Order 888727: A Contextual Theory of Dying
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excellenteps485powerpointpaperexample.pptxA Contextual Theory of Dying
Lorelle Danna
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Meaning of death varies
Viewed in many different ways
Viewed different culturally
Death
The meaning of death varies along with the rituals that follow after a person has died. The definition of dead in the dictionary is “no longer living, deprived of life.” Death can be viewed in many ways in Human Development A Life-Span View it lists ten ways death can be used. Death can be viewed as an image or object, as a statistic, as an event, as a state of being, as an analogy, as a mystery, as a boundary, as a thief of meaning, as fear and anxiety or as reward or punishment. Death is a taboo that can be celebrated, embraced, and feared. Due to this death is viewed differently around the world. Some cultures have rituals where other grief the death of the individual. While cultures such as the Orthodox Jews recite ritual prayers and cover all the mirrors in the house. The Muscogee Creek tribe’s dig the grave by hand and give a “farewell handshake” to the dead by throwing a handful of dirt into the grave before covering it. (Kail 2010).
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Born in Zurich, Switzerland
Born on July 8, 1924
One of triplets
Dream to become a Doctor
Elisabeth Kubler-Ross
Elisabeth Kubler-Ross was born July 8, 1924 to a middle class family in Zurich, Switzerland. She was the first born of triplets and commented “For me, being a triplet was a nightmare. I would not wish it on my worst enemy. I had no identity apart from my sisters. . . . It was a heavy psychological weight to carry around." (Kubler-Ross, 1997, pg. 25) Although her father planned for her to have a job as a secretary she had other plans to become a Doctor. After the triplets finished school Elisabeth took a job as a maid and laboratory assistant instead of the secretarial job her father had set up for her.
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Kubler-Ross’ stages of dying
Glaser and Strauss’ dying trajectories
Corr’s four dimension
Lack of research evaluation
Stage theories are not clear
Theories of Dying
Robert Kastenbaum and Susan Thuell evaluated three theories of dying: Kubler-Ross’ stages of dying, Glaser and Strauss’ drying trajectories, and Corr’s four dimensions. After evaluating these theoires they came to the conclusion that there is no actual theory of dying because of the lack of general research which evaluates them (Kail 2010). When evaluating other theories Kastenbaum and Thuell realized that stage theories do not have a certain duration of time before moving on to the next stage and lack the process of how ones moves to another stage or what causes the move. (Kail 2010). Each of the theories will be broken down to show in more detail what these theorists believed to be true.
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Volunteered at end of WWII
Passed Medical entrance examination
1957 became a physician
Residency in psychiatry
Had two children
Elisabeth Kubler-Ross
She then volunteered at the end of World War II in many countries and at Maidanek concentration camp. She was very moved by this concentration camp. Upon her return home she continued her work as a laboratory assistant and started studying for her medical entrance examination which she passed in September 1951. In 1957 Elisabeth passed her medical board examinations and became a physician. She then married Emanuel Ross and they moved to the United States. Elisabeth became pregnant and due to this was not allowed to complete a residency in pediatrics and as a result did her residency in psychiatry. She later ended up having a son, Kenneth, and daughter, Barbara (Kubler-Ross 1997).
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Billings Hospital of the University of Chicago
Psychology instructor in 1960’s
Students approached her about dying
Her research was controversial
Developed the Five Stages of Dying
Elisabeth Kubler-Ross (cont.)
Elisabeth Kubler-Ross was a psychology professor at the Billings Hospital of the University of Chicago in the 1960’s. It is here that she became interesting in dying and the experience of it when four students from Chicago’s Theological Seminary approached her to seek help in understanding death as a crisis in life (Encyclopedia of Death and Dying 2002). Those who worked with her thought this was a controversial topic (Kail 2010). She then began a weekly seminar with a dying patient behind glass who she asked questions to. After the patient left she discussed the interview with students and medical professionals (Encyclopedia of Death and Dying 2002). She then wrote the book On Death and Dying in 1969 which included her five stages of dying: denial, anger, bargaining, depression, and acceptance (Encyclopedia of Death and Dying 2002).
