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PROCESS OF DYING.
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Compares & contrasts 2 books: DYING WELL (I. Byock) & ON DEATH & DYING (E. Kubler-Ross).... More...
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Paper Abstract:
Compares & contrasts 2 books: DYING WELL (I. Byock) & ON DEATH & DYING (E. Kubler-Ross).
Paper Introduction:
Issues on Death and Dying
Introduction
In comparing and contrasting these two books - Dying Well and On Death and Dying - what is immediately apparent is that these books are complementary, rather than contradictory. They both focus on the individual process of dying, while they both find that there are common or typical issues that face dying individuals and their family members. Both emphasize that growth can occur through the process, and that people can die well if they are willing to go through the process with open minds and hearts. There are many other similarities and certainly some differences in their focus, and the lessons the authors drew from their experiences.
Similarities:
The similaritie
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(1997, reprint). In general,she found that they passed through them in the order given. They both drew important lessons from their work based on what theythought of as developmental theory. Following that stage,people frequently entered the bargaining stage in which they tried to makea bargain with God, the universe, or their doctors that they would dosomething, or change some behavior, if only the diagnosis was erased. New York:Collier Books. There are many other similarities and certainly some differencesin their focus, and the lessons the authors drew from their experiences.Similarities: The similarities are quite striking. Byock became active through the hospice movement, his awarenessblasted open through his father's death, though obviously he had seen theproblems of the dying regularly as a doctor. He had to acknowledge his own emotional neediness inorder to transcend it, to some extent, and he had to be able to express hisfeelings to his children and his wife in order for all of them toexperience some sense of closure. Themodel has become part of all contemporary discourse about death and dying,although it has been critiqued and many flaws have been identified. The individual hasbeen able to come to terms with the finality of his or her situation andgain some sense of closure and peace. Although Kubler-Ross was clear that people did not proceed throughthe five stages all in the same order, or for the same length of time, oreven only once during their process, she believed that for people to reachcompletion they did need to pass through each of the pages. First, people expressed their shock by entering the stage of denial.They could not believe that the diagnosis was possible, that they weredying, and that some mistake had not been made. Both books also share the common task of showing how death affectseveryone involved, not just the dying individual. Forexample, a man might bargain with God that he would never smoke or drinkagain if only his diagnosis of terminal lung cancer proved to be a mistake. She started looking at near-deathexperiences and how that transformed individuals, too. Other people had important tasks, too. The Byockbook seems much more specific to the dying process and ensuring that theperson dies as well as possible. It also seems as though her approach was more that ofthe research scientist initially, but that her medical objectivity, likeByock's, was replaced by a more and more personal interest in, andinvolvement with, her dying patients. (199 ). All this he brought into developing a newhospice system in his own region, with this being a very new development. When they are ableto feel their sadness and grieve the losses, letting those feelings passthrough, then they are able to pass into the fifth stage of the process,which is acceptance.It is this acceptance stage in the Kubler-Ross (1997) model which seemsmost analogous to Byock's (199 ) idea of dying well. Both authors try to provide awide-scale perspective on the experience, noting that it is not only theindividual who is in the dying process, but everyone around thatindividual. It shows how medicalprofessionals are impacted, and how dysfunctionally they can respond, itshows how siblings are affected, and it shows how long-estranged familymembers are still affected by the death. Both of these authors seem tobe very compassionate in their approach to dying people and their families,although they also indicate that this was not always the case. Where Byock (199 ) extended the discussion is in his focus on thedevelopmental and interpersonal tasks that need to be completed in orderfor the individual, and family members, to make it to this stage ofacceptance and the possibility of the individual dying well. He is also not as clear about what he means by developmental tasks.In the discussion of Steve, he noted the hospice principles of relationshipcompletion, which seem useful. Dying well, similarly, is not limited to the individual dyingwithout pain, but involves the individual making significant changes, ifnecessary, and coming to some sense of completion in life, work, andinterpersonal relationships.Differences between the books: There are some significant differences between the two books, too.Kubler-Ross's book seems to have a more scientific grounding, although, asmentioned earlier, there have been many critiques of her methods. It was also important for Janelle tograduate from high school, giving her a sense of accomplishment, meaning,and closure for her life. Steve, the unemotional cowboywith the COPD, had to learn to perform some of the interpersonal tasks hehad never learned. For example, in his discussion of Janelle and her mother, it wasimportant for Janelle to be able to experience her mother's love for herdirectly. In this anger stage,people fought with their loved ones and tended to drive people away withtheir rage at their loss and their unwillingness to come to terms with it.Kubler -Ross (1997) initially termed the fourth stage of the processdepression, but I like Byock's (199 ) use of the term grief better.Although these do have different meanings, essentially this is the stagewhen people allow themselves to recognize their immediate and impendinglosses, sometimes sinking into depression and despair. Issues on Death and DyingIntroduction In comparing and contrasting these two books - Dying Well and OnDeath and Dying - what is immediately apparent is that these books arecomplementary, rather than contradictory. Each of these represents only one, or a few, cases, however,so it is difficult to tell how applicable some of the developmental tasksare. Instead,they note that there was a time when they were less aware, but that theygradually became focused on issues of death and dying well for theirpatients. Forthe most part, however, it remains a useful model and one accepted by boththe general public and medical professionals, as well as social workers,pastoral workers, and others involved in the dying process. For Kubler-Ross (1997), her work tookform as a five-stage model of the process through which people passedduring their dying experience. New York: Riverhead Books. This brought fortheven more critiques of her work and actually, I think, shadowed her firstbook, casting doubt on its credibility.In some respects, Byock's (199 ) book seems more important for members ofthe helping profession to read, while Kubler-Ross's book can help eachperson. Byock's lessons often seem pointed to the helping profession,although also to family members, who do not always adequately attend to thedignity of patients or to their needs for adequate pain management.It also seems that Kubler-Ross's book is more widely applicable, with itgenerally used by people to look at the whole process of grief and loss,not just the grief and loss of death. References Byock, I. The five stages of the model included (a)denial; (b) bargaining; (c) anger; (d) depression, and (e) acceptance.Byock (199 ) seemed to recognize that Kubler-Ross's model was relevant tohis work, and one of his chapters even has a patient talking about it. On theother hand, Byock's (199 ) book is strictly anecdotal. On death and dying. He was able toextrapolate from his experience to other people's experience of the medicalsystem and he was able to draw lessons from his experience that he thoughtwould benefit other people. They both focus on theindividual process of dying, while they both find that there are common ortypical issues that face dying individuals and their family members. Another important difference is that Kubler-Ross (1997) continued towrite about death and dying, extending her work into fields generallyreserved for spiritual practitioners. These included ensuring that individualswere able to say "I forgive you", "Forgive me," "Thank you", "I love you,"and "Goodbye." As Byock (199 ) noted, this gave someone like Steve ascript to work with, a means to navigate the process with some sense ofguidance. After these stages, people often entered anger, where many peopleremained for some time, including until their deaths. Kubler-Ross, E. Dying well. He uses a casestudy model to draw upon in establishing his principles and guidelines fordying well. Thus, people talk of it as the fivestages of grief that can be experienced with being fired from a job orexperiencing a divorce, or losing a house or beloved friend. It was important for her mother to be able to experience, andexpress, her grief to get past the anger stage so that she could help herdaughter die more peacefully. For Kubler-Ross, the process of becoming empathetic to the dyingseemed more gradual. His father's death pushed himover some edge, however, into understanding death from the point of view ofthe patient and the family member's of the patient. Bothemphasize that growth can occur through the process, and that people candie well if they are willing to go through the process with open minds andhearts.
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