Microsoft Word Elisabeth Kubler-Ross On Death And Dying doc

child about death. Young children have different concepts of death, and they have to be taken into 
consideration in order to talk to them and to understand their communications. Up to the age of 
three a child is concerned only about separation, later followed by the fear of mutilation. It is at this 
age that the small child begins to mobilize, to take his first trips out "into the world," the sidewalk 
trips by tricycle. It is in this environment that he may see the first beloved pet run over by a car or a 
beautiful bird torn apart by a cat. This is what mutilation means to him, since it is the age when he 
is concerned about the integrity of his body and is threatened by anything that can destroy it. 
 
Also, death, as outlined in Chapter I, is not a permanent fact for the three-to-five-year-old. It is as 
temporary as burying a flower bulb into the soil in the fall to have it come up again the following 
spring. 
 
(P 158) 
 
After the age of five death is often regarded as a man, a bogeyman who comes to take people away; 
it is still attributed to an outward intervention. 
 
Around the ages of nine to ten the realistic conception begins to show, namely, death as a 
permanent biological process. 
 
Children will react differently to the death of a parent, from a silent withdrawal and isolation to a 
wild loud mourning which attracts attention and thus a replacement of a loved and needed object. 
Since children cannot yet differentiate between the wish and the deed (as outlined in Chapter I), 
they may feel a great deal of remorse and guilt. They will feel responsible for having killed the 
parents and thus fear a gruesome punishment in retribution. They may, on the other hand, take the 
separation relatively calmly and utter such statements as "She will come back for the spring 
vacation" or secretly put an apple out for her-in order to assure that she has enough to eat for the 
temporary trip. If adults, who are upset already during this period, do not understand such children 
and reprimand or correct them, the children may hold inside their own way of grieving-which is 
often a root for later emotional disturbance. 
 
With an adolescent, however, things are not much different than with an adult. Naturally 
adolescence is in itself a difficult time and added loss of a parent is often too much for such a 
youngster to endure. They should be listened to and allowed to ventilate their feelings, whether 
they be guilt, anger or plain sadness. 
 
Resolution of Grief and Anger 
 
What I am saying again here is, let the relative talk, cry, or scream if necessary. Let them share and 
ventilate, but be available. The relative has a long time of mourning ahead of him, when the 
problems for the dead are solved. He needs help and assistance from the confirmation of a so-called 
bad diagnosis until months after the death of a member of the family. 
 
By help I naturally do not assume that this has to be professional counseling of any form; most 
people neither need nor can afford this. But they need a human being, a friend, doctor, nurse, or 
chaplain-it matters little. The social worker may be the most 
 

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meaningful one, if she has helped with arrangements for a nursing home and if the family wishes to 
talk more about their mother in that particular set-up, which may have been a source of guilt 
feelings for not having kept her at home. Such families have at times visited other old folks in the 
same nursing home and continued their task of caring for someone, perhaps as a partial denial, 
perhaps just to do good for all the missed opportunities with Grandma. No matter what the 
underlying reason we should try to understand their needs and to help relatives direct these needs 
constructively to diminish guilt, shame, or fear of retribution. The most meaningful help that we 
can give any relative, child or adult, is to share his feelings before the event of death and to allow 
him to work through his feelings, whether they are rational or irrational. 
 
If we tolerate their anger, whether it is directed at us, at the deceased, or at God, we are helping 
them take a great step towards acceptance without guilt. If we blame them for daring to ventilate 
such socially poorly tolerated thoughts, we are blameworthy for prolonging their grief, shame, and 
guilt which often results in physical and emotional ill health. 
 
========================= 
 
(P 160) 
 
X 
 
 
Some Interviews with Terminally Ill Patients 
 
Death, thy servant, is at my door. He has crossed the unknown sea and brought thy call to my home. 
 
The night is dark and my heart -is fearful-yet 1 will take up the lamp, open my gates and bow to 
him my welcome. It is thy messenger who stands at my door. 
 
1 will worship him with folded hands, and with tears. 1 will worship him placing at his feet the 
treasure of my heart. 
 
He will go back with his errand done, leaving a dark shadow on my morning; and. in my desolate 
home only my forlorn self will remain as my last offering to thee. 
 
Tagore, from Gitanjali, LXXXVI 
 
In previous chapters we have tried to outline the reasons for the increasing difficulties patients have 
in communicating their needs at the time of serious or perhaps fatal illness. We have summarized 
some of our findings and attempted to describe the methods used to elicit the patient's awareness, 
problems, concerns, and wishes. It seems helpful to include more random examples of such 
interviews as they give a better picture of the variety of responses and reactions demonstrated by 
both the patient and the interviewer. It should be remembered that the patient rarely knew the 
interviewer; both had met only for a few minutes in order to arrange for the interview. 
 
I have selected one interview of a patient whose mother was visiting at the same time and who 
volunteered to meet with us in order to share her responses. I think they demonstrate well how 

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