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Five stages to dying
Stages can overlap
Stages can occur in any order
Denial Stage
Anger Stage
Kubler-Ross’ Five Stages of Dying
The five stages of Kubler-Ross’ Theory of dying are denial, anger, bargaining, depression, and acceptance. At first the stages were thought to be a sequence of feelings, but we later realized that the feelings can overlap and be experienced in different orders. (Kail 2010). In the stage of denial people have just found out that they have a terminal illness and can not accept the fact that they are going to die. Denial is only temporary until they have realized who will be left behind with their death. In next stage anger the individual realizes that denial can not continue. Anger follows when people ask questions about why this is happening to them and can show anger to those around them who are not dying. Most of the time people confront this anger and resolve it. (Kail 2010)
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Bargaining Stage
Depression Stage
Acceptance Stage
Stages can harm those dying
Kubler-Ross’ Five Stages of Dying (cont.)
The next stage is the bargaining stage where those who are dying try to look for a way out. They think that maybe a deal can be struck so I won’t die, but eventually they become aware that this will not work and move on. The next stage is depression where the individual dying can not deny the illness any longer. People report feeling sorrow or guilt and shame over their illness and the consequences from it. After this comes acceptance where the individual accepts that they are going to die and that the journey is finally over. Kubler-Ross states that these are not necessarily experienced in this order and can actually harm those dying if they think they are to be experienced in this order. She also states that emotional responses are different for each individual (Kail 2010).
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Can be applied to other events
Experiences at least two stages
Roller coaster effect
Dying with dignity
Kubler-Ross’ Five Stages of Dying (cont.)
Kubler-Ross’ Theory of Dying was originally for patients with terminal illnesses, but since then it has been applied to an catastrophic loss. These losses can include losing a job, death of a loved on, infertility, drug addiction, divorce. Kubler-Ross also states that not everyone experiences all of the stages, but they do experience at least two. Sometimes people can also experience stages in a “roller coaster effect”. This roller coaster effect is when an individual switches between two or more stages or comes back to a certain stage or stages more than once to work through it. Kubler-Ross also states that the grief process should not be rushed or lengthened based on an individuals imposed time frame. Some people do struggle with death until the end and because of this have more difficulty dying with dignity.
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American Sociologist
Founder of Grounded Theory Methodology
Received Ph.D. from Columbia University
Wrote Awareness of Dying
Wrote The Discovery of Grounded Theory
Barney G. Glaser
Barney G. Glaser was born in 1930 in San Francisco, CA. He is an American sociologist and one of the founders of the Grounded Theory Methodology. He received his B.A. degree at Stanford in 1952. He studied literature at the University of Paris, France and University of Freiburg. He then went on to received his Ph.D. from Columbia University in 1961 where he was a student of Paul Lazarsfeld and Robert K. Merton. Post-doc Glaser started a research collaboration with Anselm L. Strauss at the University of California, San Francisco. They later went on to write Awareness of Dying in 1965 which was based on a study of dying in California hospitals. As a response to methodological questions from this book Glaser and Strauss developed the Grounded Theory (GT) and wrote the book The Discovery of Grounded Theory in 1967.
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Started Sociology Press
Wrote a second grounded theory
Held workshops on Grounded Theory
Received honorary doctorate
Opened Grounded Theory Institute
Barney G. Glaser (cont.)
In 1970 Glaser started the publishing company Sociology Press which specialized in Grounded Theory. A second grounded theory methodology was written in 1978 by Glaser titled Theoretical Sensitivity. Glaser has published several reader grounded theory and 4 more methodologies. Glaser has also traveled the world and held workshops and seminars to those researchers on Grounded Theory. In 1998 Glaser received a honorary doctorate from Stockholm University in Sweden. Glaser has also opened the non-profit web based organization Grounded Theory Institute in 1999. Today Barney Glaser lives in Mill Valley, CA with his wife.
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Born in New York City
Received B.S. in 1939
Received M.A. in 1942
Received Ph.D. in 1945
Wrote Social Psychology
Anselm L. Strauss
Anselm L. Strauss was born December 18, 1916 in New York City, NY. His grandparents were immigrants from Germany in the United States. He grew up in Mount Vernon, NY. His physician recommend that he move to Arizona due to his bronchial problems, but after receiving his high school diploma he moved to the University of Virginia. Here Strauss received his B.S. in Biology in 1939. He then went to the University of Chicago and received a M.A. in sociology in 1942 he then went on to received his Ph.D. in 1945 also in Sociology. Here he studied symbolic interactionism under Herbert Blumer. From 1944 to 1947 Strauss was on the facility at Lawrence College. He then moved to Indiana University from 1946-1952. Here he met Alfred Lindesmith and together they publish Social Psychology in 1949. The volume has been translated into German, Swedish, and Japanese and the eighth edition was published in English in 1999.
