Kubler-Ross Redux
Francis Dominic Degnin M.P.M., Ph.D.
Department of Philosophy & World Religions
University of Northern Iowa
Clinical Ethicist
Wheaton Franciscan Health Care of Iowa
Objectives
To be able to explain the “positive” role
of each of Kubler-Ross’ first four stages of
Grief.
To identify when a stage is serving a
positive role for a patient and when it is
not.
To explain the role and limits of KublerRoss’ model.
Kubler-Ross’ Stages of Grief
1
Denial
2
Anger
3
Bargaining
4
Depression
5
Acceptance
Which are usually thought of as “bad”?
Which is usually thought of as “good”?
What if we reverse this?
Denial
Not just a river in Africa
When one would otherwise be
overwhelmed, it allows on to continue to
function.
Accepts the shock in “bits” instead of all
at once.
Examples
Billy Bud
Maria and Ishmael
(Nuland, How We Die)
When Is it a Problem?
When our denial, instead of helping us to
function and cope, puts us or others at
greater risk of harm.
Anger
What is “Catharsis”?
◦ Not just an emotional outpouring
◦ An emotional release which brings insight
(psychology)
◦ A fundamental source of truth (Ancient
Greek)
What does Anger Have to Teach Us?
Something has to stop
or
Something has to change
It may also help give us the strength to
make the change.
Common Mistake
We usually assume that what has to stop
or change is in someone else.
More often, it is something in ourselves.
Examples:
Blaming one’s spouse for problems in
one’s marriage.
Staying in a bad marriage.
◦ The woman on her 3rd divorce
When is it a Problem?
When we misplace responsibility
When we hang onto anger beyond the
point where it is helpful.
The Necessity of Forgiveness
Forgiveness is not “being a doormat”.
Forgiveness is “letting go” when one is ready to move
on.
Forgiveness often involves the other person, but
doesn’t have too.
Forgiveness does not mean taking away responsibility.
Example: Abused sister in TN.
Example: “Never again!”
Bargaining
A bit like denial, it helps one to cope with
the situation in “bits” so as not to be as
overwhelmed.
Can help to think through and clarify one’s
values.
Like Denial, is a problem when it starts to
have negative impacts on one’s ability to
cope or places oneself or others at greater
risk for harm.
DEPRESSION
Has a very bad name in our society
People who aren’t “happy” are often stigmatized (weak, defective, etc.)
Anti-depressants are the second most prescribed drugs, at over $10
Billion/year. One person in 10 over the age of 12. 70% are women.
http://www.nimh.nih.gov/about/director/2011/antidepressants-a-complicated-picture.shtml
http://www.npr.org/blogs/health/2011/10/20/141544135/look-around-1-in-10-americans-takeantidepressants
The AMA and the APA both state that at least a couple of periods of
“situational” depression are normal over the course one’s life.
Of course, clinical and situational depression need to be treated somewhat
differently.
What possible positive benefit might depression have for a person?
Depression: A “little” death?
A subtheme running through every major
religion is the claim that:
“only when knows how to die does
one know how to live”
What does this mean?
On the First Day of Death & Dying:
• I ask my students to set aside their beliefs in an
afterlife.
• There is a great deal that facing that discomfort,
that dis-ease, has to teach us.
• And that there tends to be a fundamental
difference, even in those how believe an afterlife,
between:
Those who have faced their fears and learned from them
And those who use their belief in an afterlife to escape
from those fears.
The Fundamental Question
If one accepts the possibility that this life
may be ALL there is….
What question does it raise?
“What makes this life worth living?”
When one answers this question, not
intellectually, but in one’s body and one’s
heart, one lives very differently.
In Depression, one experiences a
deadening of affect and value in life.
This raises that fundamental question:
Is anything in this life worthwhile?
Suicide becomes a possibility.
But for those who work through their
depression, the answers they find often
result in a rich, deep, and fulfilling life.
Examples:
Melissa, Psych Nurse Practitioner
David, quadriplegic
Epic of Gilgamesh
Tuesdays with Morrie
The Death of Ivan Illych
Common Threads?
One cannot be truly happy until one has come to care for
someone or something else more than just oneself.
We also need to feel that we have something to contribute
to others.
It is the sense of felt connection to others, or to something
larger than oneself, which transforms.
This is not primarily an intellectual answer, it cannot be
forced.
Plays on the inverse relationship between pain and world.
Depression
If accepted and worked through, can lead
one to a rich understanding of the
meaning for life.
If suppressed, it usually just becomes
more powerful.
When is the Stage Going too far?
When one is ready to commit suicide or
it otherwise puts oneself or others at
risk.
But the real problem is that we so often
drug people without providing other
resources for working through
depression.
Acceptance
If one has truly “worked through” the
other stages, acceptance is a rich and
wonderful outcome.
Too often, however, it’s really what Neeld
calls “the booby prize”, or resignation.
Elizabeth Neeld, Seven Choices: Finding Daylight after
Loss Shatters your World
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