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

Introduction

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.

Abstract

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.

 

過我的生活

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

我擁有時間不是時間擁有我的通告
我做想做的事情忙碌也是一種逍遙
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
不合適的音樂別來騷擾
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

寫在三十五歲前

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?

周國賢: 時空

去旅行嘅時候個friend係車上面播歌,聽到周國賢首 Children Song 覺得幾好,於是就去搵啦佢其他歌。呢首都唔錯,唔錯都幾好其實係因為有 D 共鳴。

做決定嘅時候亦都冇可能知道將來會係點。過咗去嘅就係過咗去,時間係唔會返轉頭,我亦都返唔到過去。無憾或者就係勇敢地為自己的目標作個決定然後付諸實行,希望回望嘅時候無憾。

兩句我好鍾意嘅 Quote

Decisions are a via regia, a royal road, into a rich existential domain – the realm of freedom, responsibility, choice, regret, wishing, and willing. – Irvin D Yalom

Live as if you were living for the second time and had acted as wrongly the first time as you are about to act now – Frank Vicktor

作詞:林若寧
作曲:周國賢
編曲:周國賢
監製:周國賢.[email protected]

霓虹前這位潦倒老年 淪為時光機的配件
直到活到歲月到終點 沒有自己經典
挖苦你的少年 在倒後鏡片段裡一閃
然後人生蒸發一縷煙 被發現經已大殮

如何後悔 也知道 無從後退 能探險必需探險

明日在那裡再望向這裡  怕那一位較這一位更唏噓
一個人平行時空怎去面對
從前起身嗌反對 而如今偷偷隱退
誰記得這少年和這老年 曾天生一對
六百歲再夢見過往六歲 這一天看那一天崎嶇
才對得起當天那個小孩 無負那個小孩
曾為信仰出發不理反對

捉得到一隻蟬 誤信便會抱住這花園
懷著童真可笑的某天 立紀念碑去自勉

年年度過 怕只怕 年年白過 而據點只得句點

明日六百歲再夢見過往六歲 這一天看那一天崎嶇
才對得起當天那個小孩 無負那個小孩
曾為信仰出發不理反對

還是有生活興趣 能令你生命有趣 看盡山水

如明日在這裡你又到哪裡 有這一位替那一位作先驅
出發前無人能知選錯或對
年輪都刻進骨髓 年齡都不可倒退
無悔於這旅程 留低過程 曾衝出堡壘
六百歲再夢見過往六歲 這一生看那一生興衰
還記得今天演過這一場 無論去到終場
曾為信仰掙扎可以死去

周國賢: Children Song

呢首歌除咗好聽之外,我覺得都幾有意思,仲有 d 共嗚添。個人嘗試這樣了解:

i) 當人越大被世界(又或者因比較而要求)要求達到一個所謂成熟或成功的標準,而追求嘅事係同善良[a]、無爭[b]、堅持[c]和率性[d] 的本性(歌詞提及的小孩)相違。 這個小孩-開始被放在一旁,但到最後卻再被重視。

ii) 係心理學上,(內在)小孩可以是過去在成長的創傷和壓抑 [e] (e.g. 小大人),這些內在小孩使人壓抑自己的本性而產生多一個內在小孩 (就是 (i) 提出的那個)。這個內在小孩多被其他的小孩 suppress 的。

Disclaimer: 非專業分辨,有機會錯 🙂

周國賢: Children Song

作詞:藍奕邦
作曲:周國賢
編曲:周國賢 / 藍奕邦 / Goro Wong
監製:周國賢 / Goro Wong

還記得有多久未好好哭過嗎
還記得有多久未真心歡笑嗎
為去變一個大人 凡事也裝得很化 [e]
人海裡 比賽攀爬

人活到疲倦乏力先想起你嗎
和我再抱擁牽手哭泣可以嗎
是你這可愛兒童 仍然廝守心底裡
來給我 休憩收容

如若全世界一天一點變壞
猶幸還有你一貫爛漫姿態
而你赤裸裸脫俗如像小孩
想笑就笑要嗌就嗌 [d]

嘗試以你的率真觀賞這世間
嘗試再懶得小心分清忠與奸
讓我每當困倦時 回眸總可找到你
在心裡 不見不散

如若全世界一天一點變壞
猶幸還有你一貫爛漫姿態
而你赤裸裸脫俗如像小孩
想笑就笑要嗌就嗌

猶幸赤子心總不捨得變賣 [a]? [b]?
榮幸還有你跟我在做反派
而你赤裸裸敏銳如像小孩
跟我敵抗世界病態

想要跟你解去束縛跟作反 [d]
想要將那時候校慢
跟你不怕一哭一笑被人飽覽
先知道我若要做我其實太簡單

如若全世界一天一點變壞
猶幸還有你一貫爛漫姿態 [a]
而你赤裸裸脫俗如像小孩
跟我同行到老 想笑就笑要嗌就嗌

猶幸赤子心總不捨得變賣
榮幸還有你跟我在做反派
而你赤裸裸敏銳如像小孩
跟我敵抗世界病態

如若全世界一天一點變壞
猶幸還有你一給我力量去捱 [c]
而你赤裸裸脫俗如像小孩
跟我敵抗世界病態

長在我心中你是純淨小孩 [a][b]

報紙

我主場:周國賢 迷失.重 – http://hk.apple.nextmedia.com/entertainment/art/20160304/19515189

樂評

[1] 童心:周國賢《Children Song》|林望天 – https://manjuhk.com/2015/12/14/childrensong/

Reference

[1] 內在小孩治療法簡介 – http://elodiechang.pixnet.net/blog/post/26417065-%E5%85%A7%E5%9C%A8%E5%B0%8F%E5%AD%A9%E6%B2%BB%E7%99%82%E6%B3%95%E7%B0%A1%E4%BB%8B
[2] Wikipeida – https://en.wikipedia.org/wiki/Inner_child