Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

divorce, separation, or desertion. Death is often seen by a child as impermanent, and therefore little 
distinct from a divorce, after which he may have an opportunity to see a parent again. 
 
Many a parent will remember remarks of their children such as, "I will bury my doggy now and 
next spring when the flowers come up again, he will get up." Maybe it was the same wish that 
motivated the ancient Egyptians to supply their dead with food and goods to keep them happy and 
the old American Indians to bury their relatives with their belongings. 
 
When we grow older and begin to realize that our omnipotence is not really so great, that our 
strongest wishes are not powerful enough to make the impossible possible, the fear that we have 
contributed to the death of a loved one diminishes-and with it the guilt. The fear remains 
diminished, however, only so long as it is not challenged too strongly. Its vestiges can be seen daily 
in hospital corridors and in people associated with the bereaved. 
 
A husband and wife may have been fighting for years, but "-hen the partner dies, the survivor will 
cry and be overwhelmed with regret, fear, and anguish, and will fear his own death more, still 
believing in the law of talion-an eye for an eye, a tooth for .: tooth-"I am responsible for her death, I 
will have to die a pitiful death in retribution." 
 
Maybe this knowledge will help us to understand many of the customs and rituals that endured over 
the centuries and whose purpose is to diminish the anger of the gods or society, as the case may be, 
thus decreasing the anticipated punishment. I think of the ashes, the torn clothes, the veil, the Klage 
Weiber of the old days-they are all means of asking others to take pity on them, the mourners, and 
are expressions of sorrow, grief, and shame. A person who grieves, beats his breast, tears his hair, 
or refuses to eat, is attempting self-punishment to avoid or reduce the anticipated external 
punishment for the blame he expects on the death of a loved one. 
 
The grief, shame, and guilt are not very far removed from feelings of anger and rage. The process 
of grief always includes some elements of anger. Since none of us likes to admit anger at a 
deceased person, these emotions are often disguised or repressed, and prolong the period of grief, 
or show up in other ways. It is well to remember that it is not up to us to judge such feelings as bad 
or shameful but to understand their true meaning and origin as something very human. In order to 
illustrate this I will again use the example of the child-and the child in us all. The fiveyear-old who 
loses his mother is both blaming himself for her disappearance and expressing anger at her for 
having deserted him and for no longer gratifying his needs. The dead person then turns into 
something the child loves and wants very much, but also hates with equal intensity for this severe 
deprivation. 
 
The ancient Hebrews regarded the body of a dead person as something unclean and not to be 
touched. The early American Indians talked about evil spirits, and shot arrows into the air to drive 
the spirits away. Many other cultures have rituals to take care of the "bad" dead person, and they all 
originate in this feeling of anger which still exists in all of us, though we dislike admitting it. The 
tradition of the tombstone may originate in this wish to keep the bad spirits deep down in the 
ground, and the pebbles that many mourners put on the grave are left-over symbols of the same 
wish. Though we call the firing of guns at military funerals a last salute, it is, perhaps, the same 
symbolic ritual as the Indian used when he shot his spears and arrows into the skies. 
 

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I give these examples to emphasize that man has not basically changed. Death is still a fearful, 
frightening happening, and the fear of death is a universal fear even if we think we have mastered it 
on many levels. 
 
What has changed is our way of coping and dealing with death and dying and with our dying 
patients. 
 
Having been raised in a country in Europe where science is not so advanced, where modern 
techniques have just started to find their way into medicine, and where people still live as they did 
in this country half a century ago, I may have had an opportunity to study a part of the evolution of 
mankind in a telescoped form. 
 
I remember, as a child, the death of a farmer. He fell from a tree and was not expected to live. He 
asked simply to die at home, a wish that was granted without questioning. He called his daughters 
into the bedroom and spoke with each one of them alone for a few minutes. He arranged his affairs 
quietly, though he was in great pain, and distributed his belongings and his land, none of which was 
to be split until his wife should follow him in death. He also asked each of his children to share in 
the work, duties, and tasks that he had carried on until the time of the accident. He asked his friends 
to visit him once more, to bid good-bye to them. Although I was a small child at the rime, he did 
not exclude me or my siblings. We were allowed to share in the preparations of the family just as 
we were permitted to grieve with them until he died. When he did die, he was left in his own home, 
which he had built, and among his friends and neighbors who went to take a last look at him where 
he lay in the midst of flowers in the place he had lived in and loved so. In that country today there 
is still no make-believe slumber room, no embalming, no false make-up to pretend sleep. Only the 
signs of very disfiguring illnesses are covered up with bandages and only infectious cases are 
removed from the home prior to the burial. 
 
Why do I describe such "old-fashioned" customs? I think they are an indication of our acceptance 
of a fatal outcome, and they help the dying patient as well as his family to accept the loss of a loved 
one. If a patient is allowed to terminate his life in the familiar and beloved environment, less 
adjustment is required of him. His own family knows him well enough to replace a sedative with a 
glass of his favourite wine; or the smell of a homecooked soup may give him the appetite to sip a 
few spoons of fluid which, I think, is still more enjoyable than an infusion. I do not minimize the 
need for sedatives and infusions and realize full well from my own experience as a country doctor 
that they are sometimes life-saving and often unavoidable. But I also know that patience and 
familiar people and foods could replace many 
 
a bottle of intravenous fluids given for the simple reason that it fulfills the physiological need 
without involving too many people and/or individual nursing care. 
 
The fact that children are allowed to stay at home where a fatality has struck and are included in the 
talk, discussions, and fears, gives them the feeling that they are not alone in grief and offers them 
the comfort of shared responsibility and shared mourning. It prepares them gradually and helps 
them to view death as part of life, an experience that may help them to grow and mature. 
 
This is in great contrast to a society in which death is viewed as taboo, discussion of it is regarded 
as morbid, and children are excluded with the presumption and pretext that it would be "too much" 

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