Our society has developed the belief that death and disease are to be avoided and feared. The denial that death is real and can happen has caused people to view illness and death as something that is happening to them, rather than a natural process that can be accepted without anxiety or suffering. Our thoughts and perspective on death and illness are based on fear instead of seeing them as a possible opening to an experience that can offer new learning, challenges, growth and a positive vision of our existence and ourselves. The denial that death is real and can happen has caused people to view illness and death as something that is happening to them, rather than a natural process that can be accepted without anxiety or suffering.
Realizing a terminal illness, Kubler-Ross describes the different stages a patient goes through in response to this new knowledge. Often these defense and/or coping mechanisms help the patient manage the stress of facing her own mortality. These phases include the first stage, denial and isolation; the second stage, anger; the third stage, negotiation; the fourth stage, depression; and the fifth stage, acceptance (1969). The stages are defined as consecutive, in which hope is usually present in one way or another. In the final stage of acceptance, there is no longer any hope of finding a cure and the patient may not want any more visits. A person will have finished their unfinished business and there is a sense that the patient has achieved a sense of peace (Kubler-Ross, 1969). Another indicator of the final stage is the role of hope. Once hope is gone, the patient is often close to death.
Stephen Levine, who has also worked extensively with dying people, went a step further with the stages described by Kubler-Ross, pointing out that these stages actually have more to do with changes in the mind. “These stages, rather than being swallowed whole as absolute reality, can be used as a means of focus, a way of encouraging recognition of the impermanence of all things so that one can move beyond seeing others as what they are becoming and instead experience them as they are, tap into the living truth of their being, share in the reality that lies beyond death” (Levine, 1982, p. 234). Many people have outlined the different stages that human beings experience when facing their final destination of death. When facing death, Levine (1982) defines the mind as a roller coaster, changing thoughts on a given day. During the evaluation process, the stages are reviewed more than once.
Levine adds a spiritual dynamic to his view of the stages of death that Kubler-Ross describes. He refers to her stages as psychologically based, connected to thoughts, feelings, and emotions. He adds: “The difference between the psychological and the spiritual is that the spiritual is related not only to the contents but to the space in which these contents are developed. The five stages deal with death as if it were outside of ourselves. Perhaps real acceptance is the first time we take death inside of us where death is not the enemy but becomes the great teacher directing us towards our fear and encouraging us to relate to it instead of from it. death’s teaching is to relate to our life as a whole rather than a fractured reality that you wish to escape.” (Levine, 1982, p. 242) Spirituality is often woven into the dying process, regardless of prior spiritual development.
As I have seen in my practice, a person can feel stable in a particular belief system, and with a diagnosis or when an opportunity to examine death arises, many beliefs are immediately reassessed. I have had the opportunity to work as a Chaplain in a Community Hospital, and have worked extensively with people who have recently been diagnosed with a life-threatening illness and/or know someone close to them who is going through the process. I think everyone has a different response to the particular circumstances of her life. The therapeutic process can be very helpful, supportive and beneficial in feeling and working through emotions as they arise. Therapy can also be a place to process what may be left unfinished.
As a therapist, it is my job to make room for someone else’s process instead of fixing, healing and/or denying my own experience. Through all the feelings of grievance, anger, shock, denial, and acceptance, I hold the space to choose in the midst of challenging circumstances. Sitting with another human being in this process is humbling, powerful and reminds me of how the role of choice happens until our last breath.
Sources:
Levine, S. (1997). A year to live: how to live this year as if it were the last. New York: Bell Tower.
Levine, S. (1982). Who Dies: An Inquiry into Conscious Life and Conscious Death. New York: Anchor Books.
Kubler-Ross, E. (1969). On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergymen, and Their Own Families. London: The Macmillan Company.
Kubler-Ross, E. (1974). Questions and answers about death and dying. New York: Simon & Schuster.