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121-470: Critics of the model have warned against using it too literally. Introduced as "The Five Stages of Death" by Swiss-American psychiatrist Elisabeth Kübler-Ross in 1969, this model has been known by various names, including "The Five Stages of Loss", "The Kübler-Ross Model", the "Kübler-Ross Grief Cycle", the "Grief Cycle", "The Seven Stages of Grief", and the Kübler-Ross Change Curve". The model

242-625: A healthy diet are also recommended. Supportive care in severe cases includes treatment to relieve symptoms , fluid therapy , oxygen support and prone positioning , and medications or devices to support other affected vital organs. More severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is recommended to reduce mortality. Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing. Extracorporeal membrane oxygenation (ECMO) has been used to address

363-615: A variant of concern (VoC) or a variant of interest (VoI). Many of these variants have shared the more infectious D614G . As of May 2023, the WHO had downgraded all variants of concern to previously circulating as these were no longer detected in new infections. Sub-lineages of the Omicron variant (BA.1 – BA.5) were considered separate VoCs by the WHO until they were downgraded in March 2023 as no longer widely circulating. As of 24 September 2024 ,

484-442: A 2010 song about grief, death, and the singer's deceased mother." In addition to songs, EP albums such as "Kübler-Ross" by Chine Drive (2023), "Kübler-Ross Soliloquies" album by Deadbeat (2023), "Kübler-Ross" album by Coachello (2024), and "Kübler-Ross (Five Stages of Grief)" album by Saint Juvi (2024) have been named in her remembrance. Several musical artists have also titled albums based on Kübler-Ross’s books, such as Beyond

605-564: A 256-page book titled "On Death & Dying." Coincidentally, just six days later, on July 13, 1967, St. Christopher's Hospice, the first modern hospice, admitted its inaugural patient. The book was officially registered with the US copyright office on May 19, 1969. Despite delays, the book was eventually published in November 1969 and quickly became a best-seller, profoundly altering her life. Notably, as of December 18, 1976, "On Death & Dying" remained on

726-679: A Clinical Ethicist, I Learned From Elisabeth Kübler-Ross," American bioethicist Mark G. Kuczewski outlined how Kübler-Ross laid the foundation for clinical bioethics and emphasized the need to listen to patients for understanding their needs and improving their quality of life. In 1958, she married a fellow medical student and classmate from America, Emanuel "Manny" Ross, and moved to the United States. Together, they completed their internships at Long Island's Glen Cove Community Hospital in New York. After they married, she had their first child in 1960,

847-493: A comprehensive international study. Such deaths include deaths due to healthcare capacity constraints and priorities, as well as reluctance to seek care (to avoid possible infection). Further research may help distinguish the proportions directly caused by COVID-19 from those caused by indirect consequences of the pandemic. In May 2022, the WHO estimated the number of excess deaths by the end of 2021 to be 14.9 million compared to 5.4 million reported COVID-19 deaths, with

968-493: A housemaid for a mean woman, where she met a doctor who wished to help her in becoming a doctor. She then worked as an apprentice for a Dr. Braun, a scientist in her hometown, up until he went bankrupt. Here, she remembered getting her first lab coat with her name on it. On May 8th, 1945, at the age of eighteen, she joined the International Voluntary Service for peace as an activist. Two days later, she crossed

1089-413: A lack of meaning. To address the intensity of these emotions, Dr. Kübler-Ross incorporated techniques to help participants externalize their emotions, including the release of buried rage, grief, and fear. This approach often facilitated a deeper understanding and resolution of long-standing pain, leading to a transformation of fear and grief into gratitude. Recognizing that caregivers also benefited from

1210-590: A large number of people". During the COVID-19 pandemic, as with other pandemics, the meaning of this term has been challenged. The end of a pandemic or other epidemic only rarely involves the total disappearance of a disease, and historically, much less attention has been given to defining the ends of epidemics than their beginnings. The ends of particular epidemics have been defined in a variety of ways, differing according to academic field, and differently based on location and social group. An epidemic's end can be considered

1331-448: A median range of 0.24% to 1.49%. IFRs rise as a function of age (from 0.002% at age 10 and 0.01% at age 25, to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85). These rates vary by a factor of ≈10,000 across the age groups. For comparison, the IFR for middle-aged adults is two orders of magnitude higher than the annualised risk of a fatal automobile accident and much higher than

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1452-719: A model of human development encompassing four parts— emotional, intellectual, physical, and spiritual—referred to as "The Four Quadrants," which forms the basis of her work in the beginnings of the palliative care movement. She also addressed what she called "the five core emotions" —fear, anger, natural jealousy, grief, and love—and their natural expressions and distortions. Throughout her career, Kübler-Ross extensively studied and wrote about children's perceptions of death. Her notable works include The Dougy Letter (1979), Living with Death and Dying (1981), and On Children and Dying (1983). These books explore how children understand, discuss, and respond to death, reflecting her insights into

1573-815: A random sample have consistently found that total infections considerably exceed the reported case counts. Many countries, early on, had official policies to not test those with only mild symptoms. The strongest risk factors for severe illness are obesity, complications of diabetes , anxiety disorders, and the total number of conditions. During the start of the COVID-19 pandemic it was not clear whether young people were less likely to be infected, or less likely to develop symptoms and be tested. A retrospective cohort study in China found that children and adults were just as likely to be infected. Among more thorough studies, preliminary results from 9 April 2020 found that in Gangelt ,

1694-417: A regular weekly educational seminar consisting of live interviews with terminally ill patients. She had her students participate in these despite a large amount of resistance from the medical staff. By 1966, Kübler-Ross was giving regular weekly seminars on dying patients at her hospital. In late 1966, she wrote a seventeen-page article titled "The Dying Patient as Teacher: An Experiment and an Experience" for

