Working with Children of Alocholics

A classic in the study of death, dying and grief, this first effort by Elisabeth Kubler-Ross provides the first glimpse at the true feelings and experiences of people in the process of dying. Written in 1969, Kubler-Ross uses material gathered from her many seminars and interviews with terminally ill hospital patients and in a groundbreaking gesture, suggests to the reader that instead of ignoring, avoiding or isolating the dying patient, it is important to understand the stages of grief and to allow the patient to talk openly and honestly about his situation. In earlier times, death was not a subject to be discussed aloud, and was such an uncomfortable topic, that a dying patient was not free to share his feelings, anxieties, anger and transitions with even his loved ones. Kubler-Ross presents some new possibilities, that perhaps a dying patient feels lonely and isolated, and the awkward non-communicative way we treat the dying can be transformed to help the patient feel a sense of completion, comfort and peace at the end of his life.

With the help of four theology students, Elisabeth Kubler-Ross undertook a project that involved providing seminars at hospitals to help people with the process of death and dying. In addition, the group provided one-on-one interviews with patients and their families in an attempt to help them spell out their worries, frustrations, fears and undelivered communication. They found simply listening to the patients discuss openly and frankly the prospect of their own deaths was quite calming for the patients and perhaps, helped them to move on to the preparatory stage of grief, which coincides with the final stage of acceptance.

Death is a topic difficult for even the strongest people to discuss when it affects them personally. Often, terminally ill patients are avoided by their families, isolated and lonely, because it is too difficult for relatives to communicate openly about the situation. Kubler-Ross found patients are often eager to talk about what has happened to them, and the issues among their family members that may otherwise be left unresolved. Moreover, terminally ill patients wish their doctors would be forthright with them, and express their sadness and anger over the occasionally lax treatment they receive at the hands of nurses and other hospital staff.

The author's now-famous five stages of dying or grief, have been incorporated into hospice studies and, although they are perhaps presented too rigidly, they are based on the Kubler-Ross's extensive work with many terminally ill patients. Kubler-Ross wants us to know that, although there is no set, proper way to die, the stages of grief are fairly common, and apply not only to the dying patient, but the family as well.

The thrust of her message with this book is to encourage us to talk to the dying and listen to the dying patient, giving them whatever help they need to express their feelings and wishes, and helping them to resolve the final issues that are keeping them alive or in discomfort. Perhaps more importantly, we should not avoid a dying person, but sit with them, hold their hands, and just be a source of silent strength that will allow them to complete their process with dignity and in peace.

I and II Summary and Analysis

Kubler-Ross describes the increase in modern humanity's fear of death with the rise of technology and medical science. She feels that, although we are able to prolong our lives as never before, it has contributed to our emotional problems and inability to cope with the prospect of our death. We associate death with a bad act, or "malicious intervention" from someone else, or, at least a negative event. As children, we cannot grasp the reality of death, but as adults we continue to carry the fear of death with us, and experience grief, anger and shame when a loved one passes on. Kubler-Ross tells of death in her native Europe, where family and friends accept the transition quietly, not trying to make the dead look alive with enbalming or makeup. Although pain medication and fluids are often called for, patience, friendship and support may be as important to one who is dying. We tend to hide the truth from children, and death is depersonalized, as we use machines and tubes to try to prevent the inevitable. The author feels we should spend more time focused on the experience and needs of the dying, paying more attention to the feelings of the patient than the equipment and intevention we assert in an attempt to, perhaps, mitigate our own fear of mortality.

In Chapter Two, in discussing our attitudes toward death, Kubler-Ross suggests our doctors are trained that prolonging life is a priority, as opposed to relieving suffering. The threats to our lives are more nebulous and can come out of the sky, such as nuclear holocaust, so we persist in making war on each other to deny our own mortality and defend against our own deaths. She notes we find it unfathomable for someone to go to war and survive on the front lines, only to come home and be killed in a car accident. Since we have fewer and smaller means of defending our own lives than ancient man, we tend to psychologically react more severely, trying to deny or master death. She feels if we study our attitudes toward death, we may be able to reach a more peaceful state both personally and globally, but fears of weapons of mass destruction have increased our fears of a" violent, catastrophic death." Kulbler-Ross sees the decline in religion unfortunate, since we may no longer have the comfort of those beliefs when facing death. We cannot return to a simpler time when religion, death and technology were completely different, but she feels technology and science, although they are prolonging life, could also work toward more individual contact.

The author tells a story of a man whose life had become dependent upon a respirator, and whose doctor had gone to all lengths to save him. Her team, consisting of herself and theology students, helped the patient and doctor communicate honestly about his condition, which was a great relief to both of them. The team has continued to interview patients for years, allowing them to speak and be careful listeners. These sessions are at the core of Kubler-Ross's studies on death and dying.

III and IV Summary and Analysis

Denial is the most common reaction to learning of a terminal illness. Most people are sure there must be a mistake about the diagnosis. Kubler-Ross sees denial as a buffer that allows the patient to "mobilize other, less radical defenses." She believes it is better to discuss death with a patient long before it arrives. Patients use denial to different degrees before

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