Elisabeth Kübler-Ross

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Elisabeth Kübler-Ross

Elisabeth Kübler-Ross, M.D. (July 8, 1926 – August 24, 2004) was a Swiss-born psychiatrist and the author of the groundbreaking book On Death and Dying, where she first discussed what is now known as the Kübler-Ross model. Kübler-Ross was born in Zürich, Switzerland, one of a set of identical triplets. She graduated from the University of Zürich medical school in 1957. She moved to the United States in 1958 to work and continue her studies in New York.

Life

As a youth, Kübler-Ross was determined to a make a major contribution to the world. Her father, however, thought otherwise and insisted that she become his secretary. In an interview with ABC News, she revealed that she dreamed of becoming the next Albert Schweitzer, the medical missionary and Nobel prize winner.

After graduating from medical school at the University of Zurich, she married a classmate, Emanuel Ross. After moving to the United States in 1958 they gave birth to two children. They later divorced. In 1963 Kübler-Ross s completed her degree in psychiatry at the University of Colorado. It was there that began her strong academic interest in death and dying concerns, also known as Thanatology.

In later life, Kubler-Ross became interested in metaphysics, near death and out-of-body experiences and mediumistic attempts to contact the dead. This led to a scandal connected with one medium, as well as attacks on her healing centers.

Kübler-Ross suffered a series of strokes in 1995 which left her partially paralyzed on her left side. In a 2002 interview with The Arizona Republic, she stated that she was ready for death. During this time she granted interviews and seeral documentaries were filmed. She sometimes said that she had skipped the first four stages adn was at the acceptance stage and ready to die. However close friends sometimes sensed resignation and depression. She died in 2004 at her home in Scottsdale, Arizona.

Work

As Kübler-Ross began her practice, she was appalled by the hospital treatment of patients who were dying. In her native Switzerland, death, like birth, was considered a normal part of the life cycle and people died at home comfortably surrounded by family and friends. She deplored the practices of the United States and other countries that placed more emphasis on high tech medicine and less on the patients' emotional process of dying. She began giving a series of lectures featuring terminally ill patients, forcing medical students to confront people who were dying. Her extensive work with the dying led to On Death and Dying in 1969. This groundbreaking bestseller revolutionized how physicians treat dying patients. This book advocated for and ultimately produced more humane and compassionate treatment of the dying. She wrote over 20 additional books on the subject of dying, which were translated into 27 different languages.

A key to Kübler-Ross's success was her emphasis on communication. She revealed that patients truly wanted to review their lives, their illness and imminent death. She believed that when patients and doctors could talk honestly and fearlessly, a good death could be achieved. She began interviewing dyign patients in 1967 at the University of Chicago's Billings Hospital where she was employed as a psychiatrist. She wanted to learn what patients were thinking as they lay dying. From this first hand research, she proposed the now famous Five Stages of Grief as a pattern of phases, most or all of which people tend to go through, in sequence, after being faced with the tragedy of their own impending death. The five stages of grief, in sequential order, are denial, anger, bargaining, depression, and acceptance. The five stages have since been adopted by many as applying to the survivors of a loved one's death, as well.

Balfour Mount, chair of palliative care at McGill University in Montreal, recounted how she addressed more than 5000 surgeons at an American College of Surgeons meeting, one of hundreds appearances she made around the world. "It was as if they were transfixed by her," he said. Mount called her "one of the most effective communicators of the 20th century". She was a very skilled listener and a role model for patient interviewing and active listening, and she established an entirely new field of practice—narrative medicine.

She did not found the hospice care movement, but its adherents credit her with encouraging it. In her lifetime, she received 23 honorary doctorates, a few of which are:

• Doctor of Science, H.C., Albany Medical College, New York 1974
• Doctor of Laws, University of Notre Dame, IN.,1974
• Doctor of Humanities, St. Mary's College, Notre Dame, IN. 1975
• Doctor of Humane Letters, Amherst College, MA. 1975
• Doctor of Humane Letters, Loyola University, IL 1975
• Doctor of Humane Letters, Bard College, NY 1977

Kübler-Ross model

The Kübler-Ross model describes, in five discrete stages, the process by which people deal with grief and tragedy. Terminally ill patients are said to experience these stages as they grappled with their diagnosis, adn their emotions along the way, right through to acceptance of their impending death. The model was introduced by Elisabeth Kübler-Ross in her 1969 book On Death and Dying. The stages have become well known, and are called the Five Stages of Grief. She apppealed to the medical community to use it with their dying patients.

