Chapter 19: Death, Dying, and Bereavement

Death anxiety? “According to most studies, people's number one fear is public speaking. Number two is death. Death is number two. Does that sound right? This means to the average person, if you go to a funeral, you're better off in the casket than doing the eulogy.” Jerry Seinfeld

The Experience of Death Characteristics  What  How is death defined?  Where  How

The Experience of Death Characteristics  What  Where  Where do most people die?  How

The Experience of Death Hospice Care Philosophy  Death viewed as normal  Families and the patient encouraged to prepare for death  Family are involved in patient’s care  Medical care is palliative rather than curative

Hospice Hospital-based and Home-based Care Comparison Hospital-Based CareHome-Based Care Patient PainSame Length of SurvivalSame Patient Satisfaction with Care Same Family Satisfaction with Care HigherLower Family Sense of BurdenHigherLower

Hospice

The Experience of Death Characteristics  What  Where  How  Developmental understanding of death  Process of dying

Preschoolers: reversible School-agers: permanent and universal Adolescents: inevitable; sometimes unrealistic Early adulthood: unique invulnerability; challenged by early death Middle and late adulthood: finality, inevitability, universality  Who has greatest death anxiety? Developmental Understanding of Death

What would you do about your impending death? (see Table 19.2) 1.Make a marked change in lifestyle (travel, new experiences) 2.Center on inner life (read, pray) 3.Be with others. 4.Attempt to complete projects. 5.No change in lifestyle.

Figure 19.1 Age, Ethnicity and Fear of Death

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? Questions To Ponder

The Process of Dying Preparation for Death Kinds of preparations  Practical preparations  Deeper preparations  Older adults more likely to have made these arrangements

Theoretical Perspectives on Dying Elisabeth Kubler-Ross’s Stages of Dying

Responses to Impending Death Greer: Female cancer patients Five groups  Denial (positive avoidance)  Fighting spirit  Stoic acceptance  Helplessness/hopelessness  Anxious preoccupation “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.”

Theoretical Perspectives on Grieving Attachment Theory Bowlby: Four stages of grief NumbnessYearningDisorganization and despairReorganization

Figure 19.2 Jacobs’s Model of Grieving

Theoretical Perspectives on Grieving Wortman and Silver  Normal  Chronic  Delayed- 1-5%  Absent- 26% So distress is neither inevitable nor necessary for normal grieving

Theoretical Perspectives on Grieving The Experience of Grieving: Death Rituals 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  Teens often show prolonged grief responses Modes of Death  Death with intrinsic meaning reduces grief.  Sudden and violent or suicide Gender  Incidence of depression among widows and widowers rises substantially  Death of a spouse more negative for men

Theoretical Perspectives on Grieving Pathological Grief  Depression-like symptoms lasting longer than 2 months  can lead to long-term depression and physical ailments  may continue for up to 2 years after death of loved one  BUT cultural practices may mimic pathological grief

Funeral Rites

“Have the courage to live. Anyone can die.” Robert Cody “I want to die in my sleep like my grandfather... Not screaming and yelling like the passengers in his car.” Will Shriner “Some die too young, some die too old; the precept sounds strange, but die at the right age” Friedrich Nietzsche “Death is caused by swallowing small amounts of saliva over a long period of time.” George Carlin No one can confidently say that he will still be living tomorrow. ~Euripides From my rotting body, flowers shall grow and I am in them and that is eternity. ~Edvard Munch