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CHAPTER 17 THE FINAL CHALLENGE: DEATH AND DYING

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Title: CHAPTER 17 THE FINAL CHALLENGE: DEATH AND DYING


1
CHAPTER 17 THE FINAL CHALLENGE DEATH AND DYING
2
Learning Objectives
  • How is death defined?
  • Why is the definition of death controversial?
  • How does the social meaning of death vary across
    groups?
  • What factors influence life expectancy?
  • Is it possible to extend life expectancy?
  • What is the difference between programmed
    theories of aging and damage theories of aging?
    Give an example of each.

3
Matters of Life and Death What Is Death?
  • A Harvard Medical School committee has defined
    biological death in terms of brain functioning
  • Total brain death is an irreversible loss of
    functioning in the entire brain, both the higher
    centers of the cerebral cortex that are involved
    in thought and the lower centers of the brain
    that control basic life processes such as
    breathing

4
Matters of Life and Death What Is Death?
  • According to the Harvard Medical School
    definition, to be judged dead, a person must meet
    the following criteria
  • Be totally unresponsive to stimuli, including
    painful ones
  • Fail to move for 1 hour and fail to breathe for 3
    minutes after being removed from a ventilator
  • Have no reflexes (for example, no eye blink and
    no constriction of the eyes pupil in response to
    light)
  • Register a flat electroencephalogram, indicating
    an absence of electrical activity in the cortex
    of the brain
  • As an added precaution, the testing procedure is
    repeated 24 hours later

5
Matters of Life and Death What Is Death?
  • The term euthanasia refers to hastening the death
    of someone suffering from an incurable illness or
    injury
  • Euthanasia means happy or good death
  • Active euthanasia, also called mercy killing,
    is deliberately and directly causing a persons
    death (e.g., by administering a lethal dose of
    drugs to someone in the late stages of cancer)
  • Passive euthanasia means allowing a terminally
    ill person to die of natural causes (e.g., by
    withholding extraordinary life-saving treatments)

6
Matters of Life and Death Life and Death
Choices
  • Assisted suicide is another means by which death
    is hastened
  • Assisted suicide makes available to a person who
    wishes to die the means by which she may do so
    (e.g., writing a prescription for sleeping pills
    for a person with the knowledge that she likely
    will take an overdose)

7
Matters of Life and Death Life and Death
Choices
  • Medical personnel and the general public support
    passive euthanasia
  • More than 70 of U.S. adults reportedly support
    a doctors right to end the life of a patient
    with a terminal illness
  • African Americans and other minority group
    members are generally less accepting of actions
    to hasten death than European Americans

8
Matters of Life and Death Life and Death
Choices
  • In most U.S. states it is legal to withhold
    extraordinary life-extending treatments and to
    terminate life-support activities when that is
    the wish of the dying person or when the
    immediate family can show that such action would
    be consistent with the dying persons wishes
  • A living will is a form of advance directive by
    which people can
  • State that they do not want extraordinary medical
    procedures applied to them
  • Specify who should make decisions on their behalf
    if they are unable to do so
  • Direct whether organs should be donated
  • Provide other instructions for actions to be
    carried out after death

9
Matters of Life and Death Life and Death
Choices
  • In 1997, Oregon became the first state to
    legalize physician-assisted suicide
  • Terminally ill adults with 6 or fewer months to
    live can request lethal medication from a
    physician
  • Those who have utilized physician-assisted
    suicide usually had terminal cancer and believed
    that they faced only hopeless pain and suffering
    and a loss of dignity with no chance of recovery
  • Forty states have enacted laws against assisted
    suicide

10
Matters of Life and Death Life and Death
Choices
  • Death may be universal, and the tendency to react
    negatively to loss may be too
  • However, the experiences of dying individuals and
    of their survivors are shaped by the historical
    and cultural contexts in which death occurs
  • The social meanings attached to death vary widely
    from historical era to historical era and from
    culture to culture
  • Different ethnic and racial groups have different
    rules for expressing grief and different mourning
    practices

11
Matters of Life and Death What Kills Us and
When?
  • In the U.S., life expectancy at birth is almost
    78 years
  • The average number of years a newborn can be
    expected to live
  • The life expectancy for white males is almost 76
    years
  • The life expectancy for white females is almost
    81 years
  • The life expectancy for African-American males is
    70 years
  • The life expectancy for African-American females
    is 77 years

