Liver Disease through the Lens of Kübler-Ross’s “Five Stages of Grief”

Introduction

Liver disease is a serious health concern with a profound impact on both the patient and their families. One of the most remarkable frameworks for understanding the emotional and psychological dimensions of dealing with such a chronic condition is the “Five Stages of Grief,” a model first introduced by psychiatrist Elisabeth Kübler-Ross in her seminal 1969 book, “On Death and Dying.”

The model outlines the five emotional stages people go through when facing death or severe illness: Denial, Anger, Bargaining, Depression, and Acceptance. This article aims to apply these five stages to liver disease, exploring the patient experience from diagnosis to management or end-of-life care.

References:

  1. Kübler-Ross, E. (1969). “On Death and Dying.” Macmillan, New York.
  2. Jepsen, P., Ott, P., Andersen, P. K., Sørensen, H. T., & Vilstrup, H. (2010). Clinical course of alcoholic liver cirrhosis: A Danish population-based cohort study. Hepatology, 51(5), 1675–1682.

Stage One: Denial

The Initial Shock

When diagnosed with liver disease, especially conditions like cirrhosis or liver cancer, the first reaction is often disbelief. Patients may seek multiple opinions, hoping that subsequent tests will reverse the diagnosis.

Medical Implications

Denial can be problematic as it may delay essential treatment and lifestyle changes. Early intervention is crucial for liver diseases to slow down their progression.

References:

  1. Nusrat, S., Khan, M. S., Fazili, J., & Madhoun, M. F. (2014). Cirrhosis and its complications: evidence-based answers to frequently asked questions. World Journal of Gastroenterology, 20(18), 5442–5460.

Stage Two: Anger

Emotional Response

Patients often experience intense emotions, directing anger at themselves for lifestyle choices that may have contributed to the disease, or towards medical professionals for not diagnosing the condition earlier.

Coping Mechanisms

Support from friends, family, and mental health professionals can help manage this anger. The focus should be on venting feelings safely and working towards acceptance.

References:

  1. DeMaria, R., Adler, D. (2012). Psychosocial issues in liver transplantation. Psychiatric Times.

Stage Three: Bargaining

Medical Negotiations

Patients may try bargaining with healthcare providers or even a higher power for a chance to reverse the condition or lessen its impact. They may commit to quitting alcohol or adopting healthier lifestyles in exchange for a more favorable prognosis.

The Reality

Unfortunately, while lifestyle changes can significantly impact the disease’s progression, they are not guarantees for reversibility.

References:

  1. Addolorato, G., Leggio, L., Abenavoli, L., Gasbarrini, G., & Alcoholism Treatment Study Group. (2005). Neurobiochemical and clinical aspects of craving in alcohol addiction: a review. Addictive Behaviors, 30(6), 1209–1224.

Stage Four: Depression

Emotional Toll

At this stage, the gravity of the diagnosis weighs heavily on the patient, leading to depression. Concerns about mortality, loss of function, and the burden on loved ones can be overwhelming.

Clinical Intervention

Treatment for depression, which may include medication and counseling, can often alleviate these feelings, helping the patient more effectively manage their liver disease.

References:

  1. Maisto, S. A., Conigliaro, J., McNeil, M., Kraemer, K., & Kelley, M. E. (2000). An empirical investigation of the factor structure of the AUDIT. Psychological Assessment, 12(3), 346–353.

Stage Five: Acceptance

Coming to Terms

Acceptance often comes with a certain amount of peace and planning. Patients may focus on maximizing their quality of life and spend time with loved ones.

Medical Planning

This stage often involves advance care planning, discussion of palliative options, and other end-of-life decisions, all crucial for liver disease, which can have a highly variable course.

References:

  1. Koller, A., & de Abreu, G. A. (2014). Palliative care perspectives and practices towards end-of-life liver disease management. World Journal of Hepatology, 6(9), 665–673.

Conclusion

Understanding liver disease through Kübler-Ross’s five stages can offer invaluable perspectives for both medical professionals and families involved. These stages are not mutually exclusive and can occur concurrently or out of sequence. Still, recognizing them can guide tailored interventions to improve both physical and psychological outcomes.

References

  1. Kübler-Ross, E. (1969). “On Death and Dying.” Macmillan, New York.
  2. Jepsen, P., Ott, P., Andersen, P. K., Sørensen, H. T., & Vilstrup, H. (2010). Clinical course of alcoholic liver cirrhosis: A Danish population-based cohort study. Hepatology, 51(5), 1675–1682.
  3. Nusrat, S., Khan, M. S., Fazili, J., & Madhoun, M. F. (2014). Cirrhosis and its complications: evidence-based answers to frequently asked questions. World Journal of Gastroenterology, 20(18), 5442–5460.
  4. DeMaria, R., Adler, D. (2012). Psychosocial issues in liver transplantation. Psychiatric Times.
  5. Addolorato, G., Leggio, L., Abenavoli, L., Gasbarrini, G., & Alcoholism Treatment Study Group. (2005). Neurobiochemical and clinical aspects of craving in alcohol addiction: a review. Addictive Behaviors, 30(6), 1209–1224.
  6. Maisto, S. A., Conigliaro, J., McNeil, M., Kraemer, K., & Kelley, M. E. (2000). An empirical investigation of the factor structure of the AUDIT. Psychological Assessment, 12(3), 346–353.
  7. Koller, A., & de Abreu, G. A. (2014). Palliative care perspectives and practices towards end-of-life liver disease management. World Journal of Hepatology, 6(9), 665–673