Elisabeth Kübler-Ross

Introduction

Elisabeth Kübler-Ross (8 July 1926 – 24 August 2004) was a Swiss-American psychiatrist whose 1969 book On Death and Dying proposed that terminally ill patients pass through five psychological stages: denial, anger, bargaining, depression, and acceptance. The book made her one of the most widely known medical writers of the twentieth century and is routinely credited with breaking a professional silence around death — in the 1960s, doctors in the United States commonly did not tell patients that they were dying. Her influence on hospice care, palliative medicine, and grief counselling is difficult to overstate.

The five stages are also one of the most thoroughly contested ideas in popular psychology. They were drawn from interviews with dying patients, not with bereaved people, yet they entered the culture as a description of grief. Kübler-Ross herself insisted that the stages were neither universal nor sequential, and warned against using them as a checklist, but the simplified version long ago escaped her control. Understanding her legacy requires holding both facts at once: she changed how medicine treats the dying, and the model most people associate with her name does not survive empirical scrutiny in the form in which it is usually taught.

Early Life and Education

Kübler-Ross was born Elisabeth Kübler in Zurich on 8 July 1926, one of triplets, two of them identical. She weighed roughly two pounds at birth and her survival was uncertain; she later attributed it to her mother's attentiveness. Her father wanted her to work as a secretary in his business and told her that the alternative was domestic service. She refused and left home at sixteen.

During the Second World War she worked, still a teenager, as a laboratory assistant for refugees in Zurich, and in May 1945 — days after her eighteenth birthday — joined the International Voluntary Service for Peace. Over the next four years she did relief work in France, Germany, Italy, Belgium, Denmark, Sweden, Czechoslovakia, and Poland, helping to rebuild the French town of Ecurcey and supporting survivors of the war.

In 1947 she visited the Majdanek concentration camp in Poland. She described the experience as decisive, and in later accounts returned repeatedly to the butterflies that children had carved into the walls there — work made by people who knew they were about to die. She entered the University of Zurich to study medicine in 1951 and received her medical degree in 1957. In 1958 she married Emanuel Robert Ross, an American physician she had met in medical school, and moved to the United States.

Academic and Professional Career

After interning at Glen Cove Community Hospital on Long Island, Kübler-Ross completed a three-year psychiatry residency at Manhattan State Hospital and spent a further year training at Montefiore Hospital in the Bronx. In 1962 she and her husband moved to Denver, where she joined the University of Colorado School of Medicine. In 1965 she became an assistant professor of psychiatry at the University of Chicago, working at Billings Hospital.

It was at Chicago that her career took its defining turn. With four students from Chicago Theological Seminary she began interviewing terminally ill patients on the ward, asking them directly what it was like to be dying. The seminars became notorious and oversubscribed; she was eventually required to stop running them, but the transcripts became On Death and Dying, published by Macmillan in 1969. She later delivered the Ingersoll Lecture at Harvard University on the book.

The success of the book let her devote herself to work with the dying. She founded Shanti Nilaya, meaning "home of peace," a healing centre near Escondido, California, and in the 1980s turned to patients with AIDS and to dying children. From the late 1970s her interests shifted towards near-death experiences, out-of-body experiences, and communication with what she described as spirit guides; Britannica notes that this work "diminished her reputation in the eyes of many people."

Kübler-Ross divorced in 1979. She suffered a series of strokes in 1995 and 1996 and lived afterwards in a care home in Scottsdale, Arizona, where she died on 24 August 2004, aged 78. She had two children, Ken and Barbara Ross. Her remaining papers are held at Stanford University's Green Library.

Major Contributions to Psychology

The five stages

On Death and Dying set out five responses that Kübler-Ross observed among patients told they had a terminal illness: denial and isolation, anger, bargaining, depression, and acceptance. Two qualifications in the original text are routinely lost. First, the stages were descriptions of how patients confronted their own approaching death, not of how survivors mourn other people. Second, she presented them as common patterns rather than a fixed sequence, and said explicitly that patients could revisit stages, skip them, or experience several at once.

Only in 2005, in On Grief and Grieving, written with David Kessler and published after her death, did she systematically extend the model to bereavement. By then the stages had already hardened into a rule in popular culture.

Making the dying a subject worth hearing

Kübler-Ross's more durable and less disputed contribution was methodological and moral. Before her, the systematic study of dying patients' own accounts barely existed in American medicine, and a terminal prognosis was frequently withheld from the patient. She insisted that patients be told, be asked, and be listened to. "It would take so little to remember that the sick person has feelings, has wishes and opinions, and has — most important of all — the right to be heard," she wrote in 1969.

