Transcript CHAPTER 17 THE FINAL CHALLENGE: DEATH AND DYING Learning Objectives • How is death defined? • Why is the definition of death controversial? • How.

CHAPTER 17
THE FINAL CHALLENGE:
DEATH AND DYING
Learning Objectives
• How is death defined?
• Why is the definition of death controversial?
• How does the social meaning of death vary
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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.
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
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 eye’s 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
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 person’s
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)
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)
Matters of Life and Death –
Life and Death Choices
• Medical personnel and the general public
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support passive euthanasia
More than 70% of U.S. adults reportedly
support a doctor’s 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
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Matters of Life and Death –
Life and Death Choices
In most U.S. states it is legal to withhold extraordinary lifeextending 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 person’s 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
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•
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
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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
•
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
• Caption: Life expectancy at birth for the world
and major areas 1950-2050
•
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
•
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 children’s
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
•
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)
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
Matters of Life and Death –
Theories of Aging
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•
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 individual’s 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
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
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
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
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 system’s
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
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 body’s 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
Matters of Life and Death –
Theories of Aging
• “Age spots” on the skin of older people are a
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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
Alzheimer’s disease
The most concerning effect of free radicals is
damage to DNA because the result is more
defective cells replicating themselves
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
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
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
Learning Objectives
• What are Kübler-Ross’s stages of dying?
• How valid and useful is the theory?
• What is the Parkes/Bowlby attachment model
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of bereavement?
Is there evidence to support this model?
What is the dual-process model of
bereavement?
Is there evidence to support this model?
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-Ross’s “stages of dying” called
attention to the emotional needs and
reactions of dying people
The Experience of Death – Perspectives on Dying
• Kübler-Ross’s “stages of dying” are as follows
1.
2.
3.
4.
5.
Denial and isolation
Anger
Bargaining
Depression
Acceptance
The Experience of Death – Perspectives on Dying
• Kübler-Ross’s 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
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
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
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
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
• 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
The Experience of Death –
Perspectives on Bereavement
•
Stroebe and Schut (1999) have suggested a dualprocess 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
one’s emotions and reconciling oneself to the
loss
– Restoration-oriented coping is focused on
managing daily living and mastering new roles
and challenges
The Experience of Death –
Perspectives on Bereavement
•
Stroebe and Schut (1999) have suggested a dualprocess 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 lossoriented 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
• Caption: The dual-process model of coping
and bereavement
Learning Objective
• What is the infant’s understanding of
separation and death?
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”
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
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
Learning Objectives
• How do children’s conception of death
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compare to a “mature” understanding of
death?
What factors might influence a child’s
understanding of death?
What is a dying child’s understanding of
death?
How do dying children cope with the prospect
of their own death? How do children grieve?
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
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
The Child – Grasping the Concept of Death
• Children’s 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
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 children’s
questions
– Take advantage of opportunities (such as
death of a pet) to teach children about death
and express their emotions
The Child – Grasping the Concept of Death
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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
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)
•
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
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
•
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 selfesteem, 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
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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
Learning Objectives
• What is the adolescent’s understanding of
•
death?
Is an adolescent’s reaction to death different
from the reactions of a child or adult?
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 Piaget’s
concrete-operational stage to formaloperational thinking
– Can think about the meaning of death and
hypothetical ideas (e.g., the existence of
an afterlife)
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
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
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
Learning Objectives
• How do family members react and cope with
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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?
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
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
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
•
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
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
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
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
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
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)
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
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 child’s death
is associated with more intense grief
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 child’s
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
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
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
don’t face until middle age
The Adult – Death in the Family Context
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•
Loss of a parent can be a turning point in an
adult’s 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
•
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
•
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
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 Bowlby’s 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 deceased’s
possessions, consult with the deceased and
feel his or her presence, seek to make the
deceased proud of them, etc.
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
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 individual’s personal resources
– The nature of the loss
– The surrounding context of support and
stressors
The Adult –
Who Copes and Who Succumbs?
• Coping with bereavement is influenced by the
individual’s 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
The Adult –
Who Copes and Who Succumbs?
•
Coping with bereavement is influenced by the
individual’s 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
The Adult –
Who Copes and Who Succumbs?
•
Coping with bereavement is influenced by the nature of
the loss
– The closeness of the person’s relationship to the
deceased is a key factor
– The cause of death can also influence bereavement
outcomes
• Children’s 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
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
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
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”
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 patient’s 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
Taking the Sting Out of Death For the Dying
•
•
An evaluation that compared hospice facility care, athome 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.
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
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 children’s recovery
Learning Objective
• What are the major themes of lifespan
development that have been covered
throughout the text?
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
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