Dying, Death and Grief

Chaplain Paul G. Durbin, Ph.D.

Tribute to Dr. Elisabeth Kubler-Ross (2004)

DYING, DEATH AND GRIEF: CHAPLAIN PAUL G. DURBIN, PH.D.:

TRIBUTE TO DR. ELIZABETH KUBLER-ROSS (2004):

THEORIST ON GRIEF DIES AT 78: DR ELIZABETH KUBLER-ROSS DIES AT 78:  [New Orleans Times-Picayune: Aug 26, 2004: The Associated Press]

ELISABETH KUBLER-ROSS DIES AT AGE 78 ON AUGUST 24, 2004: [From Elisabeth Kubler-Ross website: http://www.elisabethkublerross.com/ ]:

(Taken from a seminar manuscript "Dying, Death and Grief" 
By Chaplain Paul G. Durbin, Ph.D.)

From the Book of Ecclesiastes, the 5th verse of the 9th chapter, we read, "For the living know that they shall die." Life is but a short journey from the cradle to the grave. For some death comes early in life, for others in the middle years and for some it comes with old age. Whatever period of life death occurs, it comes to all. Death is the great equalizer for it comes to the rich and poor, the loved and unloved, the happy and the sad, to the male and female, the good and the bad. In some cases death can be postponed or delayed, but eventually it comes to all. None of us are exempt as we realize that one day, we too must die.

Dying, death and bereavement are fundamental and pervasive aspects of the human experience. We can only achieve fullness of living by understanding and appreciating these realities. The absence of such understanding and appreciation may result in unnecessary suffering, loss of dignity, alienation and diminished quality of living. Though education about dying, death and bereavement should be an essential component of the education process, it has been greatly neglected in both formal and informal education.

During this seminar, I hope that you will be involved as a total person with feelings, emotions and intellect. Through lecture, exercises and discussion our time together can help us better understand dying and death so that we can better face death and therefore make it a little easier for us to live and to help those who are dying.

In addition to the dying and death process, we will discuss grief resulting from the death of a significant other as well as from other loses. The next two hours may at time be painful, but hopeful helpful and meaningful. The pain may at times be sharp and at other time simply the dull throb of frustration with things as they are. There may be times when something is triggered within you concerning death that you have not death with or come to terms with. Today you might uncover feelings that you never knew you had or which long ago you buried in your subconscious mind. This is not the purpose of the seminar except how dealing with these issues may help you better deal with people who are dying or the loved one of someone who is dying.

The seminar is designed to promote sharing attitudes, approaches and insights in dealing with a person who is facing death, with a family of the patient, with a person experiencing the loss of someone or something import to their existence. For you to get the maximum benefit from our time together, share your feelings - not just what comes from the head but from the heart as well. In other words, this seminar with be most helpful if you are involved emotionally and intellectual.

Though we see death (real and fictitious) on TV many times a day and read about it each day in our newspapers, death is still a morbid subject. We tend to ignore death until death comes knocking at our door. We don't talk much about death except in quiet voices or in jokes; neither do we talk much about the mourning and grieving process. It has been said that while sex was the taboo subject of the first half of the 20th century, death has been the taboo subject of the second half.

For example, we continue to cloak death's reality with various phrases. When referring to death, what words do you use or hear other use. (participants respond) "The deceased." "He expired." "She passed away" "He is gone." She has gone to his eternal reward." "God has taken her home." But seldom do we use the simple phrase, "He died." "She died."

I remember the story of Aunt Bessie telling her friend about the death of their pastor. Aunt Bessie had been the house keeper for Mr. Stellman Willis for many years. Her house was next door to Mr. Willis'. One day as Aunt Bessie set in the swing on her porch, Mr. Willis drove his car into the drive way and he and a friend got out of the car. The friend was a member of Aunt Bessie's church so Aunt Bessie said, " Brother Williams passed." The friend did not respond so Aunt Bessie spoke louder, "I said Brother Williams passed." Startled by the tone of Aunt Bessie's voice, the friend said, "Well, where was he going?" Aunt Bessie shot back, "He died you damn fool, he died."

Though we have begun to talk more about death, it is still a fearful, frightening, happening. The fear of death is universal even if we think we have mastered that fear. Remember the words of the Ecclesiastes 9:5, "For the living know that they shall die." Although we accept the truth of that statement, we have difficulty in coping with our own feelings about death. To think of our own death is something we seldom do. What is like to be dying? If we have some idea of what the answer to that question might be, then we've going to be in a better position to help. I think it is import to come to terms with our own dying in order to more effectively help those who are dying or those whose loved one had died.

I would like for you to write the three most important people, things or activities in your life on separate sheets of paper. Now use your imagination with this exercise. You have been feeling bad for several days so you go to see your doctor. You go into the hospital and after several test, your doctor tells you that you have a terminal disease. After a few weeks you are sicker than you have ever been so you have to go back into the hospital. With this admission, you have to throw away a sheet of paper containing one of the most important people, things or activities in your life. (pause for silence) As your condition worsens, your activities are limited so you must throw away another one of your slips. (pause for silence) One day, you feel better than you have in months for intact you are complete pain free. You notice that you are looking at a doctor examining your body and then turning to the nurse and saying, "He dead." and now you have to throw away the final sheet of paper. (pause for silence) Let's talk about what you felt as we discuss this exercise. (participants respond)

Let us now share with one another our feelings about the following. What do these words mean to you? Write each word down and give room for recording your response by no more than a word, phrase or sentence. In response to these words, confine your response to a word, phrase or sentence. Write your response and we will discuss our responses. 1. Life (participants respond), my response - "relationships": 2. "Significant other" (participants respond), my response - "people who have special meaning to me: family, friends, important religious or political individuals." 3. "Unfinished business" (participants respond), my response - "Mending of relationships that are important and getting business and personal affairs in order." 4. "Death" (participants respond), - my response - "End of relationship as I know them now." 5. "After death" (participants respond), my response - "New relationship - new beginning."

