'On Death and Dying'

By Munoz, Rodrigo A. | Clinical Psychiatry News, November 2004 | Go to article overview

'On Death and Dying'


Munoz, Rodrigo A., Clinical Psychiatry News


The death of Elisabeth Kubler-Ross, M.D., in August prompted me to open my old copy of her seminal work.

I first read "On Death and Dying" when it was published in 1969. Even the preface was absorbing: "I have worked with dying patients for the past two and a half years and this book will tell about the beginning of this experiment, which turned out to be a meaningful and instructive experience for all participants."

Meaningful and instructive, indeed. The revolution triggered by the book created hospices, palliative care, and programs on pain management all over this country. The care of the dying is in the forefront of medicine, and the voices of the dying are increasingly recognized. None of this would have happened without Dr. Kubler-Ross.

Her own life underwent a dramatic change with the publication of the book. She became an international lecturer on the five psychological stages of dying that she had identified (denial, anger, bargaining, depression, acceptance), and by the end of the decade she was president of the Elisabeth Kubler-Ross Center and the Shanti Nilaya Growth and Healing Center.

In her autobiography, "The Wheel of Life: A Memoir of Living and Dying" (Scribner, 1997) she said that the focus of her work on death and dying became clear when, at age 19, she visited the Majdanek concentration camp shortly after World War II and discovered butterflies carved into the walls by those about to die.

After medical school in Switzerland, Dr. Kubler-Ross came to the United States and was appalled by the care of dying patients. In "On Death and Dying," she credited a group of theology students with encouraging her to initiate the seminars that led to her first book.

The critical component of each seminar was an interview with a dying patient. To her surprise, she found it nearly impossible to find such patients. The physicians she approached reacted with stunned looks of disbelief and abrupt changes of topic. Some protected their patients, claiming they were too tired or weak to talk. Others simply refused to take part.

But she finally found a dying patient who was willing--even eager--to talk. So that the students could be present, Dr. Kubler-Ross postponed that first interview for one day. When they all arrived the next day, the patient was no longer able to hold a conversation. "[H]e died less than an hour later and kept to himself what he wanted to share with us and what we so desperately wanted to learn. It was our first and most painful lesson," she wrote.

She persevered, interviewing many dying patients. Not only did she and her students benefit from the data collected during those interviews, but the patients themselves all expressed appreciation for having been able to express their feelings. …

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