What Elisabeth Kübler-Ross Actually Wrote
Most people know the familiar “Five Stages” as Denial, Anger, Bargaining, Depression, and Acceptance. Her own work tells a fuller story. She drew ten, not five. She revised the framework for more than a decade. And she never meant it as a simple sequence everyone must follow.
The point of the stages was never that grief is simple. It was that human responses to death, loss, and profound change are complicated.
What follows is drawn from her own charts, papers, tapes, and books. Three things changed over those years, sometimes together and sometimes separately: what the model contained, what it was called, and whom it was for.
On this page — jump to a section
- She Drew Ten, Not Five
- The Second Book: Questions and Answers on Death and Dying (1974)
- And the Chart Wasn’t the Limit
- The Five Were a Moment in a Longer History
- Three Common Claims — and What the Record Shows
- One Word, Many Meanings
- The Stages Never Stood Still
- What the Critics Tested
- Ideas That Evolve
- From Dying, to Grief, to Change
- What She Was Trying to Build
- You Can’t Paint the Five Stages With a Broad Brush
She Drew Ten, Not Five
The chart in On Death and Dying (1969) shows ten overlapping bands: shock, denial, partial denial, anger, bargaining, preparatory grief, depression, acceptance, decathexis, and hope. The bands overlap and recur. They are not steps you complete and leave behind.
Hope runs beneath all the others. It has no number on the chart, yet it has a full chapter in the book. For her, hope could live alongside anger, fear, depression, or acceptance. It was never simply another stage to pass through.
The Second Book: Questions and Answers on Death and Dying (1974)
Five years later, Elisabeth answered many of the questions readers and professionals had raised about the stages. One important question was whether these responses applied only to people who were dying.
Her answer was no.
Asked about a woman losing her sight, she said of her blind patients:
“All my patients that became blind have gone through the same stages as my dying patients.”
— Elisabeth Kübler-Ross, Questions and Answers on Death and Dying (1974)
She then broadened the point beyond blindness:
“the same stages as anyone else who is in the process of losing something very important.”
— Elisabeth Kübler-Ross, Questions and Answers on Death and Dying (1974)
She made the same point about paralysis, including young Vietnam veterans. These were people confronting profound changes in their lives, not people who were dying:
“These patients will very typically go through the stage of shock and denial…”
— Elisabeth Kübler-Ross, Questions and Answers on Death and Dying (1974)
She went on to describe a broader range of emotional responses associated with profound loss and major life change, reinforcing that her framework was never limited to a fixed set of five stages.
By 1974, what had begun as a description of responses among dying patients was clearly being applied by Kübler-Ross herself to significant loss and major life change.
This broader application helps explain why many readers and practitioners came to understand the model not simply as a theory of grief, but more broadly as a framework for change and loss. That wider application is reflected today in the Kübler-Ross Change Curve®, which applies these emotional responses to significant change and transition.
And the Chart Wasn’t the Limit
The book names responses that appear on no chart. Anxiety comes up fourteen times as part of the natural reaction to a terminal diagnosis. Envy and guilt appear in her account of what families go through. She named responses wherever she found them. The diagram held only the ones she could draw against a timeline.
The Five Were a Moment in a Longer History
The familiar five became the version the public remembered. They were concise, easy to repeat, and over time became embedded in popular culture, education, films, television, and countless summaries of grief.
But they were not the endpoint of Kübler-Ross’s thinking.
In August 1969, three months before On Death and Dying appeared, a syndicated newspaper series under her byline set out five stages, numbered and in order. That compact formulation was highly memorable.
In her 1970 clinical paper, she wrote that her patients went through five stages while describing nine states in the same eight pages. So the ordered five and the broader, overlapping framework both came from her, published within months of each other.
The problem is therefore not that the “five stages” never existed. They did. The problem is that one highly memorable formulation became frozen in popular culture while the work itself continued to evolve. Much later criticism has understandably focused on that familiar version: five stages, in order, applied universally. But that is only one frame in a much longer history.
The model’s continuing influence also appears in survey research. Avis, Stroebe, and Schut’s 2021 article cites a survey by Sawyer and colleagues in which 68% of general-public respondents and 46% of mental health professionals rated a statement about grief progressing through a predictable series of stages as probably or definitely true. These figures reflect belief in an ordered sequence; they do not establish its validity or measure how helpful people find the broader emotional vocabulary. They underline why distinguishing that familiar sequence from Kübler-Ross’s fuller, evolving work matters. Read the 2021 article.
Three Common Claims — and What the Record Shows
“There are no stages.”
Kübler-Ross herself used the word stages, but she did not consistently portray them as fixed steps in a staircase. Her 1969 chart showed overlap, her later language changed, and by 1978 she drew the responses as interlocking circles. The problem is not the existence of stages as descriptive categories; it is treating them as a compulsory sequence.
“There were never really five.”
There were five, but there were also more than five. Kübler-Ross published a five-stage summary while On Death and Dying itself contained a ten-band chart and discussed additional responses outside that chart. The five were part of the work. They were never the whole of it.
