On Death & Dying (Kübler-Ross)

Book #1, read May 2018

Elizabeth Kübler-Ross’s seminal work, On Death & Dying: What the dying have to teach doctors, nurses, clergy, and their own families (1969) seemed like a good place to start, so I started there.

You have probably heard the simplified version of Kübler-Ross’s stage theory: denial, anger, bargaining, depression, and acceptance. You may have heard it (mis)applied to those who grieve instead of those who are dealing with terminal illness (which was not the stage stuff’s original purpose, though Kübler-Ross later worked on grief). You may have heard criticisms that the Kübler-Ross stages are too prescriptive, leaving little room for patients and mourners to uncritically accept their own experiences. I had heard all these things, and arrived at the book with some baggage.

So, I was a little surprised to find the stages offered so cautiously here. Kübler-Ross writes straightforwardly and without any of the airs of a grand theorist or aspiring paradigm-shifter. Instead, Kübler-Ross briefly describes her dissatisfaction with the existing state of death studies. She boldly undertakes a simple project of finding dying patients and speaking to them, on their terms (this was logistically difficult and unpopular with the patients’ doctors). And she largely just records the interviews plus a bit of summary, without significantly theory-laden editorializing.

Then again, maybe I shouldn’t have been surprised: no abundance of clear writing has ever saved an important primary source from being misunderstood by would-be critics. Perhaps even enumerating the stages towards death creates too much pressure towards conformity of experience. But even if hearing about the stages has this tendency, it also has redeeming value: offering people in trying circumstances a quick way to make sense of one of the most difficult experiences of their lives. The stages are an entrance to understanding, not an ending.

This book, almost 50 years old, shows its age in places. Nurses at the time apparently tended to ignore terminally ill or actively dying patients. It was more common for doctors to adopt a paternalistic role, withholding details about conditions and treatments. My experience is limited to one hospital, but here in 2018 I’ve actually found the nurses aggressively cheery. It sometimes makes me want to scream “can’t you see how sick this person is??” Perhaps this is some kind of institutional overcompensation.

As for the paternalism, well now (for better or worse) we live in an age of the individual. Patient autonomy reigns supreme (at least in theory…). And in the pop psychology of today, emotional experiences are often assumed to be necessarily as unique as their bearers.

Sure, at some times, people really do like feeling special. But, in the face of death and loss, there might be more to say for drawing our attention toward human universals. No one can die or grieve for you, but the types of feelings you’re likely to feel are old and well-known to humankind.

Read this book if:

  • you like a classics/historical approach to learning new topics
  • you don’t know where else to start

Don’t read this book if:

  • you are an extremely special snowflake who finds generalities off-putting
  • you are not interested in transcripts of patients rambling a bit

 

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