the pain of loss, finding comfort and healing.

David Kessler
Hospice & Palliative Medicine

The Five Stages: Denial, Anger, Bargaining, Depression and Acceptance

My mentor and co-author, Elisabeth Kübler Ross, identified the stages of death in her ground-breaking book, On Death and Dying. I was privileged to co-author with her the follow-up book, On Grief and Grieving, finding the meaning of loss through the five stages. The stages have evolved since their introduction in 1969. They have been very misunderstood over the past four decades. They were never meant to help tuck messy emotions into neat packages.

The stages are tools to help us frame and identify what we may be feeling. But they are not stops on some linear timeline in grief. Not everyone goes through all of them or in a prescribed order. 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.

The five stages:







Marty Tousley
Hospice & Palliative Medicine
You've asked about the common stages of grief. What you may be thinking of are the stages of dying originally described by Elisabeth Kubler-Ross in her still popular book, 'On Death and Dying.' Since that book was first published (in 1969), many people have taken her findings much too literally, expecting the dying process to occur in neatly ordered stages, one following the other. The stages of dying originally described by Elisabeth Kubler-Ross are: 1) Denial and Isolation, 2) Anger, 3) Depression, 4) Bargaining, and 5) Acceptance. As wonderful as her groundbreaking work in death and dying was, her "stages" model was never meant to apply to those who are in mourning. Her studies were focused on patients who were terminally ill and dying. Unfortunately, this is a common mistake you will find repeatedly in the literature still today. But there has been a wealth of research done since Kubler-Ross' pioneering work that focuses specifically on bereavement, loss and grief. We now know that grief is the normal response to the death of a loved one, and it doesn't happen in neatly ordered "stages" as such. Most of us who specialize in grief counseling prefer to think of grief as the personal experience of the loss, and mourning as a process (not a single event) that can affect us in every dimension of our lives: physical, emotional, social, spiritual and financial. Everyone's grief journey is unique, and there is no specific time-frame for it. Although grief is different for each individual, having the support of others and knowing what reactions to expect and how to manage them can be very helpful.

In her 1969 book, "On Death and Dying," Dr. Elisabeth Kubler-Ross outlined five stages of grief that most people can expect to experience when facing a terminal illness or dealing with death. Those stages are:

  1. Denial: In the first stage, there is an outright refusal to accept the circumstances. Often, it causes the bereaved to pull away from family and friends
  2. Anger: In the second stage, anger may be directed at the circumstances, the world, the person who died or others
  3. Bargaining: In the third stage, bereaved individuals attempt to make "deals" with God or another higher power to ease their pain, or reverse the loss altogether
  4. Depression: In the fourth stage, there is typically depression and feelings of numbness
  5. Acceptance: In the fifth and final stages, the bereaved is finally able to accept that the loss has occurred and to move on

There are other variations of Kubler-Ross' stages of grief put forth by other psychologists, but most of them retain a similar framework.

These stages are simply an educated idea of how grief tends to play out, not a rigid rulebook. If you skip a stage altogether, then you skip a stage -- no one will make you go back and start over.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.