Book Report: On Death and Dying – Part I

Note: Extracted from part of book report I submitted for the course Grief Counselling in 2017 Spring


On Death and Dying was first published in 1969, authored by Elisabeth Kübler-Ross based on her experience working with terminally ill patients and their families. That was the time when medical practitioners were highly authoritarian leaving almost no room for patients to participate in decisions and society also avoided talking about death openly and privately.


Death is a universal fear. When the time comes, patients will be increasingly fearful and lonely as they were taken out from their familiar environment and medical personnel in hospital are busily preoccupied with his heart rate, pulse, electrocardiogram or pulmonary functions, his secretions or excretions but no one try to understanding their needs, worries and feelings making the process impersonal to repressing medical personnels anxieties inside. (Chapter 1)

In Chapter 2, Kübler-Ross expressed that we are less able to defend physically as technology advanced, new weapons of increasing power of destruction continue to be invented, and this intensified our fear of destruction and anxieties towards death. Medical development to prolong life and depersonalized medical care was used to master death. Kübler-Ross invited us to face our own death for inner peace so we have the courage to encounter patients death and re-think how science and technology can bring us a more humanistic world.

Chapter 3 – 7 explained the five stage of grief, also known as Kübler-Ross model.

Stage 1: Denial and Isolation (Chapter 3)

It is a temporary defense of not accepting the shocking news. They tends to believe that the diagnosis is not right or they are recovering and need not to go through further diagnosis and treatment in a short while.

Stage 2: Anger (Chapter 4)

Patients anger will be displaced and projected randomly to family members and hospital staff through complaints and guilt or shame induction resulting in less visit and avoidance. This, then, intensifies the anger in patients a vicious cycle of alienation is thus formed. Inside their anger and attention seeking acts are the fear of being forgotten, and sometimes envy of healthy people. Thus, anger shouldnt be taken personally.

Stage 3: Bargaining (Chapter 5)

Patients attempt to ask, towards God usually, for the last reward (i.e. postponing death according to the self-imposed deadline) in exchange with good behavior. Behind this could be quiet guilt towards God (e.g. not attending church, not devoted enough into the religion) or deeper, unconscious hostile wishes that needs to be taken care of.

Stage 4: Depression (Chapter 6)

As patients illness progress, they became weaker, more hospitalization and operations were imposed, sooner or later sense of great loss” will become dominate. This is the stage which patients are preparing themselves to separate from this world and losing everything they love through grief (aka. preparatory grief), communications will shift to non-verbal one and their circle of interest decreases. Thus, there arent need to cheer them up as this normally serves our own inability to face death.

Some complications may result if patients had unresolved griefs as a result of past losses or regrets of havent taking certain opportunities when they are well.

Stage 5: Acceptance (Chapter 7)

It is a stage which patients are void of feelings and death could be a relief. Patients family will need more support than patients themselves. Their circle of interest further shrank. Nonverbal communication reminds them that they wont be left alone until the very end.

If patients family failed to distinguish or accept that patients are under this stage, blaming them for giving up too early or try real hard to prolong their life, they will feel dismay and angry to their family.

Kübler-Ross talked about Hope in patients that exist in all stages in Chapter 8. Hope maintains that their sufferings will pay off eventually by recovering, by a new drug or treatment plan that helps, if they endure it a bit longer. Hope also gives them a sense of meaning in their sufferings. Kübler-Ross reminded family members and caring professionals to maintain hope but not reinforce hope at the stage of final acceptance.

Chapter 9 focuses on how patients family can help and the adjustment and preparation needed by family members when patients become weaker and eventually pass away. Family members should maintain a balance between taking care of patients and their own needs for their well beings during patients hospitalization. 

Direct communications, discussions and expression of feelings between patients and their family members about the impending death not only can avoid anger, alienation and isolation but bring closeness and deeper sense of meaning to all. After all, patients can see through the make-believe mask of their family members. This not only prepares patients to go through anger and preparatory grief and eventually accept their impeding death, but their family members to go through similar stages. 

