One of the most important psychological studies of the late twentieth century, On Death and Dying grew out of Dr. Elisabeth Kübler-Ross's famous interdisciplinary seminar on death, life, and transition. In this remarkable book, Dr. Kübler-Ross first explored the now-famous five stages of death: denial and isolation, anger, bargaining, depression, and acceptance. Through sample interviews and conversations, she gives the reader a better understanding of how imminent death affects the patient, the professionals who serve that patient, and the patient's family, bringing hope to all who are involved.<
Life A profound lesson for the living.<
Medical Opinion & Review On Death and Dying can help us face, professionally and personally, the end of life.<
Chapter 1
On the Fear of Death
Let me not pray to be sheltered from dangers but to be fearless in facing them.
Let me not beg for the stilling of my pain but for the heart to conquer it.
Let me not look for allies in life battlefield but to my own strength.
Let me not crave in anxious fear to be saved but hope for the patience to win my freedom.
Grant me that I may not be a coward, feeling your mercy in my success alone; but let me find the grasp of your hand in my failure.
Rabindranath Tagore, Fruit-Gathering
Epidemics have taken a great toll of lives in past generations. Death in infancy and early childhood was frequent and there were few families who didn't lose a member of the family at an early age. Medicine has changed greatly in the last decades. Widespread vaccinations have practically eradicated many illnesses, at least in western Europe and the United States. The use of chemotherapy, especially the antibiotics, has contributed to an ever decreasing number of fatalities in infectious diseases. Better child care and education has effected a low morbidity and mortality among children. The many diseases that have taken an impressive toll among the young and middle-aged have been conquered. The number of old people is on the rise, and with this fact come the number of people with malignancies and chronic diseases associated more with old age.
Pediatricians have less work with acute and life-threatening situations as they have an ever increasing number of patients with psychosomatic disturbances and adjustment and behavior problems. Physicians have more people in their waiting rooms with emotional problems than they have ever had before, but they also have more elderly patients who not only try to live with their decreased physical abilities and limitations but who also face loneliness and isolation with all its pains and anguish. The majority of these people are not seen by a psychiatrist. Their needs have to be elicited and gratified by other professional people, for instance, chaplains and social workers. It is for them that I am trying to outline the changes that have taken place in the last few decades, changes that are ultimately responsible for the increased fear of death, the rising number of emotional problems, and the greater need for understanding of and coping with the problems of death and dying.
When we look back in time and study old cultures and people, we are impressed that death has always been distasteful to man and will probably always be. From a psychiatrist's point of view this is very understandable and can perhaps best be explained by our basic knowledge that, in our unconscious, death is never possible in regard to ourselves. It is inconceivable for our unconscious to imagine an actual ending of our own life here on earth, and if this life of ours has to end, the ending is always attributed to a malicious intervention from the outside by someone else. In simple terms, in our unconscious mind we can only be killed; it is inconceivable to die of a natural cause or of old age. Therefore death in itself is associated with a bad act, a frightening happening, something that in itself calls for retribution and punishment.
One is wise to remember these fundamental facts as they are essential in understanding some of the most important, otherwise unintelligible communications of our patients.
The second fact that we have to comprehend is that in our unconscious mind we ca
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