When it becomes clear that the terminal illness is here to stay, many people experience depression. The increased burden of surgeries, treatments, and physical symptoms of illness -- for example -- make it difficult for some people to remain angry or to force a stoic smile. Depression, in turn, may creep in.
Kubler-Ross explains that there are really two types of depression in this stage. The first depression, which she called "reactive depression," occurs as a reaction to current and past losses. For example, a woman who is diagnosed with cervical cancer may first lose her uterus to surgery and her hair to chemotherapy. Her husband is left without help to care for their three children, while she is ill and has to send the children to a family member out of town. Because cancer treatment was so expensive, this woman and her spouse can't afford their mortgage and need to sell their home. The woman feels a deep sense of loss with each one of these events and slips into depression.
The second type of depression is dubbed "preparatory depression." This is the stage where one has to deal with the impending future loss of everything and everyone they love. Most people will spend this time of grieving in quiet thought as they prepare themselves for such complete loss.
This stage of depression is an important one to go through. It's a period of grieving that is essential for the dying person to cope with his death. If he is able to grieve fully and move through depression, the stage of acceptance will follow.