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Returned to University of Chicago
Founded Department at University of California
Developed Grounded Theory
Received Charles H. Cooley award
Died of a Heart Attack
Anselm L. Strauss
Strauss returned to the University of Chicago in 1952 and worked as an assistant professor. In 1960 Strauss went to the School of Nursing at the University of California, San Francisco where he founded the Department of Social and Behavioral Sciences. He chaired the department until 1987. Strauss collaborated with Barney Glaser and together they published Awareness of Dying (1965) and The Discovery of the Grounded Theory(1967). Even as a professor emeritus Strauss continued research and teaching activities. Strauss was elected fellow of the American Association of Advancement of Science in 1980. He also received the Charles H. Cooley award in 1980 from the Society for the Study of Symbolic Interactionism . Between 1955 and 1980 he was a visiting professor at the universities of Frankfurt and Konstanz in Germany, Cambridge and Manchester in England, Paris in France, and Adelaide in Australia. He was also a consultant with the World Health Organization (WHO) in 1962 and 1970. Anselm L. Strauss died of a heart attack September 5, 1996. Throughout his life he published over 30 books, chapter in over 30 other books, and 70 journal articles.
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Lingering dying trajectory
Quick dying trajectory
Expected quick dying trajectory
Unexpected quick dying trajectory
Glaser and Strauss’ dying trajectories
The dying trajectory is a theory by Glaser and Strauss that did research in California on dying in hospitals and nursing homes. The dying trajectory depends on the nature of the disorder, age of the patient, patient’s lifestyle, medical treatment received, and various psychological factors. There are two main dying trajectories which are lingering dying trajectory and quick dying trajectory. Under the quick dying trajectory there could be expected quick dying trajectory and unexpected quick dying trajectory. Each of the dying trajectories effects the patient and families differently. A long dying trajectory gives the patient more time to get their affairs in order and can be less stressful for the survivors. A long dying trajectory is not always desirable and when people are given a choice they would much rather die quickly to avoid physical and psychological pain. A lingering dying trajectory is described as “one in which a patient dies over a long period of time”(Aiken 2001, 277). On the other hand, a quick dying trajectory is characterized as a patient dying quickly whether or not the staff expected this. An expected quick dying trajectory were often seen in the Emergency Room of the Intensive Care Unit of the hospital. While unexpected quick dying trajectory were when the medical staff either expected the patient’s death but not that quickly of the staff did not expect the patient to die. (Aiken 2001)
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Peaks and Valleys
Plateau
Nursing Homes vs. Hospitals
Dealing with death
Dying Trajectory
A dying trajectory should not be quick or linger it should consist of peaks and valleys and plateaus. At a plateau the patient does not experience any deterioration. The patient might experience a rapid decline in health or a gradual movement towards death. Both of these are found in the research done by Glaser and Strauss. Diagnosing a patient as “well” , “acutely ill”, “chronically ill”, and “high risk of dying” should also change through out stages of dying. Studies have shown that nursing homes are better equipped to deal with patients with lingering dying trajectories than hospitals are. Hospital personnel are trained to deal with recovery and cures rather than dying, so these individuals deal with quick dying trajectories better than those with lingering trajectories. Whether dying trajectories are quick or lingering people are assumed to deal with death in a reasonable manner which differs with different ages.
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Bodily Needs
Psychological security
Interpersonal attachments
Spiritual energy and hope
Corr’s Four Dimensions of Dying
Charles Corr’s research is about the four dimensions a dying person must face. Corr states “there is no one right way to die” (Corr 1991-1992). There may be better or worse ways of coping with dying he says. The four dimensions of dying Corr discusses are bodily needs, psychological security, interpersonal attachments, and spiritual energy and hope. This is a perspective from the dying person’s mind-set. Bodily needs include nutritious food, clean water, clean air, regular sleep, keeping clean, and many others. Psychological security is tied to how we think emotionally and sexually. Psychological security is a feeling and a reality. Interpersonal attachments is your relationships with other people in your lives. This is thought about by the dying individual when they wonder what is going to happen to their family/friends after they pass away. The last dimension Corr mentions is spiritual energy and hope this is when people look to their religion or spiritual believes before passing away.
