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