A Topical Approach to LIFE-SPAN DEVELOPMENT

1. A Topical Approach toLIFE-SPAN DEVELOPMENT Chapter Seventeen: Death, Dying, and Grieving John W. Santrock

2. The Death System and Cultural Contexts • Components of the system • People: involvement of self and others • Places or contexts • Times • Objects: associated with death (e.g. caskets) • Symbols: last rites, arm bands, etc. • Most societies have • Philosophical/religious beliefs, rituals/rites

3. The Death System and Cultural Contexts • Cultural variations of the death system • Death not as common in United States as elsewhere • Conditioned early in life to live as if immortal • Other countries • Daily death on streets of Calcutta, India • African villages — death by disease and malnutrition • Young orphans from tsunami in Indonesia • Individuals more conscious of health and death in times/places of war, poverty, disease

4. The Death System and Cultural Contexts • Cultural variations of the death system • Some members of society • Embrace death • Fear it, see it as punishment • Death can mean • Loneliness, happiness, redemption • Most societies do not view death as an end to life • Gond culture of India • Tanala culture of Madagascar

5. The Death System and Cultural Contexts • Cultural variations of the death system • 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

6. The Death System and Cultural Contexts • 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

7. Defining Death and Life/Death Issues • 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

8. Defining Death and Life/Death Issues • Issues in Determining Death • Natural Death Act and Advanced directive • Patient in coma, living will • Physicians concerns over malpractice lawsuits • Euthanasia: painless ending, “mercy killing” • Passive euthanasia: withholding treatments or life sustaining equipment • Active euthanasia: deliberately induced

9. Defining Death and Life/Death Issues • Issues in Determining Death • Technical advances and issues of quality of life • Terri Schiavo case • Extraordinary medical procedures that may be used to sustain life when medical situation becomes hopeless • Publicized controversy: assisted suicide • Dr. Jack Kavorkian in Michigan • Legal in State of Oregon • Legal in Netherlands and Uruguay

10. Defining Death and Life/Death Issues • Needed: Better Care for Dying Individuals • Death in United States: often lonely, prolonged, painful • Plan for a “good” 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

11. Defining Death and Life/Death Issues • 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 • Movement rapidly growing in United States • 90% of care in person’s home • Aided by Visiting Nurse Associations

12. A Developmental Perspective on Death • Causes of death • Death can occur at any point in human life span • Prenatal— miscarriage, stillborn • Infants — SIDS: leading cause of infant death in United States • Childhood— accidents or illness • Adolescence— motor vehicle accidents, suicide, and homicide • Older adults— chronic diseases

13. A Developmental Perspective on Death • Attitudes toward death at different points in the life span • Honesty may be best way to discuss death with children • Don’t see death same as adults do; don’t understand it • About age 9 — sees finality and universality of death • Explain in simple physical/biological terms to preschooler • Be sensitive/sympathetic, encourage feelings/questions

14. A Developmental Perspective on Death • Attitudes toward death at different points in the life span • Adolescents • Often view death as remote idea; not relevant to them • Some show concern for death; seeking meaning • More abstract in conceptions than children • Death described in terms of darkness, transition, etc. • Develop religious and philosophical views of death and life afterwards

15. A Developmental Perspective on Death • Attitudes toward death at different points in the life span • Adulthood • Middle-aged adults fear death more than young adults or older adults; older adults think about death more • Increased awareness accompanies aging • Older adults think and talk about it more in conversations • Experience it more directly through loss of friends • Older dying adults – accepting; younger dying adults feel cheated

16. A Developmental Perspective on Death • Attitudes toward death • Suicide • Many factors create risks of suicide • Cultural differences in suicide exist • Gender: • Highest female rates in Sri Lanka and China • Lowest female rates in Caribbean, Egypt, Syria • Highest male rates in Lithuania and Russia • Lowest male rate in Dominican Republic

17. Serious physical illness Feelings of disparity, isolation, failure, loss Serious financial problems Drug use or prior suicide attempts Antidepressant links Rare in childhood, risk increases in adolescence Most adolescent attempts fail Linked to genetic and situational factors Gay and lesbian links not clear Suicide Risk Factors

18. A Developmental Perspective on Death • Attitudes toward death • Suicide in adolescence • Third leading cause of death in ages10-19 • 17% of high school students seriously considered or tried suicide in last twelve months • Females more likely to attempt it, males more successful at attempts • Males use more lethal means • Female Native Americans have highest risk; while females have lowest risk

19. A Developmental Perspective on Death • Attitudes toward death • Adulthood and aging • Stable rates in early, middle adulthood; increases in late adulthood • Highest rates among white older males • Male rates higher than female rates • Older adults • Less likely to tell about suicide plans • More successful attempts • Use more lethal weapons

20. Facing One’s Own Death • Knowledge of 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

21. Facing One’s Own Death • Kubler-Ross’ stages of dying • Denial and isolation: denial of coming death • Anger: denial turns to anger, resentment, rage • Bargaining: hopes death can be postponed • Depression: accepts certainty of one’s death • Acceptance: develops sense of peace and may desire to be left alone

22. Facing One’s Own Death • Kubler-Ross’ stages of dying • Criticisms of her work: stages may be reactions • Can experience many emotions at once • Emotions wax and wane • How one lived determines how one accepts death • Spirituality buffers severe depression • As one nears death, s/he becomes more spiritual

23. Facing One’s Own Death • Perceived control and denial • Perceived control is adaptive strategy • When individuals believe they can influence and control events, they may become more alert and cheerful • Denial can be adaptive or maladaptive • The Contexts in Which People Die • Most would rather die at home but worry over being a burden, limited space, altering relationships, competency and availability of emergency medical treatment

24. Coping with the Death of Someone Else • Communicating with a 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 reminiscing, express your regard • Talk with the individual when s/he wishes to talk

25. Coping with the Death of Someone Else • Grieving • Grief: emotional numbness; a complex emotional state of… • Disbelief, despair, separation anxiety • Sadness, loneliness • More a roller-coaster of ups and downs than progressive stages • Becomes more manageable over time • Prolonged grief • Disenfranchised grief

26. Coping with the Death of Someone Else • Models of Coping • 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

27. Coping with the Death of Someone Else • Cultural diversity in healthy grieving • Persistent holding on to deceased may be therapeutic • Hopi of Arizona forget quickly • Egyptians dwell on grief • Bali – mourners encouraged to be joyful and laugh • Healthy coping involves • Growth • Flexibility • Appropriateness within the cultural context

28. Coping with the Death of Someone Else • 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

29. Coping with the Death of Someone Else • 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

30. Coping with the Death of Someone Else • 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

31. Coping with the Death of Someone Else • 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

32. Coping with the Death of Someone Else • Forms of mourning • Approximately 67% of corpses are disposed of by burial, the remaining 33% by cremation • Funeral industry is source of controversy • Funeral is important aspect of mourning in many cultures • Cultures vary in how they practice mourning

33. Coping with the Death of Someone Else • 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

34. Coping with the Death of Someone Else • The Amish, Traditional Judaism, and Mourning • Traditional Judaism • Mourning in graduated time periods; each with appropriate practices • First period: Aninut— between death and burial • Second period: Avelut period — mourning proper • Shivah period — seven-day begins at burial • Sheloshim period — thirty-day period after burial • Mourning for parents lasts another eleven months

35. The End