Kübler-Ross 5 Stages of Grief
In our podcast episode “What to Expect,” Stacey and I talk about grief and how people move through it. This information focuses on the Five Stages of Grief, first published in the 1969 book On Death and Dying. We’ve shared how this theory has shown up in our sistership and our lives. We hope it’s helpful for you, too. But remember, this is just one way to look at grief. There are many other theories, tools, and recommendations out there. Take what resonates for you and leave what doesn’t. Your journey is your own.
What is Kübler-Ross and Why Does It Matter?
Elisabeth Kübler-Ross was a psychiatrist who spent her life listening to people facing death. In 1969, she shared what she learned in her groundbreaking book On Death and Dying. She noticed that many people seemed to go through similar emotional experiences as they faced loss, and she called these the Five Stages of Grief:
Denial
“This can’t be real.”
Anger
“Why is this happening to me?”
Bargaining
“If I do this, maybe things will change.”
Depression
Feeling deep sadness and overwhelm.
Acceptance
Finding some peace with what is happening.
At first, these stages described what dying people felt, but over time, they’ve been used to understand all kinds of grief – whether it’s losing someone you love, getting a life-changing diagnosis, or going through any huge, unwanted change.
Grief is not linear
Kübler-Ross explained after her original publication that these aren’t steps you complete in order. Everyone grieves differently. Some people feel all of these, some only a few, and some bounce back and forth between them.
Over the years, this idea has evolved. We now know that grief isn’t a neat set of stages. It’s messy, unpredictable, and non-linear. Stacey and I often talk about how we move back and forth between these stages until we reach acceptance.
What matters most isn’t fitting your grief into steps, but finding ways to talk about it and sit with it. Check out the “How to navigate and integrate this learning” section for exercises and other helpful information
Beneath the Surface
What we feel, why we do it, and how we find our way to acceptance.
| Action | The emotions | What it does/why we do it | How we move on/out of this stage |
|---|---|---|---|
| Denial or Shock | Avoidance, Confusion, Fear, Shock, Flight (of the fight or flight sympathetic nervous response) | Reduces the intensity of the loss or event | Acceptance! It can be slow and gradual and people often “slide” back into this stage often right after diagnosis or loss. |
| Bargaining | Struggling to find the meaning, Reactionary, Telling your story to others, Magical thinking | It can create a “stuck” space for people because they are spinning on what could have prevented the loss or what could be. It feels hopeful, but it is really damaging. | Acceptance! Specifically with addition, this is a tough space to be in and can prolong or delay getting the right help. |
| Depression | Overwhelmed, Fight (of the fight and flight sympathetic nervous response), Hostility, Hopelessness | Being overwhelmed means that your body can shut down. We just don’t have the tools or space to process the event or loss. There is tremendous sadness in getting a hard diagnosis or loss. | Grace! Have grace for yourself, self care – but try not to slip into self indulgence. Get help! Talk to a health care professional. Give yourself space and grace to yourself to walk through this. Little things like set an alarm to eat and sleep. You don’t have to do all the right things – just the NEXT right thing and that might just be – brush your teeth, or eat something and that is OK. |
| Anger | Frustration, Irritation, Anxiety, Helplessness | This can actually be rooted in feelings of abandonment. When there is a loss or the threat of an imminent loss. We feel angry that this person is leaving or has left us. This can lead to guilt. We can feel guilty for being angry. This is especially complication with addiction. | Grace! Understanding that addiction is a disease. Understanding that the loss you feel of your person or who they were at one time isn’t intentional – they were not trying to hurt you when they got themselves into this situation or died. Realizing that it is ok to be MAD, you don’t have to feel guilty for it. But don’t stay in that space. Have the feeling and then use your tools. Celebrate that person, your relationship with them. When a negative thought enters, try and immediately think of a pleasant memory. Honor that person, and your relationship with them. |
| Acceptance | Exploring options, New plan is in place, Moving on | You have done everything within your control, you have loved and cared for your person in the best way you could at that time, in your given environment and circumstance. This sucks! PERIOD. The human experience is complicated, hard, varied and there are many hard things we will have to walk through in our lifetime. Our own mortality is one of those things that we all have as a shared human experience. Love and Grief are linked and the more intense the love, the more intense the grief may be. However, loving, making memories and having this shared human experience! Acceptance helps us to integrate our emotions, thoughts, and physical health. | Healing begins to happen! Once you have reconciled some acceptance, even around just some aspects of this event or loss, you may still slide back and forth between these stages or even feel more than one at the same time. But, even a small acceptance paves the way for more acceptance. It gets easier and the other feelings reduce as your acceptance increases. |
Essentials that support us through grief
- HONESTY – Be truthful with yourself and others, even when it’s hard.
- COMMUNICATION – Speak openly. Listen deeply.
