Lifespan Developmental Psychology - Death, Dying, and Grieving

Death, Dying, and Grieving ● ● The Death System and Its Cultural Variations ○ Components of death systems across cultures: ■ People—everyone is involved in death at some point. ■ Places or contexts—hospitals, funeral homes, cemeteries, hospices, battlefields, memorials. ■ Times—time/occasions set aside to honor those who have died. ■ Objects—many objects in a culture are associated with death. ■ Symbols—symbols and religious ceremonies are connected to death. ○ Death systems serve certain functions: ■ Issuing warnings and predictions. ■ Preventing death. ■ Caring for the dying. ■ Disposing of the dead. ■ Social consolidation after death. ■ Making sense of death. ■ Killing. ■ Hurricane Katrina and Death System Functions Defining Death and Life/Death Issues ○ In the past, the end of certain biological functions were considered clear signs of death. ■ Breathing, blood pressure, rigidity of body (rigor mortis). ○ Brain death: a neurological definition of death. ■ Person is brain dead when all electrical activity of the brain ceases for a specific period of time. ■ Higher brain regions may die but lower portions may allow for continued breathing and a heartbeat. ■ Current definition among most physicians includes death of both the higher cortical functions and the lower brain stem functions. ● ● ● Decisions Regarding Life, Death, and Health Care ○ Euthanasia: the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disability. ■ Passive euthanasia: when a person is allowed to die by withholding available treatment, such as withdrawing a life-sustaining device. ■ Active euthanasia: when death is deliberately induced, as when a legal dose of a drug is injected. ○ Assisted suicide is now legal in six countries. ■ In the United States, it is allowed in California, Oregon, Washington, Montana, New Mexico, Vermont, and Washington D.C. ■ Those in favor of euthanasia argue death should be calm and dignified, not full of suffering. ■ Those against euthanasia stress it is murder; and many religious individuals say it is against God’s will. ○ Death can be lonely, prolonged and painful. ○ Care providers are increasingly interested in helping individuals experience a “good death”. ■ Physical comfort, support from loved ones, acceptance, and appropriate medical care. ○ Hospice: a program committed to making the end of life as free from pain, anxiety, and depression as possible. ■ Emphasizes palliative care—reducing pain and suffering and helping individuals die with dignity. ■ Today a majority of hospice programs are home-based. Causes of Death ○ Death can occur at any point in the life span. ■ In infancy, sudden infant death syndrome (SIDS). ■ In childhood, most often due to accidents or illness. ● Major illnesses that cause death in children: heart disease, cancer, birth defects. ■ Death in adolescence is most likely to occur because of motor vehicle accidents, suicide, and homicide. ■ Older adults are more likely to die from chronic diseases. ● Often incapacitated before death, producing a long course of dying. ■ Many young and middle-aged adults die of illnesses such as heart disease and cancer. Attitudes Toward Death at Different Points in the Life Span ○ Age influences the way death is thought about and experienced. ○ Mature, adult-like conception of death includes: ■ Understanding that death is final and irreversible. ■ Death represents the end of life. ■ All living things die. ● ● ● Attitudes Toward Death: Adulthood ○ Increase in consciousness about death accompanies individuals’ awareness of their aging. ■ Usually intensifies in middle adulthood. ○ Middle-aged adults fear death more than young adults or older adults. ○ Older adults think about death more and talk about it more in conversation than middle-aged or young adults. ■ More direct experience as friends and relatives die. ○ Younger adults who are dying often feel cheated more than older adults. ■ More likely to think they have not had the opportunity to do what they want to do with their lives. ○ Older adults may be more able to accept death. ■ Increased thinking and conversing about death. ■ Sense of integrity developed through a positive life view. ○ Even among older adults, however, attitudes toward death vary. Suicide ○ Suicide risk factors: ■ Serious physical illness. ■ Mental disorders. ■ Feelings of hopelessness. ■ Social isolation. ■ Failure in school and work. ■ Loss of loved ones. ■ Serious financial difficulties. ■ Drug use. ■ Prior suicide attempt. Suicide: Adolescence ○ Suicidal behavior escalates in adolescence and further increases in emerging adulthood. ■ Third leading cause of death among 10- to 19-year-olds in the United States. ■ Emerging adults have triple the rate of adolescents. ○ Far more adolescents think about or attempt suicide unsuccessfully than actually commit it. ○ Suicidal behavior varies by both gender and ethnicity. ■ Females make more attempts. ■ Native Americans have the highest rates. ○ Depression is the most frequently cited factor associated with adolescent suicide. ■ Sense of hopelessness, low self-esteem, high self-blame ○ In some instances, suicides occur in clusters. ■ “Copycat” suicides raise the issue of whether suicides should be reported in the media. ● ● ● Suicide: Adulthood and Aging ○ Suicide is increasing among U.S. adults. ○ Females are three times more likely to attempt suicide; but males are four times more likely to commit suicide. ○ Older adult most likely to commit suicide is male, lives alone, has lost his spouse, and is