For an "Unfinished business" exercise, I would like for you to close your eyes. You are standing before the gates of heaven. There is a person, activity or thing standing between you and the open door to heaven. That person, activity or thing is blocking your way into heaven. Now as you play this scene out in your mind what do you have to do in relationship to that person, activity or thing in order to come to terms or remove it as an obstacle? Discuss your scene. As we come to terms with our own dying, we can better help those who are dying.

In working with the dying, one of the first questions of the doctor and the family is "to tell or not to tell." Though this is often the case, I feel that the question should be, "when do I tell and how do I share this information with this individual?" If others know (members of the family, staff, friends), the patient will soon know even without being told and therefore may be a block from openly admitting that he or she in aware of their situation.

What are some problems caused by this game of denial? The failure to tell the patient sets up barriers because both the patient and others have to play games to keep from discussing the subject. Knowledge of the situation allows for better communication and gives the patient a chance to complete unfinished business and more easily pass through the stages of dying.

Even though a patient is informed of the condition, I don't think a specific time should be given because some will die within that time frame just to keep the doctor from being wrong. When given a time frame for dying, some patients will psychologically condition themselves to die within the given time, though they may have lived longer if some hope was given. Accepting the reality of the situation, I feel that hope should always be available to the patient. At this point, I am often asked about "false hope." I believe that hope can only help a person and the loss of hope is sure death. To maintain hope is not denial.

[photo of author]When one is dying there are usually five stages of dying (if time and situation permits) that one passes through. These stages were first detailed in Elisabeth Kubler-Ross's book, Death and Dying. (It is interesting that the author of the Old Testament book of Job, understood the general response to sever crisis as outlined by Kubler-Ross centuries later.) You will find that those responses are normal when referring to the dying process, to grief and to other crisis situations.

These are normal responses and therefore are not bad in themselves, but can become a problem, if one gets stuck in any of these areas. Each person may not follow the response 1, 2, 3, 4, 5 etc. Some steps may be skipped and some steps may repeated. The Bible and modern psychology says experience those emotions and pass through them to new life and a stronger faith.

[cover]1. Shock and Denial: Most people when told that they have serious disease react with shock and denial. In your experience with a dying patient, how have you seen this denial and isolation acted out? (participants s response) The main question of this stage is "Who me!" "No, not me, you have made a mistake." "It can't be true." "I want a second opinion." "I'm sure there must be some mistake." Denial functions as a buffer after receiving unexpected and shocking news. It allows the patient to collect himself or herself and if time permits, to mobilize his other resources to face dying. Denial is usually a temporary defense but some maintain it for longer periods, some go back and forth and some never get beyond denial.

The need for denial exists in every patient at times. It usually comes and goes and usually is followed by the patient's attempt to isolate himself or herself from others. During periods of isolation stick with the patient even at times when the person seems to be far away from reality or even unconscious. When a person wants isolation, we tend to neglect and forsake them or try to cheer them up. Just be available. Sometimes when visiting a patient in this state, I sometimes say, "I know you don't feel like carrying on a conversation at this time, but I would like to just sit with you for a while."

In the first chapter of Job, we see Job withstand the loss of his wealth and children. In summing up his feelings of what has occurred, we hear Job's statement, "Naked I came from the womb, naked I shall return, the Lord gives and the Lord takes away, blessed be the name of the Lord." (Job 1:20) I submit to you that Job's statement may reflect his shock and denial as well as his faith. Reeling under stock of his losses, Job withdraws to be by himself. Job could not properly express the emotions he felt. As a result, Job becomes sick with large and painful scores with covered his body. In his shock and denial, Job isolates himself from others.

During periods of insolation, stick with the patient even at times when the person is away from reality or even unconscious. When a person wants insolation, we tend to neglect and forsake them - just be available. When visiting someone in this state, I sometimes say, "I know you don't feel like carrying on a conversation at this time, but I would like to just sit with you for a while."

Denial is a normal reaction after finding out that death will soon come. Denial allows time for a terrifying idea to "sink in" so people can "collect themselves." Denial is usually temporary. Most dying people stop refusing to believe they'll die soon and go on to deal with the knowledge that death is coming in other ways. Denial returns at times. We all handle troubles better some days than others. A dying person may speak of approaching death one day and plan for the far distant future the next.

2. Anger: When the first stage of denial cannot be maintained any longer, it often replaced by feelings of anger, rage, envy and resentment. The question changes from "Who me!" to "Why Me?" Share some of your experiences with an anger patient. (participants respond) What was your feelings and how did you respond? (participants respond) The patient should be allowed to express this and you don't have to have an answer. Just listen. Anger often gets displaced. Because the patient may not know who to be angry with; they may show their anger toward family, doctors, nurses, chaplains, God, other, all. For the dying person, anger may come unexpected and can be hard to control. The people around him/her may become innocent targets of that anger. It may be hard for them to respond with understanding and love instead of with anger, hurt feelings or guilt. You may ask yourself, "How would I feel if all my life activities were to be so permanently interrupted?" Are you to take the person's anger personally? By explaining the process to family members, you can help family members better understand and accept the patient's angers.

While a Clinical Pastoral Education (CPE) student at Walter Reed Army Medical Center, I experienced my first angry patient. I had made several visits with John was dying of an infection due to a stomach wound suffered in Vietnam. One day as I walked into his isolation room, he looked at me angrily and shouted, "Get the hell out here you God damn Chaplain." I quickly left and as I shut the door, I mentally said, "to hell with you."

As I was stunned by the unexpected reception, I returned to the CPE student room. At the time, I had not the "Death and Dying" course so unaware of the dying process. I did not feel emotionally up to visiting any more patients. I began to think about the situation and how I should handle it. Should I quit visiting him, should I confront him about his verbal attack on me, or was there another way. After prayer and much thought, I decided that I did not want him to go to hell nor did I want to break off my relationship with him.