12
  • Caption Life expectancy at birth for the world
    and major areas 1950-2050

13
Matters of Life and Death What Kills Us and
When?
  • Death rates change over the lifespan
  • Infants are vulnerable, with the U.S. infant
    mortality rate standing at fewer than 7 out of
    1,000 live births
  • We have a relatively small chance of dying during
    childhood and adolescence
  • Death rates climb steeply and steadily throughout
    adulthood

14
Matters of Life and Death What Kills Us and
When?
  • The causes of death change over the lifespan
  • Infant deaths are mainly associated with birth
    complications and congenital abnormalities
  • Preschool and school-age childrens deaths are
    caused by unintentional injuries or accidents
    (especially car accidents but also poisonings,
    falls, fires, and drownings)
  • The leading killers of adolescents are accidents
    (especially car accidents), homicides, and
    suicides

15
Matters of Life and Death What Kills Us and
When?
  • The causes of death change over the lifespan
    (continued)
  • Young adults die from accidents, and cancers and
    heart diseases also begin to take a toll
  • Among the 45-to-64 age group, cancers are the
    leading cause of death, followed by heart disease
  • Among adults 65 and older, heart diseases are
    the leading cause (more than a third of all
    deaths) followed by cancers and cerebrovascular
    diseases (strokes)

16
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17
Matters of Life and Death Theories of Aging
  • Theories to explain why we age and die fall into
    two categories
  • Programmed theories
  • Emphasize the systematic genetic control of aging
  • Damage theories of aging
  • Emphasize the processes that that cause errors in
    cells to accumulate and organ systems to
    deteriorate

18
Matters of Life and Death Theories of Aging
  • Each species has its own characteristic maximum
    lifespan, or a limit on the number of years that
    a member of the species lives
  • For humans, the longest documented and verified
    life was 122 years
  • An individuals genetic makeup combined with
    environmental factors will influence how rapidly
    he ages and how long he lives compared with other
    humans
  • A fairly good way to estimate how long you will
    live is to average the longevity of your parents
    and grandparents

19
Matters of Life and Death Theories of Aging
  • Researchers have identified specific genes that
    may be implicated in the basic aging process
  • Many of these genes regulate cell division and
    become less active with age in normal adults
  • These genes are inactive in children who have
    progeria, a premature aging disorder caused by a
    spontaneous (rather than inherited) mutation in a
    single gene
  • Babies with progeria appear normal at first but
    age prematurely and die on average just as they
    are entering their teens, often of heart disease
    or stroke

20
Matters of Life and Death Theories of Aging
  • Biological researchers suggest that humans are
    programmed with an aging clock in every cell of
    our bodies
  • Hayflick (1976, 1994) discovered that cells from
    human embryos could divide only a certain number
    of times (50 times, plus or minus 10)
  • This limit is referred to as the Hayflick limit
  • Hayflick also demonstrated that cells taken from
    human adults divide even fewer times, presumably
    because they have already used up some of their
    capacity for reproducing themselves
  • The maximum lifespan of a species is related to
    the Hayflick limit for that species

21
Matters of Life and Death Theories of Aging
  • The mechanism of the cellular aging clock (as
    suggested by the Hayflick limit on cell division)
    is believed to be telomeres, the stretches of DNA
    that form the tips of chromosomes and that
    shorten with every cell division
  • The progressive shortening of telomeres
    eventually makes cells unable to replicate and
    causes them to malfunction and die
  • Thus, telomere length is a yardstick of
    biological aging
  • Chronic stress is implicated in the rate at which
    telomeres shorten
  • Chronic stress is linked to shorter than normal
    white blood cell telomeres, which in turn are
    associated with heightened risk for
    cardiovascular disease and death
  • Lack of exercise, smoking, obesity, and low
    socioeconomic status are also associated with
    short telomeres

22
Matters of Life and Death Theories of Aging
  • Other programmed theories of aging focus on
    genetically programmed changes in the
    neuroendocrine system and the immune system
  • Possibly the hypothalamus serves as an aging
    clock, systematically altering levels of hormones
    and brain chemicals in later life so that we die
  • Perhaps aging is related to genetically governed
    changes in the immune system, associated with the
    shortening of the telomeres of its cells
  • These changes could decrease the immune systems
    ability to defend against potentially
    life-threatening foreign agents such as
    infections, cause it to mistake normal cells for
    invaders (as in autoimmune diseases), and make it
    contribute to inflammation and disease

