Swiss-born American psychiatrist Elisabeth Kübler-Ross (born 1926) has pioneered the idea of providing psychological counseling to the dying. In her best-selling 1969 book, On Death and Dying, she describes the five mental stages that are experienced by those approaching death and suggests that death should be viewed as one of the normal stages of life.

Psychiatrist Elisabeth Kübler-Ross has dedicated her career to a topic that had previously been avoided by many physicians and mental-health care professionals--the psychological state of the dying. In her counseling of and research on dying patients, Kübler-Ross determined that individuals go through five distinct mental stages when confronted with death, a discovery that has helped other counselors to provide more appropriate advice and treatment to their clients. Her ideas have been presented to the public in a number of popular texts, including her groundbreaking 1969 work, On Death and Dying. She has also offered instruction and treatment at the seminars and healing centers she has run for the terminally ill and their caretakers.

Kübler-Ross had a unique childhood as one of three triplet girls born in Zurich, Switzerland, on July 8, 1926. Although the girls were all extremely small at birth, their mother, Emmy Villiger Kübler, closely attended to their physical needs and ensured their survival. Kübler-Ross, her sisters, and older brother grew up in a strict but loving household. Their father, Ernst Kübler, expected obedience from his children, but he also took them on hikes in the Swiss mountains, instilling a great love of nature in his daughter Elisabeth. One of Kübler-Ross's main concerns as she grew up was finding a way to distinguish herself from her sisters. This search for a unique identity was hampered by the fact that she was physically identical to her sister Erika, and the two were often mistaken for each other. She would frequently escape to a favorite spot in the woods to enjoy some time away from her sisters, and she also tried to develop interests that would set her apart. Seeking something completely different from her own experience, she began to study African history and one of her prize possessions was an African doll that her father gave her after she had been dangerously ill with pneumonia.

Developed Early Ideas on Death

In addition to her own brushes with death as a child, Kübler-Ross witnessed the death of others around her in a series of experiences that shaped her attitudes about mortality. When she was in the hospital at the age of five, her roommate passed away in a peaceful state. She also knew of a young girl whose death from an excruciating bout of meningitis was viewed as a release from suffering. In another childhood episode, she witnessed a neighbor calmly reassuring his family as he prepared for death from a broken neck. Such events led Kübler-Ross to the belief that death is just one of many stages of life, an experience that the dying and those around them should be prepared to encounter with peace and dignity.

Kübler-Ross excelled in science as a student and was determined to fill her life with meaningful work, but her parents were not very supportive of her goal of an advanced education. Although their son was expected to prepare himself for a business career, the triplets were sent to local schools to receive only the basic education that their parents thought was necessary for futures as wives and mothers. When Kübler-Ross was 13, World War II began with the invasion of Poland by German forces. These events provided her with a way to contribute to the well-being of others; she vowed to find some way to help the Polish people, and throughout her adolescence, she participated in numerous activities assisting victims of the war. She first worked as a laboratory assistant in a hospital that treated war refugees, and in 1945, she became a member of the International Volunteers for Peace organization. Her volunteer work took her to Sweden and the French-Swiss border, and finally, in 1948, to Poland. There she helped Polish people to rebuild their cities and lives after the war by serving in a variety of jobs, including cook, nurse, and carpenter.

Planned Career in Psychiatry

These experiences after the war convinced Kübler-Ross that her life's calling was to heal others. She firmly believed that spiritual and mental health was a necessary part of healing the physical body and incorporated these interests in her planned career as a psychiatrist. She enrolled in medical school at the University of Zurich in 1951 and graduated in 1957. For a short period after leaving school, she worked as a doctor in the Swiss countryside. In February of 1958, however, she married an American doctor she had met in medical school, Emanuel Robert Ross, and moved with him to New York. The couple would be married for 11 years. In New York both of them were accepted as medical interns at Community Hospital of Glen Cove, Long Island. After completing her internship, Kübler-Ross began a three-year residency in psychiatry at Manhattan State Hospital; during this time she also trained for a year at Montefiore Hospital in the Bronx. In her work at psychiatric hospitals, she was disturbed by the failure of staff members to treat the patients with sympathy and understanding. She attempted to use a more personal means of communicating in which she showed an obvious interest in the welfare of the patient, and her approach yielded improvements even in the cases of people suffering from acute psychoses.

