Attitudes towards death and dying – Coping Mechanisms
By Elisabeth Kűbler–Ross
Denial & Isolation
“Denial, at least partial denial, is used by almost all patients, not only during the first stages of illness or following confrontation, but also later on from time to time”
“We cannot look at the sun all the time, we cannot face death all the time”.
Denial can be maintained to the end in rare cases. The patient sets the pace and sensitivity is essential.
Anger
“When the first stage of denial cannot be maintained any longer, it is replaced by feelings of anger, rage, envy and resentment”.
Bargaining
Maybe some sort of agreement will postpone the inevitable happening
Depression
Sense of great loss – it is a contradiction and counter productive to encourage the patient not to be sad: the expression of sorrow allows acceptance to develop. Patients need courageous companionship which can tolerate the pain of sadness without trying to “save” them from it. Words can be superfluous at this time – physical contact is often comforting
Acceptance
Acceptance should not be mistaken for happiness – it is largely emotionally neutral: the pain has gone, the struggle is over, and there is a “final rest before the long journey”, but there can be a “certain degree of quiet expectation”. There is often a turning inwards and less contact with the external world is wanted. Silent contact with loved ones is important.
It is the family and close friends who need most support at this stage
Hope
Professional people and close associates (family) must not allow hope to die! Reality is one thing, hope transcends reality. But patients must not be forced to cling to life – they must be given the right to die in peace – which requires selfless strength and courage from those around them, and not abandonment.
Terminally ill – or those most close to them – need a sense of mission to provide them with meaning for their lives and help them to maintain their spirits (rationalization for suffering).
Kűbler-Ross,E
(1969) On Death and Dying - (Scribner Trade Paperback 2003)
