Elisabeth Kübler-Ross

Swiss-born American psychiatrist and writer

• Born: July 8, 1926
• Birthplace: Zurich, Switzerland
• Died: August 24, 2004
• Place of death: Scottsdale, Arizona

A leading researcher in the field of thanatology, or the study of death, Kübler-Ross is most widely recognized for having identified five stages in the process of dying that provided a framework for further work by professionals in the area of counseling the terminally ill and their families. Her work helped remove taboos surrounding death and brought a compassionate and humane approach to the care of the dying. Her name has become synonymous with respect for the dying.

Early Life

Elisabeth Kübler-Ross (KEW-blur-raws), daughter of Ernst and Emmy (Villiger) Kübler, was the first-born of triplet girls. Although she and one of her sisters weighed barely two pounds, the triplets survived as a result of their mother’s diligent care. The close-knit Kübler family was dominated by a father who was a firm disciplinarian yet who also sang songs with his children around the parlor piano and led them on summer nature hikes at the family’s Swiss mountain retreat in Furlegi. These trips instilled in Kübler-Ross a lasting love and respect for nature. Never a religious person in the traditional sense, Kübler-Ross favored a sort of pantheism and exhibited compassion for all living creatures. As a child attempting to escape from the constant company of her sisters, she chose a secret place atop a flat rock in the woods near her home to which she returned even as an adult when in need of solace.

Kübler-Ross struggled for personal identity because her childhood was spent with very few belongings or activities that were different from those of her sisters. This situation was further complicated by her being physically identical to Erika, for whom she was often mistaken. Kübler-Ross developed a fascination for African history that became the source of the first personal possession that she later recalled was not shared by her sisters. As a reward for recovering from a near fatal case of pneumonia, Kübler-Ross’s father bought her an African rag doll for which she had been yearning. This fascination with a culture that differed radically from her own resulted in the creation of a sort of tribal nonsense language used by the imaginative triplets that only they understood. Beyond that, she nurtured the dream of becoming the next Albert Schweitzer, a Nobel Prize-winning medical missionary.

Although their older brother, Ernst, was educated to enter the business world, the girls were sent to local schools with the objective that they be properly prepared for marriage. The basics bored Kübler-Ross, who longed for more challenge and saw education as her doorway to important work. She soon discovered a passion for science. Because Kübler-Ross received no parental support for her goals, her educational pursuits beyond secondary school were entirely self-motivated.

Several events in Kübler-Ross’s youth were key factors in determining the direction of her life and her profession. The peaceful death of her hospital roommate when Kübler-Ross was five years old, the release from the suffering of meningitis of a young girl in her hometown, and memories of a neighboring farmer with a broken neck calmly preparing his family for his death were never forgotten. These early experiences with death intensified the belief that later became the crux of her professional credo that death is only a stage of life and people should be able to face death with dignity and the support of those they trust.

In some ways the most crucial day in her life was September 1, 1939. When Kübler-Ross heard on the radio that the Germans had invaded Poland, she made a vow to help the Polish people as soon as she was able. First, she was involved with refugees sent to the Swiss hospitals where she worked as a laboratory assistant during the war. She joined International Volunteers for Peace in 1945, hoping to have found the right avenue to reach the Polish people. In intervals between her laboratory work, she worked on the French-Swiss border and in Sweden before her dream of being sent to Poland was finally realized in 1948. She worked at numerous jobs, including those of camp cook, gardener, carpenter, and nurse, as she assisted war victims in rebuilding. Among the many destitute and ill people whom she helped she was known as Mrs. Doctor.

These postwar experiences, combined with poignant memories of butterfly signs of hope left on barrack walls at Maidanek concentration camp, made it clear to Kübler-Ross that her purpose in life was to channel her energy and compassion into the healing of human minds as well as bodies. She worked tirelessly to complete her preliminary medical school exams in two years instead of the usual three while meagerly financing her studies working as a lab assistant in an eye clinic. In 1951, she was admitted to the University of Zurich Medical School and embarked on the winding trail that led her to the field of psychiatry. Having come to believe without question that people’s bodies often achieve healing only after their minds and souls are healthy and free, Kübler-Ross was convinced that psychiatry offered the perfect venue for the combination of her special instincts and intellect.