23
Matters of Life and Death Theories of Aging
  • Damage theories generally propose that death is
    caused by wear and tear, an accumulation of
    haphazard or random damage to cells and organs
    over time
  • Free radicals (toxic and chemically unstable
    byproducts of metabolism) damage cells and
    compromise their functioning
  • Free radicals are produced when oxygen reacts
    with certain molecules in the cells
  • There is an extra, or free, electron that
    reacts with other molecules in the body to
    produce substances that damage normal cells,
    including their DNA
  • Over time, the genetic code contained in the DNA
    of more and more cells becomes scrambled, and the
    bodys mechanisms for repairing such genetic
    damage simply cannot keep up with the chaos
  • More cells then function improperly or cease to
    function, and the organism eventually dies

24
Matters of Life and Death Theories of Aging
  • Age spots on the skin of older people are a
    visible sign of the damage free radicals can
    cause
  • Free radicals have also been implicated in some
    of the major diseases that become more common
    with age, most notably, cardiovascular diseases,
    cancer, and Alzheimers disease
  • The most concerning effect of free radicals is
    damage to DNA because the result is more
    defective cells replicating themselves

25
Matters of Life and Death Theories of Aging
  • Research on the basic causes of aging and death
    may lead to methods for increasing longevity
  • Stem cell researchers may discover ways to
    replace aging cells or modify aging processes
  • Researchers have also established that the enzyme
    telomerase can be used to prevent the telomeres
    from shortening and thus keep cells replicating
    and working longer
  • However, telomerase treatments could go awry if
    they also make cancerous cells multiply more
    rapidly

26
Matters of Life and Death Theories of Aging
  • Research on the basic causes of aging and death
    may lead to methods for increasing longevity
    (continued)
  • Some researchers are focusing on preventing the
    damage caused by free radicals
  • Antioxidants such as vitamins E and C (or foods
    high in them such as raisins, spinach, and
    blueberries) may increase longevity by inhibiting
    free radical activity and in turn helping prevent
    age-related diseases

27
Matters of Life and Death Theories of Aging
  • Research on the basic causes of aging and death
    may lead to methods for increasing longevity
    (continued)
  • At present, the most successful life-extension
    technique is caloric restriction, a highly
    nutritious but severely restricted diet
    representing a 30-40 or more cut in normal total
    caloric intake
  • Laboratory studies involving rats and primates
    suggest that caloric restriction extends both the
    average longevity and the maximum lifespan of a
    species and that it delays or slows the
    progression of many age-related diseases
  • Caloric restriction reduces the number of free
    radicals and other toxic products of metabolism

28
Learning Objectives
  • What are Kübler-Rosss stages of dying?
  • How valid and useful is the theory?
  • What is the Parkes/Bowlby attachment model of
    bereavement?
  • Is there evidence to support this model?
  • What is the dual-process model of bereavement?
  • Is there evidence to support this model?

29
The Experience of Death Perspectives on Dying
  • Psychiatrist Elizabeth Kübler-Ross (1969, 1974)
    interviewed terminally ill patients and
    identified a common set of emotional responses to
    the knowledge that one has a serious, and
    probably fatal, illness
  • Kübler-Rosss stages of dying called attention
    to the emotional needs and reactions of dying
    people

30
The Experience of Death Perspectives on Dying
  • Kübler-Rosss stages of dying are as follows
  • Denial and isolation
  • Anger
  • Bargaining
  • Depression
  • Acceptance

31
The Experience of Death Perspectives on Dying
  • Kübler-Rosss theory has been criticized
  • Dying is not stagelike
  • The nature and course of an illness affects
    reactions to it
  • Individuals differ widely in their emotional
    responses to dying
  • Personality traits, coping styles, and social
    competencies vary and influence the experience of
    dying

32
The Experience of Death Perspectives on
Bereavement
  • Responses to the death of a loved one may be
    differentiated
  • Bereavement is a state of loss
  • Grief is an emotional response to loss
  • Mourning is a culturally prescribed way of
    displaying reactions to death