The stages are:

1. Denial : The initial stage: "It can't be happening."
2. Anger : "How dare you do this to me?!" (either referring to God, oneself, or anybody perceived, rightly or wrongly, as "responsible")
3. Bargaining : "Just let me live to see my son graduate."
4. Depression : "I'm so sad, why bother with anything?"
5. Acceptance : "I know that I will be in a better place."

Kübler-Ross originally applied these stages to any form of catastrophic personal loss (job, income, freedom). This also includes the death of a loved one and divorce. Kübler-Ross also claimed these steps do not necessarily come in order, nor are they all experienced by all patients, though she stated^{[citation needed]} a person will always experience at least two.

Others have noticed^{[citation needed]} that any significant personal change can follow these stages. For example, experienced criminal defense attorneys are aware that defendants who are facing stiff sentences, yet have no defenses or mitigating factors to lessen their sentences, often experience the stages. Accordingly, they must get to the acceptance stage before they are prepared to plead guilty.^{[citation needed]}

Additionally, the change in circumstances does not always have to be a negative one, just significant enough to cause a grief response to the loss (Scire, 2007). Accepting a new work position, for example, causes one to lose their routine, workplace friendships, familiar drive to work, even customary lunch sources.

Grief

In popular culture these stages are almost exclusively applied only to news of one's own impending death. The notion that to resolve grief they must all be followed, in order, is also common.

Although, in 1974, "The Handbook of Psychiatry" defined grief as "...the normal response to the loss of a loved one by death," and response to other kinds of losses were labeled "Pathological Depressive Reactions," this has become the predominant way for counselors and professionals to approach grief, loss, tragedy and traumatic experiences.

Further, many psychiatrists believe real grieving begins after the stages are over, and that "grief work," involving its own set of stages, begins with acceptance, where the Kubler-Ross stages end.

Research on the theory

Collin Murray Parkes, consultant psychiatrist at St. Christopher's Hospice in London, credits five stage theory and it's high visiblility as a catalyst in stimulating research and changing practice in the death and dying field. However, he notes that more current information shows that the five-stage framework is not as simple as initially described.

A February 2007 study of bereaved individuals, from Yale University obtained some findings that were consistent with the five-stage theory and others that were inconsistent with it.

Criticism

The original Kübler-Ross model did not identify five stages of grief. It identified what Kubler-Ross called "the Five Stages of Receiving Catastrophic News."

There exists no real evidence that stages are present in coping with death: Using the terms stages implies that there is a set order of set conditions, meaning that everyone will go through each stage at the same time while confronting impending death. The order of the stages, as well as the amount of time each stage lasts can vary. Also, the definition of each stage is not clear, and some stages can be combined.

More specifically, there is no real evidence that people coping with their impending death move through all of the five stages. The path through the stages is not a one-way street: they can repeat, occur out of order or not at all. It is highly dependent on other qualities, such as emotional ties to family, and other relationships. These stages can also occur in a repetitive, spiral-like fashion where the individual is re-working and re-experiencing various grief stages over time. "Real events," such as moving, getting rid of the loved ones clothing or objects, etc. tend to trigger a grief regression in which the grieving individual may re-experience anger or shock or depression.

The way in which the particular loss is experienced may strongly influence how grief is played out. A sudden loss or violent loss in which one is "blind-sided," caught unaware and unprepared, may create a traumatic loss which is probably more difficult to process and work through.^{[citation needed]}

In popular culture

The five stages are sometimes mentioned in the media, for example in the following TV shows:

• In the TV show Frasier, when Frasier is unemployed, there is an episode where he cycles through the stages. (Season 6)

• In the TV show House, the 5 stages are referenced to by Dr. House when he criticizes Cameron's attitude toward diagnosing one of her patients. (Season 2)

• In the TV show Scrubs a patient goes through the 5 stages of grief and gets help from the hospitals grief counselor, Dr Hedrick, in the episode My Five Stages.

• In the TV show Monk, Adrian Monk cycles through the stages repeatedly.

• In the Comic series Fallen Son: The Death of Captain America. Following the assassination of Captain American, the five part mini-series "Fallen Son" had chapters entitled: Denial, Anger, Bargaining, Depression, and Acceptance.

