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ON DEATH AND DYING




Sergio Flores | December 3, 2011
On Death and Dying



 ELISABETH KÜBLER-ROSS, M.D.
ABOUT THE AUTHOR

• Born one of triplets in Zurich, Switzerland, Elisabeth was a
  psychiatrist, humanitarian, physician, and hospice pioneer who wrote “On Death and
  Dying” in 1969

• She authored 24 books published in 34 languages. Considered to have changed the face of
  medicine and one of the most influential people and important minds of the last century

• In 2005 the Elisabeth Kübler-Ross Foundation is formed to further the work and maintain
   her legacy
     • Provides educational programs that deepen the understanding of those dying and
        grieving for the dead
     • Develop curricula for those involved in the care of the dying
Butterflies became her symbol, symbolizing the beautiful
transformation that she believed occurred at the time of death.
The logo for her Foundation is the butterfly symbol.
(http://www.ekrfoundation.org/)
On Death and Dying



 INTERVIEWING THE DYING

• At the Hospital where she worked in New York, Kübler-Ross was appalled by the standard
  treatment of dying patients. Unlike her colleagues, she made it a point to sit with
  terminally ill patients, listening as they poured out their hearts to her. She began giving
  lectures featuring dying patients who talked about what they were going through.

• Impetus for book was conceived by four theological seminary students researching “crisis
  in human life”. They considered death as the “biggest crisis people had to face”

• In attempting to understand the needs of the dying, she addresses death in terms of
  change, by studying the terminally ill patient’s attittudes, those of their caregivers, and
  our cultural attitudes toward death – death as an analogy to change

BOOK QUOTE
”If this book serves no other purpose but to sensitize family members of terminally ill patients and hospital personnel
to the implicit communications of dying patients, then it has fulfilled its task...help the patient and his family to get „in
tune‟ to each other‟s needs and come to an acceptance of an unavoidable reality...” Kübler-Ross (2011). (p. 151)
On Death and Dying



RECURRING CHANGE THEMES

        DEATH AS CRISIS                           RESPECT AND DIGNITY
•    Death is the ultimate change         •   In control of your destiny
•    Crisis as a catalyst to change       •   Manager - Subordinate relationship
•    Dehumanizing                         •   Doctor - patient relationship
•    Envy of the living                   •   Equanimity
•    Job Loss/Retirement – Catastrophic
     change


         EMPATHY                               REAWAKINING AND HOPE
 •   Needs to be understood               • Catalyst for renewal
 •   Perceptions of death (change) will   • Collective change
     color our ability to deal with it
 •   Listenting and understanding
 •   Reassurance
 •   Trust
 •   Impact of the messenger
On Death and Dying



DEATH AS CRISIS
ENVY OF THE LIVING
 • Society has taught us to view death as a taboo
     • Feelings or emotions that death invoke in us
     • Perception toward death, dehumanizes the patient
     • As a society we rather prolong life than diminish human     ANACLITIC DEPRESSION
        suffering

 • Patiens who are informed of their imminent death respond with
   anger, detachment, denial and fear
     • Losing control of their own destiny
     • But death, like change, is inevitable

 • Patients express envy of the living
     • Avoid death (change) at all costs
     • Marasmus of the soul
     • LOE

 • Catastrophic change
     • Job Loss
     • Retirement
On Death and Dying



CATASTROPHIC CHANGE

RETIREMENT



                         • Charles Schulz dies weeks after announcing his retirement

                         • Andy Rooney dies a month after his retirement

                         • A study of Shell Oil employees shows that those that retire
                           earlier, die sooner than those who decide to work past their
                           retiring age
                            (http://www.webmd.com/healthy-aging/news/20051020/early-retirement-early-death)


"I never dreamed that this would happen to me. I always had the feeling that I
would stay with the strip until I was in my early eighties, or something like
that. But all of sudden it's gone. I did not take it away. This has been taken
away from me.“ – Charles Schulz on The Today Show
On Death and Dying



EMPATHY AND UNDERSTANDING
LISTENING AND TRUST
• Patiens who are informed of their imminent death respond with
  anger, detachment, denial and fear
    • Losing control of their own destiny
    • The act of being merciful, provides relief
    • Sit, listen, and share

• Change is intensely personal (Jeanie Daniel Duck)
    • The sick person has feelings, the right to be heard

• Change is emotional, and evokes real feelings, wounds, our past
  (Attachment Theory)
    • Patients suffer more not physically, but emotionally