33
The Experience of Death Perspectives on
Bereavement
  • Relatives and friends also experience painful
    emotions before the death
  • They may experience anticipatory grief, grieving
    before death occurs for what is happening and for
    what lies ahead
  • Anticipatory grief can lessen later distress and
    improve outcomes of bereavement if it involves
    accepting the coming loss
  • However, no amount of preparation and
    anticipatory grief can entirely eliminate the
    need to grieve after the death occurs

34
The Experience of Death Perspectives on
Bereavement
  • The Parkes/Bowlby attachment model of bereavement
    describes four predominant reactions to loss
  • Numbness
  • A sense of unreality and disbelief
  • Yearning
  • Severe pangs of grief, feelings of panic, bouts
    of uncontrolled weeping, physical pain
  • Disorganization and despair
  • Depression, despair, and apathy predominate.
  • Reorganization
  • Feel ready for new activities.
  • Identity is revised

35
The Experience of Death Perspectives on
Bereavement
  • The process of grieving normally takes a year or
    more for widows and widowers but can take much
    longer

36
  • Caption Peak times for different grief reactions
    in the Parkes-Bowlby phase model of grief in a
    sample of adults whose loved ones died of natural
    causes

37
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38
The Experience of Death Perspectives on
Bereavement
  • Stroebe and Schut (1999) have suggested a
    dual-process model of bereavement in which the
    bereaved move between coping with the emotional
    blow of the loss and coping with the practical
    challenges of living, revising their identities,
    and reorganizing their lives
  • Loss-oriented coping involves dealing with ones
    emotions and reconciling oneself to the loss
  • Restoration-oriented coping is focused on
    managing daily living and mastering new roles and
    challenges

39
The Experience of Death Perspectives on
Bereavement
  • Stroebe and Schut (1999) have suggested a
    dual-process model of bereavement (continued)
  • Both processes in the dual-process model can
    involve positive and negative emotions (happy
    memories, painful memories)
  • Over time, the emphasis shifts from loss-oriented
    to restoration-oriented coping
  • As less time and energy need to be devoted to
    coping with grief, the balance of positive and
    negative emotions shifts in a positive direction

40
  • Caption The dual-process model of coping and
    bereavement

41
Learning Objective
  • What is the infants understanding of separation
    and death?

42
The Infant
  • Infants lack the concept of death as permanent
    separation or loss and lack the cognitive
    capacity to interpret what has happened
  • However, infants develop an understanding of
    concepts that pave the way for an understanding
    of death
  • Possibly, infants first form a global category of
    things that are all gone and later divide it
    into subcategories, one of which is dead

43
The Infant
  • Attachment theory provides a means for
    understanding infants reactions to loss of an
    attachment figure
  • Infants first engage in vigorous protest,
    yearning and searching for the loved one and
    expressing outrage when they fail
  • When an infant has not succeeded in finding the
    loved one, he begins to despair, displaying
    depression-like symptoms
  • The baby loses hope, ends the search, and becomes
    apathetic and sad
  • Grief may be reflected in a poor appetite, a
    change in sleeping patterns, excessive
    clinginess, or regression to less mature behavior

44
The Infant
  • Attachment theory provides a means for
    understanding infants reactions to loss of an
    attachment figure (continued)
  • Then the bereaved infant enters a detachment
    phase, in which he takes renewed interest in toys
    and companions and may begin to seek new
    relationships
  • Infants will recover from the loss of an
    attachment figure most completely if they can
    rely on an existing attachment figure (for
    example, the surviving parent) or have the
    opportunity to attach themselves to someone new

45
Learning Objectives
  • How do childrens conception of death compare to
    a mature understanding of death?
  • What factors might influence a childs
    understanding of death?
  • What is a dying childs understanding of death?
  • How do dying children cope with the prospect of
    their own death? How do children grieve?