1815-597: A series of international chapters around the world. She received many awards and honors during her career, including honorary degrees from various universities, and is featured in a photograph exhibit at the Virginia headquarters of the National Hospice and Palliative Care Organization . The American Journal of Bioethics devoted its entire December 2019 issue to the 50th anniversary of On Death and Dying . For instance, in his article "Everything I Really Needed to Know to Be

1936-494: A set number of rigidly linear stages. Kübler-Ross, with colleague David Kessler in On Grief and Grieving , cautioned that the stages "are not stops on some linear timeline in grief. Not everyone goes through all of them or in a prescribed order." Dr. Allan Kellehear responded to the critics in the 40th anniversary edition's introduction to "On Death & Dying" the following, "the so-called “stage theory” that you will read in this book

2057-457: A social phenomenon, not just a biological one. Time reported in March 2024 that expert opinions differ on whether or not COVID-19 is considered endemic or pandemic, and that the WHO continued to call the disease a pandemic on its website. During the initial outbreak in Wuhan , the virus and disease were commonly referred to as "coronavirus", "Wuhan coronavirus", "the coronavirus outbreak" and

2178-435: A son named Kenneth, and in 1963, a daughter named Barbara. The marriage dissolved in 1979. They remained friends until his death on December 9, 1992. Kübler-Ross endured a sequence of strokes from 1987 to 1994, none of which imposed lasting physical limitations upon her. Following a Virginia house fire on October 6, 1994, and subsequent transient ischemic attack (TIA), she relocated to Scottsdale, Arizona. During this period,

2299-451: A test. Conversely, deaths of people who died from underlying conditions following a positive test may be included. Countries such as Belgium include deaths from suspected cases, including those without a test, thereby increasing counts. Official death counts have been claimed to underreport the actual death toll, because excess mortality (the number of deaths in a period compared to a long-term average) data show an increase in deaths that

2420-413: A time when patients suffering from AIDS were being disowned and discriminated against for their illness, Kübler-Ross accepted them with open arms. She conducted many workshops on life, death, grief, and AIDS in different parts of the world, teaching about the disease and working to reduce the stigma surrounding it. Later, she created a workshop meant solely for patients who had contracted AIDS; even though

2541-471: A young terminally ill woman in front of a roomful of medical students. Her intentions were not to be an example of pathology, but she wanted to depict a human being who desired to be understood as she was coping with her illness and how it has impacted her life. She stated to her students: Now you are reacting like human beings instead of scientists. Maybe now you'll not only know how a dying patient feels but you will also be able to treat them with compassion –

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2662-402: Is a lack of theoretical underpinning. Because the stages arose from anecdotes and not underlying theoretical principles it contains conceptual confusion. For example, some people criticize that some stages represent emotions while others represent cognitive processes, as if the experience felt must discern one from another. Also, there is no rationale for arbitrary dividing lines between states. On

2783-451: Is a necessary stage of life, one must be prepared to face it with dignity and peace. During World War II, at only 13 years of age, Kübler-Ross worked as a laboratory assistant for refugees in Zürich. From a young age, she was determined to become a doctor despite her father's efforts in forcing her to become a secretary for his business. She refused him and left home at 16. She began working as

2904-518: Is associated with COVID-19 and is reported in as many as 88% of cases. The disease is mainly transmitted via the respiratory route when people inhale droplets and small airborne particles (that form an aerosol ) that infected people exhale as they breathe, talk, cough, sneeze, or sing. Infected people are more likely to transmit COVID-19 when they are physically close to other non-infected individuals. However, infection can occur over longer distances, particularly indoors. SARS‑CoV‑2 belongs to

3025-600: Is discouraged altogether by the World Health Organization (WHO), due to limited evidence of its efficacy. The severity of COVID-19 varies. It may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold . In 3–4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalisation. Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died,

3146-406: Is happening; I have to figure out how to proceed. Acceptance, as you might imagine, is where the power lies. We find control in acceptance. I can wash my hands. I can keep a safe distance. I can learn how to work virtually ." Criticisms of this five-stage model of grief center mainly on a lack of empirical research and empirical evidence supporting the stages as described by Kübler-Ross and, to

3267-439: Is intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 ( COVID-19 ). Prior to the COVID-19 pandemic, an established body of knowledge existed about the structure and function of coronaviruses causing diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). This knowledge accelerated

3388-485: Is not explained by COVID-19 deaths alone. Using such data, estimates of the true number of deaths from COVID-19 worldwide have included a range from 18.2 to 33.5 million (≈27.4 million) by 18 November 2023 by The Economist , as well as over 18.5 million by 1 April 2023 by the Institute for Health Metrics and Evaluation and ≈18.2 million (earlier) deaths between 1 January 2020, and 31 December 2021, by

3509-417: Is of Vital Importance , was also composed of various lectures she had previously given. In the late 1970s, Kübler-Ross developed a series of 5-day residential workshops aimed at helping individuals who were nearing the end of their lives to live more fully during their remaining time. These workshops were designed to accommodate not only the dying but also their caregivers, who were encouraged to participate in

3630-472: Is openly described and discussed as a heuristic device. In other words, these stages are merely a set of categories artificially isolated and separately described so that the author can discuss each of these experiences more clearly and simply. The careful reader will note Kübler-Ross’s own repeated warnings that many of these “stages” overlap, occur together, or even that some reactions are missed altogether. To emphasize this conditional way of taking about stages,

3751-452: Is the ratio of deaths to diagnoses. This metric can be misleading because of the delay between symptom onset and death and because testing focuses on symptomatic individuals. Based on Johns Hopkins University statistics, the global CFR was 1.02 percent (6,881,955 deaths for 676,609,955 cases) as of 10 March 2023. The number varies by region and has generally declined over time. Several variants have been named by WHO and labelled as

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3872-406: Is the seventh known coronavirus to infect people, after 229E , NL63 , OC43 , HKU1 , MERS-CoV , and the original SARS-CoV . The standard method of testing for presence of SARS-CoV-2 is a nucleic acid test , which detects the presence of viral RNA fragments. As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited." The test

