Death and life

Because learning changes everything.®

A Topical Approach to Life-Span Development

11th Edition John W. Santrock

Chapter 17

Death, Dying, and Grieving

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Learning Goals

Describe the death system and its cultural and historical contexts.

Evaluate issues in determining death and decisions regarding death.

Discuss the causes of death and suicide at different points in development.

Explain the psychological aspects involved in facing one’s own death and the contexts in which people die.

Identify ways to cope with the death of another person.

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The Death System and Its Cultural Variations 1

Components of death systems across cultures:

• People—everyone is involved in death at some point.

• Places or contexts—hospitals, funeral homes, cemeteries, hospices, battlefields, memorials.

• Times—time/occasions set aside to honor those who have died.

• Objects—many objects in a culture are associated with death.

• Symbols—symbols and religious ceremonies are connected to death.

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The Death System and Its Cultural Variations 2

In the United States, it is not uncommon to reach adulthood without having seen someone die.

Most societies have philosophical or religious beliefs about death.

• Rituals that deal with death.

In most societies, death is not viewed as the end of existence.

• Spiritual body believed to live on.

• Perspective favored by most Americans.

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The Death System and Its Cultural Variations 3

Forms of death avoidance and denial in the United States:

• Funeral industry glosses over death and fashions lifelike qualities in the dead.

• Adoption of euphemistic language for death that implies forever.

• Persistent search for a fountain of youth.

• Rejection and isolation of the aged, who may remind us of death.

• Adoption of the concept of a pleasant and rewarding afterlife, suggesting that we are immortal.

• Medical community’s emphasis on prolonging biological life instead of diminishing human suffering.

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Changing Historical Circumstances

Today, death occurs most often among older adults.

• Two hundred years ago, nearly half of all children died before the age of 10.

Larger number of older adults today die apart from their families.

• More than 80% of deaths occur in institutions or hospitals.

• Minimizes exposure to death and painful surroundings.

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Defining Death and Life/Death Issues

In the past, the end of certain biological functions were considered clear signs of death.

• Breathing, blood pressure, rigidity of body (rigor mortis).

Brain death: a neurological definition of death.

• Person is brain dead when all electrical activity of the brain ceases for a specific period of time.

• Higher brain regions may die but lower portions may allow for continued breathing and a heartbeat.

• Current definition among most physicians includes death of both the higher cortical functions and the lower brain stem functions.

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Decisions Regarding Life, Death, and Health Care 1

Advance care planning is the process of patients thinking about and communicating their preferences for end-of-life care.

Laws in all 50 states now accept an advance directive, such as a living will.

Advance directive states preferences such as whether life- sustaining procedures may be used to prolong life.

Living will: designed to be completed while the individual can still think clearly.

• Expresses desires regarding extraordinary medical procedures that may sustain life when medical situation becomes hopeless.

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Decisions Regarding Life, Death, and Health Care 2

Euthanasia: the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability.

• Passive euthanasia: when a person is allowed to die by withholding available treatment, such as withdrawing a life-sustaining device.

• Active euthanasia: when death is deliberately induced, as when a legal dose of a drug is injected.

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Decisions Regarding Life, Death, and Health Care 3

Assisted suicide is now legal in six countries.

• In the United States, it is allowed in California, Colorado, Hawaii, Maine, New Jersey, Oregon, Vermont, New Mexico, Washington, and Washington, DC.

• Those in favor of euthanasia argue death should be calm and dignified, not full of suffering.

• Those against euthanasia stress it is murder; and many religious individuals say it is against God’s will.

Too often, death in American is lonely, prolonged, and painful.

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Decisions Regarding Life, Death, and Health Care 4

Care providers are increasingly interested in helping individuals experience a “good death.”

• Physical comfort, support from loved ones, acceptance, and appropriate medical care.

Hospice: a program committed to making the end of life as free from pain, anxiety, and depression as possible.

• Emphasizes palliative care—reducing pain and suffering and helping individuals die with dignity.

• Today a majority of hospice programs are home-based.

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A Developmental Perspective on Death

In the United States, deaths of older adults account for approximately two thirds of the 2 million deaths that occur each year.

• What is known about death, dying, and grieving is mainly based on information about older adults.

• Youthful death is much less common.

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Causes of Death

Death can occur at any point in the life span.

In infancy, sudden infant death syndrome (SIDS).

In childhood, most often due to accidents or illness.

