Endings: Death, Dying and Grieving

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LIFE-SPAN DEVELOPMENT

A Topical Approach to

John W. Santrock

Death and Grieving

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Death and Grieving

The Death System and Cultural Contexts
Defining Death and Life/Death Issues
A Developmental Perspective on Death
Facing One’s Own Death
Coping with the Death of Someone Else

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Death in Different Cultures

Perceptions of death vary; reflect diverse values and philosophies

Individuals more conscious of death in times and places of war, poverty, disease.

Most societies have
Philosophical or religious beliefs about death
Rituals that deal with death
View that death does not end existence

Death and Cultural Contexts

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U.S. Denial and Avoidance of Death

Funeral industry emphasizes lifelike qualities

Euphemisms — softening language for death

Persistent search for “fountain of youth”

Rejection and isolation of aged

Concept of pleasant and rewarding afterlife

Medical emphasis — prolonging life, not easing suffering

Death and Cultural Contexts

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Changing Historical Circumstance

Death becoming increasingly complex
When to determine death has occurred
Life expectancy has increased
Most die apart from families
Care for dying shifted away from family
Minimized exposure to death and its pain

Death and Cultural Contexts

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Issues in Determining Death

Brain death — neurological definition of death

All electrical activity of brain has ceased for a

specified period of time

Flat EEG recording

Some medical experts argue criteria for death

should include only higher cortical functioning

Defining Death and Life/Death Issues

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Decisions Regarding Life, Death, and Health Care

Natural Death Act and Advance Directive

Expresses person’s desires regarding extraordinary medical procedures that might be used to sustain life when medical situation becomes hopeless

Defining Death and Life/Death Issues

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Euthanasia

Painlessly ending lives of persons suffering from incurable diseases or severe disabilities

Passive euthanasia — withholding of available treatments, allowing the person to die

Active euthanasia — death induced deliberately, as by injecting a lethal dose of drug

Publicized controversy: assisted suicide

Defining Death and Life/Death Issues

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Needed: Better Care for Dying Individuals

Death in U.S.: often lonely, prolonged, painful

Plan for your death
Make a living will
Give someone power of attorney
Give your doctor specific instructions
Discuss desires with family and doctor
Check insurance plan coverage

Defining Death and Life/Death Issues

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Needed: Better Care for
Dying Individuals

Hospice — humanized program committed to making the end of life as free from pain, anxiety, and depression as possible

Palliative care — reducing pain and suffering and helping individuals die with dignity

Defining Death and Life/Death Issues

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Causes of Death

Death can occur at any point in human life span

Prenatal — miscarriage, stillborn

Childhood — accidents or illness

Adolescence — motor vehicle accidents, suicide,

and homicide

Older adults — chronic diseases

A Developmental Perspective of Death

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Death and Children

Honesty may be best way to discuss death with children

Explained in simple physical or biological terms to

preschool children

Be sensitive and sympathetic, encouraging

feelings and questions

Not unusual for terminally ill children to distance

themselves in final stages, may be a result of

depression

A Developmental Perspective of Death

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Attitudes Toward Death at Different Points in the Life Span

Childhood

Adolescence

Adulthood

Infant has no concept of death; perceptions of death develop in middle/late childhood; even very young children concerned about separation and loss

Develop more abstract concepts of death; common to think they are immune to death

Middle-aged adults fear death more than young adults or older adults; older adults think about death more

A Developmental Perspective of Death

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Suicide

A Developmental Perspective of Death

Serious physical illness
Feelings of disparity, isolation, failure, loss
Serious financial problems
Drug use or prior suicide attempts
Antidepressant links

Cultural and gender differences exist
Rare in childhood, risk increase in adolescence
Most adolescent attempts fail
Linked to genetic and situational factors
Gay or lesbian links not clear

Risk factors

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Suicide in U.S.

