Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

 
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Acknowledgments 
 
There are too many people who have directly or indirectly contributed to this work to express my 
appreciation to them individually. Dr. Sydney Margolin deserves the credit for having stimulated 
the idea of interviewing terminally ill patients in the presence of students as a meaningful learning-
teaching model. 
 
The Department of Psychiatry at the University of Chicago Billings Hospital has supplied the 
environment and facilities to make such a seminar technically possible. 
 
Chaplains Herman Cook and Carl Nighswonger have been helpful and stimulating co-interviewers, 
who also have assisted in the search for patients at a time when that was immensely difficult. 
Wayne Rydberg and the original four students by their interest and curiosity have enabled me to 
overcome the initial difficulties. I was also assisted by the support of the Chicago Theological 
Seminary staff. Reverend Renford Gaines and his wife Harriet have spent countless hours 
reviewing the manuscript and have maintained my faith in the worth of this kind of undertaking. Dr. 
C. Knight Aldrich has supported this work over the past three years. 
 
Dr. Edgar Draper and Jane Kennedy reviewed part of the manuscript. Bonita McDaniel, Janet 
Reshkin, and Joyce Carlson deserve thanks for the typing of the chapters. 
 
 
My thanks to the many patients and their families is perhaps best expressed by the publication of 
their communications. 
 
There are many authors who have inspired this work, and thanks should be given finally to all those 
who have given thought and attention to the terminally ill. 
 
Thanks is given to Mr. Peter Nevraumont for suggesting the writing of this book as well as to Mr. 
Clement Alexandre, of the Macmillan Company, for his patience and understanding while the book 
was in preparation. 
 
(x) 
 
Last but not least I wish to thank my husband and my children for their patience and continued 
support which enables me to carry on a full-time job in addition to being a wife and mother. 
 
E. K-R. 
 
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Preface 
 

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When I was asked if I would be willing to write a book on death and dying, I enthusiastically 
accepted the challenge. When I actually sat down and began to wonder what I had got myself into, 
it became a different matter. Where do I begin? What do I include? How much can I say to 
strangers who are going to read this book, how much can I share from this experience with dying 
patients? How many things are communicated nonverbally and have to be felt, experienced, seen, 
and can hardly be translated into words? 
 
I have worked with dying patients for the past two and a half years and this book will tell about the 
beginning of this experiment, which turned out to be a meaningful and instructive experience for all 
participants. It is not meant to be a textbook on how to manage dying patients, nor is it intended as 
a complete study of the psychology of the dying. It is simply an account of a new and challenging 
opportunity to refocus on the patient as a human being, to include him in dialogues, to learn from 
him the strengths and weaknesses of our hospital management of the patient. We have asked him to 
be our teacher so that we may learn more about the final stages of life with all its anxieties, fears, 
and hopes. I am simply telling the stories of my patients who shared their agonies, their 
expectations, and their frustrations with us. It is hoped that it will encourage others not to shy away 
from the "hopelessly" sick but to get closer to them, as they can help them much during their final 
hours. The few who can do this will also discover that it can be a mutually gratifying experience; 
they will learn much about the functioning of the human mind, the unique human aspects of our 
existence, and will emerge from the experience enriched and perhaps with fewer anxieties about 
their own finality. 
 
E. K.-R. 
 
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(I) 
 
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's 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 1 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 

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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 did not lose a member at an early age. Medicine has 
changed greatly in the last decades. Widespread vaccination has 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 have effected a low morbidity and mortality among children. The many 
diseases that used to take an impressive toll among the young and middle-aged have been 
conquered. The number of old people is on the rise, and, as a result, there is an increasing number 
of people with malignancies and chronic diseases associated particularly with old age. 
 
Paediatricians have less work with acute and life-threatening situations but they see an ever 
increasing number of patients suffering from psychosomatic disturbances and from adjustment and 
behaviour 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 their 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 an increased fear of death through 
unfamiliarity, 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 former cultures and peoples, we are impressed that death has 
always been distasteful to man and will probably always be. To a psychiatrist this is very 
understandable and can perhaps best be explained in terms of our understanding of the unconscious 
parts of the self; to the unconscious mind, 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 1 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 because they are essential in understanding some 
of the most important, but otherwise unintelligible, communications of our patients. 
 
The second fact that we have to comprehend is that in our unconscious mind we cannot distinguish 
between a wish and a deed. We can all recall illogical dreams in which two completely opposite 
statements occur side by side-very acceptable in our dreams but unthinkable in our waking state. 
just as we, in our unconscious minds cannot differentiate between the wish to kill somebody in 
anger and the act of killing, so the young child is unable to distinguish between fantasy and reality. 
The child who angrily wishes his mother to drop dead for not having gratified his needs will be 
traumatized greatly by her actual death-even if this event is not linked closely in time with his 
destructive wishes. He will always take part or all the blame for the loss of his mother. He will 
always say to himself-rarely to others-"I did it, I am responsible, I was bad, therefore Mommy left 
me." It is well to remember that the child will react in the same manner if he loses a parent by 

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