For the next five working days I would go to his door, open it and say, "Hello John." and then close the door. On the sixth visit, I opened the door and said, "Hello, John." but before I closed the door, he asked me to come in. After greetings had been exchanged, he told me that on the day of his verbal attack, his wife had told him that she was divorcing him. She would return to their hometown and was taking their two children with her. You see, I happened to be the first person to visit him after she left so I received the blunt of his anger.

For a few, it is difficult to enter this stage. When it appears that one is holding back on their feeling, I believe that they should be helped to express their feelings in nondestructive ways. The pain (physically, emotionally and/or spiritually) may be so great and the understanding of what is happening so lacking, that the person wants to shake his fist at God and cry out, "Why, God, Why?" Many are afraid to do this for fear of making God angry and so suppress their hostility, doubts and fears. From my experience as a hospital Chaplain, I have come to the conclusion that to proper express one's anger is a healthy reaction to the hurt one feels. I don't mean that one should let his or her anger out in destructive ways, but to discover what one is angry about and express it with some caring nonjudgmental person.

During my early visits to a woman dying of cancer, she spoke of the goodness of God and her love for him. It was almost like she was saying, "God I love you so be good to me and bring me healing." Though she talked of the goodness of God, there was times when she spoke of her inability to feel God's presence and I detected an underlying hostility when she said, "It seems as if my prayers are not getting past the ceiling of this room."

As a close relationship developed, she could trust me with her feeling of hostility toward God for her condition. She cried out to God in anger and frustration. From this experience, she realized that God was big enough for her anger and as a result came to realize how really close and comforting God was to her.

At her request, I read to her Psalm 130: "Out of the depths have I cried unto thee; O Lord. Lord, hear my voice: let Thy ears be attentive to the voice of my supplications. If Thou, Lord, shouldest mark iniquities, O Lord, who would stand? But there is forgiveness with Thee, that Thou mayest be feared. I wait for the Lord, my soul doth wait and in his word do I hope. My soul waiteth for the Lord more than they that watch for the morning. I say, more than they that watch for the morning. Let Israel hope in the Lord: for with the Lord, there is mercy and with him is plenteous redemption and he shall redeem Israel from all his iniquities."

This was not an isolated case, for many patients and their families were able to realize that by admitting their feelings and letting their anger out, they were able to break down the barrier between themselves and God. When these people could express and then release their anger toward God, they recognized that God was with them and their spirits were revived.

After Job's initially beautiful statement of faith and then silent suffering following his losses, he suddenly burst out with an unchecked statement of anger, "I am weary of living, let me complain freely. I will speak in my sorrow and bitterness. I will say to God. 'Don't condemn me. Tell me why you are doing it. Does it really seem right to you to oppress and despise me? ... Are you unjust like men? ... That you must hound me for the sins you know full well, I've not committed." (Job 10:7 - The Living Bible)

For those who are tempted to say to someone in crisis, "You can't question God!" remember Job. You see If I am angry with someone and cannot express it, a barrier is set up between me and the person that I am angry with. When I can talk about it with my friend, the anger can be released and a more meaningful relationship is established. The same is true when I am angry with God. In talking with God about my anger, I can let it go and a stronger faith can result. If I cannot trust God to accept my anger, how can I expect God to accept me?

3. Bargaining: "If I can't get well by being angry, maybe I can make a bargain with God or fate for longer life." The question progresses from "Who me?" to "Why Me?" to "Lets make a deal." Often a patient will revert to a childhood response. The child often makes a demand, "I want.", but when that doesn't work, he or she reasons, "If I will be good, can I?" Have you ever experienced a person making a bargain for longer life? Share you experience with us. (participants respond)

Bargaining is an attempt to postpone death which usually involves a change in behavior or a specific promise in exchange for time to live. A patient once told me that if he gets better, he was going into the ministry. He said that as a young man, he had received the call to be a minister but had not followed his call. He felt that his rejection of that call had lead to this situation. Now that he saw the errors of his ways, he wanted to be a minister.

Elisabeth Kubler-Ross tells of a patient who wanted to go to her son's wedding. She had been suffering great pain. She was very sad that she might miss her son's wedding. She said that if she could only get better and attend her son's wedding, she would be the happiest woman in the world and could die in peace. We taught her self-hypnosis which enabled her to be comfortable for several hours. Surprisingly the day preceding the wedding, she left the hospital a happy woman. Kubler-Ross said, "No would have believed her real condition. She was the happiest woman in the world and looked radiant." The first time that Ms. Kubler-Ross visited her after the wedding she said, "Now don't forget, I have another son"

A Chaplain friend of mine shared with me an incident which illustrates an unusual situation which occurred as the results of a bargain. The patient entered the hospital with symptoms of cancer which she had been cured of some five years before. Though she continued to lose weight, was suffering great pain and losing strength; none of the test showed any cancer. In the course of the

Chaplain's visits with this woman, she told him that she had made a bargain with God during her last hospitalization. She asked God to allow her to see her youngest son through college and God had granted her wish as the son had graduated the previous May. The Chaplain helped her accept the fact that God did not hold her to that bargain and that she was released from her end of the bargain which was her death. As she accepted this, she begin to improve and in a few days was released from the hospital: a healthy person in body, mind and spirit.

4. Depression: When the patient can no longer deny because of his or her weakening condition and anger and bargaining have failed to bring the desired results he/she begins to feel a sense of great loss. The question now becomes, "What is the use?" The depression may be twofold: One: depression that comes with what the patient has already lost: health, independence, ability to meet responsibilities, uncompleted business. Two: Depression that results from the knowledge of the coming loss of family, friends, the future that might have been and life. This called preparatory grief.

The patient may not talk very much, but needs and appreciates the presence of loved ones. During this period, we often try to cheer the person up, but in so doing whose needs are we meeting? Give positive impute and loving presence, but do not attempt to deny the reality of the situation.

