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Emotional Stages of a Dying Person
Emotional Stages of a Dying Person
Elisabeth Kubler-Ross was a pioneer in the psychological field of death counseling. She helped start a movement that views a dying person as a thinking, feeling human being rather than a thing which must be dealt with, thus setting up the modern method of hospice care where emotions are cared for as well as physiological needs. At the same time, while working with dying patients she analyzed what goes on in their minds. From her experience-oriented research, she found five specific emotional and mental stages that are consistent with almost all patients, all of which occur because they're emotionally beneficial in one way or another. Usually the stages require a good amount of time to experiece, as with a person diagnozed with a terminal illness. In sudden, unexpected deaths there simply isn't enough time to be emotionally and mentally affected in too many different ways.
These five stages don't usually follow any particular order, and each can be experienced more than one time.
[State 1: Denial and Isolation]
[Stage 2: Anger]
[Stage 3: Bargaining]
[Stage 4: Depression]
[Stage 5: Acceptance]
Stage 1: Denial and Isolation
Upon receiving the information that one will not be able to live much longer, one responds by thinking that it can't be true. The response comes from simple rationality. Such news often seems like a hasty conclusion, and like any time when a rash statement is made, one says "Now hang on a minute. Let's see if there's really any cause for alarm." Even though it's clear that there is no mistake, one still continues to make an effort to make sure it isn't something like a mistake. In one case a woman insisted on going to many different doctors in the hopes that one of them would tell her what she wanted to hear-- that she wasn't going to die. In most instances denial isn't of those proportions, but it does happen.
Denial also comes at varying times throughout a dying patient's days, usually in milder, more subtle form. Sometimes one changes the subject when it's brought up, wanting to talk about something more cheerful and less negative. Isolation is very much linked to denial. By having less interaction with others, one escapes the possibility of talking about the subject. It's very rare, however, for denial and isolation to be severe. There are very few instances where one makes a consistent, false reality all the way until the moment of death.
While both of these things sound like the "wrong way" to deal with death, they're an essential and natural way to relieve what can turn into constant negative emotion. The thought of one's own life ending soon is a thought that's very difficult to get out of one's mind. It's nearly impossible to see death, accept it, and look past it into the remaining time one has. So one must sometimes move the thought way, brush it aside, in order to look past it and live the remaining life.
Stage 2: Anger
"Why me?" is a question which is the product of resentment, rage, envy and anger. And like anger that arises in every day situation, it can be transferred to people and situations that aren't related to what one is really angry at and which don't deserve such hostility. A patient might complain about a health worker, maybe even directly to that person, or may be in a bad mood in general. Often what triggers anger is envy, observing something that one can no longer do because of new physical limitations, or something cherished that one will not be able to experience after one's life is over. From such things, one can also have resentment towards their higher power, be it Buddha, God, etc, for making their life end. Also, the wish to convey that one is in fact still alive causes angry outbursts. Yelling and arguing are great ways to get attention, and sometimes one really wants others to be reminded that, while death is now a common topic of discussion, one isn't dead right now, not yet. Anger can be an assertion of life.
Stage 3: Bargaining
In the same way that a child, after being denied something, will volunteer to do a few household chores in the hopes that when posing the request again he will be granted his wish, a dying person will try to bargain with the higher power in which they believe. This reaction comes from life experience. One can often make a deal in order to get what is wanted. This is a consistent strategy that's almost always worth trying during life, and when faced with something as strikingly negative as death, it's only natural to use that strategy which has succeeded so many times before. One wants to postpone their death as much as possible, and promises might be made so that maybe they can live a little longer. Often this occurs in wanting to do a particular thing one last time, as in the opera singer who wishes to perform just once more, or the mother who wants in all the world to see her last son get married. Bargaining also very often continues, having more promises to do good things in return for various experiences. This points to the idea that wanting particular things "one last time" is merely a reflection of the more broad, deep desire to have one's time to live extended.
Stage 4: Depression
This stage seems the most easy to understand-- after all, who wouldn't be extremely sad when he is about to die? But depression for a dying person isn't as clear is it seems. There are two different kinds, with two different causes. The first depression's source is found in frustration and complication. Having to think about finances, family's emotions, medications, examinations, and a world of other issues is overwhelming. Self-esteem is added into the mix when it's called into question by deteriorating physicality. All this adds to the second stage of anger, but also often causes a melancholy sadness. The second depression that a dying person goes into is about grief. There's much emotional turmoil in truly contemplating one's own death, and more significantly, the end of one's own life and all that is and used to be in it. Just as when one cries and is filled with sorrow at a loved one's end, so does one who is dying themselves. And in the same manner, it acts as emotional cleansing, necessary to the path of eventual acceptance.
Stage 5: Acceptance
A dying person, after enough time with the varyious stages in various orders, and even with various repetitions, comes to terms with their impending death. This is different than the acceptance of reality that occurs on the conscious, mental level of reason-- that usually happens well before the final stage of acceptance. It isn't the same as giving up, either, nor is it a time of joy. This is the acceptance of quiet expectation, when one is neither happy nor sad, but serene. One doesn't usually want to talk much or have things to do. However, a good thing to have in this final stage is company. Someone who can sit silently by a bedside, maybe holding a hand, is the best person to be with a person in the calm of acceptance. A patient of Kubler-Ross described it as "the final rest before the long journey."
Copyright 2001. Created by a Thinkquest team.
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