• Communication as a catalyst for reassurance and trust
    • More than 75% of those interviewed by Kübler-Ross make a
      full recovery

“People have contexts just as organizations do” – Gass, Pascale, and Athos
On Death and Dying



 RESPECT AND DIGNITY
EQUANIMITY

• Controlling your own destiny
    • Doctor‟s learn to judge whether or not a person is ready for the news
      , and the manner in which they will be told of death diagnosis - Hope
    • Subjective management of individuals
         • Achieved only by listening and understanding

• Address those that need to be heard and understood
    • “I am alive, don’t forget that. You can hear my voice, I am not dead yet”




    Do not apply the mushroom principal to change management:
        “ How to grow mushrooms?
                  Keep'em in the dark, and feed them bulls**t”
On Death and Dying



DABDA MODEL




                 DENIAL




  ANGER                   BARGAINING                DEPRESSION




                                       ACCEPTANCE
On Death and Dying



DENIAL

         Resistance is to be expected/accepted

         Who moved my cheese - Hem and Haw       DENIAL



         This cannot be happening to me

         How long will this last? Why me?




Ultimately, can lead to actual death
On Death and Dying



ANGER
              Strong emotions about change – stems
              from desperation

              Misderected – alienation of a resistor will
                                                                                ANGER
              often hinder rather than help

              Cathartic – Grief includes anger

              Should be respected, and understood



“Change is fundemantally about feelings; companies that want their workers to
contribute with their heads and hearts have to accept that emotions are essential to
the new management style” – Jeanie Daniel Duck
On Death and Dying



BARGAINING

         I‟ve been good, I can be better

         What if I don‟t participate?      BARGAINING



         Can I be the exception?

         I‟ve learned my lesson
On Death and Dying



DEPRESSION

         Loss of hope

         Emotional attachment                      DEPRESSION



         Reactive and Preparatory

         Sadness , regret, fear, and uncertainty
On Death and Dying



ACCEPTANCE

            Understanding – no more fear

            Resignation                                              ACCEPTANCE



            Detachment

            Enlightment



“Look not mournfully into the past. It comes not back again. Wisely improve
the present. It is thine. Go forth to meet the shadowy future, without fear.”
- Henry Wadsworth Longfellow (1807 - 1882)
On Death and Dying



 3-PHASE MODEL
DABDA MODEL OVERLAYED ON KURT LEWIN‟S MODEL


      Unfreeze                     Mobilise                     Refreeze
      •   Create the case for      •   Identify and mobilise     • Embed new ways of
          change                       the resources               working in the fabric of
      •   Dissatisfaction with         required to effect          the organization
          the status quo               change


      DENIAL AND ANGER
                                        BARGAINING                   ACCEPTANCE
                                       (DEPRESSION)




“Choosing a model is not an arbitrary choice--it is an ideological one. The assumptions we make
about change are also assumptions about the nature of reality and people.”
                             – Van de Ven & Poole (Theories and Models of Organizational Change)
On Death and Dying



  DIALETIC CORE PHILOSOPHY
CONSTRADICTION IS A NATURAL STATE




  • Change occurs when opposing powers (contradictory values – competing with each
    other), gain sufficient power to confront and engage the status quo.
      (http://gre.academia.edu/MJReid/Papers/252681/A_brief_review_of_Van_de_Ven_and_Pooles_1995_article_Explaining_develo
      pment_and_change_in_organizations_Academy_of_Management_Review_20_3_)


  • The DABDA model follows a directly linear representation of this philosophy, but at the
    micro, rather than macro, level
      (http://changingminds.org/disciplines/change_management/kubler_ross/kubler_ross.htm)



It is inconceivable for our unconscious to imagine an actual ending of our own life here on earth, and if this life of ours has to
end, the ending is always attributed to a malicious intervention from the outside by someone else. In simple terms, in our
unconscious mind we can only be killed; it is inconceivable to die of a natural cause or of old age. Therefore death in itself is
associated with a bad act, a frightening happening, something that in itself calls for retribution and punishment.
On Death and Dying



DABDA & ADKAR



                   KNOWLEDGE                     REINFORCEMENT
                 BARGAINING                      ACCEPTANCE
GROWTH




                AWARENESS/DESIRE                   ABILITY
                DENIAL /ANGER                    DEPRESSION




                                   ENLIGHTMENT
On Death and Dying



  REAWAKENING AND HOPE

 THE ROLE OF HOPE IN ACCOMPLISHING CHANGE

    • Even when the situation is most dire, the possibility of hope can
      facilitate change




