Elisabeth Kübler-Ross

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Elisabeth Kübler-Ross

Elisabeth Kübler-Ross (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. 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.

Interest in death as a transition into a higher state of consciousness moved from the realm of the solely religious when psychiatrist Elisabeth Kubler-Ross caused physicians, psychiatrists, and scientists to take a new look at the meaning of death. Knowledge and understanding of the afterlife can help many of us overcome fear and pain when making preparations for our own death, or for that of someone we love. Understanding can help tremendously with the grieving or separation process. Kübler-Ross also believed that her research on death and dying revealed important lessons for living— to learn unconditional love and to fulfill life's purpose which is service to others.

Life

Born in Zurich, Switzerland on born July 8 1926 Elisabeth Kübler was one of a set of identical triplets. She weighed only two pounds at birth and was not expected to survive. Elisabeth struggled to find her own identity for as a child all three girls were dressed alike, and her teachers and parents had difficulty telling them apart. They even received the same grades, even though Elisabeth was an outstanding student. She claims in her autobiography that she was best known for defending weak or handicapped children from bullies. She also created an animal hospital in her basement for wounded birds, cats, frogs, and other animals. Her harsh father never understood her love of nature and animals, and once took her pet rabbit to a butcher and then forced Elisabeth to join the family as they ate her pet for dinner.

Even as a youth, Elisabeth was determined to a make a major contribution to the world. In an interview with ABC News, she revealed that she dreamed of becoming the next Albert Schweitzer, the medical missionary and Nobel Prize winner. Her father, however, thought otherwise and insisted that she become his secretary in his business. She adamantly refused and Instead worked in a Zurich laboratory and then volunteered as a relief worker. She visited a Nazi concentration camp in Poland after the end of the war and saw, on the blighted barrack walls, hundreds of images of butterflies, a symbol of rebirth amid mass deaths. The experience left a profound impression. In an interview with Daniel Redwood, Kübler-Ross described her strikingly powerful experience as a young woman visiting a concentration camp just after the liberation in 1945, an experience which was to impact her the rest of her life. She was confronted with the highly controversial idea raised to her by the young Jewish camp survivor that she met there, that there is an aspect of Hitler in all of us. Recognizing the unspeakable horror of the Holocaust, she began to question the nature of human evil and the roots from which it springs. This experience began her exploration of the fear, denial and uncertainty, which characterize much of modern Western humanity's approach to death. She decided to study medicine and explore these issues that touched her deeply.

She attended medical school at the University of Zurich, and after graduating she married a classmate, Emanuel Ross. They moved to the United States in 1958 and later gave birth to two children. The marriage did not last and ended in divorced in 1976, however they remained friends until Emanuel's death in 1992. In 1963 Kübler-Ross 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, Kübler-Ross became interested in metaphysics, near death and out-of-body experiences and mediumistic attempts to contact the dead. She once said: "Death is simply a shedding of the physical body like the butterfly shedding its cocoon. It is a transition to a higher state of consciousness where you continue to perceive, to understand, to laugh, and to be able to grow."

After encountering her first AIDS patient, Kübler-Ross felt compelled to create her own healing center on a 300 acre farm in Virginia. When the local residents found out she had plans to adopt AIDS-infected babies who were abandoned, her neighbors attacked her - firing bullets through her windows and at her animals. In 1994 her house was set on fire, destroying all her belongings as well as years of journals and research on death, dying and the afterlife. Her understanding of loss and grieving was deepened through her own personal hardships and painful life experiences.

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 several documentaries were filmed. She sometimes said that she had skipped the first four stages and was at the acceptance stage and ready to die. Her research on death and dying, she believed, taught her the most important lessons about life - to live fully and to love unconditionally. Then, she said, "at the end of your days, you will bless your life because you have done what you came here to do." 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. In interviews, she spoke of cultures, such as in Mexico, "where people "go and visit the graves. They bring food, they talk to them, they have a feast. There are lots of cultures who have much less of a hangup. The old, old, old cultures are also much more natural. In the more sophisticated, more materialistic Western world, even to die costs a fortune. They put shoes on the dead that are comfortable to wear, and silk pillows, and put rouge on the cheeks, so they look like they're only asleep. It's so phony and so dishonest. But that's more of a modern day deterioration. In the old days, the farmers died here just like in Switzerland."

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.

When asked about the role of religion in a patient's grief process, she said: "What makes a difference is if your spiritual quadrant is open. If you have a faith, any faith, any, that is solid and internalized, you have much less of a problem than if you are a wishy-washy Protestant or a wishy-washy Catholic or a wishy-washy Jew...we're all the same. We're all the same human beings. We all are born the same way. We all die the same way, basically. The experience of death and after death is all the same. It only depends how you have lived. If you have lived fully, then you have no regrets, because you have done the best you can do." She advises "That's why I tell people, and I really mean it literally, if you're not doing something that really turns you on, do something that does turn you on, and you will be provided for to survive. Those people die with a sense of achievement, of priding themselves that they had the guts to do it."

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, and 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 a person will always experience at least two.

She explained that if patients were allowed to express their anger, to cry and grieve, to finish their unfinished business, to articulate their fears (work through the above stages), then finally they would reach the last stage of acceptance. It can be a time of quiet and peaceful expectancy. She observed that the struggle disappeared and as one patient described it " the final rest began before the long journey."

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 visibility 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 now-classic first book, On Death and Dying, is today considered the master text on the subject, and is required reading in most major medical and nursing schools and graduate schools of psychiatry and theology. Her lectures, workshops, media appearances and books have reached millions of people around the world, opening discussion of sensitive yet profound issues which affect us all. She received the Modern Samaritan Award and the Ideal Citizen Award. Her work 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 Kübler-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.

In a letter to a child with cancer, Elisabeth Kübler-Ross wrote:

When we have done all the work we were sent to Earth to do, we are allowed to shed out body, which imprisons our soul like a cocoon encloses the future butterfly. And when the time is right, we can let go of it and we will be free of pain, free of fears and worries—free as a very beautiful butterfly, returning home to God...which is a place where we are never alone, where we continue to grow and to sing and to dance, where we are with those we loved, and where we are surrounded with more love than we can ever imagine.

Selected bibliography

• 1969. On Death & Dying. New ed. Scribner, 1997. 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
• 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).
• 1997. The Wheel of Life, Simon & Schuster. (New ed. Touchstone, 1998). ISBN 0684846314.
• 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

• Chaban, Michèle Catherine Gantois. 2000. The life work of Dr. Elisabeth Kübler-Ross and its impact on the death awareness movement. Lewiston: E. Mellen Press. ISBN 0773483020 9780773483026.
• Gill, Derek. 1982. Quest: The Life and Death of Elisabeth Kubler-Ross. ISBN 0345300947 ISBN 978-0345300942.
• Redwood, Daniel, D.C. 1995. On Death and Dying: Interview With Elizabeth Kubler-Ross M.D. Health World Online. Retrieved August 15, 2007.
• 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

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