experiencing failing health. ■ Perceiving oneself as burdensome may contribute. ■ Protective factors include a supportive network of family and friends, emotional control, and comfort from religion. What to Do and What Not to Do When Someone Is Likely to Attempt Suicide Facing One’s Own Death ○ As we age, values concerning our most important uses of time change. ○ When asked how they would want to spend a remaining six months of life: ■ Younger adults prioritize travel and making accomplishments. ■ Older adults prioritize inner-focused activities such as contemplation and meditation. ○ Most dying individuals want to make some decisions about their own life and death and may want to complete unfinished business. ○ Kübler-Ross’ stages of dying: ■ Denial and isolation—denies death is taking place. ■ Anger—anger, resentment, rage, and envy. ■ Bargaining—develops a hope that death can be delayed. ■ Depression—perceives the certainty of death. ■ Acceptance—develops a sense of peace, acceptance of one’s own fate, and often a desire to be left alone. ○ Not demonstrated by independent research; and fail to take into account individual situations. ■ Some psychologists prefer to describe them not as stages but as potential reactions. ● ● ● ● Perceived Control and Denial ○ Perceived control may work as an adaptive strategy for some older adults facing death. ■ When individuals believe they can prolong their life, they become more alert and cheerful. ○ Denial can be an adaptive or a maladaptive approach to death. ■ Can insulate people from having to cope with intense feelings of anger and hurt. ■ Can keep them from having a life-saving operation. The Contexts in Which People Die ○ More than 50% of Americans die in hospitals, and nearly 20% die in nursing homes. ○ Hospitals offer important advantages to the dying individual: ■ Professional staff members are readily available. ■ Medical technology may prolong life. ○ Most individuals say they would rather die at home. ■ Many worry, however, about being a burden, about limited space, and about the competency and availability of emergency medical treatment. Communicating with a Dying Person ○ Most psychologists stress the importance of dying individuals knowing that they are dying. ○ Advantages of an open awareness of dying: ■ Can close their lives according to their own ideas about dying. ■ Opportunity to complete plans or projects, make arrangements for survivors, and participate in decisions about funeral and burial. ■ Opportunity to reminisce, converse with others, and end life conscious of what life has been like. ■ Better understanding of what is happening and what medical staff is doing. Grieving ○ Grief: the emotional numbness, disbelief, separation anxiety, despair, sadness, and loneliness that accompany the loss of loved one. ○ Pining for the lost person and separation anxiety are important dimensions of grief. ■ Intermittent, recurrent wish or need to recover the lost person; and a focus on places and things associated with the deceased. ○ Feelings of grief occur repeatedly after a loss. ■ Become more manageable over time. ○ Estimated 80% to 90% of survivors experience normal or uncomplicated grief reactions. ■ By six months, the loss is accepted as reality, and individuals become more optimistic about the future and function competently in everyday life. ○ ● ● At six months after their loss, approximately 10% to 20% of survivors have difficulty moving on. ■ Enduring despair that remains unresolved is known as complicated grief or prolonged grief disorder. ■ Greatest risk for a person who loses someone he or she was emotionally dependent on. ○ Another type of grief is disenfranchised grief: an individual’s grief over a deceased person that is a socially ambiguous loss that can’t be openly mourned or supported. ■ Relationship that isn’t socially recognized; a hidden loss such as an abortion; and circumstances that are stigmatized. ■ May intensify grief because the loss cannot be publicly acknowledged. ■ Often hidden or repressed, and may be reawakened by later deaths. Making Sense of the World ○ Stimulating individuals to try to make sense of their world is one beneficial aspect to grieving. ■ Close family members share with each other and reminisce about family experiences. ○ When death is caused by accident or disaster, the effort to make sense of it is pursued more vigorously. ■ Bereaved want to put the death into a perspective they can understand. Losing a Life Partner ○ Spouses left behind after the death of an intimate partner suffer profound grief. ■ Often endure financial loss, loneliness, increased physical illness, and psychological disorders, including depression. ○ Surviving spouses seek to cope with their loss in various ways. ■ Intensified religious and spiritual beliefs. ■ Finding meaning in death. ○ Women often experience better adjustment after their loss due to: ■ Larger network of friends. ■ Closer relationships with relatives. ■ Experience in taking care of themselves psychologically. ○ Older widows adjust more optimally than younger widows, perhaps because the death of a partner is more expected. ○ Widowers are usually left with more money than widows and are more likely to remarry. ○ Psychological and religious factors are related to the psychological well-being of older adults following the loss of a spouse. ○ Volunteering and helping behaviors also appear to reduce feelings of loneliness. ○ Social support helps widows or widowers adjust to the death of a spouse. ■ Widow-to-Widow program provides support for newly widowed women.