                                                                            `
              Positive     Focused        Flexible      Organized          Proactive

                                                - Characteristics of Resilient Individuals (Conner Partners)



Not thinking of dying, but thinking of living   Don‟t focus on the negative, focus on the positive
On Death and Dying



REAWAKENING AND HOPE

        OLD FRAME OF MIND     NEW FRAME OF MIND
           IMPERSONAL              PERSONAL
             RIGIDITY             SENSITIVITY
         QUANTITY OF LIFE       QUALITY OF LIFE
            ABSOLUTES             FLEXIBILITY
               LAW                  ETHICS
             POWER                  IMPACT
          CONTENTEDNESS           HAPPINESS
       VICTORY IN CONFLICTS   CONFLICT RESOLUTION

                                (Hey & Moore, 1998)
On Death and Dying



REAWAKENING AND HOPE

How has death changed us as
a society?
• Peresonally?
• Collectively?

The impact on our everyday
lives and decisions
• The collective reality that
   has changed our lives so
   drastically
On Death and Dying



REFERENCES

•   Change Management Learning Center - Prosci (1996 – 2011). "ADKAR“- a model for change management : Change
      Management Tutorial Series. Retrieved November 5, 2011, from http://www.change-management.com/

•   Conner, Daniel (2004). Developing Resilient Teams for Managing Change. Conner Partners website, from
      http://www.connerpartners.com

•   Duck, Jeanie Daniel (1998). Managing Change: The Art of Balancing. Harvard Business Review on Change

•   Goss, Tracy, Pascals, Richard and Athos, Anthony (1998). The Reinvention Roller Coaster: Risking the Present for a
      Powerful Future. Harvard Business Review on Change

•   Hey, Kenneth R. and Moore, Peter D. (1998). The Caterpillar Doesn‟t Know: How Personal Change is Creating
     Organizational Change. New York, NY: The Free Press.

•   Kubler-Ross, Elisabeth (2011). On Death and Dying. Simon & Schuster, Inc.. Kindle Edition.
On Death and Dying



IMAGE REFERENCES
•   http://www.indiesolo.com/files/images/10178_371241.jpg
•   http://all-silhouettes.com/silhouetteclipart/
•   http://www.serebiiforums.com/showthread.php?t=551694
•   http://www.myspace.com/ekrfoundation/photos
•   http://peanuts.wikia.com/wiki/Charlie_Brown
On Death and Dying



VIDEO AND AUDIO REFERENCES
• http://www.youtube.com/v/aO4xpkH_YMw
• http://youtu.be/CYZJXoyrHnw

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Sergio flores mptm 621 on death and dying

