A Critical Literature Review on Death and Dying.

Great distress is suffered at the time of death; however, feelings are quickly withdrawn, and the feelings of numbness and disbelief follow for some time. Many phases of grieving have been documented by researchers. There are passing episodes of separation distress as the bereaved person continues in normal functions routine tasks. Many theories have been put forward to account for death and dying including the Kubler-Ross Model, Becker’s Existential View, Freud’s Theory of Evolution, the Regret Theory put forward by Adrian Tomer and Grafton Eliason and many more small theories.

The Kübler-Ross model attempts to explain the process which are experienced by people who deal with grief and tragedy. She proposed the notion of five stages in this process, which terminally ill patients go through the stages of grief are : 1) Denial 2) Anger 3) Bargaining 4) Acceptance . Kübler-Ross initially used these stages to any personal loss scenario job, income, freedom, loss of someone or divorce. Kübler-Ross did state that these steps do not necessarily occur in the stated pattern, she stated that a person will always experience at some stages in her model, although this does not apply to every person. These stages are mostly applied to news of one’s own impending death. 1974, Researchers have argued true real grieving begins after the all the stages are over with, and that grief involving its own set of stages, begins with acceptance, where the Kubler-Ross stages end. Kubler-Ross studied the subject of death and dying and developed her model. She found that the dying persons typically experienced a progression toward an adjustment to and an acceptance of death. The order the stages are experiences and the time spend at each stage differs. It can be argued that the stages are not clearly explained as each stage can be interlinked with another. There is no gathered evidence that all the five stages are navigated throughout when dealing with the prospect of death. The route through the stages is not just in one direction for example the stages can occur in random order, or stages can be repeated , even in a spiral of going round and round experiencing the same thing over and over The Kubler-Ross model does not look at other agencies of support , i.e. emotional ties to family, and other relationships, also factors such as loved ones belongings causing grief regression in which depression be experienced again. The way in which loss is experienced may lead to how grief is expressed. A sudden loss or violent loss in which, may create a traumatic loss which is probably tougher to cope with.

Freud stated that people feared death because nobody believes in his own death. Furthermore, he stated that the unconscious does not deal with the passing of time Thus he summarised whatever one fears cannot be death because one has never died.

Another theory put forward by Becker was the Existential theory. It proposed that death anxiety is real, which involves anxiety being people’s greatest root of concern. This anxiety was very intense that it has the power to generate fears and phobias of everyday life. The impact can result in fear of being alone. In line with this theory, much of people’s routine behaviour involves attempts to deny death and thus keep’s their anxiety under control.

Another theory put forward by Adrian Tomer and Grafton Eliason was the “Regret theory” was proposed in 1996. The focus was on the method that people rated their worth of life. People generally feel more anxious if they feel that their accomplishments are not met. Studies have been focused on the cultural impact of ethnicity on attitudes toward death and dying by comparing African-Americans, Asian-Americans, and Hispanic-Americans with a comparison group of Caucasians. They compared their findings to those from Kalish’s and Reynolds’s 1970’s Death and Ethnicity Study, now thought of as a crucial study, cultural differences do exist (not studied deeply) in grieving and therefore causing problems in concurrent validity Kubler Ross’s theory.

Critics also suggest that the five stages are not capable of reflecting the full range of human reactions to death and dying. Still other researchers worry that using the term “depression” for stage four as confusing. Critics question the emotions and ask if these are normal, healthy way to respond to dying or instead, maladaptive psychological and physical symptoms. Criticism of the stage theory put by Tanenbaum is that there exists no real evidence that stages are present in coping with death. He asserts that no evidence that dying people go through the exact Kubler-Ross stages in their proper order. Any patient could experience emotions not even mentioned in the Kubler-Ross stages, or the stages in a different order. Also, there is no evidence that people coping with their impending death move through all of stages one through five. The limitations on the method of research employed by Kubler-Ross is that her method of personal interview was a valid start to her research but another data gathering technique was needed her theory would have been more valid if she had employed this method. The flaws in her work included the gathered data by the interviewer may vary depending on the relationship between the researcher and the patient Also on what was told by the participant is not everything they feel. It has become common for positive value to be placed on the transition of each new stage. This can lead to patients being pressured by family, to move through the stages to progress. Patients may feel that they need to accept their death to die properly simply because that’s what the famous theory prescribes. Also, the person’s unique personality and identity may be lost as they supposedly move through these generic stages. Each person’s experiences are unique and different, so each person’s death process is unique. A patient’s environment can have a great effect on their attitude towards death. A patient in a supportive environment is likely to reveal very different “stages” of dying that a patient in a negative and unsupportive environment.

There is lack in any real research to help us to deal with issues surrounding dying. Most of the problems with the Kubler-Ross model is in the analysis by society and the mistreatment of her research. More interest and investigation are needed to follow-up her study with more research and data.