Developmental Psychology Death - Notes

Death, Dying, and Grief Death Systems ● Every culture in the world has its own “Death System” comprised of several components: ○ People: The degree of involvement that people, across many levels, have in death. ○ Places: The locations where death occurs or is memorialized. ○ Times: Specific moments in which death is mourned, honored, etc. ○ Objects: Objected associated with death. ■ Color: ● US: Black associated with death. ● China: White associated with death. ■ Caskets ○ Symbols: Symbols used to represent death. ■ Last rites among Catholics ● Cultural Death systems impact ○ Discussion of Death ■ In the US it is not common to talk about or discuss death. ■ In other countries, particularly those marked by famine, war, and plague, death is more salient in day-to-day life. ○ Views of Death ■ Views on death range drastically. ■ Punishment from God ■ Loneliness ■ Redemption ■ A release from blight ○ Views of afterlife ■ In some societies, death is viewed as end of existence. ■ Others embrace the notion of an afterlife. ■ Still others adhere to reincarnation. ○ Our Reaction to Death ■ Some societies embrace death (e.g., Tanala view death as natural occurrence and view death more peacefully). ■ Other societies fear it (e.g., U.S.) ■ Still other societies respond in anger (e.g., Gond culture blames death on demons). Decisions Regarding Life, Death, and Health Care ● Euthanasia ○ Definition ■ Act of painlessly ending the lives of individuals who suffering from incurable disease or severe disability. ○ Types ■ Passive Euthanasia ● ● ● ● ● ● When a person is allowed to by withholding available treatment such as withdrawing life-sustaining devices (e.g., respiratory) ■ Active Euthanasia ● Deliberately inducing death through the use of a lethal dose of a drug, typically sedatives and muscle relaxers. As a whole, there has been trend towards acceptance of passive euthanasia. Active euthanasia or assisted suicide has been more contentious. ○ In United States, only five states permit it: ■ Oregon, Washington, Montana, New Mexico, & Vermont. ○ Internationally, legal in: ■ Netherlands, Belgium, Luxembourg, Switzerland, Germany, Albany, Colombia, and Japan. ○ In all other states and countries, assisted suicide is considered a manslaughter or a felony. Why is euthanasia so controversial? ○ Favor ■ Argue that death should be calm and dignified. ■ Not full of agony, pain, and prolonged suffering. ○ Against ■ Viewed as a criminal act of murder in many countries. ■ Patients may feel pressured for assisted suicide. ■ Religious groups view suicide as a going against God’s will. Nonetheless, better care is needed for dying individuals. ○ In the US, the process of dying is often lonely, prolonged, and painful. ■ Scientific advances have made dying harder. ■ Despite painkillers, 60% of dying patients experienced intense pain. ■ In many cases, insufficient information is provided to dying patients. Sparked interest in providing a “good death”. ○ Good Death often defined as one involving: ■ Physical comfort ■ Support from loved ones ■ Appropriate medical care. ○ Resulted in increase in Hospice and palliative care. ■ Focus on palliative care, or care that seeks to reduce pain and help individuals die with dignity. ■ Hospice is a program committed to making the end of life as free from pain, anxiety, and depression. The Case of Terri Schiavo ● Schiavo sustained a cardiac arrest. ● Placed her in a persistent vegetative state. ● Debate ○ Husband: Argued she wouldn't want prolonged artificial support. ○ Parents: Disputed assertions, challenged the medical diagnosis, arguing for ● ● ● ● prolonged artificial support. Case was settled in 2005, and life support was pulled. Schiavo’s case emphasizes the importance of an Advanced Directive or a living will. Advanced Directive ○ Communicates preferences for end-of-life care. ○ However, only 15% of patients have them. Recently, been pushed for a Physician Order for Life-Sustaining Treatment (POLST). ○ Translates preferences to medical orders. ○ Involves Patient and Professional conferring to determine and state wishes. ○ Only allowed in 34 states Attitudes Towards Death ● Childhood ○ Development of Concept of Death ■ Early Children (3 to 5) ● Have little or no idea what death means. ● Rarely get upset at the sight of death or being told someone has died. ● View death as something voluntary. ■ By Middle and Late childhood ● Develop more realistic perceptions across all dimensions. ○ By 7, begin to view death as universal ○ By 9, understand death is irreversible AND universal. ● Adolescence ○ Adolescents develop more abstract conceptions of death than children do. ○ Adolescence also begin to develop their religious and philosophical views about: ■ Nature of Death ■ And whether there is life after death. ● Adulthood ○ With age, consciousness. ■ Middle-aged adults tend to fear death. ■ By old age, death becomes less frightening. ● Death may take on an appropriateness it lacked in earlier years. ● Likely result of the fact that in old age one is less likely to have ○ unfinished business. ○ young children they must attend to. ○ spouses and friends are more likely to be deceased. ● May make death less emotionally painful for older adults than for younger and middle-aged adults. Kubler-Ross’s Stages of Dying ● Sought to divide behavior and thinking of dying people into sequential stages. ○ Denial: ■ Denies that death is really going to take place. ■ Typically only a temporary defense. Anger ■ Denial gives way to anger and resentment. ■ Typically begin lashing out at medical staff and family members ○ Bargaining ■ Develops the hope death can somehow be postponed or delayed. ■ Will attempt to negotiate, often with God, to delay death. ○ Depression ■ Depression kicks in as a person begins to accept the inevitable end. ■ May cut themselves off from others. ● Attempts to cheer up a person should be discouraged. ● Behavior is used as a means of contemplating their demise. ○ Acceptance ● Develops a sense of peace and acceptance. ● In many cases may include desire to be left alone. Support ○ Existence of a five-stage sequence has actually not been supported. ○ Stages neglects patients’ individual situation including ■ Relationship support ■ Specific effects of Illness ○ Increasingly viewed as potential reactions, which can change moment to moment. Contribution ○ Called attention to the needs of those coping with death. ○ ● ● Grieving ● Definition ○ Feelings that accompany the loss of someone we love. ○ Increasingly, grief has been conceptualized as a complex, evolving process with multiple dimensions. ● Dimensions ○ Pining: reflects intermittent or recurrent wish for the need to recover a lost person. ○ Separation Anxiety: preoccupation with thoughts of the deceased person – often associated with crying or sighing. ○ Despair and Sadness: sense of hopelessness or defeat, apathy, or loss of meaning involved in activities. ● Progression of Grief ○ Conceptualization ■ Viewed as a roller-coaster ride rather than an orderly process. ■ Substantial individual variation in timing and intensity. ○ Nonetheless, most emerge from grief and turn our attention once again to productive tasks. ● ● Prolonged or Complicated Grief (7 to 10%) ○ Grief that involves enduring despair and remains unresolved over an extended period of time (6+ months). ○ Usually associated with negative consequences for physical and mental health. Prolonged Grief more likely to occur in ○ Individuals who lost their spouse. ○ Lost a loved one unexpectedly. ○ Spent time with the deceased every day in the last week of that person’s life. ○ We're emotionally dependent on the individual. ○ Have a history of depression. Dual-Process Model of Coping with Bereavement ● Identified two dimensions of Coping ○ Loss-Oriented Stressors: ■ Stressors focused on deceased individuals. ■ Can involve positive and negative appraisals: ● Positive: involving acknowledging death brought relief. ● Negative: yearning for the loved one. ○ Restoration-Oriented Stressors ■ Secondary stressors that emerge as indirect outcomes of bereavement. ■ Include change in identity and need to master new skills. ● According to Dual-Process Model, ○ Both stressors can and often are carried out concurrently. ○ However, effective coping involves an oscillation between ■ coping with loss ■ coping with restoration. ○ Moreover, ■ Initial emphasis tends to be on coping with loss, ■ Followed by greater emphasis on restoration. Cultural Diversity on Healthy Grieving ● As we have discussed, ○ all development is culturally contextualized. ○ This holds true for grieving as well. ● Beliefs about maintaining bonds with the deceased vary extensively. ○ Still, among Muslims in Egypt, individuals are encouraged to dwell at length on their grief. ○ In Japan, maintaining bonds with the deceased is accepted and sustained in religious rituals. ○ Among the Hopi in Arizona, deceased are forgotten as quickly as possible.