Death And Dying By Elisabeth Kübler Ross
Death and Grieving
Imagine that the person you love most in the world dies. How would you cope with the loss? Death and grieving is an agonizing and inevitable part of life. No one is immune from death’s insidious and frigid grip. Individuals vary in their emotional reactions to loss. There is no right or wrong way to grieve (Huffman, 2012, p.183), it is a melancholy ordeal, but a necessary one (Johnson, 2007). In the following: the five stages of grief, the symptoms of grief, coping with grief, and unusual customs of mourning with particular emphasis on mourning at its most extravagant, during the Victorian era, will all be discussed in this essay (Smith, 2014).
In 1969 Elisabeth Kübler-Ross, a psychiatrist, published the Pioneering book On Death and Dying. The work acquainted the world with the grieving process, called the five stages of grief. Kübler-Ross gathered her research from studying individuals with terminal cancer (Johnson, 2007). The first stage of the grieving process is denial. In this stage the person refuses to believe that their loved one is deceased, a common thought during this period is, “This can’t be happening to me” (Johnson, 2007).The second stage of the grieving process is anger. In this level the person becomes frustrated with their circumstances, a customary complaint is “Why is this happening to me?” (Johnson, 2007). The third stage of the grieving process is bargaining. At this point the individual hopes that they can prevent their grief, this typically involves bartering with a higher power, and an ordinary observance during this time is “I will do anything to have them back” (Johnson, 2007). The fourth and most identifiable stage of grief is depression. This phase is habitually the lengthiest as the person begins to comprehend the inevitability of death. The individual is enveloped in an abysmal state of melancholia, lamentation commence at this stage of time, a natural remark at this point is “why should I go on, if they are not here with me” (Johnson, 2007). The fifth and final stage of the grieving process is acceptance. At this concluding frame of mind, the individual comes to terms with the death, and starts to move on, a normal comment in this stage is “I am at peace with the death” (Johnson, 2007). It is vital to remember that the one does not have to go through every stage in order, or to go through every stage at all. Elisabeth Kübler-Ross’s model was never expected the five stages of grieving to be a stiff frame of reference, in her own words she say “They were never meant to help tuck messy emotions into neat packages. They are responses to loss that many people have, but there is not a typical response to loss, as there is no typical loss. Our grieving is as individual as our lives” (Smith, 2014).
There is never one, or a correct way to grieve, however, countless people go through similar symptoms of mourning. Mourning has two types of symptoms: psychological and physical. The following...
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In Clock Without Hands by Carson McCullers, J.T. Malone is diagnosed with a terminal illness, and manifests the five stages of dying in the Kubler-Ross model of dying. These stages include: denial, anger, bargaining, depression and acceptance. Kubler-Ross argues that these five stages are experienced by the individual facing death. Many times, the individual is so entangled within his own situation, he cannot accept the fact that he is dying. The Kubler-Ross model helps the dying person understand what is happening to him. Kubler-Ross stresses that those who are dying want to “review their lives, their deterioration, and imminent death” (Newman, 2008, p. 627). Her model of dying outlines how individuals close to death have difficulties coming to terms with their diagnosis, dealing with their emotions, and accepting the final outcome. (p. 627). The model also helps psychologists, nurses, social workers, doctors, and loved ones to help the individual cope with the trauma of dying. Kubler-Ross claims that her model helps the dying person heal while learning to accept his own death. Each of these stages can last a brief or extended period of time. Hopefully, the individual will reach the final stage of acceptance, which Malone achieves at the end of the book. This paper focuses on Malone’s psychological journey as he goes through the Kubler-Ross five stages of dying.
McCullers begins with the opening sentence, “Death is always the same, but each man dies in his way” (McCullers, 1998, p. 1). J.T. Malone is dying in his own way throughout this book. His journey begins in Chapter One, when he is diagnosed with leukemia. His initial reaction of confusion and disbelief is the beginning of Kubler-Ross’ Stage One: denial. According to Kubler-Ross, “we can deny that we are finite” (1971, p. 54). Using the Kubler-Ross model, people are diagnosed with a terminal illness, but pretend their diagnosis has not been given or is wrong. They close their eyes to any evidence proving they are going to die. They pretend nothing is happening to them, and continue to live their lives as usual. According to Kubler-Ross, “Most patients when told they have a serious illness react with shock and denial” (1971, p. 56). Many people respond by saying, “it’s not possible – no, it can’t be me” (p. 56).
