Psychology › Emotion, motivation & happiness › Emotions and how they work
Grief and the 'five stages'
1969 (Kübler-Ross); prolonged grief disorder 2022· Theory or model
Weak or failed to replicateFamous but not holding up in careful repeats.
The emotional response to loss, and Elisabeth Kübler-Ross's famous but unsupported idea that it unfolds in five stages.
See it on the Psychology map →What it says
In On Death and Dying (1969), psychiatrist Elisabeth Kübler-Ross described denial, anger, bargaining, depression and acceptance, based on interviews with about 200 patients facing their own deaths. The stages were soon applied to bereavement and many other losses. Research tells a different story: grief comes in waves, not steps, and most people are resilient, regaining daily functioning within months. Since 2022 the US diagnostic manual includes prolonged grief disorder: intense, disabling yearning lasting a year or more.
Why it matters
The stages gave people a language for loss but can make them feel they grieve 'wrong'. Knowing that varied grief is normal, and that prolonged grief is treatable, helps.
The evidence
Status: weak or failed to replicate for the stages. A 2007 Yale study of 233 bereaved people found acceptance common from the start and yearning stronger than anger or depression. Specialized grief therapy outperformed a standard therapy in trials.
Open questions
Where normal grief ends and disorder begins; critics worry diagnosis may medicalize sorrow, while supporters say it opens access to effective help.
Connections (2)
▸Grief and the 'five stages' is a powerful form of Emotions and how they workWell replicated
The connection
Grief is not one emotion but a shifting mix: sadness, yearning, anger, guilt, sometimes relief, arriving in waves set off by reminders. Moving back and forth between facing the loss and rebuilding daily life appears healthy. Bereaved people who could still laugh or smile when talking about the person adjusted better, and persistent yearning engages the brain's reward circuits.
Who showed it and when
George Bonanno and Dacher Keltner's 1997 study of bereaved spouses; Margaret Stroebe and Henk Schut's dual process model, 1999; Mary-Frances O'Connor's 2008 brain-imaging study at UCLA.
The evidence
Long-term studies track bereaved people's emotions for years; brain imaging links persistent yearning in prolonged grief to reward-related activity.
Open questions
Why most people adapt within a year or two while roughly one in ten develop prolonged grief; attachment, circumstances of the death and support all seem to matter.
▸Grief and the 'five stages' can be mistaken for Depression and mood disordersWell replicated
The connection
Grief after a death brings sadness, poor sleep and withdrawal that can look like depression. Grief usually comes in waves tied to the loss and leaves self-worth intact; depression is more constant and pervasive. DSM-5 (2013) dropped a rule that delayed depression diagnoses in the first months after a death.
Who showed it and when
The DSM-5 committee removed this 'bereavement exclusion' in 2013 over objections from critics such as Allen Frances; DSM-5-TR added prolonged grief disorder in 2022.
The evidence
Studies by George Bonanno and others show most bereaved people are resilient, while about 10 percent develop lasting, impairing grief or depression.
Open questions
Where normal grief ends and illness begins is contested; critics fear the 2013 and 2022 changes risk medicalizing ordinary mourning.