Job refused to consider any king of bargain and moves directly to the next stage which is depression. In his depression, Job cries out, "If only I could stand before God and plead my case, but there is no one to hear my case." Job felt that he had enough. He could take suffering no longer. He could take such pain no longer. He was despondent and wished for death. Job suffered insecurity and anxiety for he felt that God had deserted him in his suffering. He then reaches a point where he willing to accept his suffering if only he could be assured or even hope that God had not abandoned him and indeed that God cared for him. Fortunately for Job, God came to him in a whirlwind. Though God did not answer Job's questions concerning his suffering, Job was assured of God's presence and love. As he experienced God's presence, he was able to move beyond depression.

I have found that guilt feelings may be a companion in any of the stages. If the patient sees illness and pain as a punishment of sin, the patient will try to determine what he or she has done to cause their situation. A woman dying of cancer was in a depressed state for abut two or three house following visits from members of her church. While they were with her and for a short time afterward,. she was elated and hopeful, but these feelings gradually faded into depression. One day she told me that if she only had enough faith, she could overcome this illness. This feeling was reinforced by her church friends who came to pray with her. As she was not improving physically, she now felt the pain of guilt for not getting better as well as the pain of her illness.

I tried to explain to her that we were born to die and that illness was not a reflection of our spiritual health for there were some saints who suffered greatly and some evil people who enjoyed good health. St. Paul prayed that the thorn be removed from his body but was not healed. Even though Paul was not healed, his knowledge of God's love undergirded him throughout life and death. Though she agreed with me, I was never sure that she accepted my explanation.

5. Acceptance: If given time (death does not come too soon) and with some help, the patient will have been able to work through the previously described stages and comes to the fifth stage: Acceptance. From the question of the first four stages, "Who me?" to "Why Me!" to "Let's make a deal!" to "What's the use?" to the statement, "I am ready!" Acceptance should not be mistaken for a happy state but may be void of much feeling. Few is any words are exchanged. Just be there.

Often the family has a more difficult time accepting the coming death than does the patient. I remember visiting a woman whose child was nearing death. The child had been unconscious for several days. As I came to child's bedside, I would ask her mother how her daughter was doing and she would reply, "Ok, I think she looks a little better today." I responded, "Yes, she does." This type of game playing went on for several days. We both know the little girl was not getting better, but could not talk about her real condition.

One day when I asked that question, "How is your daughter doing today?" She looked at me for a few minutes and began to cry, "Why? Chaplain, Why?" Before when asked such a question, I had always come up with some studious intellectual answer which met no one's needs but my own. However, It dawned on me that if I did that, I would be spiritually running form that woman's need. As tears came to my eyes, I responded, "I don't know why, but I can cry with you." We sat there holding hands and crying together. I learned two important lessons that day. One was that to be able to cry with someone may be the most helpful thing to share with them. The second was that I did not have to have all the answers in order to be a pastor. From that experience both the woman and I grew closer to God who was able to sustain us through the death of her child and beyond.

I would like to share with you some basic guidelines in working with a dying person.

(1) Be available and human. Take time to spend with the patient.

(2) Allow the patient to set the pace. In the early stages, do not try to break down their defense. On the other hand, if the patient wishes to discuss his death, he should be able to do so. Don't change the subject but hear him/her out.

(3) Accept the patient's anger. Do not react in a way that increases his sense of loneliness or make him feel humiliated or guilty for having these feelings of anger.

(4) Offer yourself as a willing listener. Share his grief verbally or nonverbally. Let the patient know you understand the seriousness of his situation. Do not avoid him. He interprets avoidance as a rejection of himself, not as your inability to deal with death.

(5) Do not abandon the patient. Even when there is no possibility of a remission of his disease, approach frequently, of only briefly. Never dampen his hopefulness. Respond with concern for problems, no matter how trivial they may appear.

(6) Respect the patient's individuality and protect his right to die in dignity.

Mrs. Sharp's Case History: Mrs. Sharps, a 61 year old woman, was in the hospital dying of cancer. She was alert, but losing strength and nearing death. The doctor consulted me for emotional and spiritual support. She was afraid to die because she felt guilty about something that had happened years before. Her friend had been harmed by some gossip that Mrs. Sharps had passed on to others. The friend had been dead for about three years. I had Mrs. Sharps imagine that her friend had come to the hospital to visit her. In the imagery, Mrs. Sharps was able to ask her friend to forgive her and the friend forgave her. Mrs. Sharps then asked God to forgive her and she felt and accepted God's forgiveness. I share with you two scripts which I used with Mrs. Sharps. She died in peace two days later.

Light At The End Of The Tunnel: I remember the story of a woman who wrote of her daughter's fear of tunnels as a child. As they traveled, the child would cling to her mother and press her face against her mother the moment they entered a tunnel. She would raise her head only after being assured that they had passed through the tunnel.

Several years later, they were traveling down the Pennsylvania Turnpike and approached a tunnel. The daughter had been gone from home for years, so her mother wondered how her daughter would react to the tunnel. As they traveled through the tunnel, the girl did not seem upset and maintained a pleasant attitude. The mother reminded her daughter of her childhood fear of tunnels, and asked her what caused the change. The girl replied, "Mother, I found out that tunnels have light at both ends." You now know that you have experienced forgiveness so you are aware that there is a light at the end of the tunnel.

illustrationGRIEF

Ever since that day when Adam and Eve been over the body of their dead son Abel, man has been suffering grief because of loss. Yet, in the full sense of the word "grief," one can go back even further to the time when Adam and Eve ate the forbidden fruit and were expelled from the Garden of Eden. They suffered grief over their loss of the Garden, so in reality, grief goes back to that point in recorded history. From the very beginning of time humans have been experiencing grief over the loss of a valued object or person.

What is grief? (participants respond) It is the strong emotion one feels when he or she comes face to face with the loss of someone or something which has been significant part of their life. It is the hurting, painful experience of loss. Though it is universal, many have difficulty understanding the nature of grief or knowing how to cope with grief in an open, healing and growth enhancing manner. Normally, we have thought of grief only in terms of dealing with the death of a loved one, but it occurs with the lose of any important person, thing, activity or way of life.

