Posted 22nd August 2020

Coping with Terminal Illness

To ask for information or to arrange an appointment,
please call Kenneth Demsky, PhD on 020 7435 6116
or send an e-mail to enquiry@drkennethdemsky.co.uk

The modern understanding of death and dying began with two significant but unrelated events in the late 1960s. In 1967, Dame Cicely Saunders, a British former nurse working as a medical social worker, founded the first modern hospice, St Christopher’s House, London. Two years later, a Swiss-American psychiatrist, Elizabeth Kubler-Ross published the seminal text, On Death and Dying: What the Dying Have to Teach Doctors Nurses, Clergy and Their Own Families.

What was revolutionary about the thinking behind these events was the emphasis placed on the inner experience of dying. The quality of life of the terminally ill was considered holistically, in addition to the unique psychological process of approaching death was explored and valued. Previously, treatment of the terminally ill had been limited to more concrete, medical and religious considerations. Now there was awareness that the internal aspects of dying—the emotional and psychological ones--could and must be taken into account when caring for such individuals.

It was Kubler-Ross who articulated the multi-stage model of coming to terms with the fact of one’s imminent death. Initially this consisted of five steps, but she eventually augmented it to contain seven. The original five stages are: denial; bargaining, anger, grief and acceptance. The later seven stage model includes these: shock/denial; pain/guilt; anger/bargaining; sadness; upward turn; reconstruction; acceptance and hope. The stages are not rigidly defined and people move into and out of these on an individual basis. Similarly, the length of each stage varies widely depending on the individual. Since each person grieves differently, the model is best considered as a general guide to what is a complex and multi-faceted process.

Kubler-Ross was opposed to euthanasis because she believed it prevented people from completing their “unfinished business”, whatever that might be to an individual.

Dame Cicely Saunders said to the dying, “You matter because you are you. You matter to the last moment of your life”. Reflecting this belief, she created the first modern purpose-built hospice as a home environment for individuals approaching the end of their lives. Her approach to serving terminally ill people was intentionally broad with physical, social, psychological and spiritual components. She believed that “as the body becomes weaker, the spirit becomes stronger”.

Rather than the conventional view of the period of dying as unrelentingly miserable and meaningless, both of these women saw this time as having unique potential as a period of personal growth in spiritual, emotional and psychological terms. Of course, they both believed that the body of the dying person was entitled to the highest levels of care to minimise discomfort. The emergence of palliative care—interdisciplinary expertise about making dying people feel physically comfortable--was directly the result of their attitudes.

Posted 22nd August 2020