3993-614: Is typically done on respiratory samples obtained by a nasopharyngeal swab ; however, a nasal swab or sputum sample may also be used. The WHO has published several testing protocols for the disease. Preventive measures to reduce the chances of infection include getting vaccinated, staying at home or spending more time outdoors, avoiding crowded places, keeping distance from others, wearing a mask in public, ventilating indoor spaces, managing potential exposure durations, washing hands with soap and water often and for at least twenty seconds, practising good respiratory hygiene, and avoiding touching

4114-499: The ABC , And When I Die, Will I Be Dead? It was adapted into a book in 1987. Kübler-Ross went on to write several books about near-death experiences (NDEs). Her book On Life After Death (1991) was compiled from three lectures she gave: The English language edition sold over 200,000 copies. The German Language edition also was a best seller with 100,000's sold. Another book, The Tunnel and The Light (1999), originally entitled Death

4235-558: The COVID-19 pandemic , Kessler applied the five stages to responses to the virus, saying: "It's not a map but it provides some scaffolding for this unknown world." "There's denial, which we saw a lot of early on: This virus won't affect us. There's anger: You're making me stay home and taking away my activities. There's bargaining: Okay, if I social distance for two weeks everything will be better, right? There's sadness: I don't know when this will end. And finally there's acceptance. This

4356-501: The Huanan Seafood Wholesale Market there, but it is possible that human-to-human transmission began earlier. Molecular clock analysis suggests that the first cases were likely to have been between October and November 2019. The scientific consensus is that the virus is most likely of a zoonotic origin, from bats or another closely related mammal. While other explanations such as speculations that SARS-CoV-2

4477-407: The Institute for Health Metrics and Evaluation estimating the true number of cases as of early 2022 to be in the billions. One measure that public health officials and policymakers have used to monitor the pandemic and guide decision-making is the test positivity rate ("percent positive"). According to Johns Hopkins in 2020, one benchmark for a "too high" per cent positive is 5%, which was used by

4598-467: The Manhattan State Hospital on July 6, 1959, marking the beginning of her career working by creating her own treatments for those who were schizophrenic along with those faced with the title "hopeless patient", a term used at the time to reference terminal patients. These treatment programs would work to restore the patient's sense of dignity and self-respect. Kübler-Ross also intended to reduce

4719-867: The United States Senate Special Committee on Aging to promote the "Death With Dignity" movement. In 1977, she was named "Woman of the Year" by Ladies' Home Journal . In 1978, Kübler-Ross cofounded the American Holistic Medical Association. Kübler-Ross was one of the central figures in the hospice care movement, believing that euthanasia prevents people from completing their "unfinished business". In 1977, she founded "Shanti Nilaya" (Home of Peace) on forty acres of land in Escondido, California. At this time, Kübler-Ross began conducting "Life, Death, and Transition (LTD) workshops with

4840-597: The basic reproduction number (R 0 ) for COVID-19 in January 2020 were between 1.4 and 2.5, but a subsequent analysis claimed that it may be about 5.7 (with a 95 per cent confidence interval of 3.8 to 8.9). In December 2021, the number of cases continued to climb due to several factors, including new COVID-19 variants. As of that 28   December, 282,790,822 individuals worldwide had been confirmed as infected. As of 14 April 2022 , over 500 million cases were confirmed globally. Most cases are unconfirmed, with

4961-474: The variants of interest as specified by the World Health Organization are BA.2.86 and JN.1, and the variants under monitoring are JN.1.7, KP.2, KP.3, KP.3.1.1, JN.1.18, LB.1, and XEC. Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness. Common symptoms include headache, loss of smell and taste , nasal congestion and runny nose , cough, muscle pain , sore throat , fever, diarrhoea , and breathing difficulties . People with

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5082-429: The "Wuhan coronavirus outbreak", with the disease sometimes called "Wuhan pneumonia ". In January 2020, the WHO recommended 2019-nCoV and 2019-nCoV acute respiratory disease as interim names for the virus and disease per 2015 international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent social stigma . WHO finalised

5203-428: The 1980s. In June 1991, she held her first LDT workshop inside a prison at Edinburgh's Saughton Prison (HM Prison). One of her greatest wishes was to build a hospice for abandoned infants and children infected with HIV to give them a lasting home where they could live until their death. Kübler-Ross attempted to set this up in the late 1980s in Virginia, but local residents feared the possibility of infection and blocked

5324-425: The 50th anniversary edition published by Simon & Schuster. In December 2019, The American Journal of Bioethics published a special issue (Volume 19, Number 12) dedicated to commemorating the 50th anniversary of Elisabeth Kübler-Ross's work, On Death and Dying . Kübler-Ross originally developed stages to describe the process patients with terminal illness go through as they come to terms with their own deaths; it

5445-636: The Canton Hospital an apprentice. After this time, she worked to support herself in a variety of jobs, gaining major experience in hospitals while volunteering to provide aid to refugees. Following this, she went on to attend the University of Zurich to study medicine, and graduated in 1957. After graduating from the University of Zurich in 1957, Kübler-Ross moved to New York in 1958 to work and continue her studies. She commenced her psychiatric residency in

5566-529: The December issue of The Chicago Theological Seminary Journal, which was themed "On Death and Dying." Although she expressed concerns about her English proficiency, the editor reassured her. Despite the journal's limited circulation, a copy of her article reached an editor at Macmillan Publishing Company in New York City. Consequently, on July 7, 1967, Macmillan offered Kübler-Ross a contract to expand her work into

5687-669: The Healing Waters Farm and the Elisabeth Kübler-Ross Center ceased operations in Headwaters, Virginia. The following month, she acquired a residence in the desert near Carefree, Arizona. After suffering a larger stroke in May 1995, she found herself living in a wheelchair and wished to be able to determine her time of death. In 1997, Oprah Winfrey flew to Arizona to interview Kübler-Ross and discuss with her whether she herself

