Kubler-Ross and Piaget

February 19, 2010 at 9:07 am Leave a comment

I Wish I had better things to say, but I am creatively and cognitively stunted at the moment.

Thee following is an essay for my religion course, there are three spelling errors where i’ve left off a letter. Read it anyway!

When reading this book, one may not be immediately be reminded of cognitive development theories, but nonetheless Elisabeth Kübler-Ross’s five stages of dying parallel the 5 stages of cognitive development as defined by Jean Piaget. The actual physical ability of the human brain seems to progress much in the way that the emotional ability of a patient who knows they are dying. This seeming equivalence makes Kübler-Ross’s stages seem almost like a re-birth, as though the dying patient has to re-learn how to think when faced with the terrifying prospect of their own death.

In Piaget’s theory, the first stage of a child’s cognitive development (between birth and age two) is called the sensorimotor stage. In this stage, the child is capable of only a basic understanding of the world around them. The child does not understand object permanence, in that they believe that when they cannot see something it is still there[1] (this is why an infant will giggle every single time you appear from behind an object when playing peak-a-boo. Every time you hide your face, to them you are disappearing; and every time you reveal yourself you are materializing in thin air.) This mindset is similar to Kübler-Ross’s first stage of denial. The act of denial itself is often an embodiment of the “If I can’t see it, it isn’t there” philosophy. By pretending that they cannot feel the pain they are in (or even in the earlier stages when sometimes they are in no pain and simply refuse to acknowledge that there is anything wrong) they allow themselves to disregard the disease completely by putting it out of sight. Also, much like how if you tried to explain the concept of permanence to a child they would not understand you; so would a patient in denial not be able to be reasoned out of their state.

The second stage of cognitive development is called the preoperational and it occurs between the ages of 2 and 7. In this stage, a child’s cognitive abilities are intuitive (meaning they are not truly able to deductively reason, or approach something objectively.) They are also inflexible and often very selective and focused on individual events. The example of Mr. X in Kübler-Ross’s second stage of anger illustrates the similarity of the selective focus of a child in the preoperational stage when he becomes excessively angry with a nurse “He said over and over to his nurse ‘You lied to me’”[2] in reaction to her putting up the guard rails on his bed despite him asking her not to. This man focuses on that one specific action of putting op the rails on the side of his bed when trying to voice his anger about feeling trapped, ignored and manipulated. Again, like the child in this stage he is uncompromising and incapable of objectively seeing the issue (that he would fall and “crack his head” without the rails. If we go by Piaget’s model we must understand that he is not being obstinate, but is simply physically incapable of that kind of reasoning while in the narrow stage of anger.

The third stage of cognitive development is when the child begins (only just begins) to understand abstract concepts. This is called the concrete operational stage and it occurs between the ages of 7 and 11. It is perhaps, the least obvious parallel stage, but there is one concept that the child grasps in this stage that pertains very much to the third stage in Kübler-Ross’s theory, that of bargaining. Simply, the child understands reversibility, “that numbers and objects can be changed, the returned to their original state” [3] they understand that if 4+4=8, then 8-4=4. They understand that when someone puts on a gorilla mask, it can be removed and that the person is not going to be permanently changed in to a gorilla. It is this idea of reversibility that is so new to a child in this stage of cognitive development that ties in so closely to the stage of bargaining. The patient begins to think that what has been done to them could be undone. As it is stated in Kübler-Ross’s book “He [the patient] knows, that from past experiences, that there is a slim chance that he will be rewarded for good behavior…”[4] the patient knows from past experience that there is a potential for reversal and so hopes that this will be the one time that their sentence is reversed.

The fourth stage of Piaget’s theory is actually the last stage his actual theory. His students came up with the fifth. It is a stage called Formal operating stage that occurs after the age of 11 and Piaget thought that this was the final stage of cognitive development. In this stage, the child understands abstract concepts like death and political asylum.  This is the stage of understanding, when the child is able to process information on an adult level. So also is the stage of depression a stage of knowing, “When the terminally ill patient can no longer deny his illness… He cannot smile it off anymore.”[5] At the same stage where the child whose brain had finally finished developing may feel a newfound sense of responsibility over their life, the patient who is coming to grips with their death may finally realize that they are in fact, dying.

The final stage of development in Piaget’s theory was one put there by his students. They believed that there was a post formal operational stage that occurred somewhere after the age of 35. In layman’s terms they believed this was the wisdom stage. This is rather loosely defined, it is really only said that when in this stage one is able to flexible and aware of emotional and interpersonal influences of knowledge, they give the example of king Solomon in the bible. This is most congruent with Kübler-Ross’s 5th stage of dying. Is acceptance not the wisest of all reactions? At this point, the patient is able to look his or her own death in the face and agree let it come. Like wisdom, it “Should not be mistaken for a happy stage”[6] and it is not surprising that this is usually a very calm stage, even Thoreau said that “It is characteristic of wisdom not to do desperate things” and so it is characteristic of acceptance to not do desperate things either.

In conclusion, sometimes when faced with the reality of their own mortality, a patient’s process of grieving can become almost regeneration, a chance for them to re-build their cognition from a new starting point, one which includes a date for their own death. This rebirth of sorts is illustrated in the similarities between Kübler-Ross’s five stages of dying and  Piaget’s five stages of cognitive development, they both have a lot to say about human psychology.

[1] Jean Piaget A child’s conception of the world New York: Rowman & Littlefield, 1975

[2] Elisabeth Kübler-Ross On death and dying New York: Scribner, 1969.

[3] Jean Piaget A child’s conception of the world. New York: Rowman & Littlefield, 1975

[4], 5 Elisabeth Kübler-Ross On death and dying New York: Scribner, 1969.

[6] Elisabeth Kübler-Ross On death and dying New York: Scribner, 1969


Entry filed under: Artz, Rambling, Wall Of Text.

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