Liver Disease Through The Lens Of Kübler-Ross’s “Five Stages Of Grief”

Introduction

Liver disease profoundly affects both patients and their families. The psychological adjustment to diagnosis, treatment, and prognosis mirrors the grief process described by psychiatrist Elisabeth Kübler-Ross in her 1969 book On Death and Dying. The model’s five stages—Denial, Anger, Bargaining, Depression, and Acceptance— provide a lens for understanding how patients emotionally navigate chronic and life-threatening liver conditions.

References: Kübler-Ross (1969); Jepsen et al. (2010).

Stage One: Denial

The Initial Shock

Following diagnosis—particularly of cirrhosis or hepatic malignancy—patients may refuse to believe the results, pursue multiple opinions, or attribute symptoms to reversible causes. Denial can delay essential medical intervention and lifestyle modifications needed to slow disease progression.

Reference: Nusrat et al. (2014). World J Gastroenterol.

Stage Two: Anger

Emotional Response

Anger may be directed inward—toward perceived personal failings—or outward, at physicians or family. This frustration often reflects a struggle to regain control and process loss.

Coping Mechanisms

Support from therapists, social workers, and peers can channel anger into motivation for treatment adherence and self-care rather than self-blame.

Reference: DeMaria & Adler (2012). Psychiatric Times.

Stage Three: Bargaining

Medical Negotiations

Patients may promise behavioral changes—such as abstaining from alcohol or adopting a healthier diet—in exchange for recovery or improved prognosis. While such changes are beneficial, they cannot always reverse hepatic damage.

Reference: Addolorato et al. (2005). Addict Behav.

Stage Four: Depression

Emotional Toll

When the reality of chronic liver disease sets in, patients often experience sadness, hopelessness, or guilt. Concerns about physical decline, finances, and the burden on loved ones are common.

Clinical Intervention

Timely mental-health evaluation and treatment—including psychotherapy or pharmacologic support—can mitigate depression and improve adherence to medical therapy.

Reference: Maisto et al. (2000). Psychol Assess.

Stage Five: Acceptance

Coming to Terms

Acceptance often brings calm, allowing patients to focus on achievable goals and quality of life. They may engage in advance-care planning and strengthen family connections.

Medical Planning

Discussions about palliative options, transplantation candidacy, or end-of-life care become essential. Acceptance fosters collaboration between patient and care team to align treatment with values.

Reference: Koller & de Abreu (2014). World J Hepatol.

Conclusion

The Kübler-Ross model offers clinicians and families a structured framework for empathizing with patients facing liver disease. These stages often overlap and recur, yet recognizing them facilitates compassionate, individualized care addressing both physical and emotional needs.

References

1. Kübler-Ross E. On Death and Dying. Macmillan; 1969.
2. Jepsen P, Ott P, Andersen PK, Sørensen HT, Vilstrup H. Clinical course of alcoholic liver cirrhosis. Hepatology. 2010; 51(5):1675-1682.
3. Nusrat S et al. Cirrhosis and its complications. World J Gastroenterol. 2014; 20(18):5442-5460.
4. DeMaria R, Adler D. Psychosocial issues in liver transplantation. Psychiatric Times. 2012.
5. Addolorato G et al. Neurobiochemical and clinical aspects of craving in alcohol addiction. Addict Behav. 2005; 30(6):1209-1224.
6. Maisto SA et al. Factor structure of the AUDIT. Psychol Assess. 2000; 12(3):346-353.
7. Koller A, de Abreu GA. Palliative care in end-stage liver disease. World J Hepatol. 2014; 6(9):665-673.

Note: This summary is educational and not a substitute for professional mental-health or medical advice.