5808-622: The Kübler-Ross Change Curve, encompasses various forms of loss, including the death of a loved one, job or income loss, major rejection, relationship breakups or divorce, drug addiction, the onset of illness or infertility, and even minor setbacks like losing insurance coverage.. Kessler has also proposed "Meaning" as a sixth stage of grief. Other authors have also explored and expanded upon stage theories, such as Claire Bidwell Smith in her book Anxiety: The Missing Stage of Grief , which addresses additional aspects of emotional response and adjustment beyond Kübler-Ross’s original framework. In 2020, during

5929-485: The New Science of Bereavement Tells Us About Life After a Loss , summarizes peer-reviewed research based on thousands of subjects over two decades and concludes that a natural psychological resilience is a principal component of grief and that there are no stages of grief to pass. Bonanno's work has also demonstrated that absence of grief or trauma symptoms is a healthy outcome. Among social scientists, another criticism

6050-777: The New York Public Library named "On Death and Dying" one of its "Books of the Century," and Time magazine recognized her as one of the "100 Most Important Thinkers" of the 20th century. Throughout her career, Kübler-Ross received over 100 awards, including twenty honorary degrees, and was inducted into the National Women's Hall of Fame in 2007. In 2024, Simon & Schuster released a list of their 100 most notable books, including Kübler-Ross's "On Death & Dying." Stanford University's Green Library currently houses her remaining archives which are available for study. Elisabeth Kübler

6171-533: The New York Times Best Seller list for trade paperbacks, listing at #3. In November 1969, Life magazine ran an article on Kübler-Ross, bringing public awareness to her work outside of the medical community. The response was enormous and influenced Kübler-Ross's decision to focus her career on working with the terminally ill and their families. The intense scrutiny her work received also had an impact on her career path. Kübler-Ross stopped teaching at

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6292-472: The Shores (On Death & Dying) by Shores of Null (2020) and Wheel of Life by Japanese saxophonist Sadao Watanabe. Marina's 2019 album Love & Fear draws inspiration from Kübler-Ross's philosophy. Kübler-Ross's impact extends to band names as well, with KÜBLER ROSS, a Swedish punk band founded by a former nurse, and Kübler-Ross, a synth/wave/industrial band from Glasgow, Scotland, whose album Kübler-Ross

6413-636: The WHO in the past. As of 10 March 2023, more than 6.88   million deaths had been attributed to COVID-19. The first confirmed death was in Wuhan on 9 January 2020. These numbers vary by region and over time, influenced by testing volume, healthcare system quality, treatment options, government response, time since the initial outbreak, and population characteristics, such as age, sex, and overall health. Multiple measures are used to quantify mortality. Official death counts typically include people who died after testing positive. Such counts exclude deaths without

6534-419: The WHO, US, European Union, and Australia. On 12 November 2022, the WHO released its Global Vaccine Market Report. The report indicated that "inequitable distribution is not unique to COVID-19 vaccines"; countries that are not economically strong struggle to obtain vaccines. On 14 November 2022, the first inhalable vaccine was introduced, developed by Chinese biopharmaceutical company CanSino Biologics , in

6655-655: The Youth (2012), Dominic Moore (2015), Andy Jenkinson (2019)Alp Aybers (2020), Audio Medic (2021), O SIZE (2022), Kübler-Ross the band (2020), Norro (2024), and Mic Lanny & James Rock (2014). In 2008 Matt Elliott release, "The Kübler-Ross Model" on his album, "Howling Songs. 'In 2006, The Gnomes released a song track titled “Elisabeth Kübler-Ross has Died.” Notably, the Oxford-based band Spring Offensive incorporated excerpts of Kübler-Ross's voice three times in their 13:20-minute rock ballad 'The First of Many Dreams About Monsters,'

6776-586: The aid of Nancy Jaicks Alexander, a workshop leader in Kübler-Ross' Life, Death, and Transition (LDT) workshops, to further explore avenues for enhancing end-of-life care for AIDS patients confined at the Vacaville facility. Nancy alongside her husband, Robert went on to co-found the first prison hospice in 1992. Concurrently, Kübler-Ross pursued additional prison-related initiatives in Hawaii, Ireland and Scotland throughout

6897-631: The border into France, leaving her home of Switzerland for the first time. Her first assignment was to help rebuild the French town of Ecurcey. For the next four years, she continued to do relief work in France, Germany, Italy, Belgium, Denmark, Sweden, Czechoslovakia, and Poland. In 1947, Kübler-Ross visited the Majdanek concentration camp in Poland, an experience that profoundly affected her understanding of compassion and

7018-448: The broad family of viruses known as coronaviruses . It is a positive-sense single-stranded RNA (+ssRNA) virus, with a single linear RNA segment. Coronaviruses infect humans, other mammals, including livestock and companion animals, and avian species. Human coronaviruses are capable of causing illnesses ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS, fatality rate ≈34%). SARS-CoV-2

7139-574: The centre of a major infection cluster in Germany, 15 per cent of a population sample tested positive for antibodies . Screening for COVID-19 in pregnant women in New York City , and blood donors in the Netherlands, found rates of positive antibody tests that indicated more infections than reported. Seroprevalence -based estimates are conservative as some studies show that persons with mild symptoms do not have detectable antibodies. Initial estimates of

7260-746: The city of Shanghai, China. For the first two years of the pandemic, no specific and effective treatment or cure was available. In 2021, the European Medicines Agency's (EMA) Committee for Medicinal Products for Human Use (CHMP) approved the oral antiviral protease inhibitor , Paxlovid (nirmatrelvir plus the HIV antiviral ritonavir ), to treat adult patients. FDA later gave it an EUA. Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), adequate intake of oral fluids and rest. Good personal hygiene and

7381-437: The contrary, empirical support for other modes of the expression of grief. Moreover, it was suggested that Kübler-Ross' model is the product of a particular culture at a particular time and might not be applicable to people of other cultures. These viewpoints have been expressed by many experts, including Robert J. Kastenbaum (1932–2013) who was a recognized expert in gerontology, aging, and death. In his writings, Kastenbaum raised

