Each person may feel very differently about dying and death. Few have journeyed down the path of trying to understand these feelings. One exception is Elizabeth Kubler-Ross. She argues that most people pass through different stages in terminal illness. It is often helpful if the person dying and the survivors understand these phases.

Kubler-Ross, a very well known psychiatrist and medical doctor, interviewed over 200 dying patients to better understand the psychological aspects of dying. She illustrates five stages these people go through when they know they are going to die. These stages can help us to understand better how terminal illness effects us.

The stages include: denial, anger, bargaining, depression and acceptance. While a sequential order is implied, the manner is which a person comes to terms with their impending death does not necessarily follow the order of the stages. Some of these phases are temporary; others will be with that person until they pass away. The stages will exist at different times and can co-exist within each other.

Denial and feelings of isolation are usually short lived. Denial distorts one's reality to make them believe this can't be happening to them. "This can't be true. You must be wrong!" Upon hearing medical news of a terminal illness, persons usually insist there is an error and look for many other opinions or for more acceptable ones. Isolation is related to the emotional support one receives. If a person feels alone and helpless they are more likely to isolate themselves.

During the anger stage, it is important to be very patient with the dying individual. They are likely to take out their anger on anyone because they can't understand. Why me? They cannot accept the reality of their situation.

Bargaining describes the period in which the ill person tries to bargain with doctors, family, clergy, or God to "buy more time". When the denial, the anger, and the bargaining come to an end - and if the ill person continues to live, depression typically arises.

Ross talks about two forms of depression. One is a reactive depression, and the other is preparatory depression. Reactive depression comes about from past losses, guilt, hopelessness and shame. Preparatory depression is associated with impending losses. "Will everything still run smoothly?" Kubler-Ross encourages caregivers to encourage the ill to keep looking on the bright side of life, to look at all the other positive things around them. Most ill persons feel guilty for leaving us so we need to help them understand that while life will change in their absence, life continues, and everything will be all right.

By the time one reaches the acceptance stage, they are almost just too tired and weak to feel much of anything. They realize this is their fate. Kubler-Ross found from her case study that this is usually the last stage.

Of interest, Kubler-Ross has suggested another phase, hope, which will usually persist through all of the stages.

Elizabeth Kubler-Ross' ideas have been helpful in understanding how some terminally ill individuals cope with their impending death.

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