46
(No Transcript)
47
The Child Grasping the Concept of Death
  • Children between age 3 and age 5 have limited
    understanding of death, especially its
    universality
  • They may believed the dead live under altered
    circumstances and retain some capacities
    (experience hunger, continue to love)
  • They may see death as reversible (as sleep, as a
    trip, or something that can be remedied with
    medical care)
  • They may think death is caused by an external
    agent

48
The Child Grasping the Concept of Death
  • Most children between age 5 and 7 understand that
    death is characterized by finality (cessation of
    life functions), irreversibility, and
    universality
  • By age 10, children understand the biological
    causality of death
  • The hardest concept of death for children to grasp

49
The Child Grasping the Concept of Death
  • Childrens concepts of death are influenced by
    the cultural context in which they live, their
    life experiences, and the specific cultural and
    religious beliefs to which they are exposed
  • A mature understanding of death is correlated
    with IQ

50
The Child Grasping the Concept of Death
  • To help children understand death, experts
    suggest that parents
  • Avoid the use of euphemisms to explain death
    (asleep or gone away)
  • Give simple, honest answers to childrens
    questions
  • Take advantage of opportunities (such as death of
    a pet) to teach children about death and express
    their emotions

51
The Child Grasping the Concept of Death
  • Research reveals that dying children are more
    aware of what is happening to them than adults
    realize
  • Dying children experience many of the emotions
    that dying adults experience
  • Preschool children may reveal their fears by
    having temper tantrums or portraying violent acts
    in their pretend play
  • School-age children understand more about their
    situation and can talk about their feelings if
    given an opportunity to do so
  • They may want to maintain a sense of normalcy and
    control in their lives
  • Terminally ill children particularly benefit from
    a strong sense that their parents are there to
    care for them

52
The Child The Bereaved Child
  • Four important messages have emerged from studies
    of bereaved children
  • Children grieve
  • Children may display cycles of intense distress,
    emotional withdrawal, anger, and emotional
    detachment (Lieberman, 2003)

53
The Child The Bereaved Child
  • Four important messages have emerged from studies
    of bereaved children (continued)
  • Children express their grief differently than
    adults do
  • Preschoolers are likely to manifest it in
    problems with sleeping, eating, toileting, and
    other routines
  • Negative moods, dependency, and temper tantrums
    are also common
  • Older children express their sadness, anger, and
    fear more directly, although somatic symptoms
    such as headaches and other physical ailments are
    also common

54
The Child The Bereaved Child
  • Four important messages have emerged from studies
    of bereaved children (continued)
  • Children lack some of the coping resources that
    adults possess
  • Children primarily have behavioral or action
    coping strategies at their disposal

55
The Child The Bereaved Child
  • Four important messages have emerged from studies
    of bereaved children (continued)
  • Children are vulnerable to long-term negative
    effects of bereavement
  • Well beyond the first year after the death, some
    bereaved children continue to display problems
    such as unhappiness, low self-esteem, social
    withdrawal, difficulty in school, and problem
    behavior
  • Some children develop psychological problems that
    carry into adulthood, such as overreactivity to
    stress and stress-related health problems,
    depression and other psychological disorders, or
    insecurity in later attachment relationships

56
The Child The Bereaved Child
  • Most bereaved children, especially those who have
    effective coping skills and solid social support,
    adapt quite well
  • They are especially likely to fare well
  • If they receive good parenting
  • If caregivers communicate that they will be loved
    and cared for
  • If they have opportunities to talk about and
    share their grief.
  • Bereavement with the help of a caring and
    supportive caregiver is associated with adaptive
    responses to stress in adulthood
  • Bereaved children who perceive a lack of caring
    support after the death may have difficulty
    handling stress later in life

57
Learning Objectives
  • What is the adolescents understanding of death?
  • Is an adolescents reaction to death different
    from the reactions of a child or adult?

58
The Adolescent
  • Adolescents understand that death means the
    irreversible cessation of biological processes
  • Adolescents are able to think in more abstract
    ways about death as they move from Piagets
    concrete-operational stage to formal-operational
    thinking
  • Can think about the meaning of death and
    hypothetical ideas (e.g., the existence of an
    afterlife)

59
The Adolescent
  • The themes of adolescence are likely to be
    reflected in the concerns of adolescents who
    become terminally ill
  • Body image
  • Acceptance by peers
  • Autonomy versus necessary dependency upon parents
    and medical personnel
  • Identity and the future

60
The Adolescent
  • Adolescents reactions to the deaths of family
    members and friends reflect the themes of the
    adolescent period
  • While still dependent on their parents for
    emotional support and guidance, adolescents who
    lose a parent to death may carry on an internal
    dialogue with the dead parent for years
  • Adolescents are often devastated when a close
    friend dies, but this grief may not be taken
    seriously by others

61
The Adolescent
  • Adolescents grieve as adults do
  • However, teens may be reluctant to express their
    grief for fear of seeming abnormal or losing
    control and it may instead manifest in delinquent
    behavior or somatic ailments

62
Learning Objectives
  • How do family members react and cope with the
    loss of a spouse, a child, and a parent?
  • What factors contribute to effective and
    ineffective coping with grief?
  • What can be done for those who are dying and for
    those who are bereaved to better understand and
    face the reality of death?

