LIFE-SPAN DEVELOPMENT

1. 17 A Topical Approach to LIFE-SPAN DEVELOPMENT Death and Grieving John W. Santrock

2. Death and Grieving • The Death System and Cultural Contexts • Defining Death and Life/Death Issues • A Developmental Perspective on Death • Facing One’s Own Death • Coping with the Death of Someone Else

3. Death and Cultural Contexts Death in Different Cultures • Perceptions of death vary; reflect diverse values and philosophies • Individuals more conscious of death in times and places of war, poverty, disease. • Most societies have • Philosophical or religious beliefs about death • Rituals that deal with death • View that death does not end existence

4. Death and Cultural Contexts 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

5. Death 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

6. 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

7. Defining Death and Life/Death Issues Decisions Regarding Life, Death, and Health Care • Natural Death Act and Advance Directive • Expresses person’s desires regarding extraordinary medical procedures that might be used to sustain life when medical situation becomes hopeless

8. Defining Death and Life/Death Issues Euthanasia • Painlessly ending lives of persons suffering from incurable diseases or severe disabilities • Passive euthanasia— withholding of available treatments, allowing the person to die • Active euthanasia— death induced deliberately, as by injecting a lethal dose of drug • Publicized controversy: assisted suicide

9. Defining Death and Life/Death Issues Needed: Better Care for Dying Individuals • Death in U.S.: often lonely, prolonged, painful • Plan for your 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

10. 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

11. A Developmental Perspective of Death Causes of Death • Death can occur at any point in human life span • Prenatal— miscarriage, stillborn • Childhood— accidents or illness • Adolescence— motor vehicle accidents, suicide, and homicide • Older adults— chronic diseases

12. A Developmental Perspective of Death Death and Children • Honesty may be best way to discuss death with children • Explained in simple physical or biological terms to preschool children • Be sensitive and sympathetic, encouraging feelings and questions • Not unusual for terminally ill children to distance themselves in final stages, may be a result of depression

13. A Developmental Perspective of Death Attitudes Toward Death at Different Points in the Life Span Infant has no concept of death; perceptions of death develop in middle/late childhood; even very young children concerned about separation and loss Childhood Develop more abstract concepts of death; common to think they are immune to death Adolescence Middle-aged adults fear death more than young adults or older adults; older adults think about death more Adulthood

14. A Developmental Perspective of Death Suicide Risk factors • Cultural and gender differences exist • Rare in childhood, risk increase in adolescence • Most adolescent attempts fail • Linked to genetic and situational factors • Gay or lesbian links not clear • Serious physical illness • Feelings of disparity, isolation, failure, loss • Serious financial problems • Drug use or prior suicide attempts • Antidepressant links

15. Adolescence 3rd leading cause of death in ages10-19 19% of high school students seriously considered or tried suicide in last 12 mos Adulthood and Aging Suicide rates increase in adulthood Older adults use more lethal ways, are more successful Racial and gender differences exist A Developmental Perspective of Death Suicide in U.S.

16. Facing One’s Own Death Facing One’s Own 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

17. Facing One’s Own Death Kubler-Ross’ Stages of Dying Denial and isolation Denies s/he is going to die Denial gives way to anger, resentment, rage, and envy Anger Develops hope that death can somehow be postponed Bargaining Comes to accept the certainty of her or his death Depression Develops sense of peace and may desire to be left alone Acceptance

18. Facing One’s Own Death Perceived Control and Denial • When individuals believe they can influence and control events, they may become more alert and cheerful • Denial can be adaptive or maladaptive

19. Facing One’s Own Death The Contexts in Which People Die • Context of dying is important for most • Most would rather die at home but worry over • Burden at home • Limited space • May alter relationships • Competency and availability of emergency medical treatment

20. 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 the dying individual to reminisce Talk with the individual when s/he wishes to talk Express your regard Coping with the Death of Someone Else Communicating with the Dying Person

21. Coping with the Death of Someone Else Grieving • Grief: emotional numbness; a complex emotional state of… • Disbelief • Separation anxiety • Despair • Sadness • Loneliness • Complicated grief • Disenfranchised grief

22. Model of Grieving • 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

23. Cultural Diversity in Healthy Grieving • Persistent holding on to deceased may be therapeutic • Hopi of Arizona forget quickly • Egyptians dwell on grief • Netherlands: integrate loss into their lives • Healthy coping involves • Growth • Flexibility • Appropriateness within the cultural context

24. 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

25. 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

26. 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

27. Coping with the Death of Someone Else Forms of Mourning • Approximately 80 percent of corpses are disposed of by burial, the remaining 20 percent by cremation • Funeral industry is source of controversy • Funeral is important aspect of mourning in many cultures • Cultures vary in how they practice mourning

28. 17 The End