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7502-480: The cumulative number of infected individuals (including asymptomatic and undiagnosed infections and excluding vaccinated infected individuals). It is expressed in percentage points. Other studies refer to this metric as the infection fatality risk . In November 2020, a review article in Nature reported estimates of population-weighted IFRs for various countries, excluding deaths in elderly care facilities, and found

7623-676: The dead. This led to a scandal connected to the Shanti Nilaya Healing Center, in which she was duped by Jay Barham, founder of the Church of the Facet of the Divinity. Claiming he could channel the spirits of the departed and summon ethereal "entities", he encouraged church members to engage in sexual relations with the "spirits". He may have hired several women to play the parts of female spirits for this purpose. Kubler-Ross' friend Deanna Edwards

7744-441: The development of various vaccine platforms during early 2020. The initial focus of SARS-CoV-2 vaccines was on preventing symptomatic and severe illness. The COVID-19 vaccines are widely credited for their role in reducing the severity and death caused by COVID-19. As of March 2023, more than 5.5 billion people had received one or more doses (11.8 billion in total) in over 197 countries. The Oxford-AstraZeneca vaccine

7865-534: The disease may have contracted it due to sexual assault from someone who was HIV-seropositive. During this period, Kübler-Ross became developed an interest in the concept of prison hospice care. In the mid-1980's, the prison facility at Vacaville, California emerged as the primary site for delivering healthcare services to incarcerated individuals. In 1984, Kübler-Ross delegated one of her staff members, Irene Smith to conduct an investigative assessment of conditions at this institution. Subsequently, Kübler-Ross enlisted

7986-527: The dying for the first time in her book, On Death and Dying : What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families (1969). Originally, this book had a thirteenth chapter on near-death experiences but her colleagues strongly advised her to remove it for the sake of public acceptance, which she did before the book went to press. In 1981, she appeared on an Australian radio documentary about death and near-death experiences that aired on

8107-432: The end of her life she was mentally active, co-authoring two books with David Kessler including On Grief and Grieving (2005). In 2018 Stanford University acquired the Kübler-Ross archives from her family and has started building a digital library of her papers, interviews and other archival material. Following extensive work with dying patients, Kübler-Ross published On Death and Dying in 1969, in which she proposed

8228-521: The end of life. Later that year, she briefly lived with Romani people near the Polish/Russian border town of Bialystok . During this period, she faced the imminent closure of borders by the Russians. She encountered American officers who assisted in her evacuation on a transport plane from Poland to Berlin. After returning to Zürich, Kübler-Ross worked for a dermatologist named Dr. Kan Zehnder at

8349-529: The ending of her association with both Jay Barham and his wife Martha in her Shanti Nilaya Newsletter (issue 7) on June 7, 1981. Kübler-Ross also dealt with the phenomenon of near-death experience . She was also an advocate for spiritual guides and afterlife, serving on the Advisory Board of the International Association for Near-Death Studies (IANDS). Kübler-Ross reported her interviews with

8470-513: The eyes, nose, or mouth with unwashed hands. Those diagnosed with COVID-19 or who believe they may be infected are advised by healthcare authorities to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items. A COVID-19 vaccine

8591-735: The final stage of grieving, the data actually showed it was the most frequently endorsed item at the first and every other time point measured; that cultural and geographical bias within the sample population was not controlled for; and that out of the total number of participants originally recruited for the study, nearly 40% were excluded from the analysis who did not fit the stage model. In subsequent work, Prigerson & Maciejewski focused on acceptance (emotional and cognitive) and backed away from stages, writing that their earlier results "might more accurately be described as 'states' of grief." George Bonanno , Professor of Clinical Psychology at Columbia University, in his book The Other Side of Sadness: What

8712-416: The following points: A widely cited 2003 study of bereaved individuals conducted by Maciejewski and colleagues at Yale University obtained some findings consistent with a five-stage hypothesis but others inconsistent with it. Several letters were also published in the same journal criticizing this research and arguing against the stage idea. It was pointed out, for example, that instead of "acceptance" being

8833-547: The foundation for her book. Although Kübler-Ross is commonly credited with creating stage models, earlier bereavement theorists and clinicians such as Erich Lindemann , Collin Murray Parkes , and John Bowlby used similar models of stages or phases as early as the 1940s. In the foreword to the first 1970 English edition of On Death and Dying , Colin Murray Parkes wrote, 'This book describes how some American individuals have coped with death.' In her book, Kübler-Ross states that

8954-474: The general public beginning in December 2020, made available through government and international programs such as COVAX , aiming to provide vaccine equity . Treatments include novel antiviral drugs and symptom control. Common mitigation measures during the public health emergency included travel restrictions , lockdowns , business restrictions and closures, workplace hazard controls , mask mandates , quarantines, testing systems, and contact tracing of

9075-612: The goal of assisting people to resolve their "unfinished business", using Shanti Nilaya as a setting for some of these five-day workshops. She also intended it as a healing center for the dying and their families. She was also a co-founder of the American Holistic Medical Association during this time period. In the late 1970s, after interviewing thousands of patients who had died and been resuscitated, she became interested in out-of-body experiences , mediumship , spiritualism , and other ways of attempting to contact

9196-657: The infected. The pandemic caused severe social and economic disruption around the world, including the largest global recession since the Great Depression . Widespread supply shortages , including food shortages , were caused by supply chain disruptions and panic buying . Reduced human activity led to an unprecedented temporary decrease in pollution . Educational institutions and public areas were partially or fully closed in many jurisdictions, and many events were cancelled or postponed during 2020 and 2021. Telework became much more common for white-collar workers as

