Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

bowel movement. The patient was irritable and angry whenever she was around. The nurses were 
appalled by her and disliked her increasingly. The social worker tried in vain to talk with the 
mother, only to be brushed away with some rather unkind remarks. 
 
What makes a mother become so oversolicitous in such a hostile way? We tried to understand her 
and to find means and ways to cut down on her attendance, which was both annoying and belittling 
to the patient and the nursing staff. After a discussion of the problem with the staff, we realized that 
we may have been projecting our own wishes to the patient, and that,-on second thought-he was 
actually contributing to if not inviting his mother's behavior. He was expected to be in the hospital 
for a few weeks of radiation treatment; he would leave the hospital to return home for a few weeks, 
probably to be readmitted again. Did we do him a service by interfering with his relationship with 
his mother, no matter how unhealthy it appeared to us? Did we not mainly act out of our own anger 
at this oversolicitous mother who made the nurses feel like "no-good mothers" and thus provoked 
our rescue fantasy? After we were able to acknowledge this, we reacted with less resentment to the 
mother but also treated the young man more like an adult, communicating to him that it was up to 
him to set limits if his mother's behavior became too belittling to him. 
 
I do not know if this had any effect as he left shortly afterwards. I think, however, that this is an 
example worth mentioning since it points out the need not to be carried away by one's own feelings 
of what is good and right for a given person. It may be that this man could only tolerate his illness 
by temporarily regressing to the level of a small child and that the mother gained some consolation 
out of the fact that she could gratify those needs. I do not believe that this was entirely true in this 
case, as the patient was obviously angry and resentful when his mother 
 
was present, but he also made few if any attempts to stop her, though he was quite able to set limits 
with other members of the family and the hospital personnel. 
 
Coping with the Reality of Terminal Illness in the Family 
 
Family members undergo different stages of adjustment similar to the ones described for our 
patients. At first many of them cannot believe that it is true. They may deny the fact that there is 
such an illness in the family or "shop around" from doctor to doctor in the vain hope of hearing that 
this was the wrong diagnosis. They may seek help and reassurance (that it is all not true) from 
fortune-tellers and faith healers. They may arrange for expensive trips to famous clinics and 
physicians and only gradually face up to the reality which may change their life so drastically. 
Greatly dependent on the patient's attitude, awareness, and ability to communicate, the family then 
undergoes certain changes. If they are able to share their common concerns, they can take care of 
important matters early and under less pressure of time and emotions. If each one tries to keep a 
secret from the other, they will keep an artificial barrier between them which will make it difficult 
for any preparatory grief for the patient or his family. The end result will be much more dramatic 
than for those who can talk and cry together at times. 
 
just as the patient goes through a stage of anger, the immediate family will experience the same 
emotional reaction. They will be angry alternately with the doctor who examined the patient first 
and did not come forth with the diagnosis and the doctor who confronted them with the sad reality. 
They may project their rage to the hospital personnel who never care enough, no matter how 
efficient the care is in reality. There is a great deal of envy in this reaction, as family members often 

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feel cheated at not being able or allowed to be with the patient and to care for him. There is also 
much guilt and a wish to make up for missed past opportunities. The more we can help the relative 
to express these emotions before the death of a loved one, the more comfortable the family member 
will be. 
 
When anger, resentment, and guilt can be worked through, the family will then go through a phase 
of preparatory grief, just as the dying person does. The more this grief can be expressed before 
death, 
 
(P150) 
 
the less unbearable it becomes afterward. We often hear relatives say proudly of themselves that 
they always tried to keep a smiling face when confronted with the patient, until one day they just 
could not keep that façade any longer. Little do they realize that genuine emotions on the part of a 
member of the family are much easier to take than a make-believe mask which the patient can see 
through anyway and which means to him a disguise rather than a sharing of a sad situation. 
 
If members of a family can share these emotions together, they will gradually face the reality of 
impending separation and come to an acceptance of it together. The most heartbreaking time, 
perhaps, for the family is the final phase, when the patient is slowly detaching himself from his 
world including his family. They do not understand that a dying man who has found peace and 
acceptance in his death will have to separate himself, step by step, from his environment, including 
his most loved ones. How could he ever be ready to die if he continued to hold onto the meaningful 
relationships of which a man has so many? When the patient asks to be visited only by a few more 
friends, then by his children and finally only by his wife, it should be understood that that is the 
way of separating himself gradually. It is often misinterpreted by the immediate family as a 
rejection, and we have met several husbands and wives who have reacted dramatically to this 
normal and healthy detachment. I think we can be of greatest service to them if we help them 
understand that only patients who have worked through their dying are able to detach themselves 
slowly and peacefully in this manner. It should be a source of comfort and solace to them and not 
one of grief and resentment. It is during this time that the family needs the most support, the patient 
perhaps the least. I do not mean to imply by this that the patient should then be left alone. We 
should always be available, but a patient who has reached this stage of acceptance and decathexis 
usually requires little in terms of interpersonal relationship. If the meaning of this detachment is not 
explained to the family, problems can arise as described in the case of Mrs. W. (Chapter VII). 
 
The most tragic death is perhaps-aside from the very young the death of the very old when we look 
at it from point of view of the family. Whether the generations have lived together or separately, 
each generation has a need and a right to live their own lives, to have their own privacy, their own 
needs fulfilled appropriate to their generation. The old folks have outlived their usefulness in terms 
of our economic system and have earned, on the other hand, a right to live out their lives in dignity 
and peace. As long as they are healthy in body and mind and self-supporting, this may all be quite 
possible. We have seen many old men and women, however, who have become disabled physically 
or emotionally and who require a tremendous sum of money for a dignified maintenance at a level 
their family desires for them. The family is then often confronted with a difficult decision, namely, 
to mobilize all available money, including loans and savings for their own retirement, in order to 
afford such final care. The tragedy of these old people is perhaps that the amount of money and 

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