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Death: The Final Stage of Growth.
By Elisabeth Kubler-Ross (Editor). New York: Simon and Schuster, Inc., 1997, 208 pp., $11.00 (paper).
Death: The Final Stage of Growth discusses several issues surrounding death and how people cope with it. Multiple authors contribute sections to the book with introductory paragraphs by Kubler-Ross. Each author takes a different perspective on how to accept death and several of the sections involve a cultural perspective beside the traditional European-American culture. For many individuals who are coping with their own impending death or working to come to terms with the death of another, this book may serve as a very useful and valuable bibliothreapy resource.
The book is structured with chapters and then divided into subsections. Some chapters have a clinical tone while others are strong emotional personal accounts. The beginning chapters contain an academic approach to the emotional difficulties presented by the prospect of dying. The following chapter has sections of various authors’ works that focus on death and dying through different cultural perspectives. Native Alaskan, Jewish, Hindu and Buddhist perspectives are each represented in the cultural chapter, helping to make the book more relevant to clients of different backgrounds. Several chapters include personal accounts, discussing both how people deal with grief as they watch loved ones die and how individuals deal with their own impending deaths. In addition to the narrative accounts, some of the contributors include poetry that was inspired by their experiences with death and dying. These latter chapters contain strong personal accounts that convey much needed empathy. With this structure, Kubler-Ross clearly tries to present death as an experience from which people grow.
Kubler-Ross' book is appropriate for well-educated adults due to the style and level at which it is written. The title of the book suggests that it is for people who are dying. But, the book actually presents dying and death as a stage of growth for both the living and as well as those who are dying. Several chapters are suitable for people in different circumstances. For example, the third section of chapter four would be suitable for a healthcare professional who needs help dealing with feelings surrounding the deaths of patients. Specifically, pages 80 through 85 present questions and answers concerning the needs of dying patients. For family members who are faced with someone dying, there are several sections that would be helpful. The fourth section in chapter four is a very moving personal account of a mother as her son dies. The material suitable for someone who is dying is limited. Another section in chapter four has some useful material for someone who is dying. Perhaps if clients might grow to accept their own death by experiencing people's reactions to others dying, the book could be therapeutic in that respect.
The book is inappropriate for children due to the level at which it is written. In that same respect, the book is advanced enough that someone without some college education may have some difficulty processing the material presented. Clinicians will therefore want to assign specific sections during treatment based on their appropriateness for each particular client. The majority population the book might be useful to are clients with a European or European-American background, although as was mentioned, there are cultural references to Jewish, Hindu and Buddhist traditions as well. Overall, this book would be helpful to adults with moderate intelligence and high enough motivation to process written material and apply it to their own situations.
Kubler-Ross' book has several strengths that make it an asset to bibliotherapy. The book makes use of personal accounts which make the reader feel empathized with. For example, one section contains the account of a man's reflection as he is dying. One may feel sorrow for him as this section is read, but in that sorrow the reader may feel the potential for growing from experiences like this in their own lives. There is variety in the way in which accounts are presented. While some are written in a narrative fashion, others are presented in the form of poetry which may be more helpful to some clients. For example, a mother's account of her son’s death includes three poems. The poems express the mother's feelings of acceptance and her will to continue with her life as well as her feelings toward the doctors who cared for son as he died. One may feel comforted in reading these poems, knowing that if someone else could show such strength and hope during hardship then they can as well. This clearly may be therapeutic to clients who are experiencing and dealing with these issues in their own lives.
Additional assets of Kubler-Ross' book are the introductory paragraphs that she includes prior to each section. These paragraphs provide a preview of the topics each section will discuss and allude to the meaning that should be taken as they are read. For the psychotherapists, this helps denote which sections will be appropriate for each client. For the clients, these preview notes might help to direct their thoughts concerning the accounts that follow. Kubler-Ross is intentional in the tone of her preview paragraphs and includes her own opinions as well as feelings the paragraphs may evoke, making it clear that she hopes readers will grow from the book's contents.
Although this book can easily be seen as an asset in bibliotherapy, there are some weaknesses present as well. Kubler-Ross' book has a mixed tone overall that may feel empathic in some parts and more clinical in others. For example, in the discussions of different cultural perspectives there are no personal experiences shared. These sections merely explain different philosophies of death in a scholarly way rather than letting the reader experience dying as a person of the Hindu or Jewish faith would. In one chapter, there is a table that presents the results of research on services for terminally ill patients. Although the implementation of the findings of this study are presented later in the section and are, in fact, useful, the description of the research design and statistical findings are not necessary. A focus on the emotional challenges present when dealing with death and dying seem more the main concern in psychotherapy. These limitations contribute to this book having a limited group of individuals for whom it may be helpful.
While being mindful of the strengths and weaknesses of Kubler-Ross' book, it can be incorporated into psychotherapy a number of different ways. The psychotherapist could use different sections of the book as reflection exercises for clients. By assigning specific chapters to clients they can read and gain insight into their feelings as they face dying either themselves or through some else's experience. For example, one particular section would be particularly helpful for clients who are having problems allowing themselves to grieve. This section gives a funeral director's account of his feelings about the death of his father and how he chose to start allowing families to help dress and prepare their loved ones' bodies for burial. This funeral director thought that it was therapeutic for some people to have that experience in order to release their emotions. This particular section is very powerful and may evoke strong emotions from clients for the client and psychotherapist to address in treatment. A psychotherapist might assign this section so that a client might read and realize that there are many different ways to express one's grief that ultimately lead to better psychological health. This realization might be achieved through the client's own reflection, which would be discussed in psychotherapy, or the clinician might have to help the client to process the reading.
The different methods of incorporating Ross' book into psychotherapy have the potential to help in working toward a number of client goals. Another example would be to assign a specific section that might be therapeutic for someone who is dealing with his or her own dying. The account that the client would read is that of a dying woman who was a nurse. After reading, the client could make a list of feelings he or she had as a result. This assignment might be beneficial in meeting the therapeutic goal of identifying feelings associated with dying that needed to be processed in treatment. Even though the homework assignments might only be to read two or three pages each time, the content of those pages could inspire hours of self-reflection at home or several sessions of working through feelings that are a result of these readings.
In sum, Death: The Final Stage of Growth can be useful in bibliotherapy if the client represents one of the appropriate populations listed previously. Selected readings from this book can be incorporated into the psychotherapy process very effectively. The therapeutic benefits of Kubler-Ross' book can be great if the client has the motivation and potential for insight that are necessary for growth. By coming to terms with death as a natural part of the life cycle, Kubler-Ross helps clients to do the therapeutic work necessary to make it a meaningful growth experience.