1. Slide 1 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 1 A Topical Approach to LIFE-SPAN DEVELOPMENT Chapter Seventeen: Death, Dying, and Grieving John W. Santrock

2. Slide 2 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 2 The Death System and Cultural Contexts Components of the system –People: involvement of self and others –Places or contexts –Times –Objects: associated with death (e.g. caskets) –Symbols: last rites, arm bands, etc. Most societies have – Philosophical/religious beliefs, rituals/rites

3. Slide 3 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 3 The Death System and Cultural Contexts Cultural variations of the death system –Death not as common in United States as elsewhere Conditioned early in life to live as if immortal –Other countries Daily death on streets of Calcutta, India African villages — death by disease and malnutrition Young orphans from tsunami in Indonesia –Individuals more conscious of health and death in times/places of war, poverty, disease

4. Slide 4 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 4 The Death System and Cultural Contexts Cultural variations of the death system –Some members of society Embrace death Fear it, see it as punishment –Death can mean Loneliness, happiness, redemption –Most societies do not view death as an end to life Gond culture of India Tanala culture of Madagascar

5. Slide 5 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 5 The Death System and Cultural Contexts Cultural variations of the death system –U.S. Denial and Avoidance of Death Funeral industry emphasizes lifelike qualities Euphemisms — softening language for death Persistent search for “fountain of youth” Rejection and isolation of aged Concept of pleasant and rewarding afterlife Medical emphasis — prolonging life, not easing suffering

6. Slide 6 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 6 The Death System and Cultural Contexts Changing Historical Circumstance –Death becoming increasingly complex When to determine death has occurred Life expectancy has increased Most die apart from families Care for dying shifted away from family Minimized exposure to death and its pain

7. Slide 7 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 7 Defining Death and Life/Death Issues Issues in Determining Death –Brain death — neurological definition of death All electrical activity of brain has ceased for a specified period of time Flat EEG recording Some medical experts argue criteria for death should include only higher cortical functioning

8. Slide 8 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 8 Defining Death and Life/Death Issues Issues in Determining Death –Natural Death Act and Advanced directive Patient in coma, living will Physicians concerns over malpractice lawsuits –Euthanasia: painless ending, “mercy killing” –Passive euthanasia: withholding treatments or life sustaining equipment –Active euthanasia: deliberately induced

9. Slide 9 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 9 Defining Death and Life/Death Issues Issues in Determining Death –Technical advances and issues of quality of life Terri Schiavo case Extraordinary medical procedures that may be used to sustain life when medical situation becomes hopeless –Publicized controversy: assisted suicide Dr. Jack Kavorkian in Michigan Legal in State of Oregon Legal in Netherlands and Uruguay

10. Slide 10 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 10 Defining Death and Life/Death Issues Needed: Better Care for Dying Individuals –Death in United States: often lonely, prolonged, painful –Plan for a “good” death Make a living will Give someone power of attorney Give your doctor specific instructions Discuss desires with family and doctor Check insurance plan coverage

11. Slide 11 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 11 Defining Death and Life/Death Issues Needed: Better Care for Dying Individuals –Hospice — humanized program committed to making the end of life as free from pain, anxiety, and depression as possible Palliative care — reducing pain and suffering and helping individuals die with dignity Movement rapidly growing in United States 90% of care in person’s home Aided by Visiting Nurse Associations

12. Slide 12 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 12 A Developmental Perspective on Death Causes of death –Death can occur at any point in human life span Prenatal — miscarriage, stillborn Infants — SIDS: leading cause of infant death in United States Childhood — accidents or illness Adolescence — motor vehicle accidents, suicide, and homicide Older adults — chronic diseases

13. Slide 13 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 13 A Developmental Perspective on Death Attitudes toward death at different points in the life span –Honesty may be best way to discuss death with children Don’t see death same as adults do; don’t understand it About age 9 — sees finality and universality of death Explain in simple physical/biological terms to preschooler Be sensitive/sympathetic, encourage feelings/questions

14. Slide 14 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 14 A Developmental Perspective on Death Attitudes toward death at different points in the life span –Adolescents Often view death as remote idea; not relevant to them Some show concern for death; seeking meaning More abstract in conceptions than children –Death described in terms of darkness, transition, etc. Develop religious and philosophical views of death and life afterwards

15. Slide 15 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 15 A Developmental Perspective on Death Attitudes toward death at different points in the life span –Adulthood Middle-aged adults fear death more than young adults or older adults; older adults think about death more Increased awareness accompanies aging Older adults think and talk about it more in conversations –Experience it more directly through loss of friends Older dying adults – accepting; younger dying adults feel cheated

16. Slide 16 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 16 A Developmental Perspective on Death Attitudes toward death –Suicide Many factors create risks of suicide Cultural differences in suicide exist Gender: –Highest female rates in Sri Lanka and China –Lowest female rates in Caribbean, Egypt, Syria –Highest male rates in Lithuania and Russia –Lowest male rate in Dominican Republic

17. Slide 17 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 17 Suicide Risk Factors Serious physical illness Feelings of disparity, isolation, failure, loss Serious financial problems Drug use or prior suicide attempts Antidepressant links Rare in childhood, risk increases in adolescence Most adolescent attempts fail Linked to genetic and situational factors Gay and lesbian links not clear