Life’s Work

Kübler-Ross graduated from the University of Zurich in 1957 and practiced for a few months as a Swiss country doctor. On February 7, 1958, she married Emanuel Robert Ross, a fellow medical student to whom she was wed for eleven years. Kübler-Ross came to the United States with her new husband, a native New Yorker, and they were able to secure internships at Community Hospital in Glen Cove, Long Island. This experience was followed by a three-year residency in psychiatry at Manhattan State Hospital on Ward’s Island and a concurrent year at Montefiore Hospital in the Bronx. Patients, even those with the most severe psychoses, seemed to respond to Kübler-Ross’s compassionate yet persistent and simple way of communicating with them. The lack of humane concern in psychiatric hospitals was appalling to the young doctor, and the more freedom she was given to work in her own way, the more successful were her treatments.

The couple felt a need to leave the city environment after the arrival of their child, Kenneth. In 1962, they accepted positions at the University of Colorado School of Medicine in Denver. Kübler-Ross was given a fellowship in psychiatry and the next year became an instructor at Colorado General Hospital. In 1965, the family, with the addition of a daughter, Barbara, moved to Chicago, where Kübler-Ross became an assistant professor of psychiatry and assistant director of psychiatric consultation and liaison services at the University of Chicago Medical School. All through her working years, she had been disturbed by the attitude of avoidance that existed in dealing with the anxiety of terminally ill patients. She found the situation the same almost universally and began quietly to develop her own methods for recognizing the anxiety of the dying and also guiding them in expressing their feelings.

It was in Chicago that fame for Kübler-Ross’s work in thanatology began. Against administrative pressures to bring as little attention to her work as possible, she networked with nurses, willing doctors, priests, and seminarians to further her studies of the counseling of the dying. She held weekly seminars that attracted overflow crowds. These seminars were eventually canceled by administrators who were concerned about public reaction to discussions about death rather than recovery of patients.

In these seminars, dying patients were interviewed by Kübler-Ross behind a one-way glass through which those who attended could observe. Kübler-Ross viewed death as the final stage of life and began to identify five stages in the process of dying that she found all patients experience, though not necessarily in the same order. The five stages were denial, anger, bargaining, depression, and acceptance. These stages and other conclusions were the subject of many guest lectures and of her best-selling work On Death and Dying (1969). The book became a standard resource for counselors, physicians, and general readers as they helped patients, friends, and relatives deal with the issue of death. Life magazine published an article on November 21, 1969, that related to the public for the first time the boldness with which Kübler-Ross approached the issue of death with patients and their open dialogue with her. The public response was overwhelming, and Kübler-Ross saw this as a turning point in her career. Her work turned solely to assisting dying patients and their families.

In 1977, she established Shanti Nilaya (home of peace), a healing center for dying persons and relatives. The center was located in the hills north of Escondido, near San Diego, California. She moved her residence there from Chicago, and profits from her lectures and books supported the center. In 1990, she then moved the Elisabeth Kübler-Ross Center to her own 200-acre farm in Headwater, Virginia, where she had retired in 1984. Kübler-Ross continued to keep abreast of current issues and attempted in 1986 to establish a hospice for babies with acquired immunodeficiency syndrome (AIDS). Because of heated community dissent, however, she abandoned the idea. Nevertheless, the center was enormously successful in its efforts to offer assistance to professionals and nonprofessionals in dealing with terminally ill patients. The center was supported by proceeds from Kübler-Ross’s workshops and lectures and by volunteer help. She later said that of all her medical projects she was most proud of her work with babies with AIDS.

Although famous for her dedication and humanity, Kübler-Ross could also be outspoken, single-minded, and difficult to work with, according to colleagues. Furthermore, her belief that death is not an end but a transformation led her in the 1970’s to a fascination with metaphysical phenomena, such as near-death experiences, out-of-body travel, spirit guides, and communication with the dead. Her connection to a California psychic, under investigation for sexual misconduct, damaged her reputation even though she eventually disavowed him.

Moreover, Kübler-Ross could show impatience with those who thought of her only as the “death and dying lady.” In her 1997 autobiography, The Wheel of Life, she wrote,

The only incontrovertible fact of my work is the importance of life. I always say that death can be one of the greatest experiences ever. If you live each day of your life right, then you have nothing to fear.

After On Death and Dying, Kübler-Ross published more than twenty other books based on her studies, including Questions and Answers on Death and Dying (1974), Death: The Final Stage of Growth (1975), To Live Until We Say Good-bye (1978), Living with Death and Dying (1981), Working It Through (1982), On Children and Death (1983), AIDS: The Ultimate Challenge (1987), and On Life After Death (1991). Her last book, Real Taste of Life: A Journal (2002), is a photographic journal that she produced with her son, Kenneth, a travel photographer.

