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Chapter 13

psy213 Chapter 13.doc

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Giampaolo Moraglia

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CHAPTER 13: Dealing with Death and Bereavement (pp. 476-521) Table of Contents 1. Changing Perspectives on Death and Dying a) Biological, Social, and Psychological Aspects of Death b) The Study of Death: Thanatology and Death Education c) Hospice Care 2. Facing Death a) Attitudes Toward Death and Dying b) Approaching Death 3. Facing Bereavement a) Forms and Patterns of Grief b) Surviving a Spouse c) Losing a Parent d) Losing a Child e) Mourning a Miscarriage 4. Controversial Issues a) Suicide b) Aid in Dying: Euthanasia and Assisted Suicide c) Assisted Suicide: Pros and Cons d) Legalizing Physician Aid in Dying 5. Finding Meaning and Purpose in Life and Death a) Reviewing a Life b) Overcoming Fear of Death c) Development: A Lifelong Process Definitions ACTIVE EUTHANASIA: Deliberate action to shorten the life of a terminally ill person in order to end suffering or allow death with dignity; also called mercy killing. Compare passive euthanasia. ADVANCE DIRECTIVE: Legal document written by an individual copes or interacts with the environment. AMBIGUOUS LOSS: A loss which is not clearly defined. ANTICIPATORY GRIEF: Grief that begins before an expected death in preparation for bereavement. ASSISSTED SUICIDE: Suicide in which a physician or someone else helps a person take his or her own life. BEREAVEMENT: Loss, due to death, of someone to whom one feels close and the process of adjustment to the loss. DEATH EDUCATION: Programs to educate people about death and to help them deal with issues concerning dying and grief in their personal and professional lives. DURABLE POWER OF ATTORNEY: legal instrument that appoints one person to make decisions in the event of another person’s incapacitation. GRIEF THERAPY: Program of treatment to help the bereaved cope with loss. GRIEF WORK: common pattern of grief in which the bereaved person accepts the loss, releases the bond with the deceased, and rebuilds a life without that person. GRIEF: emotional response experienced in the early phases of bereavement. HOSPICE CARE: warm, personal, patient- and family- centered care for a person with a terminal illness, focused on relieving pain, controlling symptoms, and maintaining quality of life. LIFE REVIEW: Reminiscence about a person’s life course in order to determine its significance. LIVING WILL: Document specifying the type of care wanted by the maker in the event of terminal illness. MOURNING: Behaviour of the bereaved and the community, including culturally accepted customs and rituals. PALLIATIVE CARE: Care aimed at relieving pain and suffering and allowing the terminally ill to die in peace, comfort, and dignity. PASSIVE EUTHANASIA: Deliberate withholding or discontinuation of life-prolonging treatment of a terminally ill person in order to end suffering or allow death with dignity. PERSISTENT VEGETABLE STATE: State in which a patient, while technically alive, has lost all but the most rudimentary brain functioning. THANATOLOGY: Study of death and dying. Chapter Notes Introduction • 50/1000 people died up to 40% (plague + natural disasters) before modern times • “mortality revolution” advances in medicine, sanitation and better-educated health-conscious population • Top causes of death in 1900’s: pneumonia and influenza, TB, diarrhea, and enteritis (mostly in children and young adults) • Death became phenomenon of late adulthood, “invisible and abstract” Changing Perspectives on Death and Dying BIOLOGICAL, SOCIAL, AND PSYCHOLOGICAL ASPECTS OF DEATH • Biological death: cessation of bodily processes • Criteria for death have become more complex with the development of medical apparatus that can prolong basic signs of life. • Social aspects: attitudes toward death, care of and behaviour toward the dying, where death takes place, and efforts to postpone or hasten it. o Disposing of the dead, mourning customs and rituals, and the transfer of possessions and roles. o Embalming (mummification) – preserving a body so the soul can return to it • Psychological aspects of death: how people feel about their own death and about the death of those close to them THE STUDY OF DEATH: THANATOLOGY AND DEATH EDUCATION • Thanatology also “the study of life with death left in” • Death education: offered to students, social workers, doctors, nurses, and other professional who work with dying people and survivors and to the community HOSPICE CARE • Hospice care: focussed on palliative care • Can be given in a hospital or another institution, at home, or through some combination of home and institution • Hospice movement began in London in 1968 o Affordable was to care for family members with a terminal illness. • Preserving dignity of dying patient o “when dying patients are seen, and know that they are seen, as being worthy of honor and esteem by those who care for them, dignity is more likely to be maintained” Facing Death ATTITUDES TOWARD DEATH AND DYING • YOUNG ADULTHOOD: o Avoid thinking about death o Personal fable – an egocentric belief that they are unique or special, are not subject to the natural rules that govern the rest of the world, and can take almost any kind of risk without danger. o Likely to feel more intensely emotional about imminent death than people in any other period of life o Extremely frustrated: they have worked terribly hard – for nothing • MIDDLE ADULTHOOD: o Most people realize they are indeed going to die o May become introspective o Think of how many years are left until death, and of how to make the most of those years • LATE ADULTHOOD: o Less anxious about death than middle-aged people o More likely to use emotion-focussed coping strategies o Erikson: people in late adulthood must death with the last of eight crises: integrity versus despair 1. Achieve wisdom that enables them to accept both what they have done with their lives and their impending death if crisis resolved APPROACHING DEATH • PHYSICAL AND PSYCHOLOGICAL CHANGES: o Psychological changes before there are overt physiological signs of dying o Terminal drop in intellectual functioning often appears at this time o Terminal drop sometimes attributed to chronic ailments that sap mental energy and motivation 1. Affects abilities that are relatively unaffected by age, such as vocabulary, and it is seen in people who die young as well as those who die at a more advanced age 2. May predict which individuals in a tested group are within a few years of death o Personality changes show up during terminal period • KUBLER-ROSS: STAGES OF DYING o Elisabeth Kubler-Ross a psychiatrist o Most terminally ill patients aware of being close to death even when they have not been told how sick they are o Stages: 1. Denial (refusal to accept the reality of what is happening) 2. Anger 3. Bargaining for extra time 4. Depression 5. Ultimate acceptance o Similar progression in the feelings of people facing imminent bereavement o Not everyone goes through all five stages, and people may go through the stages in different sequences o Dying, like living, is an individual exprience Facing Bereavement • Grief can take many forms, from rage to a feeling of emptiness • Bereavement and grief also have a cultural context • There is no one “best” way to cope with loss FORMS AND PATTERNS OF GRIEF • ANTICIPATORY GRIEF: o People prepare themselves for the loss through anticipatory grief o May help survivors handle the actual death more easily • GRIEF WORK: A THREE-STAGE PATTERN: 1. Shock and disbelief • May last several weeks • Survivors often feel lost and confused • Shock, and inability to believe in the death, may protect them from more intense reactions
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