Elisabeth Kubler Ross on Death and Dying: The Five Stages of Grief

ELISABETH KUBLER-ROSS ON DEATH AND DYING

Pain is an unpleasant sensation and we all try to avoid pain as much as possible but without pain there is no life and without pain there is no gain. Without fear, distrust and anger, we cannot experience true love and Without Death, we cannot understand the meaning of life.

According to Dr. Kubler Ross, Man has to defend himself psychologically in many ways against the increased fear of death and increased inability to foresee and protect himself against it. Psychologically man can deny the reality of his own death for a while. Since in our unconscious we cannot perceive our own death and do believe in our own immortality, but can conceive our neighbor’s death, news of numbers of people killed in battle, in wars, on the highways only supports our unconsc5ious belief in our own immortality and allows us – in the privacy and secrecy of our unconscious mind – to rejoice that it is “the next guy, not me.”

Death and Dying by Dr. Elisabeth Kubler-Ross, is “A profound lesson for the living.” This book (On Death and Dying) grew out of Dr. Elisabeth Kubler-Ross’s famous interdisciplinary seminar on death, life, and transition. Through sample interviews and conversations, Doctor Kubler –Ross (and some theology students) gives the reader a better understanding of how imminent death affects the patient, the professionals who serve that patient, and the patient’s family, bringing hope to all who are involved.

Dr. Kubler-Ross had over two and half years of experience working with the sick and the dying before taking on this task and this book tells the stories of dying patients and participants who shared their agonies, their expectations, and their frustrations with her and the main purpose of this book is to encourage others not to shy away from the “hopelessly” sick but to get closer to them, as they can help them much during their final hours.
According to Dr. Kubler-Ross, Man has to defend himself. If his ability to defend himself physically is getting smaller and smaller, his psychological defenses have to increase manifoldly. He cannot maintain denial forever. He cannot continuosly and successfully pretend that he is safe. If we cannot deny death, we may attempt to master it. We may join the race on the highways, we may read the death toll over national holidays and shudder, but also rejoice – “It was the other guy, not me, I made it.”

In the olden days, man (soldier or Civilian) had the chance to meet his enemy eye to eye and He had a fair chance in a personal encounter with a visible enemy. However, things are different these days. Weapons of mass destruction have taken over. Destruction can strike out of the blue skies and destroy thousands like the bomb at Hiroshima and Negasaki. According to Dr. Kubler Ross, It is no longer the man who fights for his rights, his convictions, or the safety or honor of his family, it is the nation including its women and children who are in the war, affected directly or indirectly without a chance of survival. This is how science and technology have contributed to an ever increasing fear of destruction and therefore fear of death. According to Dr. Kubler Ross, if a whole nation, a whole society suffers from such a fear and denial of death, it has to use defenses which can only be destructive. Wars, riots, and increasing numbers of murders and other crimes may be indicators of our decreasing ability to face death with acceptance and dignity. Perhaps we have to come back to the individual human being and start from scratch, to attempt to conceive our own death and learn to face this tragic but inevitable happening with less irrationality and fear.

Most people believed in God in the olden days and most of them believed in life after death. The Church gave hope to the poor, the sick and the dying. The church gave hope to those without hope in this life and most of these people found peace even in their sickbeds because they had hope of life in the hereafter. They believed in life after death. Most people in the olden days believed in eternal peace and a reward in heaven and because of that belief, the church was able to help these people find peace in this life and even on their dying beds. But things are different these days because most people these days do not believe in life after death and most people do not belief in a reward in Heaven and hence death seems the end of existence for most people today. According to Doctor Kubler Ross, Suffering has lost its meaning here on earth. There is not much sense in suffering these days especially during child birth which used to be very painful in those days. Drugs are given these days for pain, itching, and other discomforts that accompanied child birth. Suffering was more common in the olden days but there was a purpose and future reward in the suffering but the belief has long died that suffering here on earth will be rewarded in heaven. Suffering today seems purposeless and this according to Dr. Kubler Ross has contributed to our destructiveness and aggressiveness – to kill in order to avoid the reality and facing of our own death.

According to Dr. Kubler Ross, Those who learned to know death, rather than to fear and fight it, become our teachers about life and that dying patients especially dying children are some of our most greatest teachers. The mere fact that a patient is told that he has cancer brings his possible death to his conscious awareness but if a doctor can speak freely with his patients about the diagnosis of malignancy without equating it necessarily with impending death, he will do the patient a great service. He should at the same time leave the door open for hope, namely, new drugs, treatments, chances of new techniques and new research.