Legacy

While her most well known, On Death and Dying and the five stages framework are not her only legacy. Kübler-Ross was also a prolific author of more than 20 books. Her interests also became more specialised, addressing, for example, the care of dying children On Children and Death) and HIV infected people, including prisoners with AIDS (AIDS: The Ultimate Challenge).

In an interview with ABC News in the United States on 18 December 2001 she said that she was most proud of her work with people with AIDS and creating hospice care for prisoners with AIDS. Her last project before her death was building a hospice for children with AIDS in Virginia.

In a mission to continue Elisabeth's legacy, the Elisabeth Kübler-Ross Foundation (EKR Foundation) was formed by her son Kenneth Ross. The mission of the EKR Foundation is simple: continue and grow Elisabeth's pioneering work with the dying and their loved ones.

Since her death, Elisabeth's memory has been honored in many dedications and memorial services around the world. In May of 2005, Desert Regional Medical Center, in Palm Springs, California, named their annual hospice volunteer award the Elisabeth Kubler-Ross Hospice Volunteer Award. On June 30, 2005, Hospice of Arizona dedicated their new Pueblo Norte Inpatient Unit in honor of Elisabeth with the name The Butterfly Center. On July 8, 2005, The Dougy Center in Portland, Oregon unveiled their EKR Memorial. Elisabeth’s most recent honor is her induction into the National Women's Hall of Fame in Seneca Falls, New York in September 2007, for her work as a groundbreaking crusader for the rights of the terminally ill, including hospice care, living wills, and speaking openly about life and death..

Selected bibliography

• 1969. On Death & Dying. ISBN: 0-684-83941-5 ISBN 0684842238.
• 1972. Questions & Answers on Death & Dying. Simon & Schuster. (New ed. Touchstone, 1997). ISBN 0-684-83937-7.
• 1974. Death: The Final Stage of Growth. Simon & Schuster. (New ed. Touchstone, 1997). ISBN 0-684-83941-5.
• 1978. To Live Until We Say Goodbye,Simon & Schuster. (New ed. Touchstone. 1997). ISBN 0-684-83948-2.
• The Doughy Letter -A Letter to a Dying Child, (Celestial Arts/Ten Speed Press), 1979
• Quest, Biography of EKR (Written with Derek Gill), (Harper & Row), 1980
• 1981. Working It Through, Simon & Schuster. (New ed. Touchstone, 1997). ISBN 0684839423.
• 1981. Living With Death & Dying, Simon & Schuster. (New ed. Touchstone, 1997). ISBN 0-684-83936-9.
• 1981. Remember The Secret. Ten Speed Press. (New ed. Celestial Arts, 1998). ISBN 1883672791.
• 1985. On Children & Death. Simon & Schuster. (New ed. Touchstone, 1997). ISBN 0-684-83939-3.
• 1988. AIDS: The Ultimate Challenge. Simon & Schuster. (New ed. Touchstone, 1997). ISBN 0-684-83940-7.
• 1991. On Life After Death. Celestial Arts. ISBN 0890876533.
• 1995. Death is of Vital Importance, (Out of Print- New title: The Tunnel and the Light).
• Unfolding the Wings of Love (Germany only - Silberschnur), 1996
• Making the Most of the Inbetween, (Various Foreign) 1996
• Aids & Love, The Conference in Barcelona, (Spain) 1996
• Longing to Go Back Home, (Germany only - Silberschnur), 1997
• 1997. The Wheel of Life, Simon & Schuster. (New ed. Touchstone, 1998). ISBN 0684846314.
• Why Are We Here, (Germany only - Silberschnur), 1999
• 1999. The Tunnel and the Light. Marlowe & Co. ISBN 1569246904.
• 2000. Life lessons, (With David Kessler), Scribner. ISBN 0-684-87074-6.
• 2002. Real Taste of Life: A Journal. Publisher: Ken Ross. ISBN 1583581588

ISBN 978-1583581582.

• 2005. On Grief and Grieving. (With David Kessler). Simon & Schuster. ISBN 0743266285.

References

ISBN links support NWE through referral fees

• Worth, Richard. 2004. Elisabeth Kubler-Ross: Encountering Death And Dying. Chelsea House Publications. ISBN 0791080277

External links

• Elisabeth Kübler-Ross: Kübler-Ross's home page.
• Women's International Center biography
• Elisabeth Kübler-Ross Foundation
• Obituary in The Guardian
• Obituary in The Economist
• "Dead Like Her: How Elisabeth Kübler-Ross Went Around the Bend" by Ron Rosenbaum in Slate

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