What are some losses that can cause grief feelings? (participants respond) (1) Loss of mate (by death, separation, divorce), (2) Loss of child, (3) Loss of parent, (4) Breakup of an intimate relationship, (5) Child leaving home, (6) Loss job (fired, retired), (7) Moving from one place to another. (8) Loss of a friend, (9) Loss of opportunity, (10) Loss of pet, (11) Loss by crime, (12) Loss by accident or disaster, (13) Loss of body part mastectomy, arm, leg, burns, etc., (14) Loss of sexual ability, (15) Loss of a national or religious leader, (16) Loss of self (anticipatory grief). (Have participants discuss area where they have experienced grief and what triggered their grief)

In 1972, I was in Clinical Pastoral Education training at Walter Reed Medical Center. Bobbie, Tim, Scott and I had moved from Fort Hood, Texas to Silver Springs, Maryland. At Fort Hood, we lived in military environment. In Silver Springs, we lived in a civilian community. Monday through Friday, I spent from an hour to an hour and a half with my family and the rest was school or study. Bobbie and I were growing further and further apart. We were not having any arguments but we were not communicating. Though I loved her, should she had said "I am going back to Louisiana." I would have said, "Ok, leave me the little car and you take the big car."

I was assigned to write a paper and present a class on grief. I did a lot of research and had hand written it. Bobbie was typing it for me when she called me into the room. I thought she was probably having trouble reading my writing. She said "This is the problem!" Though I had written the paper, I had no idea what she meant so I responded, "What do you mean?" She said that she had been grieving our moving from Fort Hood to Maryland. In my paper on grief, I had mentioned some that may cause grief to include moving. While typing the paper, she was able to she that she had been grieving. She had many close friends at Fort Hood was in a painting class and was very good at landscapes. In Maryland, she felt isolated from her friends in the military community and in a sense from me. From that, we began to take more time together and once again we were close.

Let's take some time to answer the following questions: (You may want to write down your answer and then can discuss them. (1) What was your most painful experience of grief? (2) What were your feelings?

I remember an vividly an unexpected experience of grief. I was in New Orleans to attend an Annual Conference of the Methodist Church and I was walking down a street. As I stopped for a crossing, an elderly woman standing next to me was reading a newspaper and crying. She turned to me and said, "Pope John is dead." I answered, "I am sorry to hear that for he was a great person. I am Protestant, but I loved Pope John." She turned to me, put her arms around me and said, "Pope John loved the Protestant, Oh, how he loved the Protestants." It was a touching moment for me as tears came to my eyes and I experienced grief over the loss of this wonderful person.

What were you doing when you heard of Princes Di death? What kind of affect did it have on you? Certainly many grieved her death. How did you feel when told of the death of Sister Theresa? These are people who we probably never saw in person and certainly did not have a close personal relationship with and yet we grieved their deaths. Perhaps the most terrifying event since the death of President Kennedy or the attack on Pearl Harbor was September 11, 2001 terrorist attack on the US killing thousand in New York, Washington DC and Pennsylvania.   How did that affect you life. Many grieved even though they may not have known any of those involved.  

Firefighters raising flag.

Faced with the death of a significant other, bereaved persons show their feelings in various ways. A person may cry, stagger, feel week, become nauseated, tremble, shiver, faint, or keep his or her emotions under rigid control. Different people will react in different ways.

As we look at the grief process, you see a close similarity with the dying process and the response to crisis of any kind. Despite the cause of the loss, a person may go through one or all of the stages of grief. As with the stages of death, not all people go through all stages and there may be movement back and forth between the different stages.

One of the first responses to the death of a significant other is that of shock and denial. How have you experienced this stages or seen it in another? (participants respond) "No! Not Jim, you have made a mistake." "It just can't be. I was talking with her only a short time ago." "Mother is not dead, she is only sleep." As for the dying, denial serves as a buffer after receiving unexpected shocking news. It allows the individual to collect and mobilize his or her resources to face the loss. Denial is usually a temporary defense and is normal unless it is prolonged over a period of time.

Some years ago, I visited a woman who had been admitted to Methodist Hospital for her first time. When I came into the room, she was crying. I set down in a chair next to her bed and began to talk with her. I ask her what had happened. She responded, "My husband died and I am so lonely without him." I ask, "Did he recently die?" She responded, "No, he has been dead for three years." I spent some time with her and allowed her to talk of her love for her husband and how much she missed him. Some five or six years later, I walked into a woman's room and she was crying. I set down in a chair next to her bed and ask her what had happened. She said, "My husband died and I am so lonely without him." It was then that I realized that it was the same woman I had visited some five or six years before. She was experience prolonged grief.

I visited a woman in the psychological ward at an American Military Hospital in Bangkok, Thailand who was scheduled for medical evacuation to the states. After we talked for a while, she began to tell me about her mother's death. She said that when she was told of her mother's death, she began to cry. Her husband scolded her and said "Christians don't cry at death." She repressed her feelings and showed no more emotions toward her loss. After telling me the story, she seemed on the verge of tears. I told her to go ahead and cry for Jesus had blessed our mourning over the death of a loved one. She looked surprised and asked me explain. I told her that Christ had cried when told that his friend Lazarus had died and said in his beatitudes, "Blessed are they that mourn, for they shall be comforted." With that explanation, she began to cry. After her crying, she no longer had the nervous symptoms which had caused her hospitalization and was released from the hospital two days later. This woman had stopped the grief process and it had made her sick months later.

Let the person who has been told of the death of a significant other face the full pain of their loss for this is healthy. Because it is difficult for some to face grief, it is a temptation for others to suggest or request that the doctor offer a sedative. Usually, I am against giving a sedative at this time. To give a person in grief a shot or pill to tranquilize them only slows the grief process or delays it. The grieving period can be delayed but it cannot be postponed indefinitely for it will be carried out directly or indirectly. When a person is grieving the death of loved one, they know why they are hurting. There was an oil filter advertisement a few years ago which showed a mechanic standing by a car with a burned-out motor. He was holding an oil filter in one hand and pointing to the burned-out motor. He said, "You can pay me now or you can pay me later." Grief is like that. If grief is not worked through at the time of the loss and/or shortly afterward, it will be done later at a much greater cost to the personality.

