integ: dev psych (death and bereavement)

mortality revolution

Advances in medicine and sanitation, new treatments for many once-fatal illnesses, and a better-educated, more health conscious population have brought about a

Placing blame and seeking meaning

• After a death, survivors frequently feel compelled to assign blame, whether it be for failing to follow the law, not getting the necessary medical attention, or continuing bad behaviors.

• Those who have lost a loved one may place the responsibility on the deceased, on themselves or on distant parties.

• Nations may place the blame for public calamities on one another

Do not resuscitate (DNR)

A formal instruction from a Doctor that states, in the event of a patient’s cardiac or respiratory arrest, that no attempts should be undertaken to resuscitate them – sometimes prompted by the patient’s advance directive or by the request of a healthcare proxy

voluntary consent

consent: patient chooses to end life

condition: terminally ill, sever pain

non-voluntary consent

consent: proxy decision (family)

condition: patient cannot decide

involuntary consent

consent: no patient consent

condition: patient unable to respond

active euthanasia

method: direct action (lethal injection)

also known as: aggressive euthanasia

passive euthanasia

method: withholding life support

example: removing ventilator

Living will

A written declaration outlining a person’s preferences for medical interventions in the event that they are unable to communicate their own choices.

Slippery slope

The argument that a given action will start a chain of events that will culminate in an undesirable outcome.

Double effect

An ethical scenario where a given action (like giving opiates) has both an anticipated but, unintended positive consequence (like alleviating the agony of a terminally ill individual) and an unintended bad one (like hastening death by suppressing respiration)

Heath care proxy

A person chosen by another person to make medical decisions if the second person becomes unable to do so.

normal grief

including inhibited grief, masked grief, and delayed grief

absent grief

• when the person is in total denial about their loss

• not able to admit they’ve experienced loss

disenfranchised loss

occurs when society does not recognize or acknowledge the value of the loss

complicated grief

prolonged grief characterized by long-lasting & severe emotional reactions

anticipatory grief

happens before the loss occurs often during a terminal illness

secondary loss

occurs when the bereaved experiences additional losses

31%

how many percent in a study of elderly psychiatric patiends had recently been bereaved?

bereaved loved-ones

greater risl of death from heart disease and suicide as well as the onset or relapse of a variety of psychosomatic and psychiatric disorders

1/3

up to how many people who suffer a major loss (such as death of spouse or child) will suffer detrimental effects on their physical or mental health

Mourning

The rituals and actions that follow in a religion or culture to help grieving individuals express their loss following a death.

Good death

A calm, painless, and swift death that transpires during a lengthy life, in the presence of loved ones, and in conditions that are comfortable

bad death

dreaded, particularly by the elderly.

Many of them have seen people die in hospitals, semiconscious, and alone throughout their last days.

death

• viewed as a journey rather than a destination in all religious and culture.

• It is an occasion to unite rather than accentuate  differences.

• Religion offers hope at this in every faith, both historically and today.

Death anxiety

• It is the fear of one’s own death.

• It is common and normal.

• Fears of being alone, experiencing agony, having others witness one’s suffering, or losing control of one’s body and mind are among the worries associated with the dying process.

• Concerns about death include dread of the unknown, identity loss, mourning for other people, body disintegration, and suffering or retribution in the hereafter

Despair

• suggests that one’s own thoughts and viewpoints are superior and is a rejection of other people’s ideas and perspectives.

• It can be interpreted as a protective reaction against the disgust for one’s physical appearance and unsuccessful past

early childhood

The initial fear of dying, which arises during, is a reflection of the incapacity to imagine the eternally lifeless condition.

Death in adolescence and emerging adulthood

• Adolescents everywhere appear to have little fear of dying. They chase thrills, take chances, and value looks highly.

• Teenagers usually anticipate dying young.

Death in adulthood

• As adults take on greater responsibility for their families and careers, opinions change significantly.

• Death is no longer idealized but, rather something to be avoided or at least delayed.

• Many adults begin using seat belts, give up using addictive medications, and take other safety measures

Death in late adulthood

Views toward death change.

Hope arises and anxiety falls.

The elderly are less affected by life-threatening illnesses compared to others.

Death in childhood

Even 2-year-old children have some comprehension of death but, their viewpoint is different from that of more mature family members.

Adults should pay close attention to children who have lost a loved one, acknowledging their worries and allowing them to grieve

heart disease and cancer

Today, the most common causes of death are

Thanatology

study of death and dying

Hospice Care

personal, patient- and family-centered, compassionate care for the terminally ill

6 months or less

Hospice facilities offer a specialized type of palliative care for people whose life expectancy is

palliative care

Care that is intended to support and counsel the patient’s family in addition to offering the patient physical and emotional comfort rather than the purpose of curing their condition.

Terminal Drop

specifically to a widely observed decline in cognitive abilities shortly before death

Also called Terminal Decline

Near-Death Experience

often involving a sense of being out of the body or sucked into a tunnel and visions of bright lights or mystical encounters

bilateral frontal and occipital areas

Near-Death Experience is linked to stimulation or damage of various brain areas, most notably in where

endorphins

Near-Death Experience is generally experienced as positive as a result of the release of

Dementia

accelerates the rate of decline in all people

memory capacity, perceptual speed, visuospatial abilities, and everyday cognition

Areas of decline include

Denial

• “This can’t be happening to me!”