18. Slide 18 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 18 A Developmental Perspective on Death Attitudes toward death –Suicide in adolescence Third leading cause of death in ages10-19 17% of high school students seriously considered or tried suicide in last twelve months Females more likely to attempt it, males more successful at attempts Males use more lethal means Female Native Americans have highest risk; while females have lowest risk

19. Slide 19 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 19 A Developmental Perspective on Death Attitudes toward death –Adulthood and aging Stable rates in early, middle adulthood; increases in late adulthood Highest rates among white older males Male rates higher than female rates Older adults –Less likely to tell about suicide plans –More successful attempts –Use more lethal weapons

20. Slide 20 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 20 Facing One’s Own Death Knowledge of death –Most dying individuals want to make decisions regarding their life and death Complete unfinished business Resolve problems and conflicts Put their affairs in order

21. Slide 21 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 21 Facing One’s Own Death Kubler-Ross’ stages of dying –Denial and isolation: denial of coming death –Anger: denial turns to anger, resentment, rage –Bargaining: hopes death can be postponed –Depression: accepts certainty of one’s death –Acceptance: develops sense of peace and may desire to be left alone

22. Slide 22 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 22 Facing One’s Own Death Kubler-Ross’ stages of dying –Criticisms of her work: stages may be reactions Can experience many emotions at once Emotions wax and wane –How one lived determines how one accepts death –Spirituality buffers severe depression As one nears death, s/he becomes more spiritual

23. Slide 23 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 23 Facing One’s Own Death Perceived control and denial –Perceived control is adaptive strategy When individuals believe they can influence and control events, they may become more alert and cheerful Denial can be adaptive or maladaptive –The Contexts in Which People Die Most would rather die at home but worry over being a burden, limited space, altering relationships, competency and availability of emergency medical treatment

24. Slide 24 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 24 Coping with the Death of Someone Else Communicating with a dying person –Establish your presence, eliminate distraction –Limit visit time, don’t insist on acceptance –Allow expressions of guilt or anger –Discuss alternatives, unfinished business –Ask if there is anyone s/he would like to see –Encourage reminiscing, express your regard –Talk with the individual when s/he wishes to talk

25. Slide 25 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 25 Coping with the Death of Someone Else Grieving –Grief: emotional numbness; a complex emotional state of… Disbelief, despair, separation anxiety Sadness, loneliness More a roller-coaster of ups and downs than progressive stages Becomes more manageable over time –Prolonged grief –Disenfranchised grief

26. Slide 26 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 26 Coping with the Death of Someone Else Models of Coping –Dual-process model for effective coping Loss-oriented stressors Restoration-oriented stressors –Coping and type of death Sudden or violent deaths have more intense and prolonged effects Many such deaths accompanied by PTSD

27. Slide 27 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 27 Coping with the Death of Someone Else Cultural diversity in healthy grieving –Persistent holding on to deceased may be therapeutic Hopi of Arizona forget quickly Egyptians dwell on grief Bali – mourners encouraged to be joyful and laugh –Healthy coping involves Growth Flexibility Appropriateness within the cultural context

28. Slide 28 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 28 Coping with the Death of Someone Else Making Sense of the World –Grieving stimulates many to try to make sense of their world — positive themes linked to hopeful future and better adjustment –Effort to make sense of it pursued more vigorously when caused by an accident or disaster

29. Slide 29 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 29 Coping with the Death of Someone Else Making Sense of the World –Grieving stimulates many to try to make sense of their world — positive themes linked to hopeful future and better adjustment –Effort to make sense of it pursued more vigorously when caused by an accident or disaster

30. Slide 30 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 30 Coping with the Death of Someone Else Losing a Life Partner –Those left behind after the death of an intimate partner suffer profound grief and often endure Financial loss Loneliness linked to poverty and education Increased physical illness Psychological disorders, including depression

31. Slide 31 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 31 Coping with the Death of Someone Else Adjustment to Widowhood –Women live longer –Widowed men more likely to remarry –Measures of older women’s health Physical and mental health Health behaviors and outcomes –Overall, women adjust better than men Older widows do better than younger widows Support programs aid adjustment

32. Slide 32 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 32 Coping with the Death of Someone Else Forms of mourning –Approximately 67% of corpses are disposed of by burial, the remaining 33% by cremation –Funeral industry is source of controversy –Funeral is important aspect of mourning in many cultures –Cultures vary in how they practice mourning

33. Slide 33 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 33 Coping with the Death of Someone Else The Amish, Traditional Judaism, and Mourning –Amish Conservative group; family-oriented society Live same unhurried pace as ancestors Time of death met with calm acceptance Neighbors notify community; funeral at home High level of support to family for one year

34. Slide 34 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 34 Coping with the Death of Someone Else The Amish, Traditional Judaism, and Mourning –Traditional Judaism Mourning in graduated time periods; each with appropriate practices First period: Aninut — between death and burial Second period: Avelut period — mourning proper –Shivah period — seven-day begins at burial –Sheloshim period — thirty-day period after burial –Mourning for parents lasts another eleven months

35. Slide 35 © 2010 The McGraw-Hill Companies, Inc. All rights reserved. 35 The End