Adolescence

3rd leading cause of death in ages10-19

19% of high school students seriously considered or tried suicide in last 12 mos

Adulthood and Aging

Suicide rates increase in adulthood

Older adults use more lethal ways, are more successful

Racial and gender differences exist

A Developmental Perspective of Death

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Facing One’s Own Death

Most dying individuals want to make decisions regarding their life and death

Complete unfinished business

Resolve problems and conflicts

Put their affairs in order

Facing One’s Own Death

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Kubler-Ross’ Stages of Dying

Denial and isolation

Anger

Bargaining

Denies s/he is going to die

Denial gives way to anger, resentment, rage, and envy

Develops hope that death can somehow be postponed

Depression

Acceptance

Comes to accept the certainty of her or his death

Develops sense of peace and may desire to be left alone

Facing One’s Own Death

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Perceived Control and Denial

When individuals believe they can influence and control events, they may become more alert and cheerful

Denial can be adaptive or maladaptive

Facing One’s Own Death

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The Contexts in Which People Die

Context of dying is important for most
Most would rather die at home but worry over

Burden at home

Limited space

May alter relationships

Competency and availability of emergency

medical treatment

Facing One’s Own Death

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Communicating with
the Dying Person

Establish your presence

Eliminate distraction

Limit visit time

Don’t insist on acceptance

Allow expressions of guilt or anger

Discuss alternatives, unfinished business

Ask if there is anyone s/he would like to see

Encourage the dying individual to reminisce

Talk with the individual when s/he wishes to talk

Express your regard

Coping with the Death of Someone Else

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Grieving

Grief: emotional numbness; a complex emotional state of…
Disbelief
Separation anxiety
Despair
Sadness
Loneliness
Complicated grief
Disenfranchised grief

Coping with the Death of Someone Else

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Model of Grieving

Dual-process model for effective coping
Loss-oriented stressors
Restoration-oriented stressors
Coping and type of death
Sudden or violent deaths have more intense and prolonged effects
Many such deaths accompanied by PTSD

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Cultural Diversity in
Healthy Grieving

Persistent holding on to deceased may be therapeutic
Hopi of Arizona forget quickly
Egyptians dwell on grief
Netherlands: integrate loss into their lives
Healthy coping involves
Growth
Flexibility
Appropriateness within the cultural context

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Making Sense of the World

Grieving stimulates many to try to make sense of their world — positive themes linked to hopeful future and better adjustment

Effort to make sense of it pursued more vigorously when caused by an accident or disaster

Coping with the Death of Someone Else

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Losing a Life Partner

Those left behind after the death of an intimate partner suffer profound grief and often endure

Financial loss
Loneliness linked to poverty and education
Increased physical illness
Psychological disorders, including depression

Coping with the Death of Someone Else

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Adjustment to Widowhood

Women live longer
Widowed men more likely to remarry
Measures of older women’s health
Physical and mental health
Health behaviors and outcomes
Overall, women adjust better than men
Older widows do better than younger widows
Support programs aid adjustment

Coping with the Death of Someone Else

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Forms of Mourning

Approximately 80 percent of corpses are disposed of by burial, the remaining 20 percent by cremation

Funeral industry is source of controversy

Funeral is important aspect of mourning in many cultures

Cultures vary in how they practice mourning

Coping with the Death of Someone Else

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The Amish, Traditional Judaism, and Mourning

Amish
Conservative group; family-oriented society
Live same unhurried pace as ancestors
Time of death met with calm acceptance
Neighbors notify community; funeral at home
High level of support to family for one year

Coping with the Death of Someone Else

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The Amish, Traditional Judaism, and Mourning

Traditional Judaism
Mourning in graduated time periods; each with appropriate practices

1st period: Aninut — between death and burial

2nd period: Avelut period — mourning proper

Shivah period — 7-day begins at burial
Sheloshim period — 30-day period after burial

Mourning over for all but parents who mourn another 11 months

Coping with the Death of Someone Else

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The End