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The five phases of dying according to Elisabeth Kübler-Ross

Dying is a topic that occupies many people. Even if most people do not want to deal with it, we are confronted with it regularly.

But it is only when a life-threatening illness affects one of our relatives or ourselves that the topic becomes real.

As relatives we experience the time of illness and farewell differently than the dying themselves. In order to be able to assist them as much as possible during this time and to be able to deal with the things that happen during this time, I have summarised the 5 phases of dying according to Elisabeth Kübler-Ross for you here.

Elisabeth Kübler-Ross was a well-known psychiatrist and death researcher who wrote about 5 phases of dying in her book “Interviews with dying people”.

These 5 phases are not linear, they can be skipped, it is possible to move backwards or skip over them. The Kübler-Ross model provides orientation, but allows each dying person his or her individual path to death.

The 5 phases of dying

Phase 1: Denial

When the person concerned learns about his or her illness, there is often denial at first. The patient goes to other doctors in the hope of being diagnosed differently, while those around him/her hope that treatment will finally begin.

It is important for you as a family member to give the patient time to understand things at their own pace. Even if you feel the need to shake the person awake and tell him/her to face the truth in order to be able to act, you are not doing anyone any good if you try to speed up this process.  Just be there for that person and have an open ear.

Phase 2: Anger

In this second phase, the question of why is at the forefront. The first shock has been overcome and now anger, resentment and hatred gushes out of those affected. They ask themselves the questions “Why me of all people? “I have always done everything right”, etc. again and again, are angry at doctors, at people around them, at themselves and vent their anger.

During this time, the people concerned do not express themselves in a reflective manner, but seem to throw nasty remarks, nagging around. This phase can be particularly difficult for relatives, as it is not possible to please the person concerned. At the same time, it can be difficult to watch children, spouses, etc. being pushed away.

It is especially important for relatives in this phase to be aware that the anger is not directed against them personally, but represents a “natural” phase of dying. If you as a relative are affected by this, try to be aware of this at all times. Keep your distance emotionally, but if possible do not withdraw completely. If you have the feeling that children/partners of those affected suffer from this anger, discuss the situation with them or seek external help.

Phase 3: Negotiation

Kübler- Ross describes the third phase as a phase of negotiation – with doctors, God, fate. The sick want to extend their lifespan in return for good behaviour. Events still to be experienced (weddings, births, etc.) are determined. In this phase, the patients would give everything not to have to leave.

As relatives, it is important in this phase to give the affected persons hope, but not to increase unrealistic hopes.

Phase 4: Depression

In the phase of depression, the patient mourns the missed opportunities and regrets things he/she has not done. Mourning over the approaching death also plays a major role. During this time, some people become so depressed that they do not want to take advantage of other therapies recommended by doctors.

During this time it is especially important for relatives to listen to the patient openly and without judgement. By expressing all the seriousness, their fears and regrets, their feelings can often be relieved. If the patient feels the need to speak, they should not interrupt him/her as much as possible, even with words of comfort. Listen to him/her until it is enough for him/her and then give advice and comfort when he/she asks for it. For some seriously ill people, it is helpful at this stage to discuss with relatives how life in the family (with regard to children, etc.) can continue.

Phase 5: Acceptance

Elisabeth Kübler-Ross describes that this phase is not reached by all those affected. If this phase is reached, it is characterised by withdrawal. The sick person has accepted their approaching death. People who are in this phase often have no great need to talk, are unwilling to receive visitors and withdraw.

If you experience this phase as a relative, you should be aware that the withdrawal has nothing to do with you.

The easiest way for you to do this is to get involved with the dying person’s needs (for withdrawal, not speaking).

And if you are occupied with the thought that it is time for him/her to go. If you manage to do so, it is good for the dying person to feel that the relatives “agree” with his or her death when they let him or her go.