Denial, global warming and the end-of-man

The five stages of grief:                      

Denial, Anger, Bargaining, Depression, and Acceptance                                                                             

Elisabeth Kubler-Ross, M.D.           


The talking heads were at it again.  “Global warming is a hoax concocted by anti-capitalist liberal ivory tower academics to justify their inflated salaries and get tenure.”  “How could the earth be warming, if we just had a record winter?”  “The world is too big, man is too small.”  “There really is no proof.”  “Warming is natural, not man made.” “Chicken Little needs to go back to the hen house.”

I was only half listening, but there was something familiar about the argument, the discussion.  Not the ideas, we have heard them before, but the attitude, the tone, the structure.   It occurred to me that I have often listened to the same reaction, the same emotional response to information or stress; an illogical closed protective tone, begat of fear.  But, where? Of course … I hear it at cancer’s bedside, everyday. It is a natural human response.  It is anger and denial, when first told we are dying.

Our reaction to the frightening, world changing concept of global warming, is very similar to our response to terrible disease.  First, wait too long to get help, while continuing bad behavior.  Then try band-aid solutions for catastrophic symptoms.  Next, doctor shop, get multiple conflicting, poorly coordinated “expert” opinions, too many tests, wasting valuable time while desperately seeking the cathartic confirmation that “it is a mistake.”  Compound this medical disaster by using physicians who communicate badly and do not know how to tell the truth.  Finally, when it is too late, believe that an overwhelming application of technology, even in the final hours, can forestall the inevitable, there-by increasing suffering and avoiding true solutions.  Kubler-Ross was talking about our reaction to loss and disease, but she could easily have been teaching us about global politics.


“My Uncle smoked until he was 90.”

     “Even if 10 of the warmest years in history are in the last 20 years, last year was cool.”

“Oncologists and drug companies know the cure for cancer, but they are hiding it to get rich.”

     “The climate change fallacy is sponsored by builders of solar and wind power equipment.”

“I do not have time to exercise, rest or eat properly, I am too busy working.”

     “Jobs will be lost if we cut emissions, we are too busy working.”

“The medical research on cancer keeps changing and is biased.”

     “The reports about climate change are produced by biased radicals based on false science.” 

“My chest x-ray last year was normal, how could I have lung cancer now?”

     “Not every study done on climate change shows the same thing.”

“I am going to die anyway, so what does it matter?”

      “We are all going to die anyway, so what does it matter?”


Cancer is a complex disease that plays out slightly differently in each patient, but its patterns are clear.  Deny, delay, and die.  Climate change is more complex, but millions of years of the geological record show that its patterns are clear.  The earth goes through cycles of cooling and warming caused by changes in carbon dioxide and minute shifts in the earth’s orbit.  During these cycles much of the life on the planet dies.

The critical difference is that historically the changes in greenhouse gas occur because of shifts in the natural balance of production of CO2 by volcanoes and its absorption by plants.  This usually occurs over thousands or even millions of years.  Today, the rapid increase in heat retaining gas, which has already produced the highest levels of atmospheric CO2 in tens of millions of years, is caused by man.

Anger and denial, is our first reaction to terrible news.  If we are not able to move on, if we do not move from false blind hope toward acceptance, then we are doomed.  At the bedside fixed denial ends with patients losing all reasonable possibility for treatment or cure, with families in shock, and is followed by pain and suffering which transcends generations.  In the fading light, in those final hours, we cry, “why were we never told it was so bad?”  “Why wasn’t it found sooner?”  “How could the end come so fast?”  Denial begets disaster.

The terrified deniers of global warming are simply expressing the prime human instinct to suppress bad news. Nonetheless, this delay may result in the rapid transformation of the surface of our planet. They are correct, natural climate change over eons is an inevitable process.  They ignore that it has never happened so fast and they callously disregard that such massive change may include a future without mankind. The earth will be fine.  Buried under 300 feet of water, man will be gone.

Having spent my life observing humans at their courageous best, I believe that we can accept the threat and act.   We are strong and can learn, cope and grow.  Just as most patients move through the stages of grief and come to grips with disease, so the family of man can adapt and face the challenge that threatens all future generations.