If not allowed to mourn at the time, it may come out months or even years later as with the woman in Thailand or as a close friend of mine experienced. A friend of his died and when came to visit the man's widow she said, "My husband loved you as he would his own son." Later that day as he shared this with me and a few close friends, he began to cry. He had a strained relationship with his own father at the time his father died some ten years before so was unable to mourn. Through my friend was close to the man who died, he was really mourning the death of his father. Though that experience, he was able finish some unfinished business with his father and mourn his death. He could then say, "I am crying because of the death of my father." He could then accept his father as never before - accepting their differences without being angry.

In the grief process, there may be preoccupation with the image of the dead loved one or an extreme identification with him or her. What is preoccupation? (participants respond) In preoccupation, the person talks about the dead loved one: what they were like - how they lived - what they did together, etc. In the grief process, it is very important to let the bereaved to tell their story. They need to tell and perhaps tell repeatedly about events of their past with the loved or things they like about their loved one. What is identification? (participants respond) In identification, the person in grief takes on some characteristic of the dead loved one: comes to have a similar disease - takes over the business - acts in the manner of the dead loved one.

A man died about a month after he and his wife had ended their marriage by divorce. The last few days of his life, his ex-wife was by his side and even though he was unconscious; she continually told him how much she loved him. When he died, she went into extreme grief, which may have been triggered by guilt and/or love. Her husband's hobby was raising registered dogs. She had been totally uninterested in the dog and often the dogs were a cause for an argument. After his death, this became her hobby and she devoted much time to the care of the dogs.

Arthur J. Snyder wrote an article shortly after the death of Elvis Presley, titled, "Elvis's sudden death triggered by 'Anniversary Reaction?'" In that article, Snyder makes the point that there is a growing awareness among professions that anxiety, depression serious illness and even death on the anniversary of an event of importance in the patient's life and most often deals with a loss such as the death of a loved one. Elvis and his mother were very close and that he never properly mourned her death. Elvis's mother died at age 42 in the month of August. Elvis died at the age of 42 in the month of August.

Another reaction may be that of anger. Have any of you seen this grief reaction? (participants respond) The person may show feelings of anger, hostility, rage, envy and resentment. This anger may be focused upon a specific person: doctor, nurse, another family member, Chaplain, God or even the dead person. Often the anger will be expressed toward anyone happens to be in the room. As the Chaplain approached a woman whose child had just died, the mother cried out, "Why did God let this happen?" The Chaplain did not answer, but simply took her hand. She said "I need to go somewhere and cry." The Chaplain responded, "Would you like to go to the Chapel?" "Just the opposite, I need to scream and rage at God. Oh, God, why did you let this happen to my child?" The Chaplain did not criticize her feelings nor did he try to defend God, but said, "You can do that too and perhaps it will help to have someone with you." He helped her release the tension and anger so that she was able to move through her anger to readjustment.

Upon the death of her husband, a woman hit him on the chest and said, "Why did you go and die on me?" She was experiencing anger toward her husband who died and thus deserted her. Another cries out, "If they had operated sooner." Anger toward the doctor. "You damn nurses are a bunch of sadists who enjoyed seeing people suffer." Anger toward nurse. Another shouts angrily, "If John had brought mother to the doctor sooner, she would still be alive." Anger toward another family member. When anger is expressed toward you how do you handle it. (participants respond) As a helper, listen and know that if the anger turns upon you, you need not take it personally.

Following anger, a person may go into a state of depression. When numbness wears off and rage has been exhausted, depression may set in. When the full reality of the death of a significant other floods ones life, he or she may feel a sense of great loss. The feelings of sadness, loneliness, discouragement, helplessness, and even hopelessness may be experienced. A woman's husband died and she withdrew from most of her social contact. Though she had been active in her church and several social clubs, she seldom left her home. Due to the caring love of a pastor and other members of her church, she was able to finally give up her depression and live a normal life.

Guilt is perhaps the most painful companion of death. What are some responses you have heard which shows guilt feelings? (participants respond) "If I had only been home." "If i would have insisted on his going to the doctor" "If I had been a better husband/wife/father/mother/ son." The bereaved tend to believe that they should have done more, said more, or even been more. Sometimes a person feels partly responsible for the death. In a seminar at Walter Reed Army Medical Center, Edgar Jackson said, "It is accepted as an established fact that all grief involved some guilt." This is true not only of family members, but of the medical staff as well. It does no good to tell a person in grief not to feel guilty. Allow the person to talk. You may be able to help them through the guilt by just listening and/or providing positive impute concerning the relationship.

We have mainly been discussing normal grief. But what happens if a person gets stuck in the process. This is called abnormal grief or maladaptive grief. If the various feelings and struggles not expressed or ventilated long term problems can occur. We have talked about this with the woman who was still mourning her husband death years later as if it were yesterday, the man who had failed to mourn his father at the time of his death, and Elvis Presley.

Mrs. Landry's Case History: Following the death of her husband, Mrs. Landry, a 32 year old female, came to me for counseling. She said, "I just can't get over the death of my husband. I used to be active in the community, exercised four to six times a week, ate good, but now I don't go anywhere except to work, don't exercise, and don't eat properly. I don't like what I have become."

She blamed herself for her husband's death because she did not insist that he go to the doctor when he complained of chest pains. Upon questioning her, I discovered that he had complained of chest pains before that night, but would take a Rolaide and feel better after a short time. She felt that she could have been a better wife and then perhaps he would still be alive.