That principle, rather than the stage sequence, is what shaped hospice and palliative care: the shift towards treating the dying as agents with something to say about their own deaths, and towards managing pain and symptom burden rather than pursuing cure at any cost.

Later work on near-death experience

In her last two decades Kübler-Ross became a prominent figure in near-death studies, writing about out-of-body experiences and life after death and conducting séance-style workshops at Shanti Nilaya. This work brought her a large following and cost her credibility within medicine and academic psychiatry, and it is generally treated as separate from the contribution on which her reputation rests.

Major Publications

  • On Death and Dying (1969) — The book that introduced the five stages and made the experience of dying a public subject.
  • Questions and Answers on Death and Dying (1972) — A follow-up addressing the questions clinicians and families raised after the first book.
  • Death: The Final Stage of Growth (1975) — An edited collection positioning death as a developmental stage rather than a medical failure.
  • To Live Until We Say Goodbye (1978) — Photographs and interviews with people in the last months of life.
  • Living with Death and Dying (1981) — Later reflections on the care of the terminally ill.
  • On Children and Death (1983) — How children understand death and how adults should talk with them about it.
  • AIDS: The Ultimate Challenge (1987) — Her account of working with people dying of AIDS in the 1980s.
  • On Life After Death (1991) — Her case for the survival of consciousness, based on near-death reports.
  • The Wheel of Life: A Memoir of Living and Dying (1997) — Her autobiography.
  • On Grief and Grieving (2005, with David Kessler) — The posthumous extension of the five stages to bereavement.

Impact and Legacy

Kübler-Ross received more than a hundred awards and roughly twenty honorary degrees. Time named her one of the hundred most important thinkers of the twentieth century, the New York Public Library named On Death and Dying one of its Books of the Century in 1999, and she was inducted into the National Women's Hall of Fame in 2007. The stage vocabulary is now part of ordinary language, applied to everything from divorce to losing a job.

The criticism is equally substantial, and it comes in several distinct forms:

The model was built for the dying, not the bereaved. The most common use of the five stages — as a description of grief after someone else dies — is an application she did not make until 2005 and never tested. Commentators have called it a "totally erroneous application of her work," noting that a person facing their own future death and a widow facing a death already past are in fundamentally different situations.

The evidence base is thin. The stages were derived from open-ended interviews conducted by Kübler-Ross and four seminary students, who — as she noted with some pride — deliberately avoided reading the existing literature so as to have no preconceptions. Subsequent accounts observe that the model therefore rests on the interviewers' collective impressions rather than on a defined sample, a standardised measure, or a comparison group.

The first serious empirical test gave a mixed verdict that is usually misreported. Maciejewski and colleagues published the Yale Bereavement Study in JAMA in 2007 and are widely cited as having refuted the stages. What they actually found was more interesting: the five indicators peaked, on average, in the order Kübler-Ross had proposed, and the probability of that ordering arising by chance was very small — the first empirical support any stage model had received. But acceptance was the most strongly endorsed response at every measurement point, including the first month, so it was not the end of a journey. And the dominant painful experience throughout was yearning — plain missing — rather than denial or anger, which were reported at low levels throughout. The study's own authors noted its limits: single-item indicators, participants grouped into uniform time bins, and a sample that was mainly white widowed people in New England.

Grief is not a single sequence. George Bonanno's longitudinal work at Columbia identifies several trajectories, with a large share of bereaved people showing resilience and never passing through a recognisable stage order. Wortman and Silver had made a related point two decades earlier: many bereaved people simply do not show the intense distress the model predicts, and follow-up suggests this is not delayed or repressed grief. Stroebe and Schut's dual-process model, in which mourners oscillate between loss-oriented and restoration-oriented attention, has largely displaced stage models in the research literature.

The stages can do harm. Because a published list sets expectations, mourners who do not feel angry, or whose anger returns in month nine, may conclude that something is wrong with them. Clinicians, too, can end up narrating a patient's grief back to them rather than listening. There is also a clinical worry specific to the original model: Telford and colleagues argued that denial can block treatment and education, while premature acceptance of a terminal diagnosis may lead patients to forgo symptom-relieving care.

Her later career complicated the legacy. The near-death and channeling work of her final decades is not continuous with the empirical and clinical contribution of 1969, and for many clinicians it is hard to separate the two.

The fair summary is that Kübler-Ross asked a question medicine had refused to ask and was largely right about the answer that mattered — that dying people should be told the truth and listened to — while the particular framework she offered for what they feel has not held up as a description of either dying or grief.

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References

  • Kübler-Ross, E. (1969). On Death and Dying. Macmillan.

Last updated: 2026-10-20

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