9317-439: The issue of respiratory failure. Existing drugs such as hydroxychloroquine , lopinavir/ritonavir , and ivermectin are not recommended by US or European health authorities, as there is no good evidence they have any useful effect. The antiviral remdesivir is available in the US, Canada, Australia, and several other countries, with varying restrictions; however, it is not recommended for use with mechanical ventilation, and

9438-418: The lives of these individuals. She developed a program that focused on the individual care and attention for each patient. This program worked incredibly well, and resulted in significant improvement in the mental health of 94% of her patients. In 1962, she accepted a position at the University of Colorado School of Medicine . There, Kübler-Ross worked as a junior faculty member and gave her first interview of

9559-416: The majority of people who contracted AIDS at that time were gay men, women and children also contracted the disease. This surprised her, as she had not expected just how many children and babies had contracted the terminal illness. She noted in her book that babies typically contracted the disease through the mother or father or through contaminated blood transfusions, also remarking that older children that had

9680-576: The majority of the unreported 9.5 million deaths believed to be direct deaths due the virus, rather than indirect deaths. Some deaths were because people with other conditions could not access medical services . A December 2022 WHO study estimated excess deaths from the pandemic during 2020 and 2021, again concluding ≈14.8 million excess early deaths occurred, reaffirming and detailing their prior calculations from May as well as updating them, addressing criticisms. These numbers do not include measures like years of potential life lost and may make

9801-522: The medical advancements of the time were the mark of change for the way people perceive and experience death. Due to this, pediatricians have been seeing fewer life-threatening ailments for their patients compared to one-hundred years ago. In her 1974 book Questions and Answers on Death and Dying , Kübler-Ross had by then observed that the stages are not experienced in a strictly linear progression. She noted, 'Most of my patients have exhibited two or three stages simultaneously, and these do not always occur in

9922-400: The medications that kept these patients overly sedated, and found ways to help them relate to the outside world. During this time, Ross was horrified by the neglect and abuse of psychiatric patients as well as the imminently dying. She found that the patients were often treated with little care or completely ignored by the hospital staff. This realization made her strive to make a difference in

10043-428: The necessary re-zoning. In October 1994, she lost her house and many possessions, including photos, journals, and notes, to an arson fire that is suspected to have been set by opponents of her AIDS work. Kübler-Ross changed the way that the world looks at the terminally ill, she pioneered hospice care, palliative care, bioethics , and near-death research, and was the first to bring terminally ill individuals' lives to

10164-612: The now famous " five stages" model as a pattern of adjustment: denial, anger, bargaining, depression, and acceptance. This model has since become widely accepted in academia and by the general public. In the graphic that was included in "On Death & Dying", Kübler-Ross mentions other emotions as being a part of this journey including: shock, partial denial, preparatory grief (anticipatory grief), hope, and decathexis. The five-stage model has received some criticism by academics who argue against approaches that universally apply it to all bereaved groups or claim that grief should be expressed in

10285-495: The official names COVID-19 and SARS-CoV-2 on 11 February 2020. Tedros Adhanom Ghebreyesus explained: CO   for corona , VI   for virus , D   for disease and 19 for when the outbreak was first identified (31 December 2019). WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications. WHO named variants of concern and variants of interest using Greek letters . The initial practice of naming them according to where

10406-701: The other hand, there are other theoretically based, scientific perspectives that better represent the course of grief and bereavement such as: trajectories approach , cognitive stress theory , meaning-making approach , psychosocial transition model, two-track model , dual process model , and the task model. Misapplication can be harmful if it leads bereaved persons to feel that they are not coping appropriately or it can result in ineffective support by members of their social network and/or health care professionals. The stages were originally meant to be descriptive but over time became prescriptive. Some caregivers dealt with clients who were distressed that they did not experience

10527-534: The outbreak a public health emergency of international concern (PHEIC) on 30 January 2020, and assessed the outbreak as having become a pandemic on 11 March. COVID-19 symptoms range from asymptomatic to deadly, but most commonly include fever, sore throat , nocturnal cough , and fatigue. Transmission of the virus is often through airborne particles . Mutations have produced many strains (variants) with varying degrees of infectivity and virulence . COVID-19 vaccines were developed rapidly and deployed to

10648-407: The pandemic 2021's leading cause of death . The time between symptom onset and death ranges from   6 to 41 days, typically about 14 days. Mortality rates increase as a function of age. People at the greatest mortality risk are the elderly and those with underlying conditions. The infection fatality ratio (IFR) is the cumulative number of deaths attributed to the disease divided by

10769-491: The pandemic evolved. Misinformation circulated through social media and mass media , and political tensions intensified . The pandemic raised issues of racial and geographic discrimination , health equity , and the balance between public health imperatives and individual rights . The WHO ended the PHEIC for COVID-19 on 5 May 2023. The disease has continued to circulate, but as of 2024, experts were uncertain as to whether it

10890-478: The patient asks about death to discuss it. In her book, she also proposes that practitioners listen to the patient first and foremost, and that the patient's right to self-determination should still be practiced. In a posthumously published book co-authored with David Kessler , Kübler-Ross expanded the model to address a wide range of personal losses, recognizing that it might be more about change than solely about grief. This broader framework, more commonly known as

11011-415: The population's age structure and the age-specific pattern of infections. There have also been reviews that have compared the fatality rate of this pandemic with prior pandemics, such as MERS-CoV. For comparison the infection mortality rate of seasonal flu in the United States is 0.1%, which is 13 times lower than COVID-19. Another metric in assessing death rate is the case fatality ratio (CFR), which

11132-441: The process of withdrawing emotional investment from external objects or relationships. She also acknowledged other emotional responses including guilt, anxiety, and numbness. In Questions and Answers on Death and Dying, Kübler-Ross answered questions after the publication of her first book, On Death and Dying. She emphasized that no patient should be directly told that they are dying and that practitioners should try to wait until

11253-470: The public eye. Kübler-Ross was the driving force behind the movement for doctors and nurses alike to "treat the dying with dignity". Balfour Mount, the first palliative care physician in Canada and the person who coined the term palliative care , credits Kübler-Ross with sparking his interest in end-of-life care. Kübler-Ross wrote over 20 books on death and dying, which have been translated into 44 languages. At