• avoidance, confusion, elation, shock, fear

Anger

• “Why me?”

• frustration, irritation, anxiety

Bargaining

• Bargaining for extra time

• “If I can only live to see my daughter married, I won’t ask for anything more”

• overwhelmed, helplessness, hostility, flight

Depression

• Low emotional state

• struggling to find meaning, reaching out to others, telling one’s story

Acceptance

• Readiness to face the reality of death or loss

• exploring options, new plain in place, moving on

Grief

• emotional response that generally follows closely on the heels of death

• The powerful sorrow that an individual feels at the death of another.

Bereavement

• response to the loss of some whom a person feels close

• The sense of loss following a death.

Grief Work

the working out of psychological issues connected with grief

Shock & Disbelief

Immediately following a death, survivors often feel lost and confused

The initial numbness gives way to overwhelming feelings of sadness and frequent crying

May last several weeks, especially after a sudden or unexpected death

Preoccupation with the Memory of the Dead Person

May last 6 months to 2 years

Survivor tries to come to terms with the death but cannot yet accept it

Resolution

The bereaved person renews interest in everyday activities

Memories of the dead person bring fond feelings mingled with sadness rather than sharp pain and longing

Recovery Pattern

mourner goes high to low distress

Delayed Grief

moderate or elevated initial grief, and symptoms worsen over time

Chronic Grief

• distressed for a long time

• can last for years, often related to traumatic loss

Resilience

the mourner shows a low and gradually diminishing level of grief in response to the death of a loved one

4

By age of what, children build a partial understanding of the biological nature of death

troubled relationship

Adjusting to loss is more difficult if a child had a what with the person who died

loss

children do not understand death, but they understand what

Middle-Aged and Older adults

more prepared with death

Terror Management Theory

• human’s unique understanding of death, in concert with self-preservation needs and capacity for fear, results in common emotional and psychological responses when mortality, or thoughts of death are made salient

• how humans cope with the profound anxiety arising from the awareness of their own inevitable death

Infants

No concept of death

children

9

More realistic orientation towards death

Accept universality of death by age of

May feel responsible for death

Adolescence

More abstract, philosophical views of death

Unrealistic (personal fable)

May react negatively to the likelihood of death due to illness

Early Adulthood

No evidence for special orientation towards death

Believe that death is unfair

Losing a parent

 can push adults into resolving important developmental issues

Losing a child

weakens and destroys the marriage if the marriage is not strong

Suicide rates

highest in the elderly in almost all areas of the world

Men; women

who also commit suicide at higher rates than do who

Le Suicide

• Émile Durkheim Identified four types of suicide in his classic 1897

• Here, he proposed that suicide could be attributed not only to the temperament of the individual, but also to social influences

Altruistic

• Occurs when individuals are too strongly integrated into a group, to the point that they may sacrifice their lives for its benefit

• Caused by excessive social integration

Anomic

• Triggered by sudden changes in an individual’s life or society that disrupt norms and create a sense of purposelessness

• Caused by low social regulation

Egoistic

• Occurs when individuals feel detached or isolated from society or social groups

• Caused by low social integration

Fatalistic

• Occurs when individuals are under extremely high levels of control, with oppressive rules or harsh conditions leaving no hope for the future

• Caused by excessive social regulation

Brain Death

neurological condition which states the person is brain dead when all electrical activity of the brain has ceased for a specific period of time

Euthanasia

good death, intended to end suffering or to allow terminally ill person to die with dignity

The act of taking the life a person who has a terminal illness or severe disability without causing them any pain

Passive

involves withholding or discontinuing treatment that might extend the life of a terminally ill patient such as life support

Active

“mercy killing” involves action taken directly or deliberate to shorten life

Advance Directive

• contains instructions for when and how to discontinue futile medical care

• Living will or a more formal legal document called a durable power of attorney

• A written statement that includes a person’s preferences for end-of-life medical treatment, provided before that care is required.

Durable Power of Attorney

appoints another person if the maker of the document becomes incompetent to do so

Assisted Suicide/Physician-assisted suicide

• physician or someone else helps a person bring about a self-inflicted death

• A form of active euthanasia in which a Doctor provides the means for someone to end his or her own life.

suicidology

scientific study of suicide and its prevention

psychache

unbearable psychological pain

postvention

providing support to the survivors of suicide

Death Seekers

Individuals who clearly intend to end their lives at the time of the attempt

There is a strong, conscious desire to die

Death Initiators

Individuals who believe they are already dying or that death is inevitable, so they speed up the process

They think they're just hastening a natural outcome

Death Ignorers

Individuals who do not believe that death means the end of existence

They believe suicide is just a transition to a better existence

Death Darers

Individuals who are ambivalent about dying and often engage in risky or self-destructive behavior that may or may not lead to death

Mixed feelings about life and death; the act is impulsive or reckless

Life Review

a process of reminisce that enables a person to see the significance of his or her life

Prolonged Grief Disorder

Grief that lasts for a long time and is characterized by persistent despair.

funeral

a significant part of grieving in many cultures

ceremonial meal

After death, mourners in certain cultures have a

2/3

1/3

About how many of corpses are buried and the other how many are cremated.