Study of Death: Thanatology

1
DEATH AND DYING

• Study of Death Thanatology
• (Thanatos Greek God of Death)
• Pascal man is the only animal that knows he will
  die some day
• Fear of death uniquely human
• Historically, death part of daily life, high
  mortality rate, took place at home
• 20 century
• death in hospital
• medical technology
• facilitated death denial
• funeral parlours
• euphemisms

2

• About age 9-10 we realize that death is final,
  universal and inevitable
• Adolescence invulnerable, immortal cant happen
  to me, risk taking, denial
• Early adulthood change when becoming parents
• Middle age death of parents, friends, siblings.
  Highest death anxiety
• Old age lowest anxiety, though facing death of
  spouse and peers
• Role of religion true believers and atheists
  lowest anxiety

3

• What is death?
• Determined by doctor (if available). Errors
• Clinical death heart and lungs stop. But
  nowadays resuscitation through technology CPR,
  oxygen, defibrillation, etc. (NDEs)
• Brain death no EEG. New structures (cerebral
  cortex) die first, then midbrain, then medulla
  and spinal cord (vegetative functions and
  reflexes) is this person alive? Coma

4

• Euthanasia active or passive
• Active method used to terminate life, e.g. drug,
  asphyxia, etc.
• Special case assisted suicide (Kevorkian)
• Passive withhold or remove life support
• Ethical issue Nazis
• Issue of longevity and economics
• Cultural variations, Netherlands
• NDE Near death experience, increase since
  resuscitations increased

5

• First thanatologist Elizabeth Kubler-Ross
• Process in 5 stages
• Denial
• Anger
• Bargaining
• Depression
• Acceptance
• Not a typical stage process individual
  differences, order of stages, return to earlier
  stages
• Also observed in chronic illness, loss of body
  parts, loss of function

6

• Schneidman alternation of emotions instead of
  stages
• grief
• anguish
• anger
• anxiety
• denial
• NO acceptance

7

• Pattison living-dying interval, prolonged by
  technology
• 3 phases
• acute crisis time of diagnosis
• chronic gradual deterioration, longest phase due
  to medical-technological advances
• surrender giving up, not a real acceptance
• Variables that affect process
• age
• cause of death
• personality
• religious beliefs
• ethnic background
• hospital, home or hospice location

8

• Survivors
• Grief feelings
• Mourning behaviours that express grief
• Rituals e.g. Irish wake, sitting shiva
• Stages
• numbness
• yearning, anger and denial
• depression, apathy, disorganization
• acceptance, adjustment, reorganization
• All 4 can coexist and alternate

9

• Varying time span, influence of culture
• Child and spouse worst
• Widows/widowers longer grieving if bad marriage
  sanctification of dead spouse (guilt)
• Increase in morbidity and mortality (one study in
  text contradicts)
• Double whammy
• immune system weakens
• self neglect (meals, exercise, sleep, smoking and
  drinking)

10

• Psychoneuroimmunology
• Psycho thoughts and feelings
• Neuro brain and nervous system
• Immuno immune system
• Logy study of
• People who have supports fare better
• Anticipatory grief helps (when death is expected)