“She intended the stages only for dying patients.”
They began with dying patients. But Kübler-Ross herself broadened their application to blindness, paralysis, other major losses, and people confronting profound change. The expansion beyond dying was not solely a later interpretation imposed by others; it appears in her own work.
One Word, Many Meanings
She was Swiss and a native German speaker who came to English as an adult. Stage was the English word she used, but English can make the word sound more rigid than her diagrams suggest. German keeps distinctions that English can blur. Stadium can denote a fixed or ordered stage, including a medical stage of disease, while Phase can describe a period that may recur or overlap.
Since the first German edition in 1971, her book has called them Phasen, not Stadien. In English, the word “stage” can carry a staircase inside it: something you reach, complete, and leave. That staircase is not what her 1969 chart shows.
The Stages Never Stood Still
Her seminar with dying patients begins at the University of Chicago. Everything that follows comes from listening to them. The patient is the teacher.
On Death and Dying appears with its ten-band chart. The same book already shows families experiencing many of the same responses, not only patients.
A clinical paper describes nine states while summarizing them as five.
The German edition renders them as Phasen, phases rather than fixed medical stages.
In her cassette album Coping with Death and Dying, she uses names such as “Pseudo-Denial” and “Acceptance or Resignation.” The vocabulary is still moving.
Questions and Answers on Death and Dying applies the same responses to other losses, including blind patients and paralyzed Vietnam veterans, and describes people living two or three stages at once. Partial denial, named three times in 1969, is gone. Preparatory grief and hope remain.
She draws the model as overlapping circles, with no timeline and no numbered order. Denial, anger, bargaining, and depression interlock; resolution and acceptance sit below; and everything is held inside two rings, hope and dreams. Nothing says first, second, or third.
She calls the stages “the old stuff” and largely sets them aside, tired of a public that wanted a formula (watch the 1980 interview).
What the Critics Tested
Researchers have rightly asked whether people move through five stages in order, and the evidence says they do not. Those criticisms are aimed at a version of the model that is real, widely taught, and partly hers. They are therefore important criticisms — but they are not a complete evaluation of Kübler-Ross’s work.
Testing a fixed five-stage sequence leaves much of the rest of her work unexamined: responses that occur in varying combinations, overlap, recur, appear simultaneously, or may never appear at all. A 2021 review in Frontiers in Psychology found that inaccurate presentations of the stages online can leave grieving people feeling they are grieving the wrong way. That harm comes from the simplified version, and it is exactly what her fuller work warns against.
That same critical review acknowledges that Kübler-Ross’s later work emphasized the fluidity of grief. Citing On Grief and Grieving (2005), the authors recognize that she did not expect everyone to experience all the stages or follow a prescribed order. The review remains critical of the model, but it also records her later clarification. This supports the need to distinguish a fixed five-stage sequence from her fuller, evolving position. Read Avis, Stroebe, and Schut’s 2021 review.
Ideas That Evolve
Kübler-Ross’s thinking changed because she continued to listen, observe, teach, and respond to patients, families, and clinicians. That evolution should not automatically be mistaken for inconsistency. It is what can happen when an observational framework remains open to new experience.
The 1969 formulation was an important point in an evolving body of work, not the final word. Over the following decade she changed terminology, added and removed concepts, broadened the populations to whom the framework could apply, and eventually abandoned any visual suggestion of a fixed sequence.
In his foreword to the 50th anniversary edition of On Death and Dying, physician Ira Byock describes the stages as a heuristic — a way of helping people recognize and think about common human responses, rather than a rigid formula or predictive sequence.
That distinction matters. A heuristic can be useful without being universal. It can help clinicians, patients, and families recognize anger, denial, bargaining, depression, hope, fear, guilt, acceptance, and other responses without assuming that everyone must experience all of them, or experience them in any particular order.
From Dying, to Grief, to Change
The stages began as descriptions of responses among dying patients. Because families experienced many of the same responses, the language later became associated with bereavement as the Five Stages of Grief®. Because Kübler-Ross herself also applied the framework to other profound losses and changes, the same broad emotional language later entered workplaces and organizations as the Kübler-Ross Change Curve®. The content changed, the name changed, and the audience changed, each on its own schedule.
What She Was Trying to Build
She wanted a common language, a way for patients, families, nurses, and doctors to recognize what was happening and talk about it. The stages were a clinical vocabulary, descriptive rather than prescriptive. They were never meant to become a checklist or timetable for how every person must respond.
She knew a short list would be remembered and a long one would not. As she once told her son: “Kenneth, I could tell them about thirteen stages — but who would remember?” She did not mean thirteen literally. The point was that human experience contained far more than any memorable list could hold.
You Can’t Paint the Five Stages With a Broad Brush
From 1965 to 1980, the model kept changing because she kept listening. That evolution is not a footnote to the history of the stages; it is central to understanding them.
Thought leadership evolves when observation continues. Anyone who pins Kübler-Ross’s work to one list, one order, or one year is holding a single frame of a moving picture. The five were real. They were simply never the whole picture. The stages never stood still.