Kübler-Ross, Elisabeth (1926—)

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Kübler-Ross, Elisabeth (1926—)

Swiss psychiatrist and pioneer in the field of thanatology. Born Elisabeth Kübler in Zurich, Switzerland, on July 8, 1926; daughter of Ernest Kübler (a businessman) and Emma (Villager) Kübler; awarded M.D., University of Zurich Medical School, 1957; married Emanuel Ross, in 1958 (divorced); children: Kenneth; Barbara.

Moved to U.S. (1958); worked as rotating intern at Community Hospital, Glen Cove, New York (1958–59); became a naturalized citizen of the U.S. (1961); was a research fellow at Manhattan State Hospital (1959–61); was a resident at Montefiore Hospital, Bronx, New York (1961–62); was a fellow in psychiatry, Psychopathic Hospital, University of Colorado Medical School (1962–65); was an assistant professor in psychiatry, Billings Hospital, University of Chicago (1965–70); served as medical director of Family Service and Mental Health Center of South Cook County, Chicago Heights, Illinois (1970–73); was president and chair of the Board of Shanti Nilaya Growth and Health Center, Escondido, California (1977–83); moved to Virginia (1983); moved to Scottsdale, Arizona (1994).

Selected publications:

On Death and Dying (1969); Questions and Answers on Death and Dying (1974); Death: The Final Stages of Growth (1975); To Live Until We Say Goodbye (1978); Working It Through (1981); Living With Death and Dying (1981); Remember the Secret (1981); On Children and Death (1985); AIDS: The Ultimate Challenge (1988); On Life After Death (1991).

A founding pioneer in the field of thanatology (the study of death), Elisabeth Kübler-Ross, a psychiatrist by training, is widely recognized as the 20th-century's foremost authority on death and dying. Her groundbreaking work with dying patients has transformed Western medicine's approach toward the terminally ill, affected public policy and scholarly research, and radically altered Western society's attitudes toward death and dying. While most of her work has dealt with the psychological effects of dying, in recent years Kübler-Ross has sparked controversy and professional criticism of her work by venturing into the study of spirituality and the speculative realm of life after death.

I still have so much to learn from the dying, who have become my best teachers.
—Elisabeth Kübler-Ross

Elisabeth Kübler-Ross was the first of triplet girls born to Ernest and Emma Kübler on July 8, 1926, in Zurich, Switzerland. Elisabeth and Erika (her identical twin) were both thin and sickly, each weighing a mere two pounds at birth. Doctors believed that of the three only Eva (a fraternal twin) would survive infancy. But Emma Kübler was a devoted and determined mother. She moved into the nursery with her daughters, nursing them every three hours around the clock for the next nine months. During the first few months, Elisabeth had to be fed through a doll's bottle as her tiny mouth was too small to allow her to breast-feed.

Her parents shared an enormous appetite for living and seemingly limitless energy, traits they passed down to their children. Her father Ernest Kübler was a successful businessman and part-time instructor at a technical college. He was also an avid mountain climber, hiker, and skier and instilled in his daughter a love of the outdoors.

The extraordinary origin of Elisabeth and her sisters led instantly to their domination of the Kübler household, with the result that their older brother, Ernest, was eclipsed and remained a distant figure throughout Kübler-Ross' life. The girls also became minor celebrities in Zurich, where their picture appeared in advertisements and on billboards. Although Elisabeth and her sisters each had highly distinctive personalities, in the hearts and minds of their parents, schoolteachers, and the public they were simply "the Kübler triplets." Kübler-Ross later recalled rarely being called by her first name at home, in school, or in the outside world. This lack of individual recognition affected her deeply and sparked an independent, rebellious streak and what she later referred to as her "strange beckonings." One such childhood beckoning was an obsession with a picture book on life in an African village that inspired her to create her own imaginary African village, "Higaland." She then devised a special Higaland language which she taught to her sisters.

As a child, Elisabeth Kübler-Ross also exhibited a bent toward science. She turned a section of the house cellar into a laboratory where she experimented with chemicals. Another area of the cellar she converted into a makeshift hospital for injured birds and animals. In a sixth-grade composition entitled "My Dream of What I Could Be," Kübler-Ross wrote that her first aspiration was to be "a researcher and explorer of unknown frontiers of human knowledge."