I ask myself, as a physician who has helped countless families deal with awful events, what can to be done? How do I work with patients or families who because of anger and denial cannot deal with their disease?  There are several critical steps.

First, recognize fear is the basis of denial.  Simply shouting louder how grievous the danger produces more fear, more anger and amplifies denial. Recognize that it will take time to absorb the news, that denial is a natural protective reaction and that each patient requires support.  Next, systematic gentle education.  Start with simple, safe news and move gradually toward the hardest conclusions, the toughest decisions.

Finally, for my patients and their loved ones, there is one critical cure.  It sounds silly, terribly basic, but it is the most effective tool of oncologists and any caregiver that deals with horrid disease. Hold a family meeting.  Sit everyone down, patient, family, friends, and anyone else that is involved, and talk.  Start on basic shared ground, what we all believe, what we already share, and build forward.  Listen, sooth and understand each other and then teach, learn and build together.  It is the only way to deal with denial and anger for patients. Working together is the only way to heal the denial that threatens mankind.


  • Did you read this recent piece "Kingsnorth would agree with the need for grief but not with the idea that it must lead to change — at least not the kind of change that mainstream environmental groups pursue. “What do you do,” he asked, “when you accept that all of these changes are coming, things that you value are going to be lost, things that make you unhappy are going to happen, things that you wanted to achieve you can’t achieve, but you still have to live with it, and there’s still beauty, and there’s still meaning, and there are still things you can do to make the world less bad? And that’s not a series of questions that have any answers other than people’s personal answers to them. Selfishly it’s just a process I’m going through.” He laughed. “It’s extremely narcissistic of me. Rather than just having a personal crisis, I’ve said: ‘Hey! Come share my crisis with me!’ ” We are all in this together and together we have to work to do what we can to share our resources and to heal where healing is possible. Thanks once more for bringing to attention such important thinking. Lx
  • mark
    I love how they try to equate this with cancer or disease or other such things people deny. I don't believe in conspiracy theories at all and think it is ridiculous when people say our gov't and not Osama is responsible for 911 and same with theories about we already have cheap cures for cancer etc.. However, The problem here is no one is denying anything. It is the fact that there is a huge debate over this and in fact there is no proof of anything and scientists do not have a full understanging using proper comparables. the 130 years of recorded data compared to 4.2 billion years and technology changed. the issue is that if they want to talk about what man does pollutionwise, that effects the environment, that is what the focus should be, that however has absolutely zero effect on global warming/cooling/climate change. I am all for a clean environment but global warming, if you truly look at what is said is a religion.
    • James Salwitz, MD
      I agree it is an ongoing debate about how much damage will occur or how to address on a dysfunctional global scale. However, the data for the hand-of-man is solid. When "experts" state that the 35 gigatons of ancient carbon released each year into the atmosphere is not having an effect, it is as much denial as one of my 60-pack-year smokers complaining that the blood he is coughing up must be from the mold in his basement. jcs
  • paul jay
    climate change and health are linked together. we have over-mechanized, causing obesity, sedentary lifestyles and global warming. the cure is to demechanize, to get a bike, walking shoes, to turn off the motors. the lymphatic system has no pump except the moving body.
  • meyati
    Dr. Salwitz, I think that you stated this quite well. Your analogy of the 60 pack smoker a year blaming the bloody mucous on mold is one of the key problems in conservation. If a person can't see it, it does not exist-out of sight-out of mind. Even conservationists are guilty of this. People have been very happy to shut down a dirty coal powered electric plant in their area-and are proud that they have a green or less polluted city-but the electric is generated on an Indian Reservation, and is making the tribe ill, and the carbon emissions are still being pumped out. We closed down factories-steel mills, chemical plants, etc. to clean the Rust Belt up, and sent them to China. We lost jobs, and they say that the San Francisco Bay is filling up with pollutants that can be traced to China. I will add that for several years, Japanese fishing has been eroded because of a surge of Jelly fish that thrive in the warm polluted Chinese coast line. Aggressive Humboldt squid are taking over the Sea of Cortez because we've over fished and are removing the swordfish that ate the squid, and kept them under control. This is like cancer again---the sea-our bodies filled with poisonous cells that destroy the healthy cells- while we blame others. Don't forget that that sea that covers our planet might contain giant squid and poisonous jellyfish. We can't keep sending our pollution elsewhere and thinking that it won't come back to bite us in the rear..