Also in this book, Dr. Kubler-Ross explores the now-famous five stages of death: denial and isolation, anger, bargaining, depression, and acceptance. According to Dr. Kubler-Ross, Denial functions as a buffer after unexpected shocking news and the logical question becomes “Not me” and this allows the patient to collect himself and, with time, mobilize other, less radical defenses. Denial is usually a temporary defense and will soon be replaced by partial acceptance. Maintained Denial according to Dr. Kubler-Ross is a rarity and does not always bring increased distress if it holds out until the end. When the first stage of denial cannot be maintained any longer, it is replaced by feelings of anger, rage, envy, and resentment and the logical question becomes “Why me?”. In contrast to the stage of denial, this stage of anger is very difficult to cope with from the point of view of family and staff. The reason for this is the fact that this anger is displaced in all directions and projected onto the environment at times almost at random. The third stage or the stage of bargaining according to Dr. Kubler-Ross is less well known but equally helpful to the patient. The stage of bargaining lasts only for brief periods of time. If the patient has been unable to face the sad facts in the first period and has been angry at people and God in the second phase, he or she may enter into some sort of agreement which may postpone the inevitable happening as we can see in this quote: “If God has decided to take us from this earth and he did not respond to my angry pleas, he may be more favorable if I ask nicely”

According to Dr. Kubler Ross, When the terminally ill patient can no longer deny his illness, when he is forced to undergo more surgery or hospitalization, when he begins to have more symptoms or becomes weaker and thinner, he cannot smile it off anymore. His numbness or stoicism, his anger and rage will soon be replaced with a sense of great loss. The patient may now enter the stage of Depression or the fourth phase which according to Doctor Kubler-Ross is the most difficult stage for the dying patient and that when the depression is a tool to prepare for impending loss of all the love objects, in order to facilitate the state of acceptance, then encouragements and reassurances are not as meaningful. The patient according to Dr. Kubler-Ross should not be encouraged to look at sunny side of things, as this would mean he should not contemplate his impending death and that it would be contraindicated to tell him not to be sad. Eventhoug Depression is the most difficult for the dying patient, An understanding person according to Dr. Kubler-Ross will have no difficulty in eliciting the cause of the depression and in alleviating some of the unrealistic guilt or shame which often accompanies depression. If a patient has had enough time and has been given some help in working through the previous stages, he or she will be able to enter the stage of Acceptance. A stage where he or she is neither depressed nor angry about his or her “fate”. The stage of acceptance according Dr. Kubler Ross isn’t a stage of happiness and that this stage is almost void of feelings. It is a 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.

Here is a customer review I found on amazon.com “…This book is one of the first great books that Dr. Kubler-Ross has gifted us with. Her insight and compassion are unremarkable. I am sad she won't be writing any more books though. Her latest book, "On Grief and Grieving" is a wonderful book also. There are some case studies to go by and it truly touches your soul…” J. Brattin (Salem, Oregon)

This book really touches the soul and it speaks directly to the body and the spirit of the reader to do something not just for the sick and the dying but also for ourselves. I personally find this book “real” and “truthful” because it talks about real people not fiction. It talks about real life experience. The stages may not happen in the order listed in this book but all the stages do occur in real life and I have experienced almost all these stages at one point or the other. My grandmother was very old, weak, and sick and I knew for sure that my grandmother was going to die. Even though her death came as a shock, I did not find it that difficult accepting the fact that she was dead and gone but when my mother who wasn’t sick in anyway died, I found it very difficult accepting the fact that she was dead and gone. The death of my grandmother made a little bit of sense because she was sick and suffering and I personally felt bad anytime I saw her in pain but the death of my mother made no sense and anybody who tried to console me at that particular point made no sense at all and I started avoiding them. I entered the state of depression because anytime I remembered the fact that I am not going to see my mother again, everything seemed so absurd and nothing more mattered to me and at that point in time, I began to understand why my best friend was behaving so abnormally after he lost his father.
When it is not your turn, you think you are safe but when it gets to your turn, you begin to deny.

Thanks for the great summary and review of Elisabeth Kubler ross on Death and Dying. I read this book in my second year in college in one of my theology classes (theology 3000: Death and Dying) and I tell you this book changed me a lot. It touched my heart so much that after the course I decided to volunteer 3 months of my time in a community hospital nearby to care for the sick and the dying. It is such an amazing book and an amazing course to take in college. I recommend to anyone dealing with a personal or family problem and anyone dealing with the death of a family member or any disability at all. Thanks Gloria!