• Major illnesses that cause death in children: heart disease, cancer, birth defects.

Death in adolescence is most likely to occur because of motor vehicle accidents, suicide, and homicide.

Older adults are more likely to die from chronic diseases.

• Often incapacitated before death, producing a long course of dying.

Many young and middle-aged adults die of illnesses such as heart disease and cancer.

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Suicide

Suicide risk factors:

• Serious physical illness.

• Mental disorders.

• Feelings of hopelessness.

• Social isolation.

• Failure in school and work.

• Loss of loved ones.

• Serious financial difficulties.

• Drug use.

• Prior suicide attempt.

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Suicide: Adolescence 1

Suicidal behavior escalates in adolescence and further increases in emerging adulthood.

• Second leading cause of death among adolescents in the United States.

Far more adolescents think about or attempt suicide unsuccessfully than actually die by it.

Suicidal behavior varies by both gender and ethnicity.

• Females make more attempts.

• Native Americans have the highest rates.

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Suicide: Adolescence 2

Depression is the most frequently cited factor associated with adolescent suicide.

• Sense of hopelessness, low self-esteem, high self-blame.

In some instances, suicides occur in clusters.

• “Copycat” suicides raise the issue of whether suicides should be reported in the media.

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Suicide: Adulthood and Aging

Suicide is increasing among U.S. adults.

Females are three times more likely to attempt suicide; but males are four times more likely to die by suicide.

Older adult most likely to die by suicide is male, lives alone, has lost his spouse, and is experiencing failing health.

• Perceiving oneself as burdensome may contribute.

• Protective factors include a supportive network of family and friends, emotional control, and comfort from religion.

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Figure 2 What to Do and What Not to Do When Someone Is Likely to Attempt Suicide

What to do

Ask direct, straightforward questions in a calm manner: “Are you thinking about hurting yourself?”

Assess the seriousness of the suicidal intent by asking questions about feelings, important relationships, who else the person has talked with, and the amount of thought given to the means to be used. If a gun, pills, a rope, or other means have been obtained and a precise plan has been developed, clearly the situation is dangerous. Stay with the person until help arrives.

Be a good listener and be very supportive without being falsely reassuring.

Try to persuade the person to obtain professional help and assist them in getting this help.

What not to do

Do not ignore the warning signs.

Do not refuse to talk about suicide if a person approaches you about it.

Do not react with humor, disapproval, or repulsion.

Do not give false reassurances by saying such things as “Everything is going to be OK.” Also do not give out simple answers or platitudes, such as “You have everything to be thankful for.”

Do not abandon the individual after the crisis has passed or after professional help has commenced.

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Facing One’s Own Death 1

As we age, values concerning our most important uses of time change.

When asked how they would want to spend a remaining 6 months of life:

• Younger adults prioritize travel and making accomplishments.

• Older adults prioritize inner-focused activities such as contemplation and meditation.

Most dying individuals want to make some decisions about their own life and death and may want to complete unfinished business.

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Facing One’s Own Death 2

Kübler–Ross’ stages of dying:

• Denial and isolation—denies death is taking place.

• Anger—anger, resentment, rage, and envy.

• Bargaining—develops a hope that death can be delayed.

• Depression—perceives the certainty of death.

• Acceptance—develops a sense of peace, acceptance of one’s own fate, and often a desire to be left alone.

Not demonstrated by independent research; and fail to take into account individual situations.

• Some psychologists prefer to describe them not as stages but as potential reactions.

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Perceived Control and Denial

Perceived control may work as an adaptive strategy for some older adults facing death.

• When individuals believe they can prolong their life, they become more alert and cheerful.

Denial can be an adaptive or a maladaptive approach to death.

• Can insulate people from having to cope with intense feelings of anger and hurt.

• Can keep them from having a life-saving operation.

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The Contexts in Which People Die

More than 50% of Americans die in hospitals, and nearly 20% die in nursing homes.

Hospitals offer important advantages to the dying individual:

• Professional staff members are readily available.

• Medical technology may prolong life.

Most individuals say they would rather die at home.

• Many worry, however, about being a burden, about limited space, and about the competency and availability of emergency medical treatment.

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Communicating With a Dying Person

Most psychologists stress the importance of dying individuals knowing that they are dying.

Advantages of an open awareness of dying:

• Can close their lives according to their own ideas about dying.