In Clock Without Hands, Malone expresses shock and denial when told of his fatal illness. In the doctor’s office, he is told by Dr. Hayden, “there seems to be something unusual in the blood chemistry” (McCullers, 1998. p. 3). Malone immediately senses something is wrong, and begins to “chatter against the truth” (p. 3). Malone is experiencing an intuitive sense of denial even before receiving the diagnosis. He has a feeling that something terrible is happening to him - and terror seizes him. Hayden says, “The long and short of it is, we have here a case of leukemia” (p. 4). Malone does not understand that leukemia is a death sentence, and he waits for an explanation. His first response indicates that he is entering the Kubler-Ross stage of denial. He nervously talks about running a fever recently, but justifies his fever as ‘spring fever’. Kubler-Ross says “denial functions as a buffer after unexpected shocking news, allows the patient to collect himself and with time mobilize other, less radical defenses” (Sonstegard, Hansen, Zillman, Johnston, 1976, p. 1490).
Malone continues experiencing denial according to the Kubler-Ross model. He becomes confused and is unable to “acknowledge the reality of his approaching death” (McCullers, 1998, p. 9). He roams the streets aimlessly, stands transfixed at various objects, and is conflicted by the reality of his condition. Malone feels that nothing makes any sense, and there is no order or design existing in life.
His friend, Judge Clane reinforces his feelings of denial by telling him he has “the best blood in this state” (McCullers, 1998, p. 15). Clane gives Malone false hope by telling him that doctors are alarmists, and he “seldom believes a word they say” (p. 15). Malone starts feeling better as Clane tells stories about sick people who have lived, and healthy people who have died. Malone’s feelings of denial are reinforced by Clane. Clane talks about the importance of diagnosing oneself instinctually, and not to accept blood evidence as proof of a medical diagnosis. Since Malone has great admiration for Clane, he begins thinking that Dr. Hayden could be wrong about his diagnosis. According to Clane, Malone can regenerate his blood by eating crisp fried calves liver with onion sauce. He tells Malone that sunlight is a blood moderator, and sensible living along with whiskey, will restore his health. Malone listens to Clane, and thinks there is a possibility he is right. Clane’s advice is prolonging Malone’s feelings of confusion in the Kubler-Ross stage of denial. Later on, Clane tries convincing Malone that Dr. Hayden has leukemia, and he is psychologically transferring the leukemia diagnosis over to Malone. Malone thinks Clane’s transference theory could have merit. He remembers Dr. Hayden’s hairy arms, which in his mind, relates to having leukemia. Malone’s feelings of denial are also reinforced by Clane’s claim that while he was at Johns Hopkins, he could tell “the look of a mortally sick man” (p. 48). He tells Malone that he does not have that look. Clane encourages Malone to eat liver, or get liver shots, and Malone feels “bewilderment and hope” (p. 49).
If Malone had a true friend, or if he allowed his wife to comfort him, his transition out of the denial stage could have been faster and easier. According to Kubler-Ross, “They drop their denial if they know the person with them will help them to express the multitude of feelings when they face the given reality” (1971, p. 57).
Anger is Stage Two in the Kubler-Ross model of dying. Kubler-Ross notes how the transformation from denial to anger takes place: “When the first stage of denial cannot be maintained any longer, it is replaced by feelings of anger, rage, envy, and resentment” (McCullers, 1998, p. 58). When the individual stops saying “No, not me”, the next question is “Why me?” (p. 57). Kubler-Ross recommends allowing the individual to express anger. She says there is no point in answering an individual’s questions, because there are no answers (p. 57). The anger stage also includes expressing hostility toward family, friends and oneself. This type of anger is not always logical or valid (Adomaitis, 2008).
While having a conversation with Judge Clane about his illness, Malone begins feeling angry about his impending death. Malone remembers Dr. Hayden telling him, “We have here a case of leukemia” (McCullers, 1998, p. 62). Malone hated the way Dr. Hayden used the word ‘we’, when he received the bad news. However, Malone’s anger goes way beyond the word ‘we’. He was expecting a diagnosis of spring fever, not a death sentence. His anger turns to fury as he tells Clane, “I’m glad I didn’t finish medical school. I wouldn’t have it on my soul nor conscience” (p. 62). At this point, Malone has entered the anger stage of the Kubler-Ross model. He is angry at himself for not finishing medical school, and angry at the “Jew grinds” for raising the standards out of his reach (p. 7). He is angry with Hayden for being a Jew grind and for diagnosing him with a terminal illness.
