The presentation I discussed in class was that of a model of coming to terms with death, created by Dr. Elisabeth Kubler-Ross. Dr. Kubler-Ross was also a teacher, who set out to have her students’ write a paper on crisis in human life. The students themselves’ decided that the biggest crisis that people had to deal with was death. Dr. Kubler-Ross had been aiding the dying for many years, and the students did not really know how to go about getting the information they would require for this paper. Ultimately, they decided that they would get their information from people who were actually terminally ill, or critically ill. No other sources were used, and this created a very open-minded study of how people who are faced with terminal illness react to the situation. This was the first time anyone really considered that coming to terms with the reality that one will die was a process. This process was categorized into five stages.
Josephine GracchiASC 183
Dr. Christian Perring
Tues.- Thurs. 8:30 - 9:50 am
Topic: Kubler-Ross’ model of coming to terms with death, and criticisms of it.
Stage 1: Denial and Isolation
When someone is told that they have a terminal
illness, the initial reaction is that of denial. Not everyone has as a
severe denial as others, but there is always at least partial denial in
all people. "No, not me.", or "It cannot be true.", are usually the reactions
given by people who discover that they are afflicted with a life-threatening
illness. Denial functions as a buffer after unexpected, or shocking news.
It is a defense mechanism that people use to protect themselves from the
harsh realities of life. In the stage of denial, the patient can gather
his/her thoughts, and with time utilize less radical defenses. Denial is
usually replaced by partial acceptance, although some people can deny that
they are ill until they very end of their life. The need for denial exists
in every patient from time to time. Most people deal with the realities
of their situations for brief periods, and when they can no longer look
at it realistically anymore, the denial enters. This aids the patient in
looking at more brighter and cheery things, as opposed to the dreary thought
of their own death.
Isolation is usually used much later in the interim of the illness by patients. The person requires more time by themselves, but they can usually talk more about their illness and impending death when in the presence of others more readily then when they initially discovered that they were sick. Usually, they talk of their own death and illness as if in a third person point of view, outside of the predicament. They face death, and still maintain hope with this ability to isolate themselves from the situation.
Stage 2: Anger
When the first reaction of denial dawns on us,
and the second opinions that a patient usually receives proves that they
in fact are ill, a new reaction is created. Feelings of anger, rage, envy,
and resentment replace the denial. The idea of "Why me?" comes into place.
The stage of anger is usually very difficult for family members, and the
staff of doctors and nurses, caring for the sick person. Anger is presented
to anyone within the environment, in all directions, from the patient.
Wherever a patient looks at this time he/she will find grievances. The
patient desires to make sure that they will not be forgotten. The patient
will raise their voice, make demands, complain, and ask to be given attention.
These reactions can perhaps be considered one last cry. "Hey, I am NOT
dead yet!" Most people tend to get offensive, and feel that they are in
fact being persecuted by the patient, by taking these outcries personally.
Most people who do take this anger personally are not thinking of the reasons
why this person is so angry. People need to express their emotions. Rational
and sometimes irrational feelings are present, but permitting an individual
to express these feelings will lead way to helping that person accept their
fate.
Stage 3: Bargaining
Bargaining is a way of postponing the inevitable
fate that one knows they will ultimately come to. It is like that of a
child who does not get his way. The child will scream, cry, and bangs things
only to get sent to their room. They then decide, "if I clean my room,
will you let me out?" This idea is still present in the terminally ill,
but usually they are bargaining with God, or another form of higher existence,
instead of a mother or father. "If I eat all of my food, and go through
all of my treatments, will you give me an extra couple of days?" Most of
the bargaining that takes place is for an extension of life, or some time
without all of the pain and discomfort. Most bargains are made with God
in private, and usually kept a secret. This is why this stage is not readily
known.
Stage 4: Depression
When the terminally ill can no longer deny their
illness, they are beginning to get more symptoms, they are weaker, and
require more hospitalization. The feelings of anger will be replaced with
feelings of great loss. Dr. Kubler-Ross’ categorized depression into two
forms.
Reactive Depression is the first form. In reactive depression the person is usually hospitalized more so the burdens of finances are on the persons mind, also who will take care of the children, the house. "Who is going to take over all of the areas that I covered?" This burden can be lifted from the person if they have a very strong support group, usually family members who will alleviate the pressure of unattended circumstances. With this form of depression trying to cheer them up is a good tactic. Letting the sick individual know that all will be taken care of, and "not to worry."
Preparatory Depression is the second form, and very different from that of the first one. This type of depression a terminally-ill patient has to undergo in order to prepare himself for his final separation from this world. With this grief there are little or no need for words. There is no need to try and cheer the person up, because their fate is inevitable. This stage is that of emotional preparation that an individual must go through who is loosing everyone, and everything that they ever loved. In this stage depression is used as a tool to facilitate all of the impending losses, and come to the final stage of acceptance.
Stage5: Acceptance
If a patient has had enough time to go through
the stages. He will reach a stage where he is neither depressed or angry
about his fate. Having the ability to express their emotions, and mourn
their losses. They will await their fate with what can be called quite
expectation. This is not a happy stage. This stage is actually " almost
void of feelings". This is when the struggle is over, and the dying patient
has found some peace, and acceptance. The dying patients circle of interests
diminishes, no longer worried about the "outside" world. This stage is
usually most difficult for family members, and when they need more support
then they dying patient.
All of these stages can intertwine with each other, and not everyone has them in the same order. In conclusion each individual situation is different, and none are alike, but these are the stages that most people go through. The doctors were very hesitant at the beginning of the study, say that "their are no dying people here", but after they started seeing a significant difference in the patients that were interviewed. How their attitudes changed, and actually seemed more pleasant that they were able to get these things "off their chest". Many doctors started to attend these seminars with a hope toward better understanding of their terminally-ill patients, and how to deal with them.
Most of the reactions to this report were that
of understanding, and associating it to their own personal experiences.
A lot of very good questions were asked of me. Some being, "does each person
have to go through the stages in that order?" Again the answer is no, they
do not. Each person copes with their own death differently given the different
situations. Another question was "what were some of the criticisms?" Like
I said before, at the beginning of the study most of the feedback from
staff members were negative, but as the seminar went on the interest increased
on part of the staff, and opened up new ideas on how to handle the terminally-ill.
I truly do believe myself that these stages do occur, from my own experiences.
Hopefully every terminally-ill patient will be able to get to the acceptance
stage before they die.