Chapter 19:. Death, Dying, and Bereavement. In This Chapter. The Experience of Death Death Itself. Characteristics Clinical death Brain death Social death. The Experience of Death Where Death Occurs. Hospitals in the U.S. (45%) Decedent’s home (25%) Long-term Care (22%)
Death, Dying, and Bereavement
Hospitals in the U.S. (45%)
Decedent’s home (25%)
Long-term Care (22%)
Death viewed as normal
Families and the patient encouraged to prepare for death
Family are involved in patient’s care
Control of care is in the hands of the patient and family
Medical care is palliative rather than curative
Special hospice centers
Let’s take a minute to review some of these comparisons.
Young adults: Loss of opportunity to experience things; loss of family relationships
Older adults: Loss of time to complete inner work
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
At what age do you think people are most fearful of death?
What prompted your answer?
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
Religious beliefs and fear of death
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 Erikson’s stage of integrity versus despair?
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?
Kinds of preparations
Stage concept unsupported
Two additional views
Shneidman: Dying process has many “themes”
Corr: Coping with death involves taking care of specific tasks
Greer: Attitudes and behavioral choices can influence course of terminal disease
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.”
Traumatic death often followed by physical or mental problems
Grief therapy with children makes use of defense mechanisms (sublimation, identification)
Freud: Death of a loved one is an emotional trauma
Ego tries to insulate itself from unpleasant emotions through defense mechanisms such as denial
Defense mechanisms provide only temporary relief
How do people grieve in healthy ways?
Intense grief likely to occur at loss of any attachment figure
Quality of attachment related to grief
Bowlby: Four stages of grief
Sanders five stages of grief comparable to Bowlby:
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
Wortman and Silver
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
Factors Associated with Grief: Age of the Bereaved
Children express feelings of grief like teens and adults
Teens often show prolonged grief responses
Modes of Death and Grief
Immediate and long term effects on the immune system
Incidence of depression among widows and widowers rises substantially
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
Spouse death more negative for men than for women.
Risk of death higher in men immediately after a spouse’s death.
Widowers withdraw in multiple ways.
Alcohol use may influence depression.
Social relationships remain important for both sexes.
“Talk-it-out” approach to managing grief can help prevent grief-related depression.
Developing coherent personal narrative of events surrounding spouse’s death helps manage grief.
Participating in support groups helps.
Appropriate amount of time off from work to grieve is important.