11374-416: The resilience of the human spirit. The harrowing stories of survivors left an indelible mark on her, inspiring her life's mission to assist and heal others. She was also profoundly affected by the images of hundreds of butterflies carved into some of the walls there. To Kübler-Ross, the butterflies—these final works of art by those children facing death—stayed with her for years and influenced her thinking about

11495-458: The risk of dying from seasonal influenza . In December 2020, a systematic review and meta-analysis estimated that population-weighted IFR was 0.5% to 1% in some countries (France, Netherlands, New Zealand, and Portugal), 1% to 2% in other countries (Australia, England, Lithuania, and Spain), and about 2.5% in Italy. This study reported that most of the differences reflected corresponding differences in

11616-474: The same compassion that you would want for yourself Kübler-Ross completed her training in psychiatry in 1963, and moved to Chicago in 1965. She sometimes questioned the practices of traditional psychiatry that she observed. She also undertook 39 months of classical psychoanalysis training in Chicago. She became an instructor at the University of Chicago 's Pritzker School of Medicine , where she began to conduct

11737-496: The same infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum , shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhoea. In people without prior ear, nose, and throat disorders, loss of taste combined with loss of smell

11858-584: The same order.' She later regretted writing them in a way that was misunderstood. "Kübler-Ross originally saw these stages as reflecting how people cope with illness and dying," observed grief researcher Kenneth J. Doka, "not as reflections of how people grieve." In the 1980s, the Five Stages of Grief evolved into the Kübler-Ross Change Curve, which is now widely utilized by companies to navigate and manage organizational change and loss. As of 2019, On Death and Dying has been translated into forty-one languages, with

11979-510: The sessions. The workshops provided a forum for patients to share their stories and express their fears, anger, and grief regarding their impending death. A recurring theme in the workshops was addressing regrets associated with perceived wasted time and energy related to unresolved childhood issues such as abuse and neglect. These unresolved issues often manifested as misplaced anger, perfectionism, controlling behavior, prioritization of material wealth over relationships, feelings of unworthiness, and

12100-450: The stages in "the right order" or failed to experience one or more of the stages of grief. Criticism and lack of support in peer-reviewed research or objective clinical observation by some practitioners in the field has led to the labels of myth and fallacy in the notion that there are stages of grief. Nevertheless, the model's use has persisted in popular news and entertainment media, and some professionals have stated their confidence in

12221-495: The term "stages" in inverted commas in the book’s diagrammatic representation to emphasize their tentative nature. The principal aim of On Death and Dying was to fundamentally reshape attitudes toward the experiences of dying patients by advocating for a more humane and patient-centered approach in medical practice and beyond, rather than merely defining the experience of dying in "stages." Elisabeth K%C3%BCbler-Ross Elisabeth Kübler-Ross (July 8, 1926 – August 24, 2004)

12342-411: The time from symptom onset to death has ranged from two to eight weeks. Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to intensive care units (ICU). Between 5% and 50% of COVID-19 patients experience long COVID , a condition characterised by long-term consequences persisting after

12463-694: The typical convalescence period of the disease. The most commonly reported clinical presentations are fatigue and memory problems, as well as malaise , headaches, shortness of breath , loss of smell, muscle weakness , low fever and cognitive dysfunction . Many countries attempted to slow or stop the spread of COVID-19 by recommending, mandating or prohibiting behaviour changes, while others relied primarily on providing information. Measures ranged from public advisories to stringent lockdowns. Outbreak control strategies are divided into elimination and mitigation. Experts differentiate between elimination strategies (known as " zero-COVID ") that aim to completely stop

12584-429: The unique ways children express their experiences and fears. Kübler-Ross's work was partly driven by requests from patients and readers seeking a deeper understanding of the language used by terminally ill children to articulate their needs. In Living with Death and Dying (1981), she argues that children have a more nuanced awareness of death than often assumed and are more willing to discuss it openly. Influenced by

12705-451: The university to work privately on what she called the "greatest mystery in science"—death. During the 1970's, Kübler-Ross became a champion of the worldwide hospice movement . She traveled to over twenty countries on six continents initiating various hospice and palliative care programs. In 1970, Kübler-Ross spoke at the prestigious Ingersoll Lecture at Harvard University on the subject of death and dying. On August 7, 1972, she spoke to

12826-543: The variants were identified (e.g. Delta began as the " Indian variant") is no longer common. A more systematic naming scheme reflects the variant's PANGO lineage (e.g., Omicron 's lineage is B.1.1.529) and is used for other variants. SARS-CoV-2 is a virus closely related to bat coronaviruses , pangolin coronaviruses, and SARS-CoV . The first known outbreak (the 2019–2020 COVID-19 outbreak in mainland China ) started in Wuhan , Hubei, China, in December 2019. Many early cases were linked to people who had visited

12947-553: The veracity of the model. Kübler-Ross acknowledged the variability and complexity of individual experiences, using the so-called "stages" of emotional responses as a framework to describe common patterns. She explicitly described these stages as a heuristic device, noting that they are categories artificially isolated for clarity, with the understanding that emotional responses are fluid and overlapping. In her book, Kübler-Ross repeatedly warned that these "stages" can overlap, occur simultaneously, or be missed altogether, and she even placed

13068-486: The word “stages” was even put in inverted commas to emphasize their tentative nature in the only diagrammatic representation of these ideas in the book." In the 1980's, an increasing number of companies began using the five stages model to explain reactions to change and loss. This is now known as the "Kübler-Ross Change Curve" and is used by a variety of Fortune 500 companies in the US and internationally. The Elisabeth Kübler-Ross Foundation continues her work through