- EMOTIONAL SUPPORT – Lean on those who care about you. Let them hold space for your feelings.
- PROFESSIONAL GUIDANCE – Seek wisdom from therapists, counselors, or doctors when needed.
- SPACE – Allow yourself the time and room to feel everything without judgment.
- GRACE – Offer yourself kindness. Extend that grace to others too.
These aren’t steps to finish – they’re anchors to hold onto as you navigate grief’s shifting tides.
How to navigate and integrate this learning:
Let’s talk about it. Something simple to ALWAYS start with is some version of:
I know it is hard to talk about and I am grateful for…”
The Caregiver
Here are some ways that you can start the conversation as a caregiver or health advocate
DENIAL
ANGER
BARGAINING
DEPRESSION
ACCEPTANCE
REMINDER FOR CAREGIVERS
Your stage may not match theirs. That’s okay. These prompts keep communication open, honor their process which helps to give you a role as a supportive witness rather than just a fixer.
Additional Resources
- Grief, Stress, Trauma, and Support During the Organ Donation Process
This study reviews literature on the organ donation process, highlighting the stress and ethical challenges faced by families and healthcare teams. It synthesizes findings on interdisciplinary tensions and proposes strategies – including shared goals, education, systems thinking, mentorship, and self-care – to improve teamwork, support grieving families, and enhance psychosocial outcomes for both families and staff. - Chronic renal failure: A study of death anxiety in dialysis and kidney transplant patients
This 1977 doctoral dissertation by Karen B. Blakely, Chronic Renal Failure: A Study of Death Anxiety in Dialysis and Kidney Transplant Patients, explores psychological responses to life-threatening illness. Based on research with 54 patients, it examines self-esteem, locus of control, and anticipatory preparation for death, comparing dialysis patients with kidney transplant recipients. The study provides early insights into death anxiety, coping mechanisms, and therapeutic considerations for individuals facing chronic renal failure. - Family, Friends, and Faith: How Organ Donor Families Heal
This study explores how the loved ones of deceased organ donors cope with grief and what support factors aid their healing process. Based on a 20-question survey sent to donor families in San Diego and Imperial Counties (CA) between 2006 and 2007, the research highlights that family support (84%), friends (74%), and faith or cultural beliefs (37%) are the most helpful in recovery. Most families chose donation to find meaning in loss, help others, or honor their loved one’s wishes. The study emphasizes the importance of respectful hospital staff, adequate information, and attention to spiritual and emotional needs to improve the consent process and long-term healing for donor families - Gift Exchange and Organ Donation: Donor and recipient experiences of live related kidney transplantation
This qualitative, longitudinal study examines the experiences of donors and recipients involved in live related kidney transplantation, using the framework of gift exchange theory. Through a series of in-depth interviews with 11 donor-recipient pairs, the study explores how themes of giving, receiving, and reciprocating shape the emotional and relational dynamics of the transplant process. It finds that donors often make swift, voluntary decisions to donate, while recipients struggle with the emotional weight of accepting the “gift.” The research concludes that the joy of giving, not material return, serves as meaningful reciprocation for donors, and that gift exchange theory is a valuable lens for understanding the complex psychosocial dimensions of live organ donation - Grief, Stress, Trauma, and Support During the Organ Donation Process
This study explores the grief, stress, and trauma experienced by families of deceased organ and tissue donors, based on a survey of 1,672 families in Southern California. It examines how these families perceive the donation experience, their emotional responses, and the support they receive. Key findings include that while many families find meaning and comfort in donation, over half experience high stress or trauma, especially if communication from hospital or OPO staff is poor. The study emphasizes the need for sensitive, well-timed support and highlights specific improvements in how healthcare professionals can approach donor families with empathy, clarity, and care. - The Experience of Living with Uncertainty: Receiving a Solid Organ Transplant
This article examines the lived experience of uncertainty among lung transplant candidates. Using phenomenological methods, researchers interviewed patients on the waiting list to uncover how they navigate the emotional, existential, and practical challenges of waiting. The study reveals that uncertainty is not just about unknown outcomes, but a deep disruption of time, identity, and meaning. Patients experience a paradoxical state—hope and dread, life and death—simultaneously. The findings highlight the need for transplant teams to recognize and support the psychosocial toll of prolonged waiting and existential limbo. - When Life Ceases—Relatives’ Experiences When a Family Member Is Confirmed Brain Dead and Becomes a Potential Organ Donor
This article explores the experiences of relatives of patients who died in the ICU and became organ donors. Through qualitative interviews, the study examines how family members perceived the care, communication, and emotional burden surrounding the moment of death and the organ donation process. Findings reveal a complex mix of shock, ambiguity, gratitude, and distress—with particular emphasis on the difficulty distinguishing death from life support and the emotional intensity of decision-making. The study emphasizes the importance of clear, compassionate communication and consistent support for families during and after the donation process.