63
The Adult Death in the Family Context
  • Experiencing the death of a spouse or partner
    becomes increasingly likely as we age
  • The death of a partner means the loss of an
    attachment figure and often precipitates other
    changes such as the need to move, enter the labor
    force or change jobs, etc.
  • Bereaved partners must redefine their roles,
    identities, and basic assumptions about life

64
The Adult Death in the Family Context
  • Research on widows and widowers younger than age
    45 concluded that bereaved adults progress
    through overlapping phases of numbness, yearning,
    disorganization and despair, and reorganization
  • The grieving process affects physical, emotional,
    and cognitive functioning
  • Widows and widowers are at risk for illness and
    physical symptoms such as loss of appetite and
    sleep disruption
  • They tend to overindulge in alcohol,
    tranquilizers, and cigarettes

65
The Adult Death in the Family Context
  • The grieving process affects physical, emotional,
    and cognitive functioning (continued)
  • Cognitive functions such as memory and
    decision-making are often impaired
  • Emotional problems such as loneliness and anxiety
    are common
  • Most bereaved partners do not become clinically
    depressed, but many display increased symptoms of
    depression in the year after the death
  • Widows and widowers as a group have
    higher-than-average rates of death

66
  • Caption Depression symptom scores of five
    subgroups of elderly widows and widowers an
    average of 3 years before, 6 months after, and 18
    months after the death of their spouse

67
The Adult Death in the Family Context
  • Bonanno and colleagues (2008) identified the five
    most prevalent patterns of adjustment shown by
    widows and widowers
  • A resilient pattern in which distress is at low
    levels all along
  • The most common pattern, characterizing almost
    half the study sample
  • Well-adjusted, happily married people with good
    coping resources
  • Common grief, with heightened, then diminishing,
    distress after the loss

68
The Adult Death in the Family Context
  • Bonanno and colleagues (2008) identified the five
    most prevalent patterns of adjustment shown by
    widows and widowers (continued)
  • Chronic grief in which loss brings distress and
    the distress lingers
  • Chronic depression in which individuals who were
    depressed before the loss remain so after it
  • A depressed-improved pattern in which individuals
    who were depressed before the loss become less
    depressed after the death

69
The Adult Death in the Family Context
  • Bonanno and colleagues (2005) studied the
    bereavement patterns of partners of gay men who
    died of AIDS
  • About half demonstrated the resilient pattern of
    coping in which distress is at low levels all
    along

70
The Adult Death in the Family Context
  • Gay and lesbian partners sometimes experience
    disenfranchised grief
  • Grief that is not fully recognized or appreciated
    by other people and therefore may not receive
    much sympathy and support
  • Generally likely to be harder to cope with than
    socially recognized grief

71
The Adult Death in the Family Context
  • Disenfranchised grief is likely when
  • The relationship is not recognized (as when a gay
    relationship is in the closet)
  • The loss is not acknowledged (as when the loss of
    a pet is not viewed as a real loss)
  • The bereaved person is excluded from mourning
    activities (as happens sometimes to young
    children and cognitively impaired elders)
  • The cause of death is stigmatized (as in suicides
    or drug overdoses)

72
The Adult Death in the Family Context
  • Complicated grief is grief that is unusually
    prolonged or intense and that impairs
    functioning.
  • Occurs in a minority of cases, up to about 15
  • Continues for many years

73
The Adult Death in the Family Context
  • No loss seems more difficult for an adult than
    the death of a child
  • Being unable to make sense of a childs death is
    associated with more intense grief

74
The Adult Death in the Family Context
  • The death of a child alters the family system
  • The marital relationship is likely to be strained
    because each partner grieves in a unique way and
    one may not be able to provide emotional support
    for the other
  • Strains are likely to be especially severe if the
    marriage was shaky before the childs death
  • The odds of marital problems and divorce tend to
    increase after the death of a child
  • However, most couples stay together and some feel
    closer than ever

