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Chapter 17

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  1. Chapter 17 Death & Dying

  2. Social Meanings of Death • Modern American • Medical failure • More traditional societies • Natural part of life cycle • Grieving practices vary • By culture: Weeping/partying • By ethnicity: Wake/shiva

  3. Life Expectancy • Expected age at death • U.S.: 76.5 years • White females: 80 years • White males: 75 years • Black females: 75 years • Black males: 68 years • Ancient Rome: 30 years • Most deaths due to accidents early, disease later

  4. Theories of Aging and Death • Programmed theories • Maximum life span (species) • Has not changed much (even as M lifespan has) • Hayflick Limit (max # of possible cell divisions) • Shortening of telomeres (due to cell division) • Genetically determined aging processes • Progeria: genes inactive in elderly inactive in kids • Hypothalamus may regulate aging (ala puberty)

  5. Theories of Aging and Death • Damage theories • Wear and tear • Free radicals (toxins of normal functioning) • Antioxidants may increase lifespan by inhibiting these • Interaction of the two, or more • Nature + nurture • Caloric restriction, exercise, low stress, etc.

  6. Kulber-Ross’s Stages of Dying • Common set of stage-like emotional responses • Denial, Anger, Bargaining, Depression, Acceptance • Criticisms • Not a stage-like process, not sequential • Course of illness not considered • Individual differences • Ego integrity v. despair

  7. Attachment Model of Bereavement • Bereavement: The state of loss • Grieving: Emotional expressions • Mourning: Culturally approved reactions • Parkes/Bowlby model (wide individual differences) • Numbness: in shock, daze, dream-like state • Yearning: grief, anger, guilt, separation anxiety • Disorganization & despair: depression, apathy • Reorganization: revise models of self/others, less investment in grieving, begin new relationships

  8. The Bereaved Child • Children do grieve (reflects development) • Express grief differently than adults do • Misbehavior, strike out, rage • Lack adult coping skills • Will use denial, avoidance • Most adjust successfully

  9. The Adolescent • Higher levels of understanding • May carry on internal dialogue with dead • Desire to maintain attachment (parents) • Devastated at death of close friend • Importance of peers for development • Adult-like grieving • Expression limited by fears of losing control • Act out w/ deliquent behavior or somatic complaints

  10. The Adult • Death of family member difficult • Changes family dynamics, roles • Death of spouse more expected with age • More difficult when young • Elevated levels of stress • Risk increases for illness, death (elderly) • Signs of recovery after 2 years

  11. The Loss of a Child • No loss more difficult (child’s age irrelevant) • Experienced as untimely, unjust • Broken attachments • Guilt at failure to protect child • May continue relationship with dead child • Marital problems increase afterwards

  12. Grief Work Perspective • Emotions must be confronted: detachment • May be a culturally biased belief • May actually cause more distress • Delayed grief reaction not supported by research • Detachment not necessary

  13. Who Copes and Who Succumbs • Secure infant attachment related to coping skills • Low self-esteem related to more difficulty • Cause of death influences bereavement • Support system essential • Additional life stressors detrimental • Positive outcomes often found

  14. Hospice • Dying person decide what they need • De-emphasized prolonging life • Pain control emphasized • Normal setting (if possible) • Bereavement counseling for entire family • Research shows positive outcomes