Death, Dying, and Bereavement

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Chapter 19

• Death, Dying, and Bereavement

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In This Chapter
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The Experience of Death Death Itself

• Characteristics
• Clinical death
• Brain death
• Social death

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The Experience of Death Where Death Occurs

• Hospitals in the U.S. (45)
• Decedents home (25)
• Long-term Care (22)
• Hospice (14)
• Other (6)

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The Experience of DeathHospice Care

• Philosophy
• Death viewed as normal
• Families and the patient encouraged to prepare
  for death
• Family are involved in patients care
• Control of care is in the hands of the patient
  and family
• Medical care is palliative rather than curative

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Hospice CareTypes of Hospice Care

• Home-based programs
• Hospital-based programs
• Special hospice centers
• Hospice

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HospiceHospital-based and Home-based Care
Comparison
Hospital-Based Care Home-Based Care
Patient Pain Same Same
Length of Survival Same Same
Patient Satisfaction with Care Same Same
Family Satisfaction with Care Higher Lower
Family Sense of Burden Higher Lower

Lets take a minute to review some of these
comparisons.
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Dying, Death, and BereavementHospice Care

• Hospice Care
• Pros
• Reduced cost of death
• Less burden on central caregiver
• Cons
• Increased family worry about pain management

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Developmental Understanding of Death
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The Meaning of Death for Adults Death as Loss
Age

• Age differences
• Young adults Loss of opportunity to experience
  things loss of family relationships
• Older adults Loss of time to complete inner work

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The Meaning of Death for Adults Death as Loss
Ethnic Differences

• Ethnic differences
• Mexican Americans Increase time spent with
  family or loved ones
• White and African-Americans Would not change
  their lifestyle
• See Table 19.2 for responses to hypothetical
  impending death

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Stop and Think!

• At what age do you think people are most fearful
  of death?
• What prompted your answer?

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Fear of Death

• Middle-aged adults most fearful of death
• Sense of unique invulnerability prevents intense
  fear of death in young adults
• Older adults think and talk more about death than
  anyone else

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Fear of Death Religious beliefs

• Religious beliefs and fear of death
• Very religious adults less afraid of death
• Those totally irreligious may also fear death less

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Figure 19.1 Age, Ethnicity and Fear of Death
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Fear of DeathPersonal Worth

• Fear of death reduced
• Adults accomplish goals or believe they have
  become the person they set out to be
• Belief that life has purpose or meaning
• How is this related to Eriksons stage of
  integrity versus despair?

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?
?
Questions To Ponder

• Your loved one is dying of a terminal illness.
  Would you use a hospice center? Why or why not?
• If you were told that you had a terminal disease
  and only 6 months to live, how would you want to
  spend your time until you died?
• On a scale of 1 5, with 5 being high, how much
  do you fear death?

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The Process of DyingPreparation for Death

• Kinds of preparations
• Practical preparations
• Deeper preparations
• Older adults more likely to have made these
  arrangements

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The Process of DyingPreparation for Death

• Final preparations
• Unconscious changes just before death
• Terminal drop for psychological health

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Theoretical Perspectives on Dying Elisabeth
Kubler-Rosss Stages of Dying
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Theoretical Perspectives on Dying Criticisms of
Kubler-Rosss Theory

• Methodological problems
• Cultural specificity
• Stage concept unsupported

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Theoretical Perspectives on Dying Alternate Views

• Two additional views
• Shneidman Dying process has many themes
• Corr Coping with death involves taking care of
  specific tasks

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Theoretical Perspectives on Dying Responses to
Impending Death

• Greer Attitudes and behavioral choices can
  influence course of terminal disease
• Five groups/stages
• Denial (positive avoidance)
• Fighting spirit
• Stoic acceptance
• Helplessness/hopelessness
• Anxious preoccupation

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Theoretical Perspectives on Dying Responses to
Impending Death

• Greer concluded that the message may be
• Those who struggle the most, fight the hardest,
  express their anger and hostility openly, and who
  find some sources of joy in their lives live
  longer.

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Theoretical Perspectives on DyingPsychoanalytic
Theory

• Traumatic death often followed by physical or
  mental problems
• Grief therapy with children makes use of defense
  mechanisms (sublimation, identification)

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Theoretical Perspectives on Grieving

• Freud Death of a loved one is an emotional
  trauma
• Ego tries to insulate itself from unpleasant
  emotions through defense mechanisms such as
  denial
• BUT
• Defense mechanisms provide only temporary relief
• How do people grieve in healthy ways?

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Theoretical Perspectives on Grieving Attachment
Theory

• Bowlby
• Intense grief likely to occur at loss of any
  attachment figure
• Quality of attachment related to grief

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Theoretical Perspectives on Grieving Attachment
Theory

• Bowlby Four stages of grief

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Theoretical Perspectives on Grieving Attachment
Theory

• Sanders five stages of grief comparable to
  Bowlby
• Shock
• Awareness
• Conservation/withdrawal
• Healing
• Renewal

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Theoretical Perspectives on Grieving Attachment
Theory

• Revisionist Views
• Avoiding expressions of grief neither prolongs
  grief nor inevitably creates mental health
  problems
• Grieving does not occur in fixed stages
• Many themes present simultaneously but one or
  another may dominate at one point in time
• Adults develop different patterns of grieving

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Figure 19.2 Jacobss Model of Grieving
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Theoretical Perspectives on Grieving Patterns of
Grieving

• Wortman and Silver
• Normal
• Chronic
• Delayed
• Absent

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Theoretical Perspectives on Grieving
Dual-Process Model

• Alternates between

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Theoretical Perspectives on Grieving The
Experience of Grieving Death Rituals

• Psychosocial functions of death rituals such as
  funerals
• Help family and friends manage grief by giving a
  specific set of roles
• Bring family members together in unique ways
• Establish shared milestones for families

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Theoretical Perspectives on Grieving The Process
of Grieving

• Factors Associated with Grief Age of the
  Bereaved
• Children express feelings of grief like teens and
  adults
• Teens often show prolonged grief responses

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Theoretical Perspectives on Grieving Factors
Associated with Grief

• Modes of Death and Grief
• Caregiver widows may show depression.
• Death with intrinsic meaning reduces grief.
• Sudden and violent deaths evoke more intense
  grief.
• Suicide produces unique responses in survivors.

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Theoretical Perspectives on Grieving Widowhood
and Effects of Grief

• Immediate and long term effects on the immune
  system
• Incidence of depression among widows and widowers
  rises substantially

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Theoretical Perspectives on Grieving
Pathological Grief

• Depression-like symptoms lasting longer than 2
  months
• Grief lasting longer than 6 months can lead to
  long-term depression and physical ailments
• Problems may continue for up to 2 years after
  death of loved one
• BUT cultural practices may mimic pathological
  grief

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Theoretical Perspectives on Grieving Sex
Differences

• Spouse death more negative for men than for
  women.
• Risk of death higher in men immediately after a
  spouses death.
• Widowers withdraw in multiple ways.
• Alcohol use may influence depression.
• Social relationships remain important for both
  sexes.

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Theoretical Perspectives on Grieving Preventing
Long-Term Problems

• Talk-it-out approach to managing grief can help
  prevent grief-related depression.
• Developing coherent personal narrative of events
  surrounding spouses death helps manage grief.
• Participating in support groups helps.
• Appropriate amount of time off from work to
  grieve is important.