21 Elisabeth Kubler-Ross

GENERAL BIOGRAPHY

Elisabeth Kübler-Ross was born on July 8, 1926 in Zurich, Switzerland as one of three daughters (Encyclopedia Britannica, 2022).  As a young girl, Kübler took an interest in medicine.  Given the age and time, her father insisted she was better-suited for the work of a secretary, attempting to limit her choices to what he believed were the realities of the era (Encyclopedia Britannica, 2022).  Defying her father’s constraints, Kübler ran away from home at sixteen (Sack, 2017).  Free from paternal limitations, Kübler was soon introduced to the field of medicine during one of its ugliest periods in history. During World War II, Kübler volunteered for doctors at hospitals and refugee camps (Sack, 2017).  At the end of the war, she continued to volunteer her service in assisting the war-torn communities of Europe (Encyclopedia Britannica, 2022).  It was here her destiny was unexpectedly and profoundly imposed upon her.

In 1945, she was assigned to the “Majdanek”  concentration camp in Lublin, Poland (Sack, 2017).  On the walls of a gas chamber, Kübler observed hundreds of carved butterflies.  This macabre art, hastily etched by dying hands, demonstrated the final wish of those doomed children prisoners: a lasting, dying expression of hope and beauty.  Not only did her experiences at Majdanek profoundly touch Kübler, but they would eventually form the support for her own viewpoints on mortality and death (Encyclopedia Britannica, 2022).

After dedicating her service in Poland, Kübler returned to Zurich.  By that time, women were more welcomed and accepted into the medical profession and, in 1957, she received her degree in medicine from University of Zurich (Sack, 2017).  While there, she met a fellow student, Emanuel Robert Ross, whom she would marry in 1958.  Almost immediately after their wedding, the newlyweds emigrated to America.  Elizabeth Kübler-Ross’ pregnancy would make her ineligible for a residency in pediatrics, so she instead pursued a career in psychiatry (Sack, 2017).  She achieved acceptance to intern at two hospitals: Community Hospital in Glen Cove, Long Island and Manhattan State Hospital (Biography.com Editors, 2014).

Kübler-Ross’ experience at Majdanek had formed the basis for her unique insight to human mortality.  However, at this point in time, death and terminal illness were taboo subjects in American medicine, with doctors sometimes going so far as to conceal a terminal diagnosis from their patients (Editors Encyclopedia Britannica, 2022).  However, Dr. Kübler-Ross believed she needed to defy, even combat, this apparent head-in-the-sand social norm.  She refused to conform to American societal norms at the expense of her patients.  Throughout her internships, she began developing programs to candidly inform, support, and counsel patients suffering from terminal illnesses (Editors Encyclopedia Britannica, 2022).

In 1962, Dr. Kübler-Ross was invited to teach at the medical program of University of Colorado, Denver (Sack, 2017).  Although her candid and confrontational attitude toward the reality of death and the grieving process often violated the customary barrier of existing academia, she was one of the first professors to instruct medical students on how to care for terminally ill patients (Editors Encyclopedia Britannica, 2022).  Indeed, she was especially known for interviewing terminally ill patients during her lectures.  Through these interviews, she introduced to her students a model of the “grieving process” (Sack 2017).

This unique teaching model, and the insights drawn from it, formed the basis for her 5-stage grieving process, first introduced in her book, “On Death and Dying” (1969), and later expanded in “On Grief and Grieving” (2005) (Biography.com Editors, 2014).  In these landmark treatises, Dr. Kübler-Ross described the personal grieving process of terminal patients as an evolution of 5 stages: (1) denial; (2) anger; (3) bargaining; (4) depression; and, (5) acceptance (DABDA).  Based on her clinical and academic observations, Dr. Kübler-Ross argued that most patients suffer these emotions after receiving a terminal diagnosis (Newman, 2004). This unprecedented model was, in a word, sensational, and received almost immediate attention and support from professionals in the medical field (Biography.com Editors, 2014).  For most, it opened up the previously taboo subject of death and dying within the medical community, inspiring conversations among medical professionals and their patients.

