ABSTRACT
When someone dies, we grieve. It is a natural human reaction, and we do it whether we are the person who is dying, who goes through a grieving process which is well-recorded and not entirely dissimilar to what those left behind experience, or if we are the ones who are bereaved. It is a process of extreme pain, with all kinds of attendant emotions – and there is no way out of it. One cannot, properly, not grieve after a death of a loved one, and emerge normal. Literature is filled with accounts of grief, with people tearing out their hair,
in ancient times cutting their flesh, pulling off their clothes, sitting in ashes and sackcloth, and so on. Grief, though not displayed openly on the stage as much as other great emotions, is displayed by Hamlet, by Lear, by Othello – all with complications, of course – as horrible, overwhelming, almost destroying (sometimes succeeding in doing so) the person who has been bereaved. It is perceived almost as a body blow, a shock to the system. But, despite dramatic renderings of grief, in real life it is still, often, something people are expected to keep hidden and private, when it is virtually impossible to do so. How grief works and is put together has been explained fully by Dr Elisa-
beth Kubler-Ross, amongst others. In the 1960s she established a seminar at the University of Chicago to consider the implications of terminal illness for the patients and for those involved in their care. Her accounts of the attitudes which emerged during conversations and interviews are recorded in her book On Death and Dying, where she suggested that the stages through which someone is likely to pass in coming to terms with his or her own death are: Denial and Isolation; Anger; Bargaining; Depression; Acceptance, and (some
have added) Hope. Kubler-Ross originally had acceptance not as a happy stage, but as one almost ‘void of feeling’, near the end, in her sequential unfolding of emotions. Other scholars and observers have tested KublerRoss’s stages, and have some things to say about it. Colin Murray Parkes, the person who has perhaps most closely observed what people say and feel in Britain, has argued:
Others might (and probably will) adopt a different terminology when describing the phases through which the dying person passes in the course of his illness. Since individual variation is so great, it is unlikely that any one conceptual system could be applied to all. (In his foreword to KublerRoss’s On Death and Dying)
John Hinton, Lily Pincus and others have largely followed Kubler-Ross’s description of the stages through which a person goes, but challenged the universal applicability of the stages, whilst recognising that there are stages which are observable and describable through which most dying people, and indeed bereaved people, go. Michael Young and Lesley Cullen, in their excellent A Good Death: conversa-
tions with East Londoners, make the point that Kubler-Ross was studying patients in an institution. What she may have been observing, at least in part, was the effect of total institutionalisation, particularly for people who knew they were never going to emerge except in a coffin. As they say, denial, anger, bargaining, depression, acceptance, are precisely the way different people respond to incarceration in a total institution, leading to what Goffman terms mortification of the self. Since people, increasingly, die in a hospice or at home, though there are still
too many dying in hospital, those stages of experience of the total institution become much less relevant. There are also major differences between the reactions and experiences of the very elderly facing their own death and younger people, not to mention major differences according to community and religion. It is not only the case with the experiences of those who are dying that
there is such variation. Many people’s grief also does not follow such a prescribed pattern. Nevertheless, ‘stages’ we can think about can help someone who is dying, and anyone in a caring role for them, to understand what is going on. It also helps explain our need for time and space in which to think, contemplate, explore loss, say goodbyes – and, therefore, is really helpful, both to those who are dying themselves, who want to think about how to do it well, and to those who are caring for them, particularly family or close friends.
