Psychology concepts and foundations

Psychology

Application of E. Kubler-Ross Theory to Real Life Loss

Kubler-Ross Theory

Stages of Bereavement in relation to Real Life Loss

Elizabeth Kubler-Ross posits a theory that the process of loss and grief can be measured in seven distinct steps - shock, denial, anger, negotiation, depression, acceptance, and hope. While these stages may be in any order and can amount to any length of time to progress and advance to the next level, its significance is shown in the application of this theory to a real-life situation concerning the death of a loved one. This paper endeavours to explore each of the seven stages as outlined in the E. Kubler-Ross theory. Its application is also conducted on a real-life tragedy I experienced as a teenager when my childhood friend passed away. The stages of grief and loss in the E. Kubler-Ross theory does much to convey that the whole process is designed to help the mind come to terms with the loss, even if at times, the emotion-charged situation instigates irrational behavior, such as denial.

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Loss of a loved one through death is always a challenging concept in psychology to study. Many theorists have attempted to formulate a standard process of stages of grief. The most popular school of thought on this subject involves the E. Kubler-Ross theory. This paper endeavours to explore the stages of grief and loss Elizabeth Kubler-Ross posits in her theory, and then demonstrates its application to the real life death of a loved one I encountered as a child. By supporting the E. Kubler-Ross theory with empirical evidence, can one provide a true insight into the complicated progression of emotions and thinking the griever experiences when faced with the death of a loved one.

Prior to undertaking this analysis of my childhood loss, it is imperative to illustrate the various stages of the E. Kubler-Ross theory. Elizabeth Kubler-Ross studied terminally ill patients with their families in order to understand the importance and sequence of grief. She found that the dying patient and the family tend to experience the same stages of loss, although possibly at different times from each other which makes it very difficult on everyone concerned. There is no absolute time limit on any of the seven stages. A person can experience the progression of emotions in all of the stages within twenty-four hours or over a lengthy period of time. Also, the stages do not have to progress in the order as outlined in this paper. There is no set chronological order for when individuals experience certain stages of grief.

The seven phases of grief are as follows:

Phase 1 - Shock

The first thing that enters a person's mind when confronted with the death or impending death of a loved one is "This cannot be true." Shock is very much likened to denial. Although shock relates more to the feeling of 'surprise' at the news while denial pertains more to the way the mind rationalises the shock.

Phase 2 - Denial

The individual facing the death of a loved one goes through a tortuous time refusing to accept the inevitable. It may seem strange to observe a person refusing to acknowledge reality, especially if it is staring at them in the face, particularly since as a society we value truth. In fact, denial is often seen as a symptom of dysfunction, foolhardiness or even stupidity. However, Kubler-Ross asserts that denial is healthy, "Denial functions as a buffer after unexpected shocking news, allows the patient [as well as the patient's family] to collect himself, and, with time, mobilize less radical defenses."

Phase 3 - Aggression

When denial cannot be sustained, anger can set in as a barrier between the patient or family and the inevitable. This anger may be directed at the instigator of the tragedy, other people around them, or even to their own self. Anger may not only be seen as an impediment. Many analysts believe anger stimulate a positive response to a tragic calamity. "An assertion of anger is often enough to ward off an adversary, and if it fails to ward him off, it stimulates adrenaline to prepare for fight."

Phase 4 - Negotiation

The patient or family may attempt to bargain with the powers that be to spare the life or reverse the calamity. By granting the plea-bargainer this request, the powers that be is entitled to sacrifices made or favors conducted on the part of the plea-bargainer to the benefit of the entity that has granted the plea-bargainer's wish. In most cases, these negotiations are conducted privately, usually between the patient or the family and God, the doctor, or any other person seen to potentially make a difference. Kubler-Ross conveys it best: "If God has decided to take us [or a member of our family] from this earth and He did not respond to my angry demands then perhaps He will respond more favorably if we ask nicely."

Phase 5 - Depression

There is two kinds of depression. Reactionary depression is felt more by the patient since it originates from the pain or uncomfortability of the illness. Preparative depression can be felt by the patient as well as the family. It refers to the notion of what the future holds - an existence without the patient around. This depression can manifest in feelings of hopelessness and indifference. This phase differs from the other phases aforementioned because it is the first one that manages the act of facing loss as opposed to avoiding it. "Depression in individuals is an inward phenomenon. Psychoanalytic theories assert that depression is anger 'turned inward.' Therapists observe that patients who can't get angry at others become depressed."

