From interviews conducted with terminally ill patients, Dr. Rubler-Ross developed a five-stage theory of dying. She described how people who know they are going to die adjust to that knowledge. The five stages are denial, anger, bargaining, depression and acceptance.

Denial: In the initial stage of denial, individuals refuse to accept the reality of their impending death. This denial acts as a buffer to the shock of absorbing this information. After exhausting all options, they find that denial is no longer successful and they enter the next phase.

Anger: Hostility, rage and resentment characterize this phase. The anger can be directed at those close to the patient or can be expressed randomly.

Bargaining: Bargaining is an attempt to postpone the inevitable. The person tries to make a contract with a higher being to allow time to accomplish something. This phase usually lasts for only a short period of time.

Depression: The bargaining phase is followed by depression. Individuals can no longer deny the reality of their impending death and they are consumed by a sense of loss. They begin to mourn their own death. Silent guilt, fear and anxiety are typical of this phase.

Acceptance: The final stage prior to death is generally characterized by contemplation and quiet expectation. The dying person makes peace with death. Kubler-Ross says: "Acceptance should not be mistaken for a happy stage. It is almost void of feelings. It is as if the pain had gone, the struggle is over, and there comes a time for the final rest before the long journey, as one patient phrased it."

There are always individual differences in the way people adjust to the knowledge of their impending deaths. The stages do not always occur in order and may overlap. If not interpreted too rigidly, stage conceptions may offer useful guidelines for understanding the dying process and people who pass through it.

The author of this article, and founder of the Therapyinla.com website, Joyce Parker, passed away in 2011. To honor her we are keeping her articles posted at this website.