Despite his anger, Malone had his heart set on becoming a doctor. However, over the years, he developed a fierce resentment toward doctors (because he failed to become one): “Doctor’s by God; washing their hands, looking out windows, fiddling with dreadful things while you are stretched out on a table…” (McCullers, 1998, p. 62). Malone is also angry at Dr. Hayden for not suggesting any cures for leukemia: “his whole being was outraged” (p. 114). This type of anger fits the Kubler-Ross model: acting illogically and without validity. Malone’s illogical anger allows him to convince himself that his standing as a pharmacist is “as good as any bona fide M.D” (p. 114). Malone does not understand why he can prescribe solutions for “trillions of complaints”, but Dr. Hayden is unable offer him a cure for leukemia (p. 114). Malone has another illogical thought: Dr. Hayden will still be alive (along with others of his kind) after he has died, so Malone becomes angry at the unfairness of life. He cannot understand why he must die while others live.
Malone is experiencing the Kubler-Ross model of anger when he asks “why me?” He thinks about all the complaints he handled over the years. He remembers studying each customer, making a diagnosis, and selling the appropriate medicines to help them. He was always there to help everyone else, but no one is there to help him now. The ‘why me?’ of his anger is displayed when he says, “Nobody had leukemia, nobody went away empty handed” (McCullers, 1998, p. 117).
Malone is also angry at himself, because his life has no meaning. He does not love his wife, he resents her wealth, his work is unfulfilling, his dream of being a doctor did not come true, and he feels as though he has never accomplished anything. He considers his life to be a “drab livingness” and he is having a difficult time rationalizing his need to exist. He roams the house and waits with dread (McCullers, 1998, p. 114).
Malone shows his anger toward his wife (Martha) when she asks how he is feeling. He becomes enraged “until his knuckles whitened” and sarcastically thinks to himself, “A man with leukemia not feeling well? What the hell did the woman think he had…” (McCullers, 1998, p. 121). Malone answers her by saying he is no better or worse than he deserves to be (p. 121). This form of self-loathing is part of Stage Two anger in the Kubler-Ross model. Malone shows resentment toward Martha, because she is successful in business, and is contributing to the family finances: “She made good money and gave the children many advantages – and she even bought some Coca-Cola stock” (p. 8). Malone has an obsessive anger toward Martha’s Coca-Cola stock. Malone does not own stock in any company, and her Coca-Cola stock makes him feel inferior to her. In Malone’s world, people owning stocks are of a higher social class. So, Malone is constantly reminded of belonging to a lower social class than his wife (and her family). The difference between their social classes is made clear, when we learn that Malone is selling Cokes for a nickel, while his wife owns the stock.
Malone’s anger about dying reaches its climax after he takes a shower, shaves and begins to lie down in bed. He cannot rest because he is too angry. He hears his wife making a cake and becomes angrier (McCullers, 1998, p. 121). He goes out outside and begins picking greens. His wife makes the suggestion that he should be wearing a hat while out in the hot sun, and he shouts back her, “Why is it your God-damn business?” (p. 122). Just to spite his wife, he acts irrationally, and stays outside longer than he planned to. Malone is feeling uncommunicative and isolated. He is losing his sense of identity, and knows that time is running out.
The third stage in the Kubler-Ross model is bargaining. The dying person usually negotiates with divine powers for a longer life, or bargains with religious figures for enough time to complete certain tasks (Kessler, Kubler-Ross, 2008). Kubler-Ross notes that this stage is characterized by intense emotions (2008). As the anger subsides, the person tries to strike a bargain, usually with God, which is an attempt to postpone reality (2008). Sometimes, the dying person tries bargaining with his doctor for implementation of useless treatments and fraudulent cures. Many people at this stage are desperate and seek hope. They can become lost in a maze of unrealistic scenarios and may think to themselves, “if only this had happened” or “what if I had done this instead of that” (2008). They want life to return to normal, and want their health restored. Many people want to go back in time, so they can recognize the illness more quickly, or stop the accident from happening (2008). Feelings of guilt usually go along with the bargaining stage. The individual tries to find fault with himself and thinks “what could I have done differently?” (2008). He may try bargaining with God to lessen the fear, anger and pain that he is carrying around with him. He will do anything to stop the agonizing terror as death approaches. He may also try negotiating his way out of pain by continually thinking about the past.
Malone’s emotional state in the hospital lays the groundwork for bargaining. He starts thinking about going to Vermont by himself, and about “the mountains, the North, the snow the ocean...He thought of all the life he had spent unlived” (McCullers, 1998, p. 150). Malone thinks about the irony of dying without having lived. He is not bargaining with God for more time, but he is bargaining with himself for the chance to feel happiness before he dies. He buys a new suit at Schaffner and Marx and fixes his teeth – only because he is dying. He is taking better care of himself as a dying person than he did as a healthy one. He is bargaining for a better present, by living his life to the fullest in the time he has left.
