PSYC 3570 Chapter Notes - Chapter 4: Irish Mythology, Umbilical Cord, Beak

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9 Feb 2016
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Chapter #4:
“Dying”: Primped and Medicalized
Dying is primped through various linguistic maneuvers, e.g “Expiration date”, “buying
the farm”
Medicalization of dying
-The passage from life has become increasingly under the surveillance of the
medical bureaucratic complex
-“dying” is seldom heard because it is too vague and general to describe all the
distinctive pathways to death; a steady barrage of substituted terms has the
potential to narrow perspective and downsize the mortal move
-Medicalization also serves the purpose of insulating physicians and bureaucrats
from the mortal realities
-Like the patients, professional caregivers have their own share of anxiety
The Moment of Death:
-If spoken about as peacefully passing than the listener is not afraid, but is spoken
about with “in pain” “suffering” than the fear of pain increases
In Irish folklore, a death invoked a spirit known as the banshee pierced the air with its
wild lament
-Announced the painful transition of a soul to the realm of the spirits
Among the Lugbara of the central Africa, cere, a whooping kind of melody was
sounded only at the moment of a death
-Signaled a shift in communal arrangements: the deceased person’s assets and
obligation were now to be redistributed according to tradition
The deathbed scene was regarded as the climax of the Christian drama on earth for
centuries
-Attempted to provide a model for righteous living and faith that might earn
salvation in the afterlife
The Slipping Away:
More lives are now ending with an almost imperceptible slipping away, why?
-Medical advances help people survive longer with conditions that formerly had
been considered terminal
-Physicians tendency to distance themselves as a result of experiencing a patient’s
death as their own failure
-Afflicted individuals might not seem present at their deaths due to Alzheimers
disease and related dementias
-Sedation can reduce awareness, which results in indeterminacy in which a person
might be unable to respond, yet still be cognizant of the situation
-Elderly have often reduced awareness, responsivity which impair communication
and makes the pass from life to death less hopeful.
-Often the person dies alone
-Dying here is considered an experience that takes many forms, depending on the
nature and management of the illness, the social support system available, and the
unique person whose life is in jeopardy
-How and when we die is influenced by societal practices as well as physical
disorders
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-Personal lifestyles affect the timing and manner of our deaths: negative emotions
have been found to endanger health by undermining or overwhelming our immune
system (Kiecolt-Glaser, et al)
Dying as Transition:
-The transition from life includes interactions that can either be disturbing or be
comforting, communications that can either inform or confuse, and self-evaluations
that can either undermine or strengthen one’s sense of identity
-No two people bring the same thoughts, feelings, accomplishments, and illness-
related experiences
What is dying, and when does it begin?
Individual and Interpersonal Responses
-The knowledge that “I am dying” can transform the individual’s view of self and
world
-Differences in living experiences is hard to escape, and friends and relatives also are
affected, whose responses in turn affect the terminally ill person
Certainty of death makes it easier for hospital staff to shift their behaviour
patterns, which could result in isolation and dehumnization
We often treat people differently when they are perceived as dying, even if we
are not aware of the difference, e.g. a nurses were found to delay going to the
beside of a dying patients in a study
May be a product of society’s ingrained fear of contact with dying people
Onset of the Dying Process: Alternative Perspectives
-“we die from the moment we are born”?
-Programmed cellular death(apoptosis)
Questionable when it starts to express, from the removal of the umbilical cord
after birth?
-“aging might be regarded as slow dying and dying as fast aging” Jeremy Taylor
proposed three centuries ago
But elderly people cannot be described as dying ignoring their vigor and
vitality
-Dying usually begins as a psychosocial event (organ systems fail, but it is in the realm
of personal and social life that dying occurs)
(1) Dying begins when the facts are recognized
If people with life-threatening conditions were thought to begin dying, how to
differ the ones that acknowledged of the conditions from the ones who had
not?
(2) Dying begins when the facts are communicated
There can be a time lag between communication and realization since
physicians seldom break the news at the instant they reach the conclusion
(3) Dying begins when the patients realizes or accepts the facts
Patient can sometimes forget or misinterpret the central facts
Kaufman found that patients tend to overestimate their probability of survival
and therefore not dying to themselves
(4) Dying begins when nothing more can be done to preserve life
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The physician may have an opinion that is different from that of the specialist
Trajectories of Dying: From Beginning to End
Certainty and Time together can yield to 4 types of death expectation
1) Certain death at a known time
2) Certain death at an unknown time
3) Uncertain death, but a known time when certainty will be established
4) Uncertain death and an unknown time when the question will be resolved
-Especially important are situations in which expectations change, which will result in
the effort put into maintaining patient’s life
Glaser-Strauss-Benolieil research team identified 3 dying trajectories
1) The lingering trajectory
The caregivers display a characteristic pattern where seldom is there a
dramatic rescue scene
Staff members try to keep the patients comfortable but feel that they have
done all they can
It is perhaps more acceptable because the person was considered socially dead
Visits from family members often fall off sharply
Strong reactions to a patient’s death can challenge the staffs assumption that
there is little social loss in the passing of a “lingerer.”
Allows both the patient and the family time to grow accustomed to the idea of
dying, make plans, work through old conflicts and misunderstanding, and
review the kind of life
But it also can attenuate relationships and create situations in which the person
is perceived as being in limbo
2) The expected quick trajectory
Several types of expected quick trajectories were observed with its different
pattern of staff interaction
Pointed trajectory
(i) Patients are exposed to risky procedures that might either save their lives
or result in death
(ii) The staff often has enough advance time to organize its effort properly
(iii) The patient may also have the opportunity to exercise some control
and options
Danger-period trajectory
(i) Requires more watching and waiting, since it is unknown that whether the
patient will be able to survive a stressful experience such as high-risk
operation
Crisis trajectory
(i) The patient is not in acute danger at the moment, but the individual’s life
might suddenly be threatened at any time
Will-probably-die trajectory
(i) The staff believes that nothing effective can be done, and time aim is to
keep the patient as comfortable as possible
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