When someone is telling you their story over and over, they are trying to figure something outElisabeth Kübler-Ross, On grief and grieving
In the 1960s, America had a very different atmosphere. Right out of two world wars and a great depression life was not a bed of roses for most. But one particular thing added to the hopefulness of the population at large – startling breakthroughs. Physics, chemistry, engineering, and most importantly medicine.
Lethal illnesses which had no treatment before – pneumonia, chronic kidney disease, severe trauma, infection – all became a commonplace. Disease was seen as a problem that needed to be solved. With such glorious inventions, there was hope to maybe stop ageing and conquer death too.
Why so much information?
So during this time, doctors, who now had become life-savers, became highly authoritarian. The patient’s values, priorities, and preferences were the last thing that mattered. History taking and examination was an art left to be done by junior doctors.
Irked by the scenario, a female psychiatrist, decided to go to the patients, sit next to their old, debilitated beds and bodies, listen to how they feel about their disease and talk to them and their family about the disease and the future ahead. Elisabeth Kübler-Ross, eventually published these excerpts of her conversations and interviews in a book called – On death and dying, and published it in 1969.
Why is the book so important?
At a time when patients and especially a terminally ill patient was the last priority for doctors, primarily because they did not have a lot of modalities of treatment of the terminally ill, suddenly “how people died” started to make a difference. It brought about a change in the doctor-patient relationship. Moreover, it made way a new branch of medicine – Palliative Medicine. By the 1990s, pain became the fifth vital sign to be recorded along with temperature, BP, pulse rate, and respiration rate.
What is DABDA?
Kübler-Ross during her interviews with patients who were about to die saw a typical behavior pattern. All of them went through a distinctive wave of emotions. Not in a particular order, but all patients and their families, resorted to these emotions to tackle shock and grief.
The emotions were –
D – Denial
A – Anger
B – Bargaign
D – Depression
A – Acceptance
Haven’t we all gone through this cycle of emotions?
If you recollect, almost all of us have resorted to one or more of the above emotions. They are a sounding board for all of us. Even during corona times, we have all gone through these phases, in one way or another,
I had travel planned in March when the pandemic was just worsening. I was very clear in my head – “It’s just a virus, how bad can it get? Obviously the flights won’t stop and I’ll be able to come back. Obviously I won’t get the virus!” and so on. Rather the biggest superpowers in the world were in denial with the pandemic.
Only when the world saw what was happening in Italy, did the countries feel the need to take action.
We all have faced denial. It is a much-needed phase. It gives our minds the time to come to terms with reality. The virus has hit the world equally bad, and people are dying. Anyone can get it. And slowly all of us are coming to terms with this reality.
“Why on earth did this have to happen in 2020? The year when I had planned a trip to Europe. The year when I was about to attend the concert by my favorite band finally? Why me? This is unfair.” Anger at the world and the circumstances is again something we all have felt. I had to cut short my stay in the USA by 15 days because of the announcement of lockdown by India. Millennials all over the world have reported or expressed in one way or another increased aggression during these times.
But anger in such scenarios is a good thing and should be let out. Normally we are told to control our anger, but when tackling grief, anger can act as your bridge to reality. It is the first step to acceptance. And remember you are not alone. The entire world is in it equally badly.
“Okay, this time get me out of this pandemic, and I will never be unfair to people? Or save my cousin who is in ICU, and I will never fight with him again?”
You make yourself believe, that you might avoid grief by negotiation. If this happens, then I’ll change that. You are willing to make a big life modification, in desperation to get the life you had before the grief event.
Guilt is another counterpart of the bargain. “If I did not meet my cousin, he wouldn’t have tested positive! If I left for hospital 5 minutes later, I wouldn’t have come across that positive patient and so on.” All this is a part of the desperation to get the Normal Life back.
The most visible response to grief. Feeling as if the world has come to an end, there is no use in living anymore, everyone will die, hopelessness, you don’t feel like getting out of bed and you just live in a fog. Suicidal thoughts are common – ” what’s the point of living anymore?”.
Depression is a present emotion of grief. During the coronavirus pandemic and the lockdown, a spike in cases of depression has been prevalent all over the world. It needs to be tackled with empathy and care. This is one of the most critical and tender stage of grief responses.
The final stage is when we finally accept it. A pandemic has taken over the world, half of 2020 will be spent in the shadow of coronavirus, and life after this will not be the same as before.
You finally start to have better days. Days when you realize this is the new normal and you find ways to enjoy it. You start to celebrate birthdays on Zoom calls and you see people getting married around with social distancing measures.
Life is good. There are bad days, then some good days, and then maybe again some bad days. But life goes on. And so does DABDA.
It’s true. Kübler-Ross model of response to grief has no scientific proof or data supporting it. It was her experience with patients which made her come up with the hypothesis. I, personally have felt that most of the terminal patients as well as most of us, go through these phases, whenever we encounter even the smallest disappointments or shock, let alone life-threatening diseases. I am a firm believer in this model.
While reading, I am sure you will relate with one or more of the phases and rememberer instances when you resorted to DABDA. The most recent being this pandemic and the lockdown.