There are multiple aspects of death to consider. Biological death refers to the medical aspect of death when the vital organs stop functioning. As a person goes through the active process of dying, when the body is shutting down, includes an increase in sleep, decrease in food intake due to digestion beginning to slow down, and the blood may pool on the underside of the body forming dark patches  as circulation slows. Breathing often becomes more sporadic and  and following lack of respiration- clinical death occurs when the brain ceases to function.

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Another aspect of death is social death. The majority of social death occurrences stem from people feeling of discomfort towards those that are dying. Social death occurs when the social or familial circle stops visiting or calling someone who is terminally ill or in the dying process. Even health care providers may spend less time with their terminally ill patients. 

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Psychological death is the third form of death and occurs when a terminally ill  person begins to accept their death and to withdraw from others psychologically. They often  become less interested in normal activities, world events, and both intimate and social relationships. This has the capability of occurring much sooner than biological death.

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In the late 1960s, Elizabeth Kubler-Ross started to write about death in the United States.  In her book, “On Death and Dying”  Kubler-Ross outlined five psychological stages of coming to grips with one’s terminal illness. These are also applicable to coming to grips with the news that a loved one is terminally ill. The five psychological stages include denial, anger, bargaining, depression, and acceptance.  These stages are unique for each person facing severe illness and death and while many people do not follow these in a linear pattern, they are helpful in describing some of the emotions which accompany these life-changing events.

 

To better understand the world of the play and the character components of Katherine we need to understand what these stages mean and when and where in the play Katherine experiences them.

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1. Denial-When a person is  diagnosed with  a terminal illness, it's natural to enter a stage of denial and isolation. They may completely disbelieve what the doctor is telling them and pursue multiple  opinions. This stage of denial is usually short-lived. Soon after entering into this stage, many suffering from ALS accept their diagnosis as reality. Certain people, however, will use denial as a coping mechanism long into their illness and even to their death. Extended denial isn't always negative and it doesn't always bring increased distress. Katherine fits into the category of extended denial.  Her denial is already present at the start of the play and continues well through the first act.  We first see her  acknowledge the disease and give it a name at the Train Station with Gertie. 

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2. Anger-As a person accepts the reality of a terminal diagnosis,  the realization that all of their hopes, dreams, and well crafted plans for their life will not come to fruition, brings anger and frustration. Unfortunately, this anger is often directed outwardly at the world and  may get projected on others at random. For most people, this stage  is also short-lived. Again, however, this stage may continue  for much of the illness and some carry it until death. There is no definitive place in the script we experience pure rage, but rather pockets of frustration and an overall blanket of harshness with whom she deals. There is a shift following the cafe scene where she argues with Gertie. We experience a much softer Katherine, which I believe would mark the end of this phase. The question at large would be was Katherine's personality like this before diagnosis or is this a symptom or "stage" that she has progressed to leading up to that shift.

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3. Bargaining- When denial and anger don't have the intended outcome, in this case, a mistaken diagnosis or miracle cure, many people will shift their focus to bargaining. Most people who enter the bargaining phase do so through a higher power. They may agree to live a good life and be a better person, etc. if only their higher power will  cure them of their illness. Other people have been witnessed to bargain with the doctors or the disease itself. This phase is clearly defined in the script through the the sudden shift is spiritual recognition for Katherine as she lies on a MRI table and out of fear, sings the Kyrie, which is translated to "Lord, have mercy."

 

4. Depression-When it becomes clear that the terminal illness is here to stay, many people experience depression. The increased burden of surgeries, treatments, and physical symptoms of illness, begin to take their toll. Kübler-Ross explains that there are actually two types of depression that may be found in this stage. The first depression, which she called "reactive depression," occurs as a reaction to current and past losses. In the case of ALS this would refer to mobility, speech, etc. The second type of depression is coined "preparatory depression." This is the stage where one has to deal with the impending future loss of everything and everyone they love. Many people spend this time grieving in quiet thought as they prepare themselves for this idea of complete loss. This stage for Katherine in the play remains the most unclear. There is no definitive moment where we see her portray this stage and amount of grief. The question posed then would be- does it happen in the time in between scenes that are not part of the written text? Does Katherine evade this stage due to her focus on her life's work?

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5. Acceptance-The stage of acceptance is where most people would like to be when they die. It is a stage of peaceful resolution that death will occur and if a person is lucky enough to reach this stage, death has the potential to be peaceful. People who reach the stage of acceptance have typically given themselves permission to express grief, regret, anger, and depression. By doing so, they are able to process their emotions and come to terms with the actual reality of their situation. Katherine does indeed reach this stage within the play. Kauffman creatively crafts a scene called "limbo" in which Beethoven, through a hallucination, helps Katherine achieve this level of acceptance. She is able to grieve the future loss, express anger and grief. 

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One remaining question....

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Why didn't Katherine  end her life as she had planned, utilizing drugs, with Gertie's assistance, when her health severely declined? Was it due to her conflict with Clara at the cafe? Is it possible she was in a different psychological stage at that juncture? Was there some other outlying factor?

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My research has concluded that it may be combination of psychological stage differences and spiritualization as a coping strategy found within within that stage. In this particular  shift, the anger stage combined with the planful coping mechanism gives way to spiritualization and the acceptance stage.