Kubler-Ross on stages

Swiss-born psychiatrist Elisabeth Kubler-Ross (1926-2004) defined five mental or behavioral stages of dying in her 1969 book, On Death and Dying. The stages are:

  1. Denial and isolation
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance

The stages were later extrapolated to grief in general. Opponents argued that the stages are not necessarily ordered, depending on the subject, and not necessarily experienced at all in situations where social environment is healthy and individuals are resilient. But the objections come late compared to Kubler-Ross’ work in the fifties and sixties when death, dying, and grief were still experienced by most Americans (those are the subjects she interviewed) in a traditional fashion. Medical personnel was aloof and hospitals were themselves intended to be a last stage for dying patients. Kubler-Ross recounts her childhood in Switzerland and the forms of dying centered in family and village life, the absence of medical technology and hospitals, and the centrality of religious and cultural expression — none of which are constructive factors today, with the larger exception of the hospice movement that Kubler-Ross inspired.

Kubler-Ross notes that hope of recovery was consistently high, even to the end, not only in religious-minded patients but in firmly non-religious. Perhaps it was culture-based, personality-dependent, or simply a survival mechanism. Otherwise, psychology and personality may alone have formed the attitudes of those harboring degrees of anger and resentment. Kubler-Ross’ gentle methods of eliciting a consciousness of these feelings in her patients shows that, indeed, she was aware of variables in individual temperament and resilience.

In retrospect, depression is not as dominant a stage as one might guess. Deriving grief from depression, in turn, suggests a backward application of depression in dying. While real, depression and grief are nevertheless experienced very subjectively. Not surprisingly, they early were targets of the medical and pharmaceutical industries to which Kubler-Ross referred negatively and which preempt the dying process decisively today.

The dying process best culminates in voluntary and conscious decathexis, the withdrawal from people, objects, environments. One might apply the term philosophically in order to approximate the eremitical and sage traditions that have always suggested that life is a process of dying, and that withdrawal and simplicity best nourish this course.

Later in life, Kubler-Ross took a serious interest in near-death studies, tangential but somewhat more speculative, to be sure, versus the psychology of dying. In meditative traditions, the phenomenology of near-death experience is parallel to the pursuit of esoteric powers, to be looked upon with suspicion as a distraction from the true goal of living, and dying.

Less noticed but effective in On Death and Dying is how Kubler-Ross links poetic lines from Rabindranath Tagore to the various attitudes and mindsets typical in the emotional life and in the dying process. This poetic context enriches the somewhat clinical observations in the book, which are, after all, largely transcripts of dying people’s feelings. By developing this poetic and philosophical sense of life and nature, death and dying, the question of resilience and environment can give way to a sensibility that is whole and complete, as should be the dying process itself.

  1. Denial and isolation.
    “Man barricades against himself.” (Stray Birds, 79)
  2. Anger.
    “We read the world wrong and say that it deceives us.” (Stray Birds, 75)
  3. Bargaining.
    “The woodcutter’s axe begged for its handle from the tree. The tree gave it.” (Stray Birds, 71)
  4. Depression.
    “The world rushes on over the strings of the lingering heart making the music of sadness.” (Stray Birds, 44)
  5. Acceptance.
    “I have got my leave, Bid me farewell, my brothers! I bow to you all and take my departure.
    Here I give back the keys of my door — and I give up all claims to my house, I only ask for last kind words from you.
    We were neighbours for long, but I received more than I could give. Now the day has dawned and the lamp that lit my dark corner is out. A summons has come and I am ready for my journey.” (Gitanjali, 93)


The “pro-introvert” advice of writings like Susan Cain’s Quiet: The Power of Introverts in a World That Can’t Stop Talking risks manufacturing a class of aberrant individuals with special needs. Cain herself compares introverts to women in a patriarchal world, calling introverts “second-class citizens.” But the intent to help introverts succeed in an insane world is inevitably paralleled by advice to authorities, managers, and bosses on how to best tap the skills and insights of introverts — for the former’s use.

But the mature introvert doesn’t want to succeed in an insane world, and powerful people only want to employ, direct, and socialize with others useful to themselves.

Introversion is a personality characteristic that exists across all cultural and social groups, and largely created by heredity, family, psychological, and social environment in children (especially to age 5 years). Introversion is not pursued consciously as a style but within the persona as integral to the psyche. Other factors in their early lives include treatment by parents, haphazard evolution of self-esteem, slower emergence of social skills, and the development of solitary self-sufficiency in routine pursuits of play and interest in environment.

Introverts understand instinctively the role of these factors in their upbringing and how it limits them in social contexts. But while many introverts may find frustrating their inability to operate smoothly in social contexts, they quickly learn from discomfort that they can survive with a minimum or no such settings. They discover that they can be reconciled to their personality, and, indeed, find strong and fruitful resources to sustain themselves.

