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Kubler-Ross Death and Dying

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Proposed in her 1969 book "On Death and Dying," Elizabeth Kubler-Ross explores the various stages people go through after being diagnosed with a terminal illness or experiencing the death of a loved one. In it she states that "Denial, Anger, Bargaining, Depression, and Acceptance" are the five steps in the grieving process, and while I agree with this, it seems as though most of the points she makes deal more with the psychological aspects of grieving, but not the very real, emotional, everyday responses that are so hard to live through, after a loved one has died. She also doesn't make it very clear that these steps can occur in a different order, though they frequently do.

Kubler-Ross' first stage is Denial. In this stage, grieving people are unable or unwilling to accept that the loss has taken (or will shortly take) place. It can feel as though they are experiencing a bad dream, that the loss is unreal, and they are waiting to "wake up" as though from a dream, expecting that things will be normal. Kubler-Ross states that, "Among the over two hundred patients interviewed, most reacted to the awareness of a terminal illness at first with the statement, "No, not me, it cannot be true!" She states that patients made use of denial not only in the initial stages of their illness, but in later periods also. Denial, states Kubler- Ross, "...functions as a buffer after unexpected shocking news, allows the patient to collect himself and, with time, mobilize other, less radical defenses. Eventually, she states, "Denial is usually a temporary defense and will soon be replaced by partial acceptance."

I've never really lived through a death that suddenly happened to someone. I've never experienced a "surprise death," with something quick happening like a car accident, or sudden heart attack. The deaths around me, and I will focus on one for the sake of this paper; have always happened slowly and with advanced notice. I remember feeling, and thinking that a certain special someone was going to die. This is where denial set-in the first time. I remember the last time I saw him, how sick he had been and how worried I was because of it. I remember tearing up and panicking. Others were panicking too. We were all aware that his time was running out, and that's when I stopped returning phone calls. I was "busy" with full-time work, full-time school, a full-time boyfriend, and a full-time social life, and that gave me a way out of seeing the last months/days of his life. I remember two voicemails in particular. I remember what he said, when I checked them, and how I had to push them out of my mind to continue on with everything else. I had to press "mute" on the dying, because I only wanted to remember the living. I wanted to remember him at his best, at his healthiest, at his chunkiest, and the person on the line leaving a message was not that person any more. I loved him, and I loved him even through the dying, but I just couldn't handle it any more. The pain of it all pushed me into denial. I convinced myself I didn't need to return his calls, because I'd just "call him next week," even though deep down I understood that there may not be a next week. More denial came later it never seemed like I was only in one stage at one time.

After people have passed through denial and accepted that the loss has occurred (or will shortly occur), they may begin to feel Anger at the loss and the unfairness of it. They may become angry at the person who has been lost (or is dying). Feelings of abandonment may also occur. This is the substituting stage to denial. From her perspective, "When the first stage of denial cannot be maintained any longer, it is replaced by feelings of anger, rage, envy, and resentments." This stage is distinguished from denial in the fact that patient's displace their feelings of anger toward medical staff, family, the physician, onto the environment, etc. Kubler-Ross suggests that since the patient's reasoning to be angry may be irrational, the patient's anger, when cast on to others, should not be taken personally.

For me, anger came right before he died, and again after the depression for me. I was angry when I realized that he would die, but I became even angrier when I realized that - no matter what I did - he was going to die. No amount of praying, or pacing at night, or being well behaved, or getting good grades, or calling him, or painting him pictures would save him from cancer. Nothing I could have done was going to change his outcome, or the victor of this battle. I was angry, thinking that I had been serving God and people were being pulled away from me - not just by death at this point, but by life, and changes, moving, and mistakes. I was angry because I was putting everything into serving God, and it didn't make sense to me to be punished.

Next comes Bargaining, in this stage, people beg their "higher power" to undo the loss, saying things along the lines of; "I'll change if you bring her (or him) back to me". This phase usually involves promises of better behavior or significant life change which will be made in exchange for the reversal of the loss. From her perspective, although this stage is not well known, it is equally helpful to patients, thought only for brief periods of time. During this stage, states Kubler-Ross: "If we have been unable to face the sad facts in the first period and have been angry at people and God in the second phase, maybe we can succeed in entering into some sort of an agreement which postpone the inevitable happening: 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." From her point of view, this stage could be related to children first demanding, and then asking for a favor. In that sense, patients who are in the stage of bargaining may use the same maneuvers. In Kubler-Ross' words: "He [the patient] knows, from past experiences, that there is a slim chance that he may be rewarded for good behavior and be granted a wish for special services. In Kubler-Ross' conception, the bargaining stage is a period of negotiation with a higher being. She describes this aspect of bargaining by suggesting that:




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