Week 13 (Adult Development, Death and Dying)

Dying

Process — Prior to death. Vary in duration. Experience is different.

Death

End of life. Event. Irreversible cessation of all function of the brain (brain death) or irreversible cessation of circulation of blood (circulatory death).

Bereavement

the state of having been deprived of someone of value through death. Experience of the people who remain living.

Grief

Range of responses or reactions to loss. Internal. Emotional state/reaction.

Mourning

Displays affected by cultural and public norms. Expression of grief. Public display.

Age distribution of death has changed across history - Data

1907 26% of deaths were among young children (0-4) vs 0.6% in 2023.

Median Age at death in Australia (M and F) AIHW, 2023

• 80 for males

• 85 for females

The age has increased over time, however, the difference between M and F has not changed.

Speaking broadly, what is the leading underlying cause of death in Australia? (AIHW, 2023)

Chronic health diseases.

Death understanding: The stages

Sequential between age 5-10

1. Irreversibility

2. Universality/Applicability

3. Inevitability

4. Non-functionality

5. Causality

1. Irreversibility

Cannot come back to life. Death is permanent. — Age: 5-6 years

2. Universality or Applicability

Death only happens to living things (plants, animals, humans) — Age: 7-9 years.

3. Inevitability

All living things will die eventually. — Age: 7-9 years.

4. Non-functionality

Bodily functions cease to exist/work/function (e.g.,speech, thinking, hearing)

(?confounded by religion) — Age: 7-9 years.

5. Causality

Internal (illnesses) and external (car crash) factors that can cause death — Age: By 10 years.

Fear of Death

By age 7 and throughout adolescence, death is the most common fear on the Fear Survey Schedule for Children (FSSC-R; Ollendick, 1983)

Terror Management Theory (TMT) (BECKER, 1973)

Motivation to live VERSUS Inevitability of death

= Existential Terror

Psychological Mechanisms that protect against Existential Terror

1. Belief in cultural worldviews

• gain literal (e.g., afterlife) or symbolic (legacy) immortality by ascribing to beliefs

2. Self-esteem

• Sense of personal value that is created by living up to the cultural standards created by that worldview

3. Close interpersonal relationships

• Feeling securely attached to others provides a sense of symbolic continuity

• Provide validation of one’s worldviews and self-esteem needed to maintain confidence in them

Kubler-Ross Stages of psychological reaction to dying

1. Denial and isolation

2. Anger

3. Bargaining

4. Depression

5. Acceptance

Kubler-Ross Stages of psychological reaction to dying — CRITIQUE

• (Never intended to imply) Prescriptive linear stages with goal of acceptance

• (Never intended to imply) Ubiquity

• Different illness courses

A good death — ZAMAN ET AL., (2021) LANCET HEALTHY LONGEVITY

1. relief from physical pain and other physical symptoms;

2. effective communication and relationship with health-care providers;

3. the performance of cultural, religious, or other spiritual rituals;

4. relief from emotional distress or other forms of psychological suffering;

5. autonomy with regards to treatment-related decision-making;

6. dying in the preferred place;

7. life not being prolonged unnecessarily;

8. awareness of the deep significance of what is happening;

9. emotional support from family and friends;

10.not being a burden on anyone; and

11.the right to terminate one’s life

Patterns of Grief — SZUHANY, 2021

• Stable low grief symptoms - 26-45% (← Most people)

• Stable high levels of grief – 7-10% (← Might require additional support)

Risk factors for Prolonged Grief

• 7-10%

• Older age

• Female

• Lower SES

• History of depression, bipolar disorder or childhood adversity

• Early depression symptoms post-loss

• Caregivers, especially if they were caring for a partner or had experienced depression before the loss.

• Sudden or traumatic death circumstances

• Maladaptive thoughts (e.g., blame)

• Avoidance behaviours

• Inability to manage painful emotions

• Lack of social support that interferes with adaptation to loss

Current theories of Bereavement

― Dual processing Model

― Meaning reconstruction

― Attachment

― Continuing Bonds

― Mental representation theory

Dual Processing Model — STROEBE & SCHUT (1999)

Coping Model.

Reconstruction of meaning — NEIMEYER (2001, 2019)

• Death can lead to disruption in one’s life narrative and core beliefs about the world

• Coping with grief involves creating new meaning

  • Sense-making

  • Benefit-finding

  • Identity reconstruction

Attachment theory — BOWLBY

• Secure attachment – react emotionally to loss, but not overwhelmed by grief. Generally cope well unless there is traumatic circumstances or betrayal.

• Dismissive attachment – inhibited grief, less overt emotional reaction, supress/avoid memories

• Preoccupied – chronic grief, high emotionality and expressiveness in grief, inability to talk or cope constructively

• Disorganised – difficulty talking coherently, poor adaptation, ?trauma response

Continuing Bonds — KLASS, SILVERMAN & NICKELMAN (1996)

• Challenged the belief that ties to a decreased person need to be relinquished for adaptive bereavement

• Establish and maintain continuing bonds with the deceased person

• Moving from a concrete attachment to a symbolic attachment

• “Life ends but not a relationship”

Mental representation theory — BOERNER & HECKHAUSEN (2003)

• Framework for mental representations of the deceased

• Stored in explicit memory and can be retrieved by a bereaved person for comfort or discomfort (e.g., my mother was never helpful, so I will make sure I do things differently).

• Explicit and implicit representations affect the extent and kind of bond to the deceased.

• Adaptive coping involves connection and disengagement.

Growing around grief — TONKIN, 1996

Grief doesn’t disappear from our lives, but becomes incorporated into it, changing and moving as our life changes.