75
The Adult Death in the Family Context
  • The death of a child alters the family system
    (continued)
  • Children are deeply affected when a brother or
    sister dies, but their grief is often not fully
    appreciated
  • Their distraught parents may not be able to
    support them effectively
  • Grandparents grieve following the death of a
    child, both for their grandchild and for their
    child, the bereaved parent
  • Grandparents may also experience disenfranchised
    grief, ignored while all the supportive attention
    focuses on the parents

76
The Adult Death in the Family Context
  • Adjusting to the death of a parent is usually not
    as difficult as adjusting to the death of a
    romantic partner or child
  • The death of a parent is a normative life
    transition that we expect and that most of us
    dont face until middle age

77
The Adult Death in the Family Context
  • Loss of a parent can be a turning point in an
    adults life with effects on his identity and
    relationships with his partner, children (who are
    grieving the loss of their grandparent),
    surviving parent, and siblings
  • Adult children may feel vulnerable and alone in
    the world when their parents no longer stand
    between them and death
  • Guilt about not doing enough for the parent who
    died is common
  • Compared with adults who are not bereaved, adults
    who have lost a parent in the past 3 years have
    higher rates of psychological distress, alcohol
    use, and health problems

78
The Adult Challenges to the Grief-Work
Perspective
  • Research on bereavement has been guided by the
    grief-work perspective, the view that to cope
    adaptively with death, bereaved people must
    confront their loss, experience painful emotions,
    work through those emotions, and move toward a
    detachment from the deceased
  • This view is widely held in our society by
    therapists and people in general
  • The grief-work perspective influences what we
    view as an abnormal reaction to death

79
The Adult Challenges to the Grief-Work
Perspective
  • Recently the grief-work perspective has been
    challenged
  • Cross-cultural studies reveal that there are many
    ways to grieve and suggest that the grief-work
    model of bereavement may be culturally biased
  • There is little research support for the
    assumption that bereaved individuals must
    confront their loss and experience painful
    emotions to cope successfully

80
The Adult Challenges to the Grief-Work
Perspective
  • The grief-work perspective has been challenged
    (continued)
  • The view that we must break our bonds to the
    deceased to overcome our grief is under attack
  • Bowlby (1980) observed that many bereaved
    individuals revise their internal working models
    of self and others and continue their
    relationships with their deceased loved ones on
    new terms
  • Recent research supports Bowlbys observations
    and suggests that many bereaved individuals
    maintain their attachments to the deceased
    indefinitely through continuing bonds
  • They reminisce and share memories of the
    deceased, derive comfort from the deceaseds
    possessions, consult with the deceased and feel
    his or her presence, seek to make the deceased
    proud of them, etc.

81
The Adult Challenges to the Grief-Work
Perspective
  • The grief-work perspective has been challenged
    (continued)
  • Many individuals who continue their bonds benefit
    from the continuing, but redefined, attachment
  • Other research found that, for some people,
    continuing bonds was a sign of continued yearning
    and prolonged or complicated grief
  • When the bonds involved hallucinations and
    illusions that reflected a continuing effort to
    reunite with the deceased

82
The Adult Who Copes and Who Succumbs?
  • Researchers have attempted to determine what risk
    and protective factors distinguish people who
    cope well with loss from people who cope poorly
  • Coping with bereavement is influenced by
  • The individuals personal resources
  • The nature of the loss
  • The surrounding context of support and stressors

83
The Adult Who Copes and Who Succumbs?
  • Coping with bereavement is influenced by the
    individuals personal resources (continued)
  • Attachment style can be an important resource or
    it can be a liability
  • Having a secure attachment style is associated
    with coping relatively well with the death of a
    loved one
  • Individuals who developed a resistant, avoidant,
    or disorganized attachment style do not cope well
    with loss

84
The Adult Who Copes and Who Succumbs?
  • Coping with bereavement is influenced by the
    individuals personal resources (continued)
  • Personality and coping style are personal
    resources that influence how successfully people
    cope with death
  • Individuals who have difficulty coping tend to
    have low self-esteem and lack a sense that they
    are in control of their lives
  • Many also rely on ineffective coping strategies
    such as denial and escape through alcohol and
    drugs
  • People who are optimistic, find positive ways of
    interpreting their loss, and use active coping
    strategies experience less intense grief
    reactions and are more likely to report personal
    growth after their losses than other bereaved
    adults

