The Psychology of Dying

1. The Psychology of Dying

2. Kubler-Ross • 5 stages: • 1) Denial: (and Isolation) • “the defense mechanism by which a person is unable or refuses to see things as they are because such facts are threatening to the self” • 2) Anger: • “blame directed toward another person” • 3) Bargaining • 4) Depression • 5) Acceptance

3. William Worden • 4 Tasks of Mourning: • Task One: To Accept the Reality of the Loss • Task Two: To Experience the Pain of Grief and to Express the Emotions Associated With It • Task Three: To Adjust to an Environment in Which the Deceased is Missing • Task Four: To Emotionally Relocate the Deceased or Other Changed Condition and Move On With Life

4. Lofland • “dying scripts” • Elements: • Space • Population • Knowledge • Stance

5. Em. M. Pattison • 3 phases of the dying process: • 1) acute crisis phase • 2) chronic living-dying phase • 3) terminal phase

6. A. Weisman • 3 degrees of denial: • 1) the person denies the facts • 2) the person accepts the diagnosis but refuses to believe that it is terminal • 3) person vacillates beween open acknowledgement of death and its repudiation

7. Glaser and Strauss • 4 contexts of awareness: • 1) closed awareness • 2) suspicion • 3) mutual pretense • 4) open awareness

8. Duties of the Dying • 1) arrange a variety of affairs • 2) adapt to the loss of loved ones and self • 3) manage medical needs and balance emotions • 4) plan for future loss • 5) identify and cope with the death encounter

9. Role of the FD With the Dying • Prerequisites for the FD: • 1) acknowledge one’s mortality • 2) understand the grief process • 3) effective listening and appropriate response • 4) commitment to the dying • 5) knowledge of personal limits

10. Social Responses to Death • variety of socialization processes • demographic norms • Preindustrial: high mortality rates • small, tightly integrated communities • Postindustrial: drop in mortality rates • death is distanced, sanitized

11. Death of a Parent • natural event • unfinished emotional business • little/no allowance for untimely, violent, or unexpected death • allow the adult child to express the feelings of loss • support groups

12. Death of a Spouse • secondary losses • social issues • support groups

13. Death of a Child • parents and siblings aren’t the only ones who mourn the loss of a child, but the parental grief response is the most complex • friends may avoid the parents • “service guilt”, “survivor’s guilt”

14. Guilt • Composed of: • Regrets • Misgivings • Unresolved past conflicts with the child • Every aspect of the relationship and childcare

15. Secondary Losses • child may have filled a “gap” • child as well as friend • sense of status/self-esteem/purpose • continued guilt can give rise to complications • changed identity • camily structure is altered

16. Parental Anger • feel that core identities have been ripped out • world no longer makes sense • rage at those perceived to have a role in the death • feelings of betrayal • anger directed toward survivors

17. Coping With Other People • Need to be aware that there are people in their lives from whom they will never get the support they would have expected or desire.

18. Parental Fear • Fear of losing other children or any close person causes bereaved parents to overprotect.

19. “New Me in a New World” • The image of the child exists within but is no longer physically available as an external reality. • Create a new internal picture of who they are in the outside world. • Their loss and grief accompany them everywhere they go.

20. Painful Reminders • seasonal reminders • unexpected “moments” • continual acknowledgment of the child at family events • can still feel connected

21. Linking Objects and Continuing Bonds • helps maintain continuity of a relationship • provide support for grieving parents

22. FD Responsibilities • reinforce that their feelings are acceptable and normal • point out to them society’s inability to comprehend their loss • well-meaning people’s comments • create an atmosphere of security, comfort and accessibility

23. High Divorce Rate Myth • 1999: 72% still married 28%: 16% ended due to death of spouse 12% ended in divorce Grieving parents do experience some marital strain and have to make readjustments in their marriages.

24. Death of a Sibling • greater chance of healing if parents remain in their lives • parents grieve openly • parental grief is shared • siblings may experience shame or embarrassment • preteens and teens are particularly sensitive

25. Replacement Expectations • parents may inappropriately place expectations on children • parents may consciously or unwittingly communicate that surviving children take on the dead sibling’s role • parents may deify the dead child • parents may focus on the dead child to the exclusion of the surviving siblings

26. Surviving Adult Siblings • least acknowledged by society • facing the death of someone in their own generation…..personal confrontation with their own mortality • FD should be available to them

27. Implications for Funeral Directors • 1) society’s perception of the death may not “track” with the individual’s response • 2) be sensitive to conflict between what is expected and what they feel • 3) provide information about resources • 4) small library of books, tapes etc. • 5) provide clear, complete and accurate communication