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Posts Tagged ‘Kübler-Ross model’

I got on youtube this morning and searched for “grief”.  I was pretty sad with what I found.  After a few pages of scrolling through a lot of oddities, I simply closed the window, my head shaking from side to side.

I’ve decided that the only good stage is the one that people perform on… like my young friends here, my favorite hams…

My favorite Harry Potter impersonator putting a hex on his sister!

“It is not meant to be a textbook on how to manage dying patients, nor is it intended as a complete study of the psychology of the dying. It is simply an account of a new and challenging opportunity to refocus on the patient as a human being, to include him in dialogues, to learn from him the strengths and weaknesses of our hospital management of the patient.”

~~Elisabeth Kubler-Ross, On Death and Dying.

I’ve re-read Elisabeth’s book for an essay I am writing for my qualifying essays at school on current grief theory.  What I am wondering is if anyone in the field has read it lately?

WOW!

I had no idea that people felt very passionate about Elisabeth’s work.  I know that everyone has co-opted it and turned it into a cartoon about the stages of grieving something or another… but there is almost down right hatred out there.  One journal article I read suggested that EKR (I’m just going to refer to her as EKR for short hand) had unfinished business with her father’s death and imposed her pathology on us.

I have read some articles that suggest she was a charlatan.  But in all actuality, they thought that the entire field of thanatology and end-of-life work was a get rich scheme for pathologizing people and making a dime off their pain.    I’d like to see who they think has made loads of money doing grief work.

I don’t like what we did with her work and we should slap our own hands that we have taken exactly what she said and done the exact opposite.  But I don’t know if people have read just what they wanted to or they haven’t gone back to her work.

I feel bad at some of the choices in language that EKR used… like the stages…

Some of my training has been in existential phenomenological psychology and research.  We are interested in qualitative research, like EKR’s but we frame it that are inquiry is to help illuminate the phenomenon that we are researching.

And in some ways, I think she did this.  If she had said, I’m interested in the dying, I’m going to do some interviews and take some “snapshots” of what their inner world is like and share them with the world, then we wouldn’t be having this ongoing debate.  If she had only stopped at what goes on, the interviews, and what we can learn from patients in order to help them.

Maybe it was because her first language wasn’t English?  Maybe it’s because it was 1969?  Maybe it’s because our country has a fascination with steps… quick steps to losing weight, making your man go crazy in bed, finding bliss consciousness, starting a business, recovering from 100 different things…. all I know is that despite some flaws, we can’t overlook what she did give us.

When was the last time a doctor looked into your eyes? Put a hand on your arm, not to take a pulse? This is being present!

And what was that?  She helped us all to see that dying patients were in the rooms at the end of the hall, far away from the nurses station.

We learned that doctor’s didn’t tell patients they were dying, they told their families.

We learned that patient’s knew they were dying before anyone had to tell them (I cannot believe that this was ever in question).

We learned that when doctors, nurses, chaplains, and social workers weren’t being honest with patients and listening to them, they would find it elsewhere, like in fellow patients or the cleaning woman if it meant that they might be seen and heard.

We learned that when a person has it in the forefront of their consciousness that they have a life-limiting illness that will most likely kill them, and they are in the hospital for treatment, there are some similar things that these individuals go through.  There were 5 themes that EKR focused on in her writing.

But look at the quote from her book… she wasn’t going to write a Magnum Opus on the life-world of the dying patient.  She didn’t want to write a handbook for people to quote and take step by step, literally, on how to manage people.

HELLO!!!!????

She wanted us to be in dialogue with people who are dying.  She wanted us to listen deeply and speak compassionately with them like she did.

And what did she find when people did that, patients changed, softened, opened up, shared, had less stress, and found some peace.

 

There are many theories as to how the “stages” went from an understanding of a group of patients and what some of their experiences were when they knew they were going to die to the “stages of grief“.  Some suggest that EKR was studying the grief that a dying patient goes through and if they did it, wouldn’t everyone who was grieving go through similar things was the thinking…

Stages???? That's what you face while you eat pop corn and watch a performance!

Hmmmm…. that’s like Bobby Flay grilling anything piece of food that comes his way… he’s a grill guy and that’s what he does.  That doesn’t mean that the only way you can serve pineapple, pork chops, or porcini mushrooms is to grill them.

Over the next several months, I will be using Dr. Kubler-Ross’ own words from her book On Death and Dying to show you that we really had a lot to learn from her as we moved into the 1970s and well, there are a lot of people who could still benefit from reading her today — most doctors out there!

It’s hard to believe that 40 years ago it was a novel ideas to sit and talk to patients.