Phase 6 - Acceptance

This phase is known for the peace the patient and family finally experience in accepting the inevitable. Usually decisions are made such as living life to the fullest or enjoying as much time as one has with the person who is dying. This phase is illustrated in the old adage, 'Why cry over spilt milk?' It adds a measure of positive rationalization to the whole process. Notice how it contrasts with the rationale at work in the phase of denial. It puts to rest the phrase penned by Dylan Thomas:

Do not go gentle into that good night.

Rage, rage against the dying of the light?"

Phase 7 - Hope

Even right up til the end, the patient dying and the family feel hope, whether it is physical salvation or spiritual salvation. This phase is an extension of the phase of acceptance.

There are many theorists who believe in variations of E. Kubler-Ross' theory. J. Bowlby highlights the stages of 'protest, disorganization and reorganization.' Wayne Oates, a pastoral theologian, identifies four stages - shock, culturally dictated behaviour controls, trial and error behaviour, and finally 'repatterning'. Colin Parkes prefers to monitor the emotions inherent in the process of grieving, that of distress, seeking out answers, yearning, and eventually the pain of grief.

A greater understanding of the stages of loss occurs when the E. Kubler-Ross theory is applied to a real-life situation. A number of years ago when I was about 15 years of age, my childhood friend was hit by a car as she was jaywalking on her way home from school. She was 18 years of age. She was taken to hospital and battled her injuries for 5 days. However, it all proved too much and after 5 days when the doctors conducted the seven tests to scan for life in the brain, she failed all seven. Her parents then decided to turn off artificial life support.

It was a particularly difficult time for me. She was really the first person who had died that was close to me. I had grandparents die over the years but since they lived in another country and I was not close to them, the impact of their eventual deaths was not as dire as my friend's death. Her parents had migrated to this country the same time my parents did. Our parents were close friends so it was natural that we became close friends too. I grew up with her as well as her two sisters (she was the middle child). When she died, it is safe to say that her family, my family and I experienced the stages of grief as outlined in E. Kubler-Ross's theory, albeit at different speeds.

Phase 1 (shock) hit all of us at the same time due to the nature of the accident. She had been walking home from school one sunny afternoon. Her house was on a busy highway and instead of walking approximately 30 meters out of her way to the nearest crosswalk, she decided to cross 4 lanes of traffic where the bus dropped her off because her house was directly opposite on the other side of the road. She had often jaywalked to get to her house. She had lived on this busy highway since she was a baby. She must have jaywalked more than a thousand times without incident until that day. My family and I found out about it that night when a member of her family called us to accompany them at the hospital.

For my family and I denial quickly set in. Prior to us arriving at the hospital, we were trying to convince ourselves that it must be a mistake, they must have gotten the patients confused somehow (even though it was a member of her family who had informed us over the telephone). When we got to the hospital and saw her lying on the bed, the gravity of the situation didn't really hit us. The doctors were throwing in phrases like "possible brain damage" and "inability to breathe on her own." Whenever we heard those phrases we threw in our own phrases such as "requiring a second opinion" and "I think I saw her move her little finger."

The phase of aggression came when we enquired as to the sequence of events, which led her to the hospital. My family and I felt a lot of anger towards the driver of the car who ran her down, the doctors who seemed hell-bent on convincing us to prepare for the inevitable, and even for my friend who had foolishly gambled on her life all for convenience. The phases of anger, negotiation and depression would fight for dominance in our psyche throughout the 5 days when she was on life-support. We would take turns to stay up with her all day and all night, hoping for any movement of her fingers, toes, eyes, hoping for a miracle. In the dead of night, I would pray to God to save her life. I was brought up a Catholic but living in a largely secular society, I had ceased practicing Catholic tenets as faithfully as I should. I would offer God a trade - if he spared her life, I promised to attend mass every Sunday. I promised to give every homeless person on the street the change in my wallet without my characteristic cynicism that they were probably going to spend it on alcohol or drugs instead of food. I would even talk to my friend as she lay on the hospital bed. I would promise to go out with her more, spend more time with her, if she continued to fight. I would promise to go to the movies with her as soon as she gets out of the hospital if she would only wiggle her finger or bat an eyelid. However, when overt life signs did not materialize, anger would resume its hold over me or a state of depression would ensue as I tried to think of new ways to force her to get better.