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Graduate scholarship in philosophy
Ph.D. in psychology
Founded Omega
Published first textbook on death
Robert Kastenbaum
Robert Kastenbaum received a graduate scholarship in philosophy and a Ph.D. in psychology from the University of Southern California in 1959. Kastenbaum was interested in life-span development, aging, time perspective, creativity, and death and dying. These were not well know at the time of Kastenbaum’s studying. Kastenbaum founded Omega with Dick Kalish which is the first peer-reviewed journal focused on death-related issues. He went on to establish the first university-based educational and research center on death and dying at Wayne State University in 1966.Kastenbaum taught the first regularly-scheduled class on death and came up with the first textbook titled Death, Society, & Human Experience in 1977. Other books written by Kastenbaum includeThe Psychology of death, Is Youth the Only Thing Worth Having? , On Our Way, The Final Passage Through Life and Death. He served at the editor of the Macmillen Encyclopedia of Death and Dying
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Co-Founded National Caucus
U.S. Senate Special Subcommittee Aging
Veteran’s Administration’s geriatric research
National Hospice Demonstration Project
Life-span approach to dying
Robert Kastenbaum (cont.)
Robert Kastenbaum has also served as the co-founder of the National caucus on Black Aging. He has also been a consultant to the United States Senate Special Subcommittee on Aging. Furthermore Kastenbaum has been a participant in developing the Veterans Administration’s geriatric research and educational centers. He is the landmark of the National Hospice Demonstration Project. Today Robert Kastenbaum lives in Tempe, Arizona with his wife, Bunny, dog , Angel, and two cats, Pumpkin and Snowflake. He has been writing book and verse for musicals and operas. Robert Kastenbaum has been arguing for a life-span development approach to death and dying. This approach incorporated a biopsychosocial perspective which views deather from the outside as an observer and from the inside as the person dying. To fulfill this Kastenbaum has looked at deathbed scences as a way of developing a more complete understanding of dying at the most critical point of the process.
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Robert Kastenbaum and Susan Thuell
Holistic Approach
Importance of families coping with death
Broader contextual approach
Contextual Theory of Dying
Robert Kastenbaum and Susan Thuell talk about the contextual theory of dying. The believe that the difficulty of theories of dying are because there is a lack of research evaluating them in different contexts. Kastenbaum and Thuell also collaborate with Corr’s research that there is no “right way to die” and that this approach recognizes this approach is from the mind-set of a dying person. This is a holistic approach to dying which acknowledges induvidual differences and rejects broad generalizations. This approach also recognizes the importance of the coping family members, friends, and caregivers as well as those of the dying person. Kastenbaum and Thuell’s argument to Corr is that what is needed is an even broader contextual approach that have a more inclusive view of the dying process. (Kail 2010)
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Wide variety of terminal illnesses
Socio-enviornmental context
Contextual approach
Contextual Theory of Dying (cont.)
Kastenbaum and Thuell point out theories must be able to handle people with a wide variety of terminal illnesses. Be sensitive to the dying people’s own perspectives and values related to death. The socio-enviornmental context within which dying occurs must also be recognized and that this process changes over time. The example used is a person may begin the dying process by going from living independently and end up to in a long-term care facility. A contextual approach on the other hand would provide guidance for health care professionals and families for discussing how to protect the quality of life, provide better care, and prepare caregivers for dealing with the end of life. This approach also provides numerous research questions. Although we do not have a comprehensive theory of dying Kastenbaum and Thuell state we can reject a reductionist approach that focuses on set stages in favor of a truly holistic one. To accomplish this we can examine people’s experiences that can be written from many point of view.
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Aiken, L.R. (2001). Dying, Death & Bereavment. Mahwah, NJ: Lawerence Eribaum Associated Inc. Publishers
Cavanaugh, J.C. & Blanchard-Fields, F. (2006). Adult Development and Dying 5th Edition. Belmont, CA:Thomas Higher Education.
Corr, C.A., Wabe, C.M. & Corr, D.M. (2009). Death and Dying, Life and Living 6th Edition. Belmont, CA: Wadsworth.
Howarth, G. & Leaman, O. (2001). The Encyclopedia of Death and Dying. New Fetter Lane, London:T &F Books UK
References
Kail, R.V. & Cavanaugh J.C. (2010). Human Development: A Life-Span View 5th Edition. Belmont, CA: Wadsworth.
Kübler-Ross, E. (1975). Death the Final Stage of Dying. New York, NY: Touchstone.
Kübler-Ross, E. (1973). On Death and Dying, New York, NY: Scribner.
Kübler-Ross, E. (1997). The Wheel of Life: A Memoir of Living and Dying. New York, NY: Touchstone.
References (cont.)
NationMaster (2005). Barney Glaser. Retrieved from:http ://www.statemaster.com/encyclopedia/Barney-Glaser
University of California, San Francisco. Anselum Strauss. Retrieved from:http ://sbs.ucsf.edu/medsoc/anselmstrauss/
Other References