  • Two of your comments interested last chest x-ray was normal...etc. was the 1st. Was it normal for someone who smokes and has a problem? I knew the physiological changes I went through....drastic changes....and when I started sensing something was wrong and told it was 'normal' my response was...'not for me'. The second was the chicken little quotation. A doctor was holding a gyno surgical instrument behind his back with a sardonic look on his face....and when I asked how painful was the procedure..nothing offered or rescheduling for what he was up to...I was not real explanation of why or how or what for, I said I was a chicken....I would describe him as a sadistic rapist at this point...Trick..coercion, manipulation. We are all dying..everyday we are alive....some more quickly than others.....but I do understand your article. Thanks again for an interesting post.
  • Radiohead and Passenger....two very good groups!
  • susan Dougherty
    Susan Dougherty here thanking you for this insightful perspective. we are dealing with hospice right now and it is a comfort to know people will walk us through each step.
  • D Someya Reed
    When I first read this piece it came across, to me and especially in paragraph three, as if you were saying that everyone who receives a devastating diagnosis should do nothing but whatever that particular first practitioner says to do…no second opinions, no further tests…nothing. And if you try to do so, you will die. Kind of the “we know best,” “we went to school for this, you didn’t,” and “you couldn’t possibly know more than we do” attitude. I’ve both seen and been on the receiving end of these as I’m sure you have too but maybe in a different context. After stepping away and upon subsequent readings, I still believe this was “partially” your intent though not for any malicious reasons. However, everything you’ve stated (on both sides) has an element or elements of truth to it. The real issue is determining how much truth and the motives (and ethics) of the teller, isn’t it? Just pick any of your examples: “My Uncle smoked until he was 90.” Doesn’t mean that you can do so with the same effect. Is the asker asking for approval? “Not every study done on climate change shows the same thing.” Absolutely true…they don’t. How often are studies flawed, biased, etc.? But then you said something with which I have very personal experience: “”In the fading light, in those final hours, we cry, “why were we never told it was so bad?”” and “Why wasn’t it found sooner?”” How many times in other posts, lectures, and commentaries have you said, yourself, that far too many doctors don’t like to talk about death and terminal illness with their patients and withhold information so as not to stress the patient? In our own case, and we did not wait until those “final hours,” the initial doctor had no idea what was wrong so he said that he wanted to “wait and see” how things developed. Not “denial” but “dumb” on his part. Should we have done as we were told and waited based upon the proposed more medically educated opinion? When the breast lump ultimately appeared visible through the skin, as if overnight, we did ask, “How did you miss it?” Only to be told that it had to have been there for a long time because cancer has a “consistent rate of growth.” What part of “uncontrolled and intermittent bursts of growth” that IS cancer did they not understand? Not to mention the fact that they did a breast (palpation) exam each time we came in and just 3 days before the visible lump appeared. Seems they must’ve missed it. I do get your overall point but I don’t see how your solution will work with the familial and human problems we have in dealing with one another. In some cases, it is likely to make the situation worse. In my own biological family, a family meeting would never occur in a million years. Yet, in my wedded family (in-laws) it would happen in a heartbeat. Then you have to add the privacy issues, I don’t want this one to know but that one’s OK, conflicting and entrenched opinions and so on. It would be nice if it were that easy to just get everyone together and focused solely on the benefit of the person who is ill. It is a wonderful thought, I applaud you for promoting it and I do support you all the way in it. Incidentally, Elisabeth Kübler-Ross, M.D. did not coin the concept of the “five stages of grief” as you opened this piece with. That was later adapted by others for their own purposes. Kübler-Ross developed the “five stages of loss.” It’s an important distinction because you can have loss without grief (lack of love toward the dying or deceased) just as you can have grief without loss (pining for what one does not have) not to mention that this was not her work at the time. This misapplication has become so pervasive even though one of her later books (if not her last) titled, ‘On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss’ clearly illustrates this distinction. But this is really no different than the commercialization of the term “holistic” in its application as a good thing to everything from medical services to toasters all in the pursuit of turning your head and turning a profit.

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