These precocious school-girl aspirations were temporarily sidetracked following the completion of her compulsory education in 1942. Her father decided that she should join his business rather than continue with her education. When Kübler-Ross refused, he ordered her either to join his business or go to work as a domestic servant. She defiantly chose the latter and for the next year was employed as a housekeeper in the French-speaking part of Germany.

She returned to her family in 1943 and, again against her father's wishes, accepted a three-year apprenticeship in a biomedical research laboratory. She also began attending classes in chemistry, physics, and mathematics in order to obtain her technician's certification. Kübler-Ross consistently ranked at the top of the class, and when the laboratory went bankrupt she won a coveted apprenticeship with Dr. Karl Zehnder, director of the dermatology department at Camden Hospital. At Camden, much of her work involved taking blood samples from prostitutes suffering from venereal diseases for an on-going study. This constituted Kübler-Ross' first direct contact with patients, and she quickly discovered that she had a natural empathy and compassion for those whom most physicians

and hospital staff treated carelessly. It was, she later recalled, her first inkling that there was something greatly amiss "when the dispassionate technology of medicine could not be linked to the cries of the heart and an understanding of the mind." Kübler-Ross began to seek out the sick children at the hospital, visiting and playing with them during her lunch hours.

Elisabeth Kübler-Ross' humanitarian instincts were aroused again in 1944 when scores of refugees from the war were sent to Camden hospital to be deloused. Without the approval of her department, she began working with the delousing team, counseling refugees rather than performing her duties at the lab. A desire to be more involved in relief work prompted her in the summer of 1945 to take a leave of absence from her apprenticeship and join the International Voluntary Service for Peace. Her first assignment as an unpaid relief worker concerned the rebuilding of the French town of Ecurcey. In the fall, she returned to Zurich and took her medical technician's exam, finishing first out of 32 students. After an unsatisfying stint in a research laboratory, Kübler-Ross was hired in 1947 by Professor Marc Amsler, head of the ophthalmology department at the University of Zurich. Once again, her main satisfaction derived from counseling the patients—many threatened by blindness—who came for treatment.

Kübler-Ross spent another few months in the summer of 1947 working as a relief worker in Belgium, Poland, and Stockholm, Sweden. Her experiences with refugees and Holocaust survivors strengthened her resolve to study medicine. She enrolled in the Medical School at the University of Zurich in 1952, after successfully passing the Mature examination, and continued to work full-time in the ophthalmology department. She received her medical degree in 1957 and early the following year married Emanuel Ross, an American medical student, after a lengthy courtship. The couple left Switzerland for the United States at the end of June 1958.

Upon arriving in America, Kübler-Ross accepted a one-year internship at the Glen Cove Community Hospital in Long Island, New York. The following year, she applied for and was accepted as a resident at the prestigious Columbia Presbyterian Medical Center, but an unexpected pregnancy (which later ended in a miscarriage) forced her to refuse the coveted residency. Instead, she accepted a research fellowship at Manhattan State Hospital, an underfunded, underequipped hospital that served indigent mentally ill patients. Kübler-Ross was originally hired to observe and record patient responses to a variety of experimental drugs (the drugs, she later discovered, were LSD, psilocybin, and mescaline). Appalled by the apathy of most of the staff and the horrendous conditions under which the patients lived, she worked tirelessly to clean up the wards, spoke out against the use of experimental drugs and shock therapy, and earned a reputation with the patients and the staff as a compassionate and empathetic doctor.

In 1960, she gave birth to her son Kenneth (daughter Barbara would be born in 1963), and in 1961, after deciding on a career in psychiatry, she left Manhattan State Hospital and started a residency in psychiatry at Montefiore Hospital. Once there, she abandoned the classical Freudian technique of free association and interpretation preferred by the other physicians in favor of a less fashionable approach. She offered each patient individualized attention and based her diagnoses and treatment on intuition. Her colleagues criticized her unorthodox methods, yet her results were often extraordinary. Kübler-Ross later recalled that it was during these early years in New York that she began formulating some of the theories she would later pioneer. She noted that physicians at the hospital tended to regard the death of a patient as a personal failure and that the medical personnel's views of terminally ill patients were informed by their own fears of death. She also observed that physicians often showed a greater reluctance to accept a poor prognosis than did their patients.

