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Psychiatrist Changed How We Look at Death

August 26, 2004|Elaine Woo | Times Staff Writer

Dr. Elisabeth Kubler-Ross, the Swiss-born psychiatrist whose groundbreaking study of the end stages of life humanized the treatment of the terminally ill and helped to inspire the hospice movement in this country, died of natural causes Tuesday in Scottsdale, Ariz. She was 78.

Kubler-Ross had been in declining health since 1995, when she suffered a series of debilitating strokes. Surrounded by family and friends, she died at an assisted-living center, where she had lived for the last few years, her son, Kenneth, told The Times on Wednesday.

She had wanted to die after the strokes left her partially paralyzed and unable to live independently. At the time, she expressed bitterness that she was still alive and made headlines around the country about how the guru of the "good death" could not achieve one for herself.

But in the end, she "died with acceptance on her face," said David Kessler, a hospice expert and close friend who was among those present at her death.

Kubler-Ross was the author of "On Death and Dying," a 1969 bestseller that illuminated the emotional life of dying patients by identifying five stages of the experience: denial, anger, bargaining, depression and acceptance. The book, which has been translated into more than 25 languages and is still a widely used text, spurred a revolutionary movement within the medical community to lift the taboo on discussions about the dying and infuse their treatment with dignity and affection.

"Prior to Elisabeth's work, patients who were dying were objectified, seen as a collection of manifestations of disease," said Dr. Ira R. Byock, a longtime hospice physician and past president of the American Academy of Hospice and Palliative Medicine. "She forced the medical profession and healthcare in general to listen to the person who was confronting the end of life. This was a radical notion

Kubler-Ross began her work when American medicine was heady over its successes at prolonging life with new antibiotics, heart and kidney transplants and other advances in surgery, intensive care and cardiology. To talk of death, from the vantage point of physicians in the 1960s, was to acknowledge defeat.

Thus, as astonishing as it might seem today, when Kubler-Ross began to look for patients who could teach her students about the end of life, colleagues told her they could not help her because none of their patients were dying.

"They told her nobody comes here to die; they come here to be treated," said Dr. Joanne Lynn, a senior scientist with Rand Health, a nonprofit research enterprise based in Santa Monica.

Lynn, who also directs the Washington Home Center for Palliative Care Studies in the nation's capital, added: "Her biggest legacy is just to have us notice that there really is a piece of time when it is reasonable to take notice of the fact that time is likely to be very short and to treat that phase of our life somewhat differently.... She gave us the tools -- and, most of all, the courage -- to notice the obvious."

In later years, Kubler-Ross directed her attention to people with AIDS, particularly infected babies, trying to improve their care at a time when the disease was still widely misunderstood.

She also took a direction that startled many in the medical community: exploring "out of body" experiences and other phenomena reported by people who had come close to dying. She began to speak of contacts she said she had with spirits. Death, she seemed to be suggesting, was just another phase to be surmounted.

Such reports caused some of her colleagues in the medical profession to doubt her sanity. But the "death and dying lady," as Kubler-Ross came to be known, did not attempt to foist her unconventional views on others, arguing that skeptics would one day finally experience the truth for themselves.

Death impinged early on Kubler-Ross' world. She was born in Zurich on July 8, 1926, the smallest of a set of triplets ("a 2-pound nothing," she called herself later) who was not expected to live. But, proving herself a rebel from birth, she survived.

She had a difficult childhood under the thumb of a domineering father. One of her earliest memories was of his forcing her to take her pet rabbit to the butcher, then watching her family "eat my bunny" for dinner. That incident taught her to be tough -- "tougher than anyone" -- she recalled in her 1997 memoir "The Wheel of Life."

She was interested in medicine from an early age and, despite her father's initial opposition, eventually embarked on a career in the field. She was working in a Zurich laboratory at the end of World War II, when the opportunity arose to volunteer as a relief worker and visit Maidenek, a Nazi concentration camp in Poland.

Her tour of the death camp left a profound impression. Etched on the walls of the barracks were hundreds of images of butterflies, symbols of rebirth lighting the dank interiors of otherwise hellish scenes.

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