13189-959: The work of Susan Bach and Gregg Furth, Kübler-Ross examined how children's drawings serve as a crucial means of communication. She identified two distinct types of communication related to death in children. "Nonverbal Symbolic Language" is used by younger children, who may express their understanding of death through drawings, pictures, or objects, as they might lack the verbal skills to articulate their feelings directly. As children grow older, they may transition to "Verbal Symbolic Language," characterized by complex stories and unusual questions that serve to express their emotions and concerns about death. Children may be fearful of asking direct questions regarding their death, so they may come up with stories or strange questions that will meet their needs. This form of communication reflects their evolving ability to articulate their feelings and fears, though they may still struggle with direct inquiries about death. During

13310-433: The workshops, Dr. Kübler-Ross opened the sessions to anyone seeking to live more fully until death. A distinctive feature of the workshops was the use of impromptu crayon drawings, a technique influenced by the work of Jungian analyst Dr. Susan Bach. Dr. Kübler-Ross instructed participants on drawing interpretation to help uncover unconscious reasons for their attendance and to address past losses. Additionally, she presented

13431-622: Was a Swiss-American psychiatrist , a pioneer in near-death studies , and author of the internationally best-selling book, On Death and Dying (1969), where she first discussed her theory of the five stages of grief, also known as the " Kübler-Ross model ". In 1970, Kübler-Ross delivered the Ingersoll Lecture at Harvard University, focusing on her book, On Death and Dying . By July 1982, Kübler-Ross had taught 125,000 students in death and dying courses in colleges, seminaries, medical schools, hospitals, and social-work institutions. In 1999,

13552-443: Was accidentally released from a laboratory have been proposed, as of 2021 these were not supported by evidence. Official "case" counts refer to the number of people who have been tested for COVID-19 and whose test has been confirmed positive according to official protocols whether or not they experienced symptomatic disease. Due to the effect of sampling bias , studies which obtain a more accurate number by extrapolating from

13673-578: Was born on July 8, 1926, in Zürich , Switzerland, into a Protestant Christian Family. She was one of a set of triplets , two of whom were identical. Her life was jeopardized due to complications, weighing only 2 pounds at birth, but she said she survived due to her mother's love and attentiveness. Elisabeth later contracted pneumonia and was hospitalized at age 5, during which she had her first experience with death as her roommate died peacefully. Her early experiences with death led her to believe that, because death

13794-976: Was buried at the Paradise Memorial Gardens Cemetery in Scottsdale. In 2005 her son, Ken Ross, founded the Elisabeth Kübler-Ross Foundation in Scottsdale, Arizona. The trademark 'Elisabeth Kübler-Ross,' along with all associated copyrights and other trademarks associated with Kübler-Ross, is managed and controlled by her children through the Elisabeth Kübler-Ross Family Limited Partnership. Since Kübler-Ross' death, many songs and albums have been named after her or dedicated to her. Songs such as "Kübler-Ross" have been named after her by artists including: Matthew B Everett (2008), Chuck Wilson (2010), Elephant Rifle (2010), Permute (2011), Taylor Whitelow of

13915-541: Was going through the five stages of grief . July 2001 saw her traveling to Switzerland to celebrate her final birthday (her 75th) with her three triplet sisters. In a 2002 interview with The Arizona Republic , she stated that she was ready for death and even welcomed it, calling God a "damned procrastinator". From 2002 until August 2004, she was in a nursing home under hospice care, spending her final days there. Kübler-Ross died with her two children at her side in Scottsdale on August 24, 2004, aged 78 of natural causes. She

14036-445: Was introduced by Kübler-Ross in her 1969 book On Death and Dying , and was inspired by her work with terminally ill patients. Motivated by the lack of instruction in medical schools on the subject of death and dying, Kübler-Ross examined death and those faced with it at the University of Chicago 's medical school . Kübler-Ross's project evolved into a series of seminars which, along with patient interviews and previous research, became

14157-453: Was invited to attend a service to ascertain whether allegations against Barham were true. He was found to be naked and wearing only a turban when Edwards unexpectedly pulled masking tape off the light switch and flipped on the light. Despite the accusation of sexual misconduct Kübler-Ross defended him for over a year. The authorities did not press charges against the Barhams. Then she announced

14278-626: Was later applied to grieving friends and family as well, who seemed to undergo a similar process. The stages, popularly known by the acronym DABDA, include: Kübler-Ross identified additional stages of emotional response beyond the five widely recognized stages of grief, illustrated in a full-page graphic on page 251 of the 50th anniversary edition of On Death and Dying . Alongside the well-known stages of denial, anger, bargaining, depression, and acceptance, Kübler-Ross detailed other "stages" such as shock, partial denial, preparatory grief (also known as anticipatory grief), hope, and decathexis, which refers to

14399-627: Was nominated for Album of the Year in Scotland in 2021. A South Korean math rock band named Dabda , an acronym representing the Five Stages of Grief, was formed in 2014. Viewing: COVID-19 pandemic The COVID-19 pandemic (also known as the coronavirus pandemic and COVID pandemic ), caused by severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2 ), began with an outbreak of COVID-19 in Wuhan , China, in December 2019. It spread to other areas of Asia, and then worldwide in early 2020. The World Health Organization (WHO) declared

14520-457: Was still a pandemic. Pandemics and their ends are not well-defined, and whether or not one has ended differs according to the definition used. As of 24 November 2024, COVID-19 has caused 7,075,455 confirmed deaths. The COVID-19 pandemic ranks as the fifth- deadliest pandemic or epidemic in history . In epidemiology , a pandemic is defined as "an epidemic occurring over a very wide area, crossing international boundaries, and usually affecting

14641-502: Was the most widely used. According to a June 2022 study, COVID-19 vaccines prevented an additional 14.4 million to 19.8 million deaths in 185 countries and territories from 8 December 2020 to 8 December 2021. On 8 November 2022, the first recombinant protein-based COVID-19 vaccine (Novavax's booster Nuvaxovid ) was authorised for use in adults in the United Kingdom. It has subsequently received endorsement/authorisation from

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