In 1962, Elisabeth Kübler-Ross and her husband accepted joint positions at the University of Colorado. While there she worked, first as an assistant and then as an instructor, under the brilliant Vienna-trained psychiatrist Sydney Margolin. Margolin had a similarly independent nature and employed unusual techniques, including hypnosis. He became her mentor, encouraging rather than criticizing the spiritual dimension she brought to her work and her growing preoccupation with the psychological aspects of dying. Death was the subject of Kübler-Ross' first lecture to medical students. During the lecture, she interviewed a 16-year-old girl dying of leukemia, questioning her about her reactions to the prognosis. Then she invited the medical students to question the patient and observed their obvious discomfort as they avoided personal questions and instead asked questions related to symptoms and the patient's medical history. At the end of the emotionally charged lecture, Kübler-Ross challenged the students to confront their own fears of death and expressed her conviction that modern medicine's emphasis on technology and efficiency was undermining the genuine art of healing.

This lecture was a prototype of the seminars Kübler-Ross later developed at the University of Chicago's Billings Hospital, where she served as assistant professor in psychiatry from 1965 to 1970. She was considered a gifted teacher, and her lectures at the university were enormously popular. For each of her five years on the faculty, the students honored her with the "Most Popular Teacher" award. Though her main responsibilities were lecturing to medical students on psychiatry and caring for patients in the psychiatric in-patient unit, her interests were again drawn in another direction. She began conducting regular staged interviews with terminally ill patients for the benefit of medical students, nurses, chaplains, social workers, and therapists. The interviews served the purpose of alerting caregivers to the special psychological and spiritual needs of the terminally ill. By 1966, Kübler-Ross' Death and Dying seminars were gaining her larger audiences and academic popularity. She agreed to join the staff of the Lutheran Theological Seminary as a counselor in pastoral care in order to train future pastors to minister effectively to the ill or dying.

Elisabeth Kübler-Ross' years of research and work with the terminally ill culminated in her 1969 book On Death and Dying. In it, she systematically examined the human response to dying and identified the five "stages" of dying: denial, anger, bargaining, depression, and acceptance. Denial is typically the patient's initial reaction to the prognosis. Eventually the denial gives way to anger, as well as to displaced feelings of rage, envy, and resentment. The third stage, bargaining, is characterized by the patient's attempts to enter into an agreement, such as trading in good behavior, to put off or avoid the inevitable. Depression follows, in which the patient is overcome by feelings of loss. The final stage, acceptance, occurs when the patient experiences a void of feelings and quietly accepts his fate.

On Death and Dying became a bestseller, and Kübler-Ross' work won wide praise from physicians and specialists. Subsequent articles in popular publications like Life and appearances on national television catapulted her to international fame. Almost overnight, she was hailed as the foremost authority on death, and her work inspired a new field of study, thanatology. Following her example, theologians began devoting more time to exploring the meaning of death, while medical personnel started exhibiting greater compassion toward dying patients. Psychologists, sociologists, and anthropologists began researching death-related behavior, and universities like Harvard and Stanford began offering courses on the subject of death and dying.

Elisabeth Kübler-Ross' fame became so great that she received up to 3,000 letters a week and a steady stream of invitations to lecture and conduct workshops. She resigned from the faculty of the University of Chicago in 1970 so that she could to devote herself full time to her work with the terminally ill. Her "Life, Death and Transition" workshops, which she conducted throughout the United States and abroad, attracted thousands of ill people, their families, and members of the medical profession. Though the first modern hospice to care for the dying was established in England by Cicely Saunders , Kübler-Ross was largely responsible for bringing the concept to the United States, and she subsequently served on the boards of numerous hospices across the country.