85
The Adult Who Copes and Who Succumbs?
  • Coping with bereavement is influenced by the
    nature of the loss
  • The closeness of the persons relationship to the
    deceased is a key factor
  • The cause of death can also influence bereavement
    outcomes
  • Childrens deaths may be painful because they are
    often the result of senseless and violent
    events such as car accidents, homicides, and
    suicide
  • However, sudden deaths are not necessarily harder
    to cope with overall than expected deaths from
    illnesses
  • Possibly because any advantages of being
    forewarned of death are offset by the stresses of
    caring for a dying loved one

86
The Adult Who Copes and Who Succumbs?
  • Coping with bereavement is influenced by the
    surrounding context of support and stressors
  • Grief reactions are influenced positively by the
    presence of a strong social support system
  • Good parenting is especially important for the
    child or adolescent whose parent dies
  • Family members of all ages recover best when the
    family is cohesive and family members can share
    their emotions
  • Friends and colleagues can provide social support
  • Grief reactions are negatively by additional life
    stressors
  • It is particularly difficult when stressors
    demand what the dual-process model of bereavement
    calls restoration-oriented coping
  • Require energy and resources

87
The Adult Bereavement and Human Development
  • Scholars are finding that bereavement can have
    positive consequences and sometimes foster
    personal growth
  • Many bereaved individuals believe that they have
    become stronger, wiser, more loving, and more
    religious people with a greater appreciation of
    life
  • Many widows master new skills, become more
    independent, and emerge with new identities and
    higher self-esteem, especially those who depended
    heavily on their spouses and then discover that
    they can manage life on their own

88
Taking the Sting Out of Death For the Dying
  • The care of dying people has improved in the past
    few decades
  • Palliative care is aimed at meeting the physical,
    psychological, and spiritual needs of patients
    with incurable illnesses, not at curing disease
    or prolonging life
  • Hospice is a form of palliative care that
    supports dying people and their families through
    a philosophy of caring rather than curing

89
Taking the Sting Out of Death For the Dying
  • Hospice care includes the following features
  • The dying person and his family decide what
    support they need and want
  • Attempts to cure the patient or prolong his life
    are deemphasized (death is not hastened)
  • Pain control is emphasized
  • The setting for care is as normal as possible
    (preferably the patients own home or a homelike
    facility that does not have the sterile
    atmosphere of many hospital wards)
  • Bereavement counseling is provided to the family
    before and after the death

90
Taking the Sting Out of Death - For the Dying
  • An evaluation that compared hospice facility
    care, at-home hospice care, and conventional
    hospital care in Great Britain found that hospice
    patients spent more of their last days without
    pain, underwent fewer medical interventions and
    operations, and received nursing care that was
    more oriented to their emotional needs.
  • Spouses and partners, parents, and other
    relatives of dying people who received hospice
    care appear to display fewer symptoms of grief
    and have a greater sense of well-being 1 to 2
    years after the death compared to similar
    relatives who coped with a death without benefit
    of hospice care.

91
Taking the Sting Out of Death For the Bereaved
  • Most bereaved individuals deal with death as a
    normal life transition on their own and with
    support from significant others
  • However, there are many treatment options
    intended to prevent problems before they arise
    and interventions designed to treat serious
    psychological disorders precipitated by a loss
  • Bereaved individuals at risk for complicated
    grief or depression can benefit from therapy or
    counseling aimed at preventing or treating
    debilitating grief

92
Taking the Sting Out of Death For the Bereaved
  • Because death takes place in a family context,
    family therapy can help bereaved parents and
    children communicate more openly and support one
    another
  • Family therapy also can help parents deal with
    their own emotional issues so that they can
    provide the warm and supportive parenting that
    can be so critical in facilitating their
    childrens recovery

93
Learning Objective
  • What are the major themes of lifespan development
    that have been covered throughout the text?

94
Major Developmental Themes
  • Nature and nurture truly interact in development
  • We are whole people throughout the lifespan
  • The developmental domains are interrelated
  • Development proceeds in multiple directions with
    both continuity and discontinuity
  • There is much plasticity in development

95
Major Developmental Themes
  • We are diverse individuals and become even more
    so as we age
  • We develop in a cultural and historical context
  • We are active in our own development
  • Development is a lifelong process
  • Development is best viewed from multiple
    perspectives
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