COVID-19 and Doctor Kübler-Ross
In 1969, Dr. Elizabeth Kübler-Ross published her seminal book On Death and Dying, in which she proposed a model how people cope with illness and dying. This remarkable book heralded the beginning of increased public awareness of and discussion about how people, especially in the developed world, think about their own mortality. In an admitted oversimplification, she defined five stages of grief: denial, anger, depression, bargaining, and acceptance. As I observe my own and others’ reactions to the situation we live in under the threat of COVID-19, I wondered if Dr. Kübler-Ross’s model might have something to say to us.
DENIAL: Most of us, when we first heard about a novel coronavirus that was rapidly spreading in Wuhan, China, thought, “That’s very sad, but it’s not likely to be my problem.” My wife and I had trips planned, including one to Cambodia, we had family celebrations planned, I had a national convention to attend, and, even as a some unfortunate nursing home residents in Washington were getting sick, it was easy for me to ignore, to pretend it wouldn’t affect me. That didn’t last long.
There is another part of denial, though, that persisted even after we all shut down; I call this going into “survival mode.” In this temporary lifestyle, we obeyed all the hygiene rules, learned to wash our hands and not pick our noses, but also gutted stores of essential and less essential supplies. We were afraid of the disease but saw our robotic compliance and over-preparation as a talisman that would protect us from the impending danger. Others might get sick, but we wouldn’t.
ANGER: This is most clear in the protests, the blame game, and the conspiracy theories; we don’t like what is happening to us, we resent our convenient easy freedom being restricted, so we look for someone to punish. But the more pernicious anger is not what happens on cable news channels or on the steps of state capitol buildings, it is what happens at home. When we feel trapped, we react against whatever irritating target is at hand, and that is usually those we live with, those we are closest to.
DEPRESSION: Physical isolation and feelings of impotence to produce change can combine to produce a sense of hopelessness. It is a small step from there to images of worthlessness. “I sit here every day, nothing changes, nobody seems to care, why should I even bother?”
BARGAINING: This is where we are as a nation as we try to open up business, restart personal interaction. On the governmental level, the bargain is weighing increased numbers of people getting sick, even dying from the novel coronavirus versus economic recovery and political expediency. On the individual level I have seen those who decided they are “done with” the distancing precautions, seemingly thinking that since neither they nor someone they loved had gotten sick, they had done enough. It seems those accepting this Faustian bargain are few, and I hope that remains the case.
ACCEPTANCE: A recent thought-provoking column in The New York Times asked if our society would soon start to look on the hundreds dying each day of COVID-19 like we seem to look at victims of gun violence—bemoaning and demanding change when a particularly heinous crime occurs but otherwise tolerating it as just the way things are. Achieving a sense of acceptance implies that we realistically see what is the new normal, but does not mean that we somehow say that it is OK. Acceptance in its best sense is realistic, and can still be defiant.
A sense of acceptance on a societal level would have us all recognize that we share the responsibility for and consequences of actions to minimize the suffering and death. It would defy corruption and self-serving partisanship, would hold blunderers and criminals responsible, but would not play the blame game. It would more like post-9/11 America and less like Antietam or Andersonville. It is difficult, maybe impossible, for our current society to achieve this positive sense of acceptance, but without it, our health and healing will remain incomplete.