Non-introverts sympathetic with the marginalization of introverts in corporate or institutional settings need not fret that introverts are slighted, even punished. Knowing that they cannot coach introverts into behaving like extroverts or even balanced personalities, much well-intentioned advice instead ends up counseling corporate and institutional managers on how to elicit participation from introverts. Much of the practical advice is fair and do-able, and for managers and authorities to realize techniques for eliciting introvert input on group projects and “teamwork” is not unreasonable given the boss’s job. But an important insight is being overlooked in these relationships.

Introverts are frequently excellent critics of what goes on around them. They do not usually voice their views — not only because they are socially uneasy but often because they are not going to accede to group thinking, to organizational goals and objectives to which they ultimately may not subscribe.

Introverts develop their self-image from their own insights, imaginations, and vision — not from their work-for-money efforts or social circles of insiders, intimates, or buddies. In the corporate and work world, introvert know that the efforts are put on for vague social conventions, while workplace maneuvering is often just for private gain. Introverts simply don’t identify with these social methods or private gains. Simply put, smart introverts already know (or are on the way to knowing) themselves and their vision of how things should be, at least for themselves, whether in creative, natural, psychological, or spiritual senses. In nearly every way, these senses or intimations of how things should be in the world (but are not) differ from what a collective social group of any sort can attain, or, further, is even aware.

The appearance of distraction, alienation, lack of cooperation, or just an apparent “attitude” attributed to the introvert when in a social context is not directed against anyone or anything. It is just that introverts are actively tending their gardens while others either think they are ready to harvest or haven’t even planted a seed. Introverts have a low tolerance for small talk.

Pro-introvert advice that cheer-leads the hapless introvert is self-defeating. What can be more frustrating to the introvert in the world than the intransigence of authorities running institutions and organizations is realizing that his or her fate is in the realm of their worse skill, their least interest, namely, of pretending to be other than what one is.

Metta Sutta

The Metta Sutta or Metta prayer, petition, recitation or wish-granting aspiration, is a traditional Buddhist prayer originating in Theravada practice as the Karaniya Metta Sutta but popular in Mahayana practice as well in its association with the bodhisattva. More elaborate versions exist but here is a short, specific version:

May all beings be peaceful.
May all beings be happy.
May all beings be safe.
May all beings awaken to the light of their true nature.
May all beings be free.

The prayer has an external philosophical meaning, an epistemological premise about the nature of things. Our wish or desire is a sentiment or aspiration (“may this, may that …” ), but with an understanding that no one can change intrinsic reality. We may throw up our hands at wishful thinking.

But internally the prayer transforms the reciter towards a motivation for enlightenment. All beings ought to be at peace in this universe. They ought to be happy. They ought to be safe. So while humans might claim this desirable state for themselves because we theoretically are capable of it, we now affirm the desirability on behalf of all creatures, something that not all religions incorporate in their aspirations.

May all beings be peaceful.
May all beings be happy.
May all beings be safe.

And we affirm it for ourselves and all creatures not as a Kantian imperative from elsewhere — beings are not capable of it — but in the universal empathetic sense of responding to the question of why there is suffering. It ought not to be such, we say to ourselves on behalf of other creatures. And from that moment, we no longer think of ourselves but enter into communion with nature and all beings.

How is it possible to make a state of being for all beings that is peaceful, happy, and safe? Just as the bodhisattva vows to work indefinitely for this goal in an active way, the reciter of the Metta Sutta does so more modestly but positively nevertheless. It is done by changing personal actions, behaviors, and habits that promote this set of conditions in the self and indirectly promote these states for all beings. An ethical agenda emerges from an aspiration that now transforms self. How one lives, consumes, spends, eats, drinks, acts, speaks, lives — everything takes on an ethical dimension. What best promotes the well-being of plants, animals, people, even inanimate beings, promotes our own well-being.

Yet this progress of thought, which has the potential for progress towards enlightenment, is brought to one’s consciousness from outside of ourselves but emerges from deep thought about the nature of things. Thus it is not found outside the self ultimately, not coerced or compelled at this stage but grown by oneself, within oneself, often against society, social conventions and habits, and societal consciousness.

May all beings awaken to the light of their true nature.

Finally comes the essential part tying in with Buddhist metaphysics. The true nature of all beings is interdependence, prescribing a necessary empathy or consciousness, confirming the previous affirmations. But also true of the awakening to true nature is the reality of impermanence, of transience, which all beings seem to harbor. This reality gives even more urgency to the delicate interdependence and the first three aspirations. To realize impermanence, to awake to this truth, is to awaken to true nature, unalterably reality.

May all beings be free.

Paradoxically, then, the Buddhist (and Hindu) notion of rebirth, springing from a more primordial, less philosophical religious tradition, seems to contradict impermanence, transience. Like rebirth, or fear of rebirth, the awareness of impermanence is a profound source of suffering. The poignancy of transience, of “mono no aware,” ought to frustrate the goal of aspiration. So in either case, we want, and all creatures want, to be free — free from suffering, free from rebirth, even free from transience. And this is nirvana.