Evaluation of Kubler Ross' Model with Focus on the "Acceptance" Stage

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First off, I would like to begin by stating that this article will focus especially on the “Acceptace” stage in Kubler Ross’s model, as much as there has been the greatest deal of medical controversy on this postulated stage in the model. I also clearly state before I narrate more details that, perspective-wise, I am undeniably a functionalist. In addition, it has to be clearly noted that my hypothesis in this article will be explanatory rather than descriptive, as much as the human society has yet to fully understand any of how to define what we call “cognition,” “stimuli,” and “intelligence.”

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What will be central for my hypothesis in this article is the postulate that the phenomenon by which the absolute majority of dying individuals experience cognitive impairment during their process of dying, whose magnitude tends to precipitate exponentially right before the moment of death, is not just a coincidental phenomenon that happened to be the case by chance, but rather a bodily procedure itself that is in accordance with how a body coordinates its functions. In the functionalist perspective, intelligence is a pseudonym for a function that enables an agent to survive and prosper in a given environment. In this vein, the postulate for this article would be that, perhaps, the reason why cognitive impairment takes place within a dying individual is not merely coincidental, but in fact, stems from the individual’s body itself ceasing its own functions (in a more proper term, “atrophy”) based on the realization that they won’t be used anymore as much as the person oneself is dying.

Of course, there is seemingly a counterexample for this postulate – How about the cases that involve “closed awareness,” by which the dying person oneself is not let realize his/her own death? Yet, there remain a couple problems with this counterexample of “closed awareness.” First off, it was already mentioned in the class material for this semester that this “closed awareness” is highly difficult to be maintained, as much as dying people are able to read the cues around them, which leads to their self-realization about the impending death. Yet, additionally, I would like to come up with a conjecture on how this can be explained especially in the neurological scope, and in the meantime, I would like to give an example of a real dying person. According to a biography on Franz Schubert, an Austrian composer, Schubert was one of those individuals whose dying trajectory included a very long phase of “closed awareness,” which means that, even while the composer himself was dying from the gastrointestinal illness with his relatives preparing for the moment of death, Schubert was not aware of the fact that he was dying. Instead, according to one description, when his relatives and friends gathered around in his house to prepare for his deathbed, Schubert himself thought that his acquaintances were “going after him,” of which the mistaken agitation could be alleviated only after he was consulted by his brother. This appears to stem from the fact that Schubert himself used to have conflicts with some of his acquaintances, as they opposed him for his decision to become a professional musician.

Yet, what has to be noted importantly in this case is that, as much as he was dying from the gastrointestinal illness, Schubert clearly was going through bodily sufferings during his dying trajectory, (In fact, his strange assumption that his close acquaintances were in his bedroom to “go after him,” was also partly caused by the delirium he was having at the moment because of the bodily suffering.) even though “Schubert himself” did not grasp the fact that he was dying from the illness. The reason for quoting the phrase above, is because it can be said, theoretically, that it was just Schubert’s frontal lobe of the neocortex, neurologically speaking, that had not realized the impending death. In contrast, I postulate that Schubert’s autonomic nervous system and peripheral nervous system must be said to have grasped the fact of impending death, when Schubert himself was going through serious sufferings from his illness. In fact, that is what actually matters, theoretically speaking, as much as the termination of one organic body has more to do with the destruction of its brain stem, and then the cellular deaths that eventually complete the termination. This particular case of Franz Schubert involved a gastrointestinal illness as the cause of death, but it is doubtful if the situation would be different in any case, as much as even “natural deaths,” (apart from the fact that their denotation still remains very vague and debated,) accompany a fully realized physical discomfort, especially on the individuals’ lung functions, before these deaths are completed.

In other words, even though it has to be admitted that this conjecture is not exactly scientific, as it was based on this “case study,” the postulates for this article, when throwing it straightforward, are that there can be no “closed awareness” in the truest form to its denotation in the empirical reality, and finally and centrally, that an organic body, upon the realization of its impending death, is programmed to cease its functions, or in another word, “intelligence,” when it is grasped that the death means the termination of their necessity. Once again, this is based on the idea that, even when an organic individual’s executive part is “not aware” of the impending death, it still has to be said that various other parts of the organic body have grasped the fact of impending death as long as there exists an experience of the terminal suffering. This central postulate, when in relation to Kubler Ross’s model, is intended for providing an explanatory hypothesis on why the “Acceptance” stage is bound to take place, as her model suggested.

Finally, as one may easily deduce, this article actually assumes that, in contrast to Kubler Ross’s own suggestion by herself, the “Acceptance” stage in her model is rather mechanical, in relation to the issue of cognitive impairment, than emotional. Yet, once again, it still has to be noted that so called “emotion” is largely a phenomenon in direct relations to the peripheral nervous system. In other words, even if I agree that Kubler Ross’s meaning for “emotionally accepting one’s own impending death” must have been somewhat different from the “acceptance caused by cognitive impairment,” I would still doubt if we can ever come up with the clear distinction between the two, given that even the cognitive impairment as mentioned above is actually a bodily procedure of “atrophy,” or ceasing its own functions that are not to be used after the impending termination of the body. Yet, on the other hand, this is actually to agree with Kubler Ross’s own idea that the “Acceptance” stage is for real, as she suggested, as much as this postulate indicates the idea that there is absolutely no reason to deny the word “acceptance” for this fifth stage of Kubler Ross’s model, as much as there is no clear boundary between what is “emotional” and what is “caused by cognitive impairment” when adopting this functionalist perspective about what happens during a dying trajectory for a human being.

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