Dr. Kübler-Ross ultimately left the University to focus her career on the grieving model (Editors Biography.com, 2014).  Her own health concerns would eventually prohibit her from expanding on her research.  In 1995, after a series of strokes that left her partially paralyzed, Dr. Kübler-Ross was forced to retire to Arizona (Sack, 2017).  In a paradoxical stroke of fate, those close to her characterized her mental state as skipping the four stages of grief and moving immediately to acceptance (Newman 2004).  On August 24, 2004, Dr. Elizabeth Kubler-Ross, by all accounts, died in peace.  She died, perhaps, in body, but not in legacy.

Dr. Kubler-Ross’ grief model continues to have an immense influence both within the medical community, and in the world at large.  By the time of her death, Dr. Kubler-Ross had written 20 books on the subject of death.  Her living words have shaped the approach of the medical community to advising patients regarding death, and the general public to the approach of the inevitable.  (Encyclopedia Britannica, 2022).  In what is likely not a final tribute to her, Dr. Elisabeth Kübler-Ross was inducted into the National Women’s Hall of Fame in 2007 for her work in psychology (Editors Biography.com, 2014).

IMPORTANT ACHIEVEMENTS

Dr. Elizabeth Kübler-Ross has many achievements under her belt. Most of her work surrounds death and the care of the elderly along with the care of dying children. Perhaps her most notable achievement was her development of a theory describing the psychological processes that occur during one’s death. In her first book, entitled On Death and Dying, she introduced the five stages of grief that she argued were experienced by all people facing unexpected death or terminal illness.  These stages are, as follows: denial, anger, bargaining, depression, and acceptance (Kübler-Ross, 1969).

Dr. Kübler-Ross has made a lasting impact on conversations and treatments regarding death and grief, both within the fields of psychology and medicine. In the year 1969, when her model was first introduced, it was regarded as revolutionary because death was a topic that was hardly discussed, even in American medicine.  Dr. Kübler-Ross’s development of this grief model additionally played a role in how dying patients were being treated (Newman, 2004).  Until Dr. Kübler-Ross’s expansion on the grieving process became popular in America, it was typical for patients to be neglected by their medical providers in their final moments.  Dr. Kübler-Ross contextualized death as merely another stage in life (Kübler-Ross, 2015).  This newly derived definition of death prioritized finding more humane ways of treating and caring for dying patients.

Originally, Dr. Kübler-Ross’s idea of the five-stage grief model was designed around terminally ill patients coming to terms with dying (Newman, 2005).  However, Dr. Kübler-Ross’s framework has evolved and changed, this model is now known as the Kübler-Ross Model. Dr. Kübler-Ross was also able to help with providing hospice care to terminal patients, and introduced the first prison hospice in California.  Her work with terminally ill children, the elderly, and AIDs patients, along with her publications detailing her research on death and dying, helped shape how death is examined now (“Elizabeth Kubler-Ross Biography”, 2019). Her biggest achievement was successfully changing the way that people talked and treated those who were passing on.

Though Dr. Kubler-Ross is most renowned for her work with the elderly, she also made impactful progress working with dying children. Dr. Kubler-Ross was especially interested in the impact that childhood death had on families, as emphasized in her book On Children and Death (1983) (Sisk & Baker, 2019).  She played an influential role in providing palliative care for children.  Additionally, Dr. Kübler-Ross was one of the first existing pediatric palliative care physicians, and for 19 years, she served as a medical director of a pediatric palliative care service in Canada (Sisk & Baker, 2019). Overall, Dr. Kübler-Ross has had many important contributions to exploring the psychology behind death and dying as it affects every age group.

HISTORICAL CONTEXT

Kübler was influenced by several factors that led to her achievements in psychology and the field of death and dying. One of the most significant factors was her experience working with terminally ill patients in a hospital setting. As noted by Tornstam (2002), Ross “became involved in working with the terminally ill while she was a medical student at the University of Zurich” (p. 142).  Through her work with terminally ill patients, she became acutely aware of the emotional and psychological needs of dying patients, and the ways in which healthcare providers often failed to address these needs.