Well, not really.

The last time I knew anyone who went for a doctor’s visit and they had a 7 minute session and got charged hundreds of dollars.

Doctor’s listened for keywords while they were going through taxonomy trees in their heads rather than compassionately listening to the person before them.

They looked at what was wrong, rather than what was right and they looked at where the disease was rather than at the whole person as a whole being.

Cover of "On Death and Dying"

Have you actually read it?

So, before everyone burns a copy of On Death and Dying, maybe they should take another look — or a first look.  If she taught us nothing else 40 years ago, Dr. Elisabeth Kubler-Ross taught us the most valuable and healing thing… the healing power in being present to the person before us.

Expect to see more from Elisabeth. . . maybe we can honor what she did teach us rather than deciding everything she did in her career was wrong.

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Cognitive Reactions
  • Obsessive thinking
  • Inability to concentrate
  • Fantasizing
  • Apathy
  • Dreams
  • Disorientation and confusion
  • Rehearsing and reviewing aspects of the loss

Some call it brain fog.  Others call it day dreaming.  We can experience it as being at a loss for words.  Or we can experiencing it as searching for our lost keys, only to find that we’ve been holding them in our hand during the hunt for the last 45 minutes.  And yes, it can all be a reaction to our loss.

We don’t tend to think about the thinking aspects of grief a lot.  We don’t think about our need to perserverate on specific details of the bedside, or the last this or that.  This can be obsessional thinking, but not OCD.  We may find that we cannot attend to details, write down numbers backwards and this is not ADD.

Maybe you just don’t hear the people around you who are talking to you… you only see their mouths move and kind of hear the same noise that Charlie Brown’s teachers make… it just doesn’t sink in.

There are those that would say that this is shock, part of the “Fright, Flight, Freeze, Freak out” response (4Fs).  Others would say that it is the first step in the stages of grief.  I think it is that we are totally overwhelmed mind/body/spirit and to be cleared headed in that moment (however long that moment lasts) would be more than we could cope with.

I think we have to be honest and remember that our grief is adaptive.  It keeps us from being so overloaded that we can’t function at all… functioning at diminished capacity is still more adaptive than not being able to function so it’s in human being’s best interest to have a 4Fs response.

Grief is a time when we often go within.  We question what’s real and what’s not.  We delve inward to make sense of our world, to cognitively reframe what we are feeling and thinking, what our past has been, what our present is, and what a future could hold.

This is the area, especially in the earliest moments of grief that a practice helped me.  I found myself using mantras a lot as they would sometimes stop my thoughts.  If I didn’t have my mala on my wrist, I went looking for my mom’s rosary beads (if she wasn’t using them).  I held crystals and rocks because it was something tactile that I could cling to when I felt so unanchored.

This was also the time in my meditation that when I was counting four exhales, I would end up at 72 or 49 or worse, I would stay at one because I wasn’t able to stay present more than one breath.

I tried to cope with my cognitive scatter… I wrote lists, only to lose the lists.  I tried having a routine but then I would stop mid routine and wonder, “what am I doing?  what do I do next?”

This was a time when it was really hard for me to have compassion with myself; I had always prided myself on my intellectual and scholastic abilities.  I was blessed to have a loving mentor who kept reminding me that I wasn’t going crazy.  Her words would help, in the moment, for a second, or until I drove away.  Then I would lose myself in fog again.  I didn’t have a lot of faith in the process of grief but I stuck with what I knew would be some saving graces.

With a lot of time, a lot of sharing, retelling my narrative, going deep within to find meaning in my life, taking care of myself, exercising, having a purpose (to go to graduate school), and I finally felt like I had made it to some other shore and had lived to tell about it.

Actually, on that other shore, I simply acknowledged that I had gotten to a place of comfort with my achy heart and I could sit with someone in their achy heart and neither one of us would explode.

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One of my biggest pet peeves is trying to box people into dignoses or worse, into things such as stages, steps, tasks, etc… And well, the field of grief work is full of them.  And this is a topic I will be writing more about as I start looking at different grief theories and why we need to take a new fresh look — and how some people already are…

I’ve been thinking about this topic for a long time now… after studying for so many years that psychology (certain kinds of psychology like phenomenology) is all about letting an event, person, situation, “phenomenon”, blossom before you so that it can be illuminated rather than crushed by our ideas.

So, as I work on this series, I leave you with this link (click on the photo of the cast) to an episode of Fraiser that’s posted on Youtube.  The title is aptly put, “Good Grief”, in which he “mocks” the stages of grief — though the loss is not due to the death of a loved one.  But please watch and keep this in mind as you tune back in to this blog.

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