Grandma Embroidering A Pillowcase: (Good for someone in grief or facing a baffling situation.) A number of things happen in life which are difficult to understand and certainly the death of a loved one is one of those things. St. Paul must have been thinking of these things when he wrote, "Now we see through a glass darkly, but then face to face. Now I know in part, but then shall I know even as I am known." These problems are indeed difficult to comprehend, for now we see only the baffling reflection in a mirror, but then face to face.

Our knowledge is sometimes limited and we do not have enough facts to pass judgment. As humans we often take the short view because we don't have all the facts. My grandmother used to embroider pillowcases and I remember as I sat at her feet watching her sew, there seemed to be no meaning or design to what she was doing. It was just threads crossed and re-crossed. Seeing that I was puzzled, she told me to come stand beside her so that I could see the pattern from her side. I did as she requested and as I looked at it from her view point, I saw a beautiful scene being sewed to perfection; thread by thread and strand by strand. It is often so with us in our view of life. We look at life from one side only, and from this side it often looks like a blotch of threads crossed and re-crossed in wild confusion. Until we are able to see life from both sides and have more facts at hand, we often see only the baffling reflection in a mirror.

I then had Mrs. Landry imagine her husband sitting in a chair in front of her so she could talk to him and complete any unfinished business with him. I said, "Say what you want to your husband." She said, "Bill, I am so sorry that I did not go with you to your mother's that last weekend. Please forgive me. I am sorry I didn't insist on your going to the doctor that night." She experienced his forgiveness for he said that he understood that she had a difficult week at work and just needed to relax for the weekend. He asked forgiveness for making a big deal of it and leaving to see his mother mad at his wife. He also reminded her that she had tried to get him to go to the doctor that night, but he refused.

I said, "You have been forgiven and have forgiven, now forgive yourself. As you forgive yourself, you are free from the need to punish yourself. You can begin to live a full life once again. You can be active in your community, exercise appropriately, eat well, and feel good about yourself." I concluded the session with "Overcoming Depression # 2."

Granger E. WestbergAs you work with people in grief, remember that it is healthy to cry, to express those deep feelings of anger and the guilt feelings will probably accompany the loss. Let them talk about those feelings without being judgmental. If they are able to work through the grief process, they can emerge healthy through the experience. Granger Westburg in his book Good Grief, says that healing begins as the person passes through the grief process by starting to free himself from the bondage of the dead loved one, makes readjustments in the environment in which the loved one is missing and begins to form new relationships or patterns or interaction that brings reward and satisfaction.

Edgar Jackson calls normal grief, "The illness that heals itself." We who deal with people in grief can help that process be normal in many cases that would otherwise be abnormal. If we, as members of the helping profession, can help people in grief get "in tune" with their feelings and begins the grief process, we can avoid some unnecessary agony and suffering in the future for that person.

Jesus put it this way, "Blessed are they that mourn for they shall be comforted." I would like to paraphrase that statement, "Blessed are they who can adequately mourn for on the other side of suffering and sorrow, there is comforted."

What is the place of religious faith regarding grief? Some friends and even ministers may use religious language in such a way that it will hinder the expression of various emotion we have discussed, or even slow the passage toward "reaffirmation of life." Scripture, prayer, statements of religious belief can certainly be very helpful and supportive when used appropriately: but they can also be misused. Even if we have struggled with a crisis of faith, it is our religious faith or our spirituality that enables us to experience personal growth from the agonizing pain of grief. If we do not experience personal growth then the frustrating difficulties of our loved ones become even more tragic. It is our deepened spirituality that has sustained us. In spite of our loss, our faith can move us to learn "to get on with living" again give an affirmative "Yes!" to life.

TRIBUTE TO DR. ELIZABETH KUBLER-ROSS (2004)

 

I was first introduced to the writings of Dr. Kubler-Ross while attending Clinical Pastoral Education at Walter Reed Medical Center in Washington DC 1972. We had a course on "Death, Dying and Grief" using her book On Death and Dying. We also had to work with a terminally ill patient during one of our four quarters at WRAMC. I remember waiting till the fourth quarter to accept a patient to work with. To some degree, I had to work out my own feelings about death before I could effectively work with someone who was dying. The course on "Death and Dying" and other experiences during CPE helped me to come to the point where I could finish the course by working with a terminally ill patient.

She developed her theories while working with some theological students who were supervised by her while they worked with terminal ill patients. Her work On Death and Dying has helped many people with terminal illnesses and those who work with the dying patient. In 1999, Time magazine named Kubler-Ross as one of the "100 Most Important Thinkers" of the past century. (Chaplain Paul G. Durbin, Ph.D)

THEORIST ON GRIEF DIES AT 78: DR ELIZABETH KUBLER-ROSS DIES AT 78:  [New Orleans Times-Picayune: Aug 26, 2004: The Associated Press]

PHOENIX - Dr. Elisabeth Kubler-Ross, a psychiatrist who famously theorized in 1969 that terminally ill patients go through five stages of grief: denial, anger, bargaining, depression and acceptance - has died at age 78 after her own prolonged bout with illness. She was best known for her 1969 book On Death and Dying, bringing the topic of terminal illness into the public discourse. She pioneered hospice care after working with dying hospital patients whose plight she considered intolerable.

As for her own death, she was in the acceptance stage for years, said her son, Kenneth Ross.

Kubler-Ross moved to Arizona nine years ago after a series of strokes left her partially paralyzed on her left side. In a 2002 interview with The Arizona Republic, she said she was ready to die: "I told God last night , he's a damned procrastinator:"

She once said: "Death is simply a shedding of the physical body like the butterfly shedding its cocoon. It is a transition to a higher-state of consciousness where you continue to perceive, to understand, to laugh and to be able to grow:"

ELISABETH KUBLER-ROSS DIES AT AGE 78 ON AUGUST 24, 2004 [From Elisabeth Kubler-Ross website: http://www.elisabethkublerross.com/

Dr. Elisabeth Kübler-Ross, psychiatrist and prolific author of the ground- breaking book, On Death and Dying, died Tuesday evening, August 24, 2004, in Scottsdale, Arizona of natural causes. She was surrounded by her family and close friends. She was 78. " Every moment of her life was devoted to dying patients and what they were going through," noted long-time friend Mwalimu Imara, who has been close to her since the beginning of her research. "Her prolonged illness following several strokes only made her even more determined to speak up for the rights of the terminally ill."