By the mid-1970s, Elisabeth Kübler-Ross had begun delving into the spiritual aspects of death. In her 1974 book, Questions and Answers on Death and Dying, she wrote: "Before I started working with dying patients, I did not believe in life after death. I now do believe in life after death without a shadow of a doubt." Her vision of life after death included a happy, peaceful existence in which the physical and mental ailments of the body disappeared. This note of hope consoled her terminally ill patients and contributed greatly to the continued success of her workshops but also drew professional criticism. Further scientific skepticism was aroused by her claims that she had encountered "materialized" supernatural spirits, including a former patient. Countered Kübler-Ross:

I have had many wonderful mystical experiences, from cosmic consciousness to the awareness and ability to be in touch with my own guides, although I come from a conservative Protestant, authoritarian European background and I have never sought or previously understood the concept of "higher consciousness." I have never been able to meditate regularly; activities of this nature do not accord with my personality. I have never had a guru. … I have lived a life of unremitting work; leisure has never had much part in it. Yet despite all this, I have had, very possibly, every mystical experience that human beings are capable of having. I have experienced the greatest highs without ever having taken any drugs. I have been able to see the light that my patients see in their near-death experiences, and I have been surrounded by that incredible unconditional love that all of us experience when we make the transition called death.

In 1977, she formed a fleeting professional alliance with self-proclaimed medium Jay Barham (a former Arkansas sharecropper who established the Church of the Facet of Divinity in 1975) and began participating in seances at Shanti Nilaya, a healing retreat she founded that year in Escondido, California. Kübler-Ross' reputation suffered a sustained blow when disgruntled participants alleged that sexual misconduct had occurred during the seances. The charges were ultimately dismissed, and Kübler-Ross continued to defend her belief that communication with the dead was a reality and that she could act as a visionary.

Throughout the 1980s, Elisabeth Kübler-Ross' efforts were focused on AIDS. She designed workshops in response to the special needs of AIDS patients and devoted a considerable effort on behalf of children with AIDS. In 1985, she sparked controversy again when she announced plans to build a hospice for children with AIDS at Healing Waters Farm, her 250-acre farm in rural Highland County, Virginia, where she had moved the base of her operations two years earlier. Her plan met with immediate resistance from local residents who staunchly opposed providing a haven for AIDS patients in their community. The local government supported the residents and denied her request to rezone the land. After much heated community debate, she abandoned the idea and instead set up a national network to place children with AIDS in other health centers across the country. In 1987, meeting with continued local disapproval, Kübler-Ross established a teaching center at the farm to train therapists working with the terminally ill and began operating workshops for grieving survivors. She detailed her struggles with the community in her 1987 book AIDS: The Ultimate Challenge. The book includes case histories of patients and explores the special needs and complex feelings associated with the disease; it also advocates a more compassionate and humane treatment of those stricken with AIDS and calls on society to meet the challenge of combating the disease. In the book, she writes:

We can destroy ourselves with our own self-imposed fears, blame, shame, negativity. … Or we can make our choices based on love and begin to heal, to serve those with AIDS and other diseases, to show compassion and understanding, and finally, before it is too late, to learn the final lesson, the lesson of unconditional love.

The nine-year battle between Kübler-Ross and local residents over her attempts to found AIDS-related care or educational facilities in Highland County culminated in November 1994 when arsonists burned her farm and training center to the ground. Following the fire, she curtailed her professional activities in Virginia and moved to Scottsdale, Arizona.

Elisabeth Kübler-Ross is the recipient of numerous honorary degrees from universities, including Smith College, the University of Notre Dame, Amherst College, and Loyola University, as well as several awards including the Teilhard Prize from the Teilhard Foundation (1981). In an epilogue to her biography, written by Derek Gill, she wrote:

Those years in the French part of Switzerland, in Poland, France, Germany, Belgium and Italy were gifts of awareness, gifts of sharing with other human beings who had survived the war but lost many loved ones under the most tragic of circumstances. By viewing the gas chambers, the concentration camps, the train filled with the baby shoes of murdered children in Maidanek, by talking with the Jewish girl who had lived through the nightmare of seeing her family march to their deaths, I learned that it is our choice, our own personal choice, whether we want to continue living as victims of resentment, negativity, the need for revenge; or whether we elect to leave the negativity behind and view such tragedies as the windstorms of life which can both strengthen us and help us to grow.