On Kubler-Ross

Anyone who tries to find out about coping with terminal illness will very quickly discover Kübler-Ross and the five stages of grief.  The 1969 book On Death and Dying describes the process by which people deal with being diagnosed with a terminal illness, but the ideas were so simple and so powerful that they were quickly applied to other types of losses.

A bit of nonsense has grown up around Kübler-Ross as well.  The original book, based on observations of actual dying patients, cautioned that not everyone experiences all five stages, but at least two are always present. In spite of that you can google up websites (including the Slate obit, but not the one in the Guardian) that exclaim with horror that not everyone experiences all the stages in the exact order.  You would think they would read the book, or even observe dying people for themselves, before writing something so grossly inaccurate.

In spite of the nonsense, the Kübler-Ross contribution to thanatology and the Hospice movement has been huge. What a gift for someone caring for a terminally ill family member to know that the roller coaster of denial, anger, bargaining, depression, and acceptance detailed in the book that they may see being played out in the life and death of their own loved one is not anything personal but is a predictable part of coming to terms with the illness.

Here’s a taste of the muddled Slate obit:

Are we in denial if we don’t watch every terrorist beheading video or gaze repeatedly at the descent of those who jumped from the World Trade Center towers? Come to think of it, aren’t Kübler-Ross’ five stages arbitrary in their order? Wouldn’t it be more fun to go out angry or better, bargaining, than depressed and accepting? Or maybe with a different “stage” of our own devising. Laughter in the dark? I’m sure Kübler-Ross was well intentioned and serious-minded before she commodified and quantified her caring into a D ‘n’ D industry. And I understand why people will turn to her books in time of grief when consolation of any sort is the first priority. Millions of the dead and dying have reason to be grateful to her for raising their standard of care. I just feel we who are about to die (well, sooner or later) deserve better than this treacly simulacrum of pseudo-science to guide us.

Well, obviously Kübler-Ross wasn’t writing about terrorists and the World Trade Center back in 1969, so even for those who haven’t read On Death and Dying, as the writer so obviously has not, it’s easy enough to identify the straw-man quality of that terribly, terribly unkind (and unbalanced) summation of one person’s life.

But what about it, do we deserve better?  Sadly, no one, but no one has come up with anything better than Kübler-Ross.  Not the New York Times, not Mayo Clinic. And in spite of the years I spent working with hospice, I’m not ready to write one either. Instead let me offer Johnny Cash’s final album, American VI: Ain’t No Grave released posthumously, and recorded during the last two years of the singer’s degenerative illness.










1 Ain’t No Grave
2 Redemption Day
3 For the Good Times
4 I Corinthians 15:55
5 Can’t Help but Wonder Where I’m Bound
6 A Satisfied Mind
7 I Don’t Hurt Anymore
8 Cool Water
9 Last Night I Had the Strangest Dream
10 Aloha Oe

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