Kübler-Ross suggests that family members will feel void and emptiness after the funeral when relatives depart, thus right timing for human beings to talk and care them, and allow them to express their angry, despair or loneliness. Children and adolescence should be taken care of as well. For members who are pre-occupied with fantasies with the deceased, we should understand and allow them to express their feeling and not to ridicule or confront them too frequently. 

Additional interviews, their transcripts and analysis can be found in Chapter 10. For Chapter 11 & 12, Kübler-Ross shared the adversaries and oppositions from medical personnel throughout her works of interviewing terminally ill patients, and how this helps bringing a whole new perspective to medical personnel to provide humanistic and less impersonal medical care, and the courage to face death for both medical personal, patients themselves and their families.


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屬於我的那杯茶 要什麼味道 沒最好 要剛好  只能由自己來調

投我所好 倘若有希望就有失望
享受那些煩惱 感受我想要的味道

沒什麼重不重要 只在乎需不需要
哪怕外面再熱鬧 沒被感動到
我寧可 一個人 無聲無息中睡著

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Bowen Family Therapy

ISS Family Institute (HK): Bowen Theory – Introduction [English] [Chinese]

  • More organized notes on Bowen Theory – 4 Foundation Concepts (Anxiety, Two Basic Life Forces, Emotional System and The Family as an Emotional Unit) and 8 Emotional Processes

Psychology In Seattle: Bowenian Therapy (10 mins)

  • 10-minute video going through concepts like Anxiety, Togetherness vs Separateness, Feelings vs Intellect, Differentiation and Triangulation, and Critiques

Erica E. Hartwell: Bowen’s Eight Concepts (30 mins)

  • 30-minute video going through concepts like Anxiety, Differentiation, Two basic life force: togetherness and separateness, emotional system and family as an emotional unit) and Triangles, and Process like Nuclear Family Emotional Process, Family Projection Process, Multi-generational Transmission Process, Sibling Position and Emotional Cut-off

Diane Gehart: Bowen YouTube (30 mins) 

  • Therapy Textbook Author going through Bowen Family Therapy which is informative, clear and easy to understand

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當講起自己幾多歲嘅時候,有時我會講自己三十五歲, 實際上我係三十四歲。未到生日,一日都可以 claim 自己三十四歲。但係日子一日一日今過,三十四同三十五歲嘅分别其實越來越小,直到一日 ,boom,喜歡與否已經係三十五歲。

如果我真係叮噹,我希望返去過去,再為選擇作決定。當然,呢個只係一個FF 。Viktor Frankl 係 Man’s Search for Meaning 一書面今講 “Live as if you were living for the second time and had acted as wrongly the first time a you are about to act now”。此時此刻作一個決定又點知啱定係唔啱。可能係因為我欠決一d 野而作出一個決定去 fill-up 一d 野,若果果d 野出現返,又或者不再需要,又或者成就唔到,呢個決定就好似無乜價值,當初嘅決定就好似係錯嘅今。

人越大本錢就越來越小,健康、精神、記憶力、學習能力都係,就越輸唔起。係無時光機嘅今日應該以乜野準則作決定呢?歐文亞隆係生命的禮物一書提出”決定是進入豐富的存在領域的捷徑,這個領域包括了自由、責任、選擇、懊悔、願望和意志… 接受膚淺而過早提出的勸告, 等於讓他們放棄探索存在領域的機會。”

好一個探索存在領域的機會。我treasure d 乜呢?

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CCDP/ Cisco ARCH (v.3): Further Readings

It may be that due to the nature of this course – focusing on theory and design instead of digging into command and “computer architecture” kind of topic, it may be good for 300-320 ARCH exam but explanation given was not clear for a techie. Below are some of the contents I found useful to enhance my domain knowledge complimenting Cisco CLN E-Learning: Designing Cisco Network Service Architectures (ARCH) v3.0 (Other Learning Resources here )

More links will be added here, so come back from time to time 🙂

Last Update: 2016/07/13 – Including readings for Ch23 Designing Firewall and IPS Solutions

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