Tributes began pouring in almost immediately from people around the world who have been stirred by Dr. Kübler-Ross’ teachings. According to her longtime publishing agent Barbara Hogensen, Kübler-Ross authored more than 20 books, many of which have been translated into more than twenty-eight languages. Titles include: To Live Until We Say Good-Bye, On Children and Death, AIDS: The Ultimate Challenge, and her autobiography, The Wheel of Life. Her most recent book, Real Taste of Life, was a photographic journal produced in collaboration with her son, Kenneth, a travel photographer, who helped care for her both personally and professionally since she officially retired to Arizona in 1995. She had recently finished drafting her final book, On Grief and Grieving, with longtime collaborator and friend, David Kessler.

Dr. Kübler-Ross was born as one of triplet sisters in Zurich, Switzerland, on July 8, 1926. Always spirited, she decided upon a medical career early in her childhood against the wishes of her father. The focus of her work in death and dying crystallized in 1945. She was a member of the International Voluntary Service for Peace who helped in ravaged communities after World War II. In the concentration camp, Maidanek, carved into the walls where prisoners spent their final hours, she discovered the symbolic butterflies which would become her symbol of the beautiful transformation that she believed occurred at the time of death.

After graduating from medical school at the University of Zurich, where she met future husband and fellow medical student Emanuel "Manny" Robert Ross, she came to the United States in 1958. She worked in major hospitals in New York, Colorado, and Chicago, and she was appalled by the standard treatment of dying patients." They were shunned and abused; nobody was honest with them," she said. Unlike her colleagues, she made it a point to sit with terminal patients, listening as they poured out their hearts to her. While simultaneously raising two small children, she began giving lectures featuring dying patients who talked about their most intimate dying experiences. "My goal was to break through the layer of professional denial that prohibited patients from airing their inner-most concerns," she wrote.

Her bestselling first book, On Death and Dying, 1969, made her an internationally-renowned author. Even today, her trail-blazing book is required reading in most major medical, nursing, and psychology programs. A 1969 Life Magazine article outlining her work gave further mainstream credibility and awareness to this new way of dealing with dying patients, although her conclusions were quite revolutionary at the time. "People today find it hard to believe that her now commonly-accepted conclusions were quite revolutionary at the time," said her sister, Eva Bacher. "She was always very proud that her work helped to bring the hospice movement into the mainstream in the United States."

Throughout the 1970's, Dr. Kübler-Ross led hundreds of workshops and spoke to standing-room-only crowds throughout the world. The "five psychological stages of dying" (denial, anger, bargaining, depression and finally acceptance) outlined in her book became accepted as common knowledge throughout the world. She continued to both learn and teach in many important medical facilities and hospitals as her influence grew.

She assumed the Presidency of the Elisabeth Kübler-Ross Center and the Shanti Nilaya Growth and Healing Center in the late 1970's, a base from which she gave "Life, Death and Transition" workshops worldwide. (Durbin insert: "Shanti Nilaya is Sanskrit for ‘Final Resting Place of Peace’"). She also continued her personal interest in mysticism, the afterlife, and other less commonly-accepted forms of therapy. In the 1980's, she purchased a 300-acre farm in Head Waters, Virginia, to serve as a healing and workshop center, and called it Healing Waters. "Always controversial, she turned her focus at the time into helping babies born with AIDS when nobody else wanted anything to do with them," said Frances Leuthy, who was her assistant and ran the Virginia center. She officially retired to Arizona in 1995, after a series of serious strokes debilitated her body, and a fire, which destroyed her house and all of her belongings. She left her farm behind for a fresh start near to son, Kenneth.

Even in retirement, she continued to receive hundreds of visitors from around the world, including celebrities such as Mohammed Ali, Susan Sarandon, and Lady Sarah Ferguson. The March 29, 1999 issue of Time Magazine named her one of "The Century's Greatest Minds" in a summary of the 100 greatest scientists and thinkers of the century. Throughout the span of her life, she continued to encourage students with similar interests, and regularly contributed forwards, chapters, and sections to numerous other authors’ books regarding death, dying, and grief. She was the recipient of more than 20 honorary degrees from colleges and universities across the country. She participated in a number of advisory boards, committees and societies, and was one of the founders of the American Holistic Medical Association.

Always outspoken, her work in challenging the medical profession to change its view of dying patients brought about great change and advanced many important concepts such as living wills, home health care, and helping patients to die with dignity and respect. "She always was, and will continue to be, a strong voice for the rights of terminally ill patients," noted Dr. Gregg Furth, New York Jungian psychologist, a close family friend and supporter.

In the final years of her life, she looked forward to her own quick "transition" and tried to deal with the frustration of helping thousands of people to accept their own death, and yet being unable to direct her own. Never fearing death, she wanted only to follow what she believed, "Life doesn't end when you die. It starts." She is survived by son Kenneth Lawrence, a photographer in Scottsdale, Arizona; daughter Barbara Lee Rothweiler , a clinical psychologist in Wausau, Wisconsin, (husband, Jeffrey); granddaughters Sylvia and Emma; and sister Eva. She is preceded in death by former husband Manny; brother, Ernst; and sister, Erika. Public services will be held on Saturday, September 4th, at Scottsdale Bible Church, 7601 E. Shea Blvd., 3PM in Scottsdale, Arizona. The burial will be the next morning, Sunday, Sept. 5th, 10am, Paradise memorial Gardens, 9300 East Shea Blvd., Scottsdale, AZ. (RSVP requested) Once saying of her impending death, "I am like a plane that has left the gate and not taken off. I would rather go back to the gate or fly away."

 

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