Another important influence on Dr. Kübler-Ross was the broader cultural and social context of the 1960s and 1970s in the United States. According to Wortman and Silver (1989), this period was marked by “a new emphasis on individualism, self-awareness, and spirituality” (p. 69).  This was a period of social upheaval and change, marked by the civil rights movement, the women’s liberation movement, and the anti-war movement, that emphasized the importance of individual rights, dignity and autonomy.  The counterculture of the time also emphasized personal growth, self-awareness, and spirituality, which were themes that resonated with Dr. Kübler-Ross’s work. Within the field of psychology, Dr. Kübler-Ross was influenced by the work of Sigmund Freud and Carl Jung, as well as existential philosophy (Strada & Donnelly, 2003).  Her interest in death and dying also brought her into contact with the emerging field of thanatology, which focused on the study of death and the ways in which people cope with it.

Dr. Kübler-Ross’s work had a profound influence on the field of psychology and on society as a whole. Her theory of the five stages of grief has become a widely recognized framework for understanding the emotional and psychological experience of dying and bereavement (Maciejewski et al., 2016).  Her advocacy for hospice care and her emphasis on the importance of addressing the emotional needs of dying patients and their families have also had a lasting impact on healthcare and social policy (Morrow et al., 2016).

Kübler-Ross’ work was influenced by her experiences growing up in Switzerland during World War II, which gave her a firsthand understanding of the impact of death and trauma on individuals and societies. As noted by Kissane et al. (2014), “Kübler-Ross’s experiences in Switzerland during World War II exposed her to the impact of death and trauma on individuals and their communities” (p. 5). Her work was also influenced by the growing awareness of global issues such as environmental degradation, war, and inequality, which were issues that reflected the broader concerns of the time.

Overall, Ross’s experiences working with terminally ill patients, the cultural and social context of the 1960s and 1970s, the field of psychology and thanatology, and global events all contributed to her achievements in psychology and the field of death and dying.

HISTORICAL IMPACT

Dr. Elisabeth Kübler-Ross made an extensive impact on psychology that even reached into other fields of study.  Her model of the five stages of grief has revolutionized modern therapy practices, allowing numerous people across the globe to heal and move forward when a loved one has passed away.  Dr. Kübler-Ross’s work has also been applied to palliative healthcare at children’s hospitals. Kübler-Ross has written more than twenty books on the concepts of grief and palliative care, which have provided reassurance and coping mechanisms to individuals and families facing a terminal diagnosis.  Kübler-Ross’s impacts on psychology will continue to help those in need of mental support for years to come.

REFERENCES

Britannica, T. Editors of Encyclopaedia (2022, December 1). Elisabeth Kübler-Ross. Encyclopedia Britannica. https://www.britannica.com/biography/Elisabeth-Kubler-Ross

Editors of Biography.com (2014, April 7).  Elisabeth Kubler-Ross.  Retrieved from    https://www.biography.com/scientists/elisabeth-kubler-ross

Elisabeth Kübler-Ross Biography. EKR Foundation. (2019, September 12). Retrieved February 25, 2023, from https://www.ekrfoundation.org/elisabeth-kubler-ross/

Kübler-Ross, E. (1969).  On death and dying. Macmillan Publishing Co.

Morse, J. M., & Johnson, J. L. (1991). Toward a theory of illness behavior. In J. M. Morse (Ed.), Qualitative health research (pp. 240-259). Sage Publications.

Newman, L. (2004, September 11). Elisabeth Kübler-Ross. BMJ: British Medical Journal. Retrieved April 9, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC516672/

Sisk, B. A., & Baker, J. N. (2019, December). The underappreciated influence of Elisabeth Kübler-Ross on the development of palliative care for children. The American Journal of Bioethics : AJOB. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886676/

Tyrrell, P., Harberger, S., Schoo, C., & Siddiqui, W. (2022, November 19). Kubler-Ross stages of dying and subsequent models of grief – NCBI bookshelf. National Library of Medicine. Retrieved February 26, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK507885/