Kubler Ross: Pastoral Training

Pastoral Care and the Psychology of the Patient

Kubler Ross, the great pioneer in the study of dying looked at death and dying from a socialogical prism.  Her natural compassion and sympathy for the patient pushed her to great insight in regards to treatment of the patient and care of the “person”.  Within the Pastoral Care field, I think it is important, especially for those in pastoral care within the hospital setting, to study her research regarding the pyschology of the patient within the hosptial.

One of the first obersevations is how the patient or person feels upon being admitted into the hospital.  Kubler Ross noted that patients first, felt stripped of autonomy.  From the stripping of the clothes, surrending of personal items and confiscation of medication, the patient becomes total dependent upon the hosptial system.  In many cases, they see the hospital staff as interlopers who are breaking down the relationship between them and their primary physician.

On the other hand, the hospital, while its staff and system should be commended for saving lives, unfortunately at times, seems like a repair shop.  It is there to repair the disease, not the person.  Ideas of death, are seen as failure.  In Kubler Ross’s article, she even points out that such words as “dead” or sometimes unconsciously substituted with “expire” or “loss”.  The death of a patient is seen as failure.  With these things in mind, we can see why the emerging importance of hospice is critical, especially if hospitals do not have the pastoral training necessary to treat the whole person.

Continuing on with the admission of the patient, the patient soon understands two realities during the hospitial visit.  First, “I must survive the stay” and second, “how can I ensure that I am cared for?”.  In regards to the second point, the patient may feel uneasy over-using the help button.  This forces the patient to possibly manage pain to save the button for only the most important needs.  A simply sigh by a nurse or disgruntled expression can effect the patient’s willingness to call when needed.  Furthermore, a reward versus punishment paradigm develops in their mind.  The rules of the game indicate waiting as punishment, while anticiapation of their needs as a reward for their good behavior.  Other subtle rewards are seen as a doctor who sits instead of stands while speaking to them, or a nurse who takes the time to merely touch their shoulder while explaining something.   The reality is patients are testing their boundaries all the time.  They are trying to see what is acceptable and what is not.   One patient interveiwed by Kubler Ross, said she wished to acknowledge the busy schedule of the nurse as a token of appreciation, in a hope the nurse would appreciate her.   This is an unfortunate psychological reaction of the patient in the hospital and one that should not come into play but unfortunately does.

Another element is entitlement.  Patients feel they are entitled to a certain level of care, not based on money spent, but how ill they are.  Fever and pain level are two indicators in how much a patient will risk punishment for entitlement.  The closer to death, the more a patient will push the button, feeling they deserve more.

Ultimately, a hospital is about recovery of the injured body part.  While it should strive also to serve the personhood of the patient, it sometimes falls short.  Nurses are trained more in technological aspects that keep the patient alive instead of interpersonal skills that keep the patient secure and happy.  Kubler Ross applauded the hospital system and understood the nature of the system, but also wished to make it better with a more sincere effort to make the patient also emotionally and spiritually happy.

If you are interested in learning more about Pastoral Thanatology, then please review the program.

Mark Moran, MA