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Three stages of truth for scientists:

(1) It's not true.

(2) If it is true, it's not very important.

(3) We knew it all along.

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Each work has to pass through these stages — ridicule, opposition, and then acceptance. Those who think ahead of their time are sure to be misunderstood.

The five stages - denial, anger, bargaining, depression, and acceptance - are a part of the framework that makes up our learning to live with the one we lost. They are tools to help us frame and identify what we may be feeling. But they are not stops on some linear timeline in grief.

As I look back, I think of my own grandmother, who made some of the biggest adjustments I ever saw a human being make. I came to the conclusion that she was able to make them partly because, with advancing age, you accept the blows of life more philosophically. In fact, you accept life, which is perhaps nature’s way of preparing you to accept death. It seems to me that when people grow old, death gradually becomes part of the natural scheme of life. Death is unnatural when it comes to the young, but with age it is normal and inevitable and, like everything else that has been inevitable in life, becomes easier to accept.

Philippe Ariès, in a series of lectures he delivered at Johns Hopkins in 1973 and later published as Western Attitudes toward Death: From the Middle Ages to the Present, noted that beginning about 1930 there had been in most Western countries and particularly in the United States a revolution in accepted attitudes toward death. “Death,” he wrote, “so omnipresent in the past that it was familiar, would be effaced, would disappear. It would become shameful and forbidden.

Living apart and at peace with myself,I came to realize more vividly the meaning of the doctrine of acceptance. To refrain from giving advice, to refrain from meddling in the affairs of others, to refrain even though the motives be the highest, from tampering with anothers way of life-so simple, yet so difficult for an active spirit. Hands Off.

How, then, do we know when a patient is giving up “too early” when we feel that a little fight on his part combined with the help of the medical profession could give him a chance to live longer? How can we differentiate this from the stage of acceptance, when our wish to prolong his life often contradicts his wish to rest and die in peace? If we are unable to differentiate these two stages we do more harm than good to our patients, we will be frustrated in our efforts, and will make his dying a painful last experience.

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