  • 1. ON DEATH AND DYING Sergio Flores | December 3, 2011
  • 2. On Death and Dying ELISABETH KÜBLER-ROSS, M.D. ABOUT THE AUTHOR • Born one of triplets in Zurich, Switzerland, Elisabeth was a psychiatrist, humanitarian, physician, and hospice pioneer who wrote “On Death and Dying” in 1969 • She authored 24 books published in 34 languages. Considered to have changed the face of medicine and one of the most influential people and important minds of the last century • In 2005 the Elisabeth Kübler-Ross Foundation is formed to further the work and maintain her legacy • Provides educational programs that deepen the understanding of those dying and grieving for the dead • Develop curricula for those involved in the care of the dying Butterflies became her symbol, symbolizing the beautiful transformation that she believed occurred at the time of death. The logo for her Foundation is the butterfly symbol. (http://www.ekrfoundation.org/)
  • 3. On Death and Dying INTERVIEWING THE DYING • At the Hospital where she worked in New York, Kübler-Ross was appalled by the standard treatment of dying patients. Unlike her colleagues, she made it a point to sit with terminally ill patients, listening as they poured out their hearts to her. She began giving lectures featuring dying patients who talked about what they were going through. • Impetus for book was conceived by four theological seminary students researching “crisis in human life”. They considered death as the “biggest crisis people had to face” • In attempting to understand the needs of the dying, she addresses death in terms of change, by studying the terminally ill patient’s attittudes, those of their caregivers, and our cultural attitudes toward death – death as an analogy to change BOOK QUOTE ”If this book serves no other purpose but to sensitize family members of terminally ill patients and hospital personnel to the implicit communications of dying patients, then it has fulfilled its task...help the patient and his family to get „in tune‟ to each other‟s needs and come to an acceptance of an unavoidable reality...” Kübler-Ross (2011). (p. 151)
  • 4. On Death and Dying RECURRING CHANGE THEMES DEATH AS CRISIS RESPECT AND DIGNITY • Death is the ultimate change • In control of your destiny • Crisis as a catalyst to change • Manager - Subordinate relationship • Dehumanizing • Doctor - patient relationship • Envy of the living • Equanimity • Job Loss/Retirement – Catastrophic change EMPATHY REAWAKINING AND HOPE • Needs to be understood • Catalyst for renewal • Perceptions of death (change) will • Collective change color our ability to deal with it • Listenting and understanding • Reassurance • Trust • Impact of the messenger
  • 5. On Death and Dying DEATH AS CRISIS ENVY OF THE LIVING • Society has taught us to view death as a taboo • Feelings or emotions that death invoke in us • Perception toward death, dehumanizes the patient • As a society we rather prolong life than diminish human ANACLITIC DEPRESSION suffering • Patiens who are informed of their imminent death respond with anger, detachment, denial and fear • Losing control of their own destiny • But death, like change, is inevitable • Patients express envy of the living • Avoid death (change) at all costs • Marasmus of the soul • LOE • Catastrophic change • Job Loss • Retirement
  • 6. On Death and Dying CATASTROPHIC CHANGE RETIREMENT • Charles Schulz dies weeks after announcing his retirement • Andy Rooney dies a month after his retirement • A study of Shell Oil employees shows that those that retire earlier, die sooner than those who decide to work past their retiring age (http://www.webmd.com/healthy-aging/news/20051020/early-retirement-early-death) "I never dreamed that this would happen to me. I always had the feeling that I would stay with the strip until I was in my early eighties, or something like that. But all of sudden it's gone. I did not take it away. This has been taken away from me.“ – Charles Schulz on The Today Show
  • 7. On Death and Dying EMPATHY AND UNDERSTANDING LISTENING AND TRUST • Patiens who are informed of their imminent death respond with anger, detachment, denial and fear • Losing control of their own destiny • The act of being merciful, provides relief • Sit, listen, and share • Change is intensely personal (Jeanie Daniel Duck) • The sick person has feelings, the right to be heard • Change is emotional, and evokes real feelings, wounds, our past (Attachment Theory) • Patients suffer more not physically, but emotionally • Communication as a catalyst for reassurance and trust • More than 75% of those interviewed by Kübler-Ross make a full recovery “People have contexts just as organizations do” – Gass, Pascale, and Athos
  • 8. On Death and Dying RESPECT AND DIGNITY EQUANIMITY • Controlling your own destiny • Doctor‟s learn to judge whether or not a person is ready for the news , and the manner in which they will be told of death diagnosis - Hope • Subjective management of individuals • Achieved only by listening and understanding • Address those that need to be heard and understood • “I am alive, don’t forget that. You can hear my voice, I am not dead yet” Do not apply the mushroom principal to change management: “ How to grow mushrooms? Keep'em in the dark, and feed them bulls**t”
  • 9. On Death and Dying DABDA MODEL DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE
  • 10. On Death and Dying DENIAL Resistance is to be expected/accepted Who moved my cheese - Hem and Haw DENIAL This cannot be happening to me How long will this last? Why me? Ultimately, can lead to actual death
  • 11. On Death and Dying ANGER Strong emotions about change – stems from desperation Misderected – alienation of a resistor will ANGER often hinder rather than help Cathartic – Grief includes anger Should be respected, and understood “Change is fundemantally about feelings; companies that want their workers to contribute with their heads and hearts have to accept that emotions are essential to the new management style” – Jeanie Daniel Duck
  • 12. On Death and Dying BARGAINING I‟ve been good, I can be better What if I don‟t participate? BARGAINING Can I be the exception? I‟ve learned my lesson
  • 13. On Death and Dying DEPRESSION Loss of hope Emotional attachment DEPRESSION Reactive and Preparatory Sadness , regret, fear, and uncertainty
  • 14. On Death and Dying ACCEPTANCE Understanding – no more fear Resignation ACCEPTANCE Detachment Enlightment “Look not mournfully into the past. It comes not back again. Wisely improve the present. It is thine. Go forth to meet the shadowy future, without fear.” - Henry Wadsworth Longfellow (1807 - 1882)
  • 15. On Death and Dying 3-PHASE MODEL DABDA MODEL OVERLAYED ON KURT LEWIN‟S MODEL Unfreeze Mobilise Refreeze • Create the case for • Identify and mobilise • Embed new ways of change the resources working in the fabric of • Dissatisfaction with required to effect the organization the status quo change DENIAL AND ANGER BARGAINING ACCEPTANCE (DEPRESSION) “Choosing a model is not an arbitrary choice--it is an ideological one. The assumptions we make about change are also assumptions about the nature of reality and people.” – Van de Ven & Poole (Theories and Models of Organizational Change)
  • 16. On Death and Dying DIALETIC CORE PHILOSOPHY CONSTRADICTION IS A NATURAL STATE • Change occurs when opposing powers (contradictory values – competing with each other), gain sufficient power to confront and engage the status quo. (http://gre.academia.edu/MJReid/Papers/252681/A_brief_review_of_Van_de_Ven_and_Pooles_1995_article_Explaining_develo pment_and_change_in_organizations_Academy_of_Management_Review_20_3_) • The DABDA model follows a directly linear representation of this philosophy, but at the micro, rather than macro, level (http://changingminds.org/disciplines/change_management/kubler_ross/kubler_ross.htm) It is inconceivable for our unconscious to imagine an actual ending of our own life here on earth, and if this life of ours has to end, the ending is always attributed to a malicious intervention from the outside by someone else. In simple terms, in our unconscious mind we can only be killed; it is inconceivable to die of a natural cause or of old age. Therefore death in itself is associated with a bad act, a frightening happening, something that in itself calls for retribution and punishment.
  • 17. On Death and Dying DABDA & ADKAR KNOWLEDGE REINFORCEMENT BARGAINING ACCEPTANCE GROWTH AWARENESS/DESIRE ABILITY DENIAL /ANGER DEPRESSION ENLIGHTMENT
  • 18. On Death and Dying REAWAKENING AND HOPE THE ROLE OF HOPE IN ACCOMPLISHING CHANGE • Even when the situation is most dire, the possibility of hope can facilitate change ` Positive Focused Flexible Organized Proactive - Characteristics of Resilient Individuals (Conner Partners) Not thinking of dying, but thinking of living Don‟t focus on the negative, focus on the positive
  • 19. On Death and Dying REAWAKENING AND HOPE OLD FRAME OF MIND NEW FRAME OF MIND IMPERSONAL PERSONAL RIGIDITY SENSITIVITY QUANTITY OF LIFE QUALITY OF LIFE ABSOLUTES FLEXIBILITY LAW ETHICS POWER IMPACT CONTENTEDNESS HAPPINESS VICTORY IN CONFLICTS CONFLICT RESOLUTION (Hey & Moore, 1998)
  • 20. On Death and Dying REAWAKENING AND HOPE How has death changed us as a society? • Peresonally? • Collectively? The impact on our everyday lives and decisions • The collective reality that has changed our lives so drastically
  • 21. On Death and Dying REFERENCES • Change Management Learning Center - Prosci (1996 – 2011). "ADKAR“- a model for change management : Change Management Tutorial Series. Retrieved November 5, 2011, from http://www.change-management.com/ • Conner, Daniel (2004). Developing Resilient Teams for Managing Change. Conner Partners website, from http://www.connerpartners.com • Duck, Jeanie Daniel (1998). Managing Change: The Art of Balancing. Harvard Business Review on Change • Goss, Tracy, Pascals, Richard and Athos, Anthony (1998). The Reinvention Roller Coaster: Risking the Present for a Powerful Future. Harvard Business Review on Change • Hey, Kenneth R. and Moore, Peter D. (1998). The Caterpillar Doesn‟t Know: How Personal Change is Creating Organizational Change. New York, NY: The Free Press. • Kubler-Ross, Elisabeth (2011). On Death and Dying. Simon & Schuster, Inc.. Kindle Edition.
  • 22. On Death and Dying IMAGE REFERENCES • http://www.indiesolo.com/files/images/10178_371241.jpg • http://all-silhouettes.com/silhouetteclipart/ • http://www.serebiiforums.com/showthread.php?t=551694 • http://www.myspace.com/ekrfoundation/photos • http://peanuts.wikia.com/wiki/Charlie_Brown
  • 23. On Death and Dying VIDEO AND AUDIO REFERENCES • http://www.youtube.com/v/aO4xpkH_YMw • http://youtu.be/CYZJXoyrHnw