Over the years, Kübler-Ross was recognized for her selfless devotion and tireless efforts by numerous organizations, including the Teilhard Foundation (1981) and the American Academy of Achievement (1980). She was named Woman of the Decade by Ladies’ Home Journal in 1979. She was one of the founders of the American Holistic Medical Association and was a member of other major medical and psychological associations. Honorary degrees were bestowed upon her by more than twenty institutions, including Smith College, the University of Notre Dame, the Medical College of Pennsylvania, Albany Medical College, Hamline University, Amherst College, and Fairleigh Dickinson University. Time magazine named her one of the twentieth century’s one hundred greatest minds in 1999. In 2007 she was inducted into the National Women’s Hall of Fame.

In 1995, Kübler-Ross suffered the first of a series of strokes, which left her partially paralyzed. She retired to a farm near Scottsdale, Arizona, where her son helped care for her while she recuperated and helped her make the farm self-supporting. She continued to write, advise, and give interviews. A parade of celebrities and champions of alternative approaches to healing visited her, including Deepak Chopra and Muhammad Ali.

Kübler-Ross died in a home for the elderly in Scottsdale on August 24, 2004, surrounded by friends and family. She was survived by her son and her daughter, a clinical psychologist. Immediately after her death, tributes began arriving from admirers worldwide, and the Elisabeth Kübler-Ross Foundation was established to continue her work.

Significance

Kübler-Ross’s legacy includes, most significantly, the practice and promotion of narrative medicine being attentive, caring, and reflective when the ill and the dying tell stories of their experiences. She also helped found the discipline of thanatology, or the study of death and dying, and promoted the hospice movement as a credible alternative to end-of-life medical care. She was almost solely responsible for the humanitarian focus on the care of the dying patient. She responded also to individual pleas and often flew to the bedside of patients in their final stages of life to listen and give comfort to them and their families.

Laura Newman pointed out in an obituary for Kübler-Ross in the British Medical Journal that Kübler-Ross emphasized communication above all things, because a patient wanted and needed to review his or her life, illness, and imminent death. This approach revolutionized the area of psychology dealing with death and dying, not only in the United States but also around the world. Although later research modified Kübler-Ross’s findings about the five stages of grief, her work remains fundamental. On Death and Dying has been required reading in most major university programs in medicine, psychiatry-psychology, and related disciplines.

Bibliography

Bartlett, Kay. “No Stranger to Death, Kübler-Ross Turns Her Attention to AIDS.” Los Angeles Times, May 10, 1987. Kübler-Ross discusses her feelings about the afterlife of the human spirit and the application of her thanatological research to the counseling of children and adults suffering with HIV-AIDS.

Gill, Derek. Quest: The Life of Elisabeth Kübler-Ross. New York: Harper & Row, 1980. The first full-length biography of Kübler-Ross. An intimate volume that contains an epilogue by Kübler-Ross and covers her life through 1969, the year that On Death and Dying was published and the year her attentions turned solely to work with the terminally ill.

Goleman, Daniel. “We Are Breaking the Silence About Death.” Psychology Today, September, 1976. Kübler-Ross discusses her work and traces the path of her career. The article includes an interview about dealing with the death of children, the difficult subject of much of her recent writing.

Kübler-Ross, Elisabeth. On Death and Dying. New York: Macmillan, 1969. Kübler-Ross’s first work and the one in which she defines her famous five stages in the process of death. The best-known treatise in the field, this work set the standard for later research.

‗‗‗‗‗‗‗. The Wheel of Life: A Memoir of Living and Dying. New York: Scribner, 1997. The author recounts her youth and career, offering lessons on how to live a productive, fulfilling life despite such setbacks as a home lost to fire and a debilitating stroke. Includes photographs.

Kübler-Ross, Elisabeth, and David Kessler. Life Lessons. New York: Scribner, 2000. The authors consider the spiritual lessons needed for people to live full lives, and Kübler-Ross reflects upon her own experiences recovering from a stroke.

Newman, Laura. “Elisabeth Kübler-Ross.” British Medical Journal 329 (September 11, 2004). A concise obituary that covers the immediate impact of Kübler-Ross’s work, calling her one of the most effective communicators of the twentieth century and a leading proponent of narrative medicine, which she helped develop and define.