Confronting Mortality

Irvin Yalom and Elizabeth Kübler-Ross: Thoughts on Death and Dying

Jun 30, 2009

Renowned psychiatrists Irvin Yalom and Elizabeth Kübler-Ross have made significant contributions to the fields of thanatology and existential psychology.

Be it a morbid or spiritual topic, death is one thing that every living being has in common. While the intensity of mortality has the power to drive people into deep denial, theorists and practitioners in the field of death and dying suggest that facing these fears can provide openings to a more fulfilling, whole life.

Elizabeth Kübler-Ross: Five Stages of the Dying

Swiss-born psychiatrist and death and dying expert Elisabeth Kübler-Ross made pinnacle contributions to the field of thanatology. Through her pioneering work and advocacy for dying patients, she helped shaped the hospice movement and palliative care.

Kübler-Ross observed five general stages of death, which is now known as the Kübler-Ross model. Grieving individuals will likely find they jump about these stages. In other words, it’s not a linear map as everyone’s grieving process is unique.

The first phase is shock and denial, sometimes known as the “No, not me!” phase. During this time, the patient is usually unable to fully hear and register what’s being conveyed: it’s simply too unbearable and often there is an unspoken conspiracy of silence around the person’s illness.

The second phase, anger or the “Why me, why now?” stage follows and leads into the bargaining phase, during which time the patient engages in “Yes, it’s me, but…” conversations, often with God or some higher power. In her book Living with Death and Dying: How to Communicate with the Terminally Ill, Kübler-Ross describes this phase as a “temporary truce, during which the patient is at relative peace; he feels that he is ready now to face it but asks and hopes for a little extension, usually to finish unfinished business.”

Once the bargaining has slowed to a stop, the patient embarks on the depression phase, or the “Yes, me” stage. First the patient encounters a reactive depression in which he or she mourns past losses. Then the patient begins to mourn future losses, including one’s own death and the loss of everyone he or she has ever known, during an often silent, preparatory grieving period.

The final stage, acceptance, is marked by a feeling of inner and outer peace. This is not to be confused with resignation in which the patient, defeated, tired and bitter, has given up. Rather, Kübler-Ross notes that acceptance is founded in facing and embracing finiteness, that it is “a feeling of victory, a feeling of peace, of serenity, of positive submission to things we cannot change.”

Irvin Yalom: Facing Death Anxiety

An accomplished existential psychiatrist and author, Dr. Irvin Yalom considers death to be one of four existential givens of human existence. When it comes to the subject of death and dying, modern Western society tends to push this taboo fact of life to the edge of awareness.

For Yalom though, the psychological boundaries between life and death are blurred. In Existential Psychotherapy, he states, “…psychologically, life and death merge into one another…Death is in fact life.” Wholeness in life presupposes that we envisage mortality and face the subsequent anxiety that arises, which Yalom terms the “death anxiety.”

Difficult life events, such as illness, loss, and death, act as “boundary situations.” If the anxiety and fear of the boundary situation is faced, profound shifts can occur. In his book Staring at the Sun: Overcoming the Terror of Death, Yalom writes that confronting mortality “may serve as an awakening experience, a profoundly useful catalyst for major life changes.”

A dilemma to this whole process is articulated in an insightful statement by Searles, which Yalom quotes in Existential Psychotherapy: the notion that “the patient cannot face death unless he is a whole person, yet he can become a truly whole person only by facing death.” Yet another paradox, perhaps partially accounting for the touch and go, back and forth, up and down journey that one embarks on when attempting to come to terms with impending loss.

Yalom and Kübler-Ross have made wonderful inroads in demystifying illness, mortality, and end of life issues. Their message that life and death are one can serve as a touchstone for living a life and dying a death that is gracious and whole.

The copyright of the article Confronting Mortality in Psychology is owned by Krista Wissing. Permission to republish Confronting Mortality in print or online must be granted by the author in writing.