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Are There Five Stages of Grief?
Reading time: 5 min.
Answer: Only for the dying.
Elizabeth Kübler-Ross is known to many as the authority on grief. In her most famous book, On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families, she outlines the five stages of grief: denial, anger, bargaining, depression, and acceptance. Popular culture misinterprets the five stages as applying to the grieving felt after the loss of a loved one. But she meant it solely in respect to what the terminally ill experience after learning that they’re going to die.
Not everyone passes through all five stages, and we’re predisposed to start and stay in certain stages. Someone may remain in one stage longer than another or not make it through the five stages at all. People who avoid conflict may hide in denial. Those with anger issues are more likely to thrust themselves into the anger stage and stew there. Bargainers bargain. The depressed stay seeped in depression. Those who take life in stride get to meander straight to the acceptance stage. But anyone told of a terminal illness goes through at least one of them.
On Death and Dying isn’t really about grief; much of it is a critique of how hospital staff treat the dying. Kübler-Ross disapproves of the way hospitals mechanize and depersonalize death. Hospital staff ignore dying patients, opting instead to treat deteriorating bodies. Kübler-Ross’s interest lay less in pinning down the number of phases a person experiences when nearing death and more in improving late-life medical care by empowering patients. Her interest in the five stages was less about preparing us for death than giving us a way to communicate our emotional responses, particularly with our doctors.
Religion comes in—a bit. Only a few patients interviewed are devoutly religious or truly atheist. Most hover somewhere in the middle. But those patients who don’t believe that God intends only the best for them accept death more easily; those without an abiding faith do not.
As much as Kübler-Ross wants to improve our relationship with death, she also refers to dying as a battle. The patient, family, and doctor are at war with the illness. Fighting against death is a kind of bargaining (the fourth stage) but not necessarily bad.
The bulk of On Death and Dying is harrowing. Far from being a stiff overview of certain psychological stages, it’s primarily a series of interviews with dying patients. Page after page of my worst nightmare: people talking about how they felt having learned that they have months or (if they’re lucky) years to live. The patients interviewed are identified by their titles—Mr. or Mrs. or Ms.—and a letter—Mr. H, Mr. J, Mrs. C, etc. (Oddly, single women don’t appear in the book.) But the anonymity of the patients interviewed doesn’t make them any less real.
My response to the book was bodily. Often, I was sick to my stomach. Too much time spent reading it induced panic attacks. How could Kübler-Ross sit with those patients, day after day, and hear their stories of impending death?
If Kübler-Ross were alive, I’d try to ask her, but she passed away in 2004. How could she—how could anyone—not suffer from death anxiety? Or did all those conversations and thinking and writing about death cure her of it?
Kübler-Ross is survived by her son and daughter. (Survived is such a strange term as if the living escape death each time someone dies.) Ken Ross, Kübler-Ross’s son, is the founder and president of the Elisabeth Kübler-Ross Foundation and lives in Arizona. Barbara Ross Rothweiler, her daughter, is a clinical neuropsychologist and has a private practice in rural Wisconsin.
I want to talk to them not so much about Kübler-Ross but to find out what it was like to grow up with the authority on death telling them to brush their teeth. Being raised by Kübler-Ross, they must have had all the advantages the rest of us didn’t; instead of living in fear of death the way I did, they must be exempt. Was there a lot of talk about death in the house? Were they taught not to fear it? Did it work?
About their childhood, they’ve said little. Barbara Ross Rothweiler commented only this: “Her lessons to us, her children, were taught in fearless love and by example and were consistent with her approach to the [sic] life and death. We remember some of her most frequent quotes: Every experience-painful or not-is an opportunity to learn and grow. Everyone has something to teach you. Don’t live life in perpetual fear. Don’t be afraid to make and acknowledge mistakes. Work hard, but don’t forget to play. Do what you love and you will do a wonderful job.”
It’s the Don’t-live-life-in-perpetual-fear part that gets me. I assume that includes death.
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