DABDA: 5 stages of the fight against death

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The Five Stages of Coping with Death (DABDA) were first described by Elisabeth Kubler-Ross in her classic 1969 book On Death and Dying. They describe the stages people go through when they learn that they (or a loved one) is dying , from the moment of shock (or denial) to the moment of acceptance.

While these stages are unique to each person facing illness, death, or loss, and most people do not follow them in a linear fashion, they are helpful in describing some of the emotions that accompany these life-changing events.

Get Medical Information / Andrea Hickey

Stages of overcoming

DABDA stages mean the following:

  • Denial
  • Anger
  • Negotiate
  • Depression
  • Adoption

The five stages of the Kübler-Ross stage model are the best-known descriptions of the emotional and psychological reactions that many people experience when faced with a life-threatening illness or situation.

The stages apply not just to death, but to any life-changing event in which you deeply feel a loss, such as divorce, loss of a job, or loss of a home.

Survival process

The stages do not have to be complete or chronological. Not all people who experience a life-threatening or disruptive event feel all five responses, and not all people who experience them will do so in the order they are written. Reactions to illness, death, and loss are as unique as those of the person experiencing them.

In his book, Kübler-Ross analyzes this theory of coping in a linear way, that is, one goes through one stage to reach the next. the way a person goes through the stages is as unique as they are.

It is important to remember that some people will experience all stages, some in order and some not, and other people may only go through a few stages or even get stuck in one. It is also interesting to note that how a person has faced adversity in the past will affect how the diagnosis of an incurable disease is resolved .

For example, a woman who has always avoided adversity and used denial to cope with tragedy in the past may be trapped in denial to cope for a long time. Similarly, a man who uses anger to deal with difficult situations may not be able to get out of the stage of dealing with anger.

Denial

We all want to believe that nothing bad can happen to us. Unconsciously, we can even believe that we are immortal.

When a person is diagnosed with an incurable disease, it is natural for them to enter a stage of denial and isolation. They may not categorically believe what the doctor tells them and seek second and third opinions.

They may require a new set of tests, considering that the results of the first one are false. Some people may even isolate themselves from doctors and refuse further treatment for a time.

It is not uncommon for you to isolate yourself from family and friends during depression, or to actively avoid talking about the trauma or event. It is a self-defense mechanism whereby a problem "ceases to exist" if you do not recognize it.

This denial stage is usually short-lived. Soon after, many begin to accept their diagnosis as reality. The patient can come out of isolation and resume treatment.

Some people, however, will use denial as a survival mechanism for many years of their illness and even death. Long-term denial isn't always bad; it doesn't always bring more suffering.

Sometimes we mistakenly believe that people need to find a way to accept their death in order to die in peace. Those of us who have seen people continue to deny to the end know that this is not always true.

Anger

When a person accepts the reality of an incurable diagnosis, they can begin to ask, "Why me?" Realizing that all your hopes, dreams, and well thought out plans will not come true creates anger and frustration. Unfortunately, this anger is often directed at the world in a random fashion.

Anger is the stage where the repressed feelings from the earlier stages are released in a tremendous stream of pain and directed towards anyone who gets in the way.

In the hospital, the doctors and nurses are yelled at; family members are received with little enthusiasm and often experience occasional tantrums. Even strangers are not immune to actions that can cause anger.

It is important to understand where this anger is coming from. A dying person can watch television and see people laughing and dancing, a violent reminder that they can no longer walk, much less dance.

In his book On Death and Dying, Kübler-Ross insightfully describes this anger: 'He will raise his voice, demand, complain and ask for attention, perhaps as the last loud cry:' I am alive, don't forget about that. You hear my voice I'm not dead yet! ''

For most people, this stage of coping is also short-lived. However, again, some people will remain angry about the disease. Some will even die angry.

Negotiate

When denial and anger do not lead to the expected result, in this case a misdiagnosis or a miracle cure, many people turn to negotiation. Most of us have already tried to negotiate at some point in our lives.

Children learn early that getting mad at mom when she says it doesn't work, but you can try a different approach. Like a child who has time to rethink his anger and begin negotiating with his parents, many people with an incurable illness do so.

Most people who enter the negotiation stage do so with their God. They can agree to live a good life, help those in need, never lie again, or do any number of "good" things if their higher power will only cure them of illness.

Other people can negotiate with doctors or with the disease itself. They could try to negotiate longer by saying something like, "If only I lived long enough to see my daughter get married …" or "If only I could ride my motorcycle one more time …".

Trading is the stage where a person clings to an irrational hope, even when the facts suggest otherwise. This can be expressed openly as panic, or it can manifest itself in an internal dialogue or in a prayer, invisible to others.

The reciprocal favor implied is that they would not ask for more if only their wish were fulfilled. People who enter this stage quickly understand that negotiation does not work and inevitably move, as a rule, to a stage of depression.

Depression

When it becomes clear that an incurable disease is going nowhere, many people become depressed. For example, the increased burden of surgery, treatment, and the physical symptoms of the disease make it difficult for some people to get angry or show a lasting smile. Depression, in turn, can creep in.

Kübler-Ross explains that there are actually two types of depression at this stage. The first depression, which he called "reactive depression," occurs in reaction to current and past losses.

For example, a woman who is diagnosed with cervical cancer may first lose her uterus due to surgery and hair due to chemotherapy. Her husband is left without help to care for their three children while she is ill and is forced to send the children to a relative out of town.

Because cancer treatment was so expensive, this woman and her spouse cannot afford a mortgage and must sell their home. The woman experiences a deep sense of loss with each of these events and becomes depressed.

The second type of depression is called "preparatory depression." This is the stage where a person must deal with the impending loss of everything and everyone they love in the future. Most people will spend this time of grief in quiet contemplation, preparing for such a total loss.

Depression is considered a stage without which a decision is unlikely to be made. Also, during the same event, you may feel many different losses. It can take time to get rid of these feelings during which the person can slip in and out of depression.

Adoption

The acceptance stage is where most people would like to be after death. This is the stage of the peaceful resolution of the beginning of death and the calm expectation of its arrival . If one is lucky enough to reach this stage, death is usually very peaceful.

People who have achieved recognition generally allow themselves to express pain, regret, anger, and depression. By doing so, they can process their emotions and accept the "new reality."

Perhaps they had time to make amends and say goodbye to their loved ones. This man also had time to mourn the loss of so many important people and things that mean so much to him.

Some people who are diagnosed at an advanced stage of the disease and don't have time to work through these important stages may never experience true acceptance. Other people who cannot pass another stage, for example, a person who is angry at the world to death, may never experience the peace of acceptance .

For the fortunate one who has nonetheless reached acceptance, the final stage before death often takes place in quiet contemplation as they turn inward to prepare for their final departure.

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