On Death and Dying (Elisabeth Kubler-Ross)
OVERVIEW
On Death and Dying is the seminal work by Elisabeth Kubler-Ross that first presented the “5 stages of grief.”. It was a landmark psychological study of over 200 terminally ill patients and one of the first attempts to map how humans face their own mortality. In 1965, Kubler-Ross was approached by students from the Chicago Theological Seminary, who were researching a paper for “crisis in human life.” Unsurprisingly, they considered death to be life’s biggest crisis, and so sought out Kubler-Ross who was a psychiatrist in the field. Though she and the students initially faced fierce resistance from doctors, nurses, and medical staff, they eventually succeeded in interviewing over 200 terminally ill patients, recording their sessions and mapping the patients’ responses into what is now known as the 5 stages of grief (although to my memory Kubler-Ross doesn’t actually describe them as such at any point in the book). The five stages are: denial, anger, bargaining, depression, and acceptance.
Stage 1: Denial and Isolation
Denial for most is a temporary defense. We think “this can’t be happening to me.” We may come out of this denial/disbelief temporarily, but then wish to return to daydreaming or thinking of something more cheerful. Hope is an important thing, and for some of us it’s temporarily critical to maintaining our sanity and composure. We should be allowed to face reality in our own time.
Stage 2: Anger
Eventually denial (this can’t be happening to me) gives way to anger (why me?). When standing to lose everything, it’s natural to feel anger or rage. We may also feel envy or resentment toward those who aren’t losing everything, who we see as taking for granted all that we stand to lose. Although it’s common for loved ones or caregivers to want to withdraw during this stage, it’s important that they don’t (and also that they don’t take our anger personally).
Stage 3: Bargaining
Kubler-Ross says that most bargains are made with god, but this likely extends to atheists appealing to anyone we perceive as having the power to grant (tangible) wishes (e.g. assuring the medical team that we’ll be very cooperative and pleasant if they’ll let us leave to attend our son’s wedding).
Stage 4: Depression
Depression is a normal response to loss. Given that dying presents us with the loss of our entire world, depression should be expected. Kubler-Ross separates reactive depression (grieving the loss of our mobility, our job, our hobbies, etc.) from anticipatory depression (our response to impending loss). The second, a preparatory grief, is necessary to ultimately achieve acceptance. There’s no need to try and cheer us up, or offer encouragement/assurances – none of that will be meaningful at this stage.
Stage 5: Acceptance
While many may assume that acceptance means achieving a happy peace (I certainly did), Kubler-Ross is quick to point out that acceptance is not a happy stage. She says acceptance is “almost void of feelings.” Cues become more nonverbal than verbal, and we may become disinterested and quiet. We lose energy and spend more time sleeping or unconscious. In this period before death, it may be important to have the quiet presence of loved ones, or we may prefer to be left alone. This phase can be very difficult for the family, as their loved one detaches. It often feels like rejection. Reassuring family that this stage means we’ve accepted or made peace with our death can help.
In addition to the 5 stages, I liked two additional prompts from Kubler-Ross. There’s the reminder that seriously ill patients should be allowed to hold on to whatever hope they want – whether it’s the hope for a cure, or the hope for at least one more good day. There’s also the prompt that loved ones often feel guilty for not getting the patient to the doctor sooner, or for brushing aside symptoms, so remember that loved ones need extra care and reassurance too.
WHAT NOW? (actions for mortal atheists)
There are two juicy actions I want to share, which illustrate exactly what I was hoping to get out of this book. The 5 stages of grief are part of our cultural lexicon, but what else do you learn from interviewing more than 200 dying patients? As it turns out, Kubler-Ross also leaves us with these two important observations.
Examine how you meet stressful situations
How you handle stress is how you’ll handle death. Read that again. How you handle stress is how you’ll handle death. What defense mechanisms do you use in times of crisis? Voila. That’s how you’ll die. Dying (as the theological students intuited) is life’s most significant and final crisis, and we are creatures of habit.
Consider your ambition
Kubler-Ross observed that affluent and highly educated people, those ambitious professionals who have dedicated their lives to accumulating bigger houses, nicer cars, better stuff, are the ones least likely to die peacefully. It’s not a judgment, but it is a caution. A life dedicated instead to service and relationships is a life that prepares you for death. If dying peacefully and with some semblance of contentedness is highly important to you, take this to heart.
IN SUM:
Is this book entirely secular? No. Almost all of the interviewees included in the book talk about their faith and religion, and of course the study was requested by theological students.
If you had to describe the book in one sentence? The seminal work that firsts presented the 5 stages of grief, which is the five stages dying patients go through after a terminal diagnosis.
Who should read this book? Anyone who believes that knowing how they’ll react to a terminal diagnosis is useful information to have.