Tâm lý học - Chapter 20: Death, dying, and grieving

Life-Span DevelopmentThirteenth EditionChapter 20: Death, Dying, and Grieving©2011 The McGraw-Hill Companies, Inc. All rights reserved 1The Death System and Its Cultural VariationsComponents comprising the death system:PeoplePlaces or contextsTimesObjectsSymbolsThe Death System and Cultural Contexts2The Death System and Its Cultural VariationsCultural variations in the death systemAncient Greeks – to live a full life and die with gloryMost societies have a ritual that deals with deathIn most societies, death is not viewed as the end of existence as the spiritual body is believed to live onThe Death System and Cultural Contexts3Changing Historical Circumstances:The age group in which death most often occurs, most often among older adultsLife expectancy has increased from 47 years for a person born in 1900 to 78 years for someone born todayLocation of death; 80% of deaths in the U.S. today occur in institutions or hospitalsThe Death System and Cultural Contexts4Issues in Determining DeathBrain Death: a person is brain dead when all electrical activity of the brain has ceased for a specified period of timeA flat EEGIncludes both the higher cortical functions and the lower brain-stem functionsDefining Death and Life/Death Issues5Decisions Regarding Life, Death, and Health CareNatural Death Act and Advance DirectiveLiving Will is designed to be filled in while the individual can still think clearlyAdvance directive: states that life-sustaining procedures shall not be used to prolong their lives when death is imminentDefining Death and Life/Death Issues6Decisions Regarding Life, Death, and Health CareEuthanasia: the act of painlessly ending the lives of individuals who are suffering from an incurable disease or severe disabilityPassive euthanasia: treatment is withheldActive euthanasia: death deliberately inducedRecent cases: Terri Schiavo and Jack KevorkianDefining Death and Life/Death Issues7Decisions Regarding Life, Death, and Health CareNeeded: Better Care for Dying IndividualsDeath in America is often lonely, prolonged, and painfulA “good death” involves physical comfort, support from loved ones, acceptance, and appropriate medical careDefining Death and Life/Death Issues8Decisions Regarding Life, Death, and Health CareFail-safe measures for avoiding pain at the end of lifeMake a living willGive someone power of attorneyGive doctors specific instructions such as “Do not resuscitate” or “Do everything possible”Discuss with the family whether or not you want to die at homeCheck insurance to see if it covers home care or hospice careDefining Death and Life/Death Issues9Decisions Regarding Life, Death, and Health CareHospice: a program committed to making the end of life as free from pain, anxiety, and depression as possibleEmphasizes palliative care: reducing pain and suffering, helping individuals die with dignity90% of hospice care is in patients’ homesDefining Death and Life/Death Issues10Causes of DeathCauses of death vary across the life span:Prenatal death through miscarriageSIDS is the leading cause of infant death in the U.S.Accidents or illness cause most childhood deathsMost adolescent and young adult deaths result from suicide, homicide, or motor vehicle accidentsMiddle-age and older adult deaths usually result from chronic diseasesA Developmental Perspective On Death11Attitudes Toward Death at Different Points in the Life SpanChildhoodYoung children believe the dead can be brought back to lifeAround 9 years of age, children view death as universal and irreversibleHonesty is the best strategy in discussing death with childrenA Developmental Perspective On Death12Attitudes Toward Death at Different Points in the Life SpanAdolescenceDeath regarded as remote and may be avoided, glossed over, or kidded about.Death of friends, siblings, parents, or grandparents bring death to the forefront of adolescents’ livesDevelop more abstract conceptions about death than childrenA Developmental Perspective On Death13Attitudes Toward Death at Different Points in the Life SpanAdulthoodMiddle-aged adults actually fear death more than young adultsOlder adults are forced to examine the meanings of life and death more frequently than younger adultsA Developmental Perspective On Death14Knowledge of death’s inevitability permits us to establish priorities and structure our timeThree areas of concern:Privacy and autonomy in regard to their familiesInadequate information about physical changes and medication as death approachedMotivation to shorten their lifeFacing One’s Own Death15Kübler-Ross’ Stages of Dying:Denial and Isolation: “It can’t be!”Anger: “Why me?”Bargaining: “Just let me do this first!”Depression: withdrawal, crying, and grievingAcceptance: a sense of peace comesFacing One’s Own Death16Facing One’s Own DeathKübler-Ross’ Stages of Dying17Perceived Control and DenialPerceived control may be an adaptive strategy for remaining alert and cheerfulDenial insulates and allows one to avoid coping with intense feelings of anger and hurtCan be maladaptive depending on extentFacing One’s Own Death18The Contexts in Which People Die More than 50% of Americans die in hospitals and nearly 20% die in nursing homesHospitals offer many important advantages:Professional staff membersTechnology may prolong lifeFacing One’s Own Death19Communicating with a Dying PersonOpen communication with a dying person is very important because:They can close their lives in accord with their own ideas about proper dyingThey may be able to complete plans and projects, and make arrangements and decisionsThey have the opportunity to reminisce and converse with othersThey have more understanding of what is happening to themCoping With The Death Of Someone Else20Grieving Dimensions of GrievingGrief: emotional numbness, disbelief, separation anxiety, despair, sadness, and loneliness that accompany the loss of someone we lovePining or yearning reflects an intermittent, recurrent wish or need o recover the lost personCognitive factors are involved in the severity of griefCoping With The Death Of Someone Else21Grieving Good family communications can help reduce the incidence of depression and suicidal thoughtsProlonged Grief: difficulty moving on with their lifeDisenfranchised Grief: an individual’s grief involving a deceased person that is a socially ambiguous loss that can’t be openly mourned or supportedExamples: ex-spouse, abortion, stigmatized death (such as AIDS)Coping With The Death Of Someone Else22GrievingDual-Process Model of Coping and BereavementTwo Main DimensionsLoss-oriented stressors: focus on the deceased individualRestoration-oriented stressors: secondary stressors that emerge as indirect outcomes of bereavementEffective coping involves oscillation between coping with loss and coping with restorationCoping With The Death Of Someone Else23GrievingCoping and Type of DeathImpact of death on surviving individuals is strongly influenced by the circumstances under which the death occursSudden deaths are likely to have more intense and prolonged effects on surviving individualsCoping With The Death Of Someone Else24GrievingCultural Diversity in Healthy GrievingSome cultures emphasize the importance of breaking bonds with the deceased and returning quickly to autonomous lifestylesNon-Western cultures suggest that beliefs about continuing bonds with the deceased vary extensivelyThere is no one right, ideal way to grieveCoping With The Death Of Someone Else25Making Sense of the WorldGrieving often stimulates individuals to try to make sense of their worldA reliving of the events leading to the death is commonWhen a death is caused by an accident or a disaster, the effort to make sense of it is often pursued more vigorouslyCoping With The Death Of Someone Else26Losing a Life Partner The death of an intimate partner often brings profound griefWidows outnumber widowers because women live longer than menWidowed women are probably the poorest group in AmericaMany widows are lonelyCoping With The Death Of Someone Else27Forms of Mourning Approximately two-thirds are buried and one-third are crematedFunerals are an important aspect of mourning in many culturesCultures vary in how they practice mourningCoping With The Death Of Someone Else28