In 1962, after the birth of their first child, Kenneth, Kübler-Ross and her husband decided to leave New York City; they obtained jobs at the University of Colorado School of Medicine in Denver. The next year, Kübler-Ross began teaching at Colorado General Hospital. While in Colorado, another child, Barbara, was born to the family. In 1965, they moved again, traveling to Chicago, where Kübler-Ross became an assistant professor of psychiatry as well as assistant director of psychiatric consultation and liaison services for the University of Chicago. In the coming years, she increasingly turned her focus to the subject of psychological treatment for terminally ill persons suffering anxiety. She found that many doctors and mental health professionals preferred to avoid the topic, leaving patients with few resources to help them through the difficult process of facing death. Her interests were viewed with disapproval by medical school officials, who did not want to draw negative attention for focusing on death rather than recovery of patients. But Kübler-Ross went on with her work, organizing seminars to discuss the topic with a wide range of caregivers, including doctors, nurses, priests, and ministers. The seminars drew large numbers of interested people, demonstrating the need for information and ideas on counseling the dying. In these sessions, participants sat behind a one-way mirror and viewed Kübler-Ross interviewing terminal patients, discussing their fears and concerns.

Published Landmark Book on Dying

School administrators finally forced the psychiatrist to end her popular seminars. She continued her personal research, however, gradually discovering that all dying patients went through similar crises and discoveries. She organized her findings into five distinct stages of dying, which she identified as denial, anger, bargaining, depression, and acceptance. Her theory on the stages of dying and suggestions for how to use this information to treat patients were compiled in the 1969 book On Death and Dying. The book became a best-seller and was soon established as a standard text for all professionals who worked with dying patients and their families. Kübler-Ross's growing acclaim as an expert on the psychology of dying received an even greater boost when she was featured in a Life magazine article that described her frank discussions of death with terminally ill subjects. Overwhelmed by the tremendous public response to the article, Kübler-Ross decided to devote her career to helping dying patients and their loved ones.

While treating individuals on a case-by-case basis, Kübler-Ross also continued to put out more books. In 1974 she published Questions and Answers on Death and Dying, which was followed by two other books in that decade, Death: The Final Stage of Growth (1975) and To Live until We Say Good-bye (1978). During this time, she sought a way to reach more people with her counseling; the result was her creation of the Shanti Nilaya ("Home of Peace") healing center outside of Escondido, California, in 1977. In the 1980s, she began to focus on special themes within the topic of death, reflected in her books On Children and Death (1983) and AIDS: The Ultimate Challenge (1987). The early 1990s brought an apparent shift in her own philosophy of death. In the book On Life after Death she revises her earlier understanding of death as the final stage of life, stating that death is in fact a transition to a new kind of life. In 1998's The Wheel of Life: A Memoir of Living and Dying Kübler-Ross defines the four stages of life after death.

Honored for Pioneering Work

In 1990, Kübler-Ross moved her healing center to her farm in Headwater, Virginia. After her house there burned down in 1994, she decided to hand over the operation of the center to an executive director, and she moved to Arizona to live near her son. She continues her work through ongoing workshops and lectures. Her groundbreaking career in the guidance of dying patients has been recognized with a number of awards, including receiving recognition as "Woman of the Decade" by Ladies' Home Journal in 1979 and honorary degrees from schools such as Smith College, the University of Notre Dame, Hamline University, and Amherst College. Such honors testify to the importance of Kübler-Ross's revolutionary approach of providing psychological support and comfort to the dying, an idea that has benefitted both doctors and patients.

Associated Works

Further Reading

• Gill, Derek, "The Life of Elisabeth Kübler-Ross," Quest, Harper & Row, 1980.
• Goleman, Daniel, "We Are Breaking the Silence about Death," Psychology Today, September 1976, pp. 44-47.
• Kübler-Ross, Elisabeth, On Death and Dying, Macmillan, 1969.
• Wainwright, Loudon, "Profound Lesson for the Living," Life, November 21, 1969, pp. 36-43.