Malone wants to feel the satisfaction of putting his affairs in order. He bargains with himself about how to distribute his financial assets, and decides to leave everything to his wife. He feels satisfied with his financial condition, but finds little comfort in having no debt. He still feels he has some unfinished business, but these feelings relate to bargaining for the return of his ‘self’. Malone feels ‘loss of self’, but does not understand how to find ‘return of self’.
Every Sunday Malone goes to church, but the preacher does not console him. He is offended by the preacher’s comparison between the “tanking up” of the Holy Sacraments and an automobile (McCullers, 1998, p. 154). Since Malone is offended by such an analogy, he must have respect for a higher power, the Church, or possibly both. Since he is not bargaining with God, it is important to know if he believes in God. However, this is a difficult question to answer. Malone’s thoughts and actions suggest that he is agnostic. He prays – but, he does not know what he is praying to – so, he stops. He tries learning about God, the soul, and afterlife, but his preacher is uncomfortable talking about these morbid subjects. He gives Malone vague answers and shows him little compassion. When Malone asks, “how do you prepare for death?” - the preacher answers, “By righteous living” (p. 156). Malone has led an honest life (except for a brief extramarital affair), and most people in his position would think they have some bargaining power with God. However, Malone is not interested in cashing-in his ‘righteousness’ bargaining chips, and realizes the answers from the preacher are meaningless. Malone wants to bargain for the return of his lost ‘self’, but he does not know how, or who, to bargain with. This uncertainty reinforces his fear of death.
Later on, a meeting is called in Malone’s drugstore to talk about a young black man (Sherman Pew), who has moved into a white neighborhood. Malone and others draw ‘lots’ to select a person to bomb Pew’s house. Malone draws the ‘lot’ with the ‘X’ – so, he is the one who must kill Pew. Malone is not surprised when he sees the ‘X’, but does not accept the terms of this of this bargain. He tells the others he will not kill Pew for fear of risking the loss of “his immortal soul” (McCullers, 1998, p. 224). He refuses to participate in the bombing of Pew’s house, and does what he thinks is right. He is also bargaining for the return of his ‘self’ by acting courageously, and by rising above the opinions of Judge Clane and the other men. This single act of heroism is a defining moment in Malone’s life. He finds value in having an immortal soul, and will not bargain it away.
Bargaining for Malone is an escape from fear and pain, and a distraction from the unhappy “drabness of his life” (McCullers, 1998, p. 156). Unlike most people, Malone does not try bargaining with God, but finds some relief in bargaining with himself.
Stage Four in the Kubler-Ross model is depression. The dying person is feeling a great sense of loss as the depression stage begins (Newman, 2004, p. 627). According to Kessler and Kubler-Ross, “Empty feelings present themselves, and grief enters our lives on a deeper level, deeper than we ever imagined. This depressive stage feels as though it will last forever” (Kessler, Kubler-Ross, 2008). During this stage, the dying person withdraws from life, feels intense sadness, and wonders if there is any reason to continue living (2008). Depression is a normal and appropriate response in the dying process, and not experiencing depression would be unusual (Kubler-Ross, 1971, p. 58). When a terminally ill patient begins having more symptoms, or becomes weaker and thinner, “he cannot smile it off anymore” (p. 58). His numbness, stoicism, anger, and rage will soon be replaced with a sense of great loss (Kubler-Ross, 2006, p. 97).
Malone begins feeling the terror of death approaching. He feels like a part of him has already died. In the hospital, he reads a passage about ‘loss of self’ in Sickness Unto Death by Kierkegaard: “The greatest danger, that of losing one’s own self, may pass off quietly as if it were nothing; every other loss, that of an arm, a leg, five dollars, a wife, etc, is sure to be noticed” (McCullers, 1998, p. 147). According to Park, Sickness Unto Death describes the existential crises:
Sometimes our “sickness unto death” is the utter lack of a self. We are so disintegrated internally that we have no real selves at all. Life is like struggling to gain control of a dream. Absurd things keep happening to us, one after another, but we lack the ability to prevent these events or to make our lives change course (2008).
