Tuesday, December 05, 2006

Kubler-Ross Is Junk

Note: Killing time at meetings today, I got 122 European rivers. Took the whole 90 minutes, though.

Elisabeth Kubler-Ross’s Five Stages of Grief have firmly embedded themselves in popular culture. The idea that we go through some patterned, normal territory in response to crisis, especially death, seems to be attractive to us. It has expanded beyond the territory of accepting death, and is now applied to loss of jobs, pets, marriages, and I don’t know, maybe

There is no evidence that it is true.

Which is not to say that it is precisely false. It is so vague as to be difficult to disprove. Kubler-Ross herself taught that the stages did not necessarily come in order, and that not everyone went through all stages. Everyone goes through at least two, she thought. Because a dying person can get “stuck” at a stage, then all evidence can be bent to confirm the hypothesis. Are you sad? Well, that’s just the “Depressed” stage, then. Or maybe Anger. Are you cheerful? That’s Denial. Or maybe Acceptance. Or maybe some odd variant of Bargaining. It depends. It’s rather like reading the horoscope about your Sun Sign: “You are sociable, but you value your time to yourself.”

Try and think of a reaction to bad news that you couldn’t squeeze into one of the five stages.

Kubler-Ross is credited with bringing attention to the feelings of grief, and attention to the feelings of the dying. Before her book On Death And Dying in 1969, the story goes, the medical profession disregarded the feelings of the dying and the experiences of the family. Death was hushed up and swept under the rug. Doesn’t this strike you as fairly unlikely? In the era of house calls, ethnic wakes and funerals, stable neighborhoods and extended families, that the medical profession was less likely to notice the emotional and family needs?

If anything, the Five Stages of Grief sound like a replacement or compensation for other changes in the culture: people were less connected to churches, moved from neighborhoods and extended families, and went to hospitals to die. Along comes this nice little woman with a Swiss-German accent (so you just know you can believe her) who seems to genuinely care and has what you’re going through all mapped out. And she’s a doctor – did I mention her accent? And she’s talked to hundreds of dying people.

The idea is pernicious because it creates the idea that there's this "process" that can't be interrupted, or you're screwed. Limping anyway. You grieve. You don't go through a "grief process."

I was thinking this because we had the Employee Assistance Program people come in today to talk to us. They had heard there had been two suicides from our team over the weekend. Actually, there was one three weeks ago, and a death over the weekend that was probably accidental, of a patient who left three weeks ago. Details, details. They wanted to debrief us, and let us know that it was alright to feel what we are feeling, because it was normal. How would they know? I’m a heartless bastard who isn’t the least disturbed. I do have some sorrow for the families involved. Other than that, I’m just annoyed at having to go to more meetings. Is that normal and alright? If it’s Denial, then I never get out of that stage, and must be a pathological SOB. If it’s Acceptance, then obviously I’ve got this grief thing licked, rolling through the 5 stages in about 3 minutes.

We were encouraged to try and make something positive out of the experience. Gag. But I’ll dutifully do my homework. I’ll blog. Which I was going to do anyway. I’m not sure that telling you the uselessness of the conventional wisdom is what they would call “something positive.” I’d better come up with something else.

1 comment:

Anonymous said...

Gee, to hear a professional say it, makes me feel much better. I always thought the "grief stages" were a lot of hand-waving, anyway. As you pointed out, AVI, it's kind of like reading a vague horoscope, that tells you that "you will meet a stranger who will have a profound effect on your life." Then you get pulled over for speeding. Aha! The horoscope was right!!