• Opportunity to complete plans or projects, make arrangements for survivors, and participate in decisions about funeral and burial.

• Opportunity to reminisce, converse with others, and end life conscious of what life has been like.

• Better understanding of what is happening and what medical staff is doing.

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Grieving 1

Grief: the emotional numbness, disbelief, separation anxiety, despair, sadness, and loneliness that accompany the loss of loved one.

Pining for the lost person and separation anxiety are important dimensions of grief.

• Intermittent, recurrent wish or need to recover the lost person; and a focus on places and things associated with the deceased.

Feelings of grief occur repeatedly after a loss.

• Become more manageable over time.

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Grieving 2

Estimated 80%–90% of survivors experience normal or uncomplicated grief reactions.

• By 6 months, the loss is accepted as reality, and individuals become more optimistic about the future and function competently in everyday life.

At 6 months after their loss, approximately 7%–10% of survivors have difficulty moving on.

• Enduring despair that remains unresolved is known as complicated grief or prolonged grief disorder.

• Greatest risk for a person who loses someone they were emotionally dependent on.

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Grieving 3

Another type of grief is disenfranchised grief: an individual’s grief over a deceased person that is a socially ambiguous loss that can’t be openly mourned or supported.

• Relationship that isn’t socially recognized; a hidden loss such as an abortion; and circumstances that are stigmatized.

• May intensify grief because the loss cannot be publicly acknowledged.

• Often hidden or repressed and may be reawakened by later deaths.

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Grieving 4

Dual-process model of coping with bereavement emphasizes two dimensions:

• Loss-oriented stressors focus on the deceased individual and can include grief work and both positive and negative reappraisal of the loss.

• Restoration-oriented stressors involve secondary stressors that emerge as indirect outcomes of bereavement.

Coping with loss and engaging in restoration can be carried out simultaneously.

• Oscillation may occur over short term or longer term.

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Grieving: Coping and Type of Death

Deaths that are sudden, untimely, violent, or traumatic are likely to have more intense and prolonged effects on survivors.

Coping process is more difficult.

Often accompanied by symptoms of post-traumatic stress disorder (PTSD).

• Intrusive thoughts, flashbacks, nightmares, sleep disturbance, concentration problems, and so on.

There is no ideal way to grieve.

• Healthy coping with death involves growth, flexibility, and appropriateness within a cultural context.

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Making Sense of the World

Stimulating individuals to try to make sense of their world is one beneficial aspect to grieving.

• Close family members share with each other and reminisce about family experiences.

When death is caused by accident or disaster, the effort to make sense of it is pursued more vigorously.

• Bereaved want to put the death into a perspective they can understand.

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Losing a Life Partner 1

Spouses left behind after the death of an intimate partner suffer profound grief.

• Often endure financial loss, loneliness, increased physical illness, and psychological disorders, including depression.

Surviving spouses seek to cope with their loss in various ways.

• Intensified religious and spiritual beliefs.

• Finding meaning in death.

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Losing a Life Partner 2

Women often experience better adjustment after their loss due to:

• Larger network of friends.

• Closer relationships with relatives.

• Experience in taking care of themselves psychologically.

Older widows adjust more optimally than younger widows, perhaps because the death of a partner is more expected.

Widowers are usually left with more money than widows and are more likely to remarry.

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Losing a Life Partner 3

Psychological and religious factors are related to the psychological well-being of older adults following the loss of a spouse.

Volunteering and helping behaviors also appear to reduce feelings of loneliness.

Social support helps widows or widowers adjust to the death of a spouse.

• Widow-to-Widow program provides support for newly widowed women.

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Forms of Mourning

In the United States in 2018, 53.1% of deaths were followed by cremation.

• Americans have been moving away from public funerals toward private funerals followed by a memorial ceremony.

Funeral industry has been a source of controversy.

• Help to provide a form of closure.

• Critics claim funeral directors are there to make money and embalming is a grotesque practice.

Traditional forms of mourning vary greatly across cultures.

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Review

• Describe the death system and its cultural and historical contexts.

• Evaluate issues in determining death and decisions regarding death.

• Discuss the causes of death and suicide at different points in development.

• Explain the psychological aspects involved in facing one’s own death and the contexts in which people die.

• Identify ways to cope with the death of another person.

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© McGraw Hill LLC. All rights reserved. No reproduction or distribution without the prior written consent of McGraw Hill LLC.