Malone is suffering from ‘an utter lack of self”. He is disintegrating internally and struggling with fear of death. He relates to Kierkegaard’s passage and reads it over and over again. He admits that if he were not dying, this passage would hold no meaning for him. However, Kierkegaard’s words resonate with Malone, and he memorizes this passage. He was depressed before entering the hospital, but now he is losing control over his life and cannot find peace of mind. He takes hot baths and tries to nap, but cannot sleep. He lies in bed at night and feels terror, boredom and dread (McCullers, 1998, p. 150). He hates the afternoons when he is not working, and feels as if he is wasting the little time he has left.
Before entering the hospital, Malone thinks about committing suicide. He opens a bottle of forty Tuinal capsules and considers the benefits of suicide. He thinks to himself, no longer would he be roaming the house in terror, going to the pharmacy, thinking about his wife’s Coca-Cola stock (and three houses), or listening to complaints from his customers. His life has no meaning or purpose, and he may be better off dead. He is feeling empty and alone while living in the shadows of life. He cannot understand how he lived so dreadfully for so long. Malone compares himself to “a plodding old mule going round and round a sorghum mill” (McCullers, 1998, p. 115). He is repulsed by the thought of sleeping with his wife, and he has nowhere to go except back to the “drabness” of his home and the pharmacy (p 115). He is unable to communicate with anyone and is not allowing himself to receive love. In the depths of his depression he thinks, “How much water would [I] have to drink to swallow forty capsules?”, but, he stops himself from committing suicide, and chooses to live (p. 115).
Malone is “a man watching a clock without hands” (p. 25). A ‘clock without hands’ has no purpose and neither does Malone. Time has stopped for him, and the past and future hold no meaning for him. Only the present moment has meaning, and these moments cannot be measured by the hands of a clock. The only time that matters to Malone, is the amount of time he has left to live – and that amount of time is unknown. This type of uncertainty is one of the causes of his depression.
Stage Five of the Kubler-Ross model is acceptance. Kubler-Ross says, “Acceptance should not be mistaken for a happy stage. It is almost void of feeling. The individual feels as if the pain is gone and the struggle is over. There comes a time for the final rest before the long journey” (Stonstegard, Hansen, Zillman, Johnston, p. 1492). Stage Five is accepting the reality that death is coming soon. The dying person does not like this reality, but learns to accept it, and live with it. (Kessler, Kubler-Ross, 2008). The dying process becomes the new norm that the person learns to live with (2008). During the acceptance stage, the individual moves past depression, and copes with the situation as best he can. The dying person tends to disconnect from the world and is ready for whatever comes next.
Malone reaches the final stage of acceptance. After the meeting regarding Sherman Pew, Malone realizes he is losing his stamina and wants to stay at home in bed. This behavior fits the Kubler-Ross model: he is resting for the journey and not wanting to struggle anymore. He has a new appreciation of nature’s beauty. He thinks about lavender waterfalls, gold green willows, and the earth revolving with the seasons. He accepts the fact that he is dying, but does not think about death. This behavior fits the Kubler-Ross model: he is learning to accept a new reality and is living with it. Malone feels lightness “come upon his soul and he is exalted…He was no longer a man watching a clock without hands” (McCullers, 1998, p. 236). He feels himself reconnecting to the ‘lightness of being’ and feels whole again. Like the changing of the seasons, and the rotation of the earth, Malone understands he is part of everything in the universe, and no longer feels frightened, empty, or alone.
Malone is resolving his inner crises. He has found his lost ‘self’, and no longer feels isolated, uncommunicative, imbalanced, lopsided, or fragmented (Park, 2008). He is transforming into a more sensitive, appreciative and loving person. His love for Martha returns, and he appreciates the value of her love. As death approaches, Malone is not suffering mentally or physically. He is overcoming fear of death, and waiting patiently for its arrival (while eating watermelon and milkshakes). He expresses his emotions by crying, but his tears are those of joy and euphoria, not of sorrow. As Malone is dying, the life-force leaves his body and death comes “slowly, gently, without struggle or fear…it sounded like a sigh” (McCullers, 1998, p. 241). Malone faces his final moments with courage, peace, and a feeling of unity with cycles of nature, and the mysteries of life.
In the beginning of the book, McCullers writes, “Death is always the same, but each man dies in his own way” (McCullers, 1998, p. 1). Malone moves through the dying process in his own way. He experiences the five stages of dying according to the Kubler-Ross model, and accepts death on his own terms. There are times when the various stages of dying overlap, and sometimes, Malone moves back and forth between stages, but overall, he completes every stage, and the model works.
We can learn about the difficult, dark, and painful journey of the dying process from Kubler-Ross and McCullers. We can view Malone as an ‘everyman’, and learn from his psychological struggles with fear of death and the dying process.
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