attitudes toward death and dying exam two

Numbing

Adult Mourning (Phase 1) (Denial, Shock)

Yearning and Searching

Adult Mourning (Phase 2) (anger, Guilt, Intermittent hope)

Disorganization and Disrepair

Adult Mourning (Phase 3) (realizes the person is actually dead and that they must begin the process of reorganization)

Reorganization

Adult Mourning (Phase 4) (fill unaccustomed roles, resume a social life, acquire new skills, meet new people)

To accept the reality of the loss

Task 1: can be viewed on a continuum from slight distortion to full-blown delusion

to process the pain of grief

task 2: (can include guilt, anciety, anger, depresson, loneliness, sadness, and dysphoria)

to adjust to a world without the deceased

task 3: (external adjustments, internal adjustments, spiritual adjustments)

to find a way to remember the deceased (while embarking on the rest of ones journey through life)

task 4: finding a way to withdraw energy from the deceased and reinvesting it in another relationship, find a place for the deceased (remembrances) so that one can continue through life

external adjustments

living alone, raising children alone, facing an empty house, managaing finances

internal adjustments

how does the death affect self-definition, self-esteem, and a sense of self efficacy?

in some relationships a persons self-definition, self-esteem, and self-efficacy are dependent on the person who died

spiritual adjustments

death can shake ones fundamental life values and philosophical beliefs (can cause resentment and doubt toward God, dissatisfaction with the spiritual support received, substantial changes in the bereaved person's spiritual beliefs and behaviors )

the causes and circumstances of the loss

condition responsible for differences in outcome of childrens mourning (special reference to where and what a child is told and what opportunities are later given to them to inquire about what happened)

the family relationship after the loss

condition responsible for differences in outcome of childrens mourning (special reference to whether they remain with the surviving parent, and if so, how the patterns of relationship are changed as a result of the loss)

the patterns of relationship within the family

condition responsible for differences in outcome of childrens mourning (special reference to the patterns obtained between the parents themselves and between each of them and the bereaved child)

complications in child grieving

some symptoms: fear of further loss, fear the child will die, hopes of reunion, persisting blame and guilt, overactivity (aggressive or destructive outbursts), compulsive caregiving and self-reliance, euphoria and depresonalization

construal level theory

says that when people are not currently present in one's immediate reality, they could be gone for a few different reasons. these reasons include distance, time, and social closeness...so even though we are not directly experiencing someone through our senses, we can use predictions, memories, and speculations to imagine the person. these mental representations transcend the immediate situation

PCC (posterior cingulate cortex)

important when retrieving emotional, auto-biographical memories. in fact, it enables the feeling of grief. it is the part of the brain which measures the amount of closeness between people

ACC (anterior cingulate cortex)

directs our attention to things deemed important

loss-oriented (constitute what we typically think of as grief)

grief work, intrusion of grief, breaking bonds/ties/relocation, denial/avoidance of restoration changes

restoration-oriented (the tasks that we have to do now because the person is gone)

attending to life changes, doing new things, distraction from grief, denial/avoidance of grief, new roles/identities/relationships

uncomplicated bereavement

a description of "normal grief," but the individual may seek/need therapy

adjustment disorder

when the bereavement is judged to be out of proportion to what would be expected or signifigantly impairs self-care and interpersonal relations

nightmare disorder

dysphoric dreams may occur during bereavement but typically involve loss and sadness and are followed by self-reflection and insight, rather than distress, on awakening)

prolonged grief disorder

twelve months of persistent grief responses characterized by either intense yearning/longing for the deceased person, and/or preoccupation with thoughts or memories of the deceased person

absent grief

feelings of grief and mourning are totally absent

inhibited grief

a lasting inhibition of the many manifestations of normal grief, with the apperance of other symptoms such as somatic complaints in their place; they may throw themselves into work, over commit to responsibiltiies, or isolate themselves from reminders of the loss

delayed grief

normal or conflicted grief may be delayed for an extended peiod of time

conflicted grief

an exaggeration or distortion of one or more of the manifestations of normal grief (extreme anger or extreme guilt)

chronic grief

the person continously exhibitis intense grief reactions that we would usually see in the early stages of grief

unanticipated grief

a sudden unanticipated loss that is extraordinarily disruptive

abbreviated grief

a short, but normal form of grief

anticipatory grief

grief that is felt in light of future loss. this is seen often in cases where the person expects someone to die soon (i.e. terminal illness)

Nagy's Stage One: ages 3 to 5 (There is no Definitive Death; Death as Departure; Sleep)

the child does not know death as such. they attribute life and consciousness to the dead. there are two variations of this affirmation: death as departure/sleep or the child recognizes the fact of physical death but cannot separate it from life, they consider death as gradual or temporary

Nagy's Stage two: ages 5 to 9 (Personification of Death)

death identified with the dead

Nagy's Stage three: 9 and older (The Cessation of Bodily Activities)

the child reaches the point of recognizing that death is the cessation of corporal life. when they understand that death is a process operating within us, they realize its universal nature

piagets sensorimotor stage (0-2)

developmental issues: object permanence, stranger anxiety

the world is experienced through senses and actions

piagets preoperational stage (2-6)

developmental issues: pretend play, egocentrism, language development

children use words and images to represent things, but they lack logical reasoning, they can think symbolically

piagets concrete operational stage (7-11)

developmental issues: conservation, mathematical transformations

children understand concrete events and analogies logically and perform arithmetic operations. they tend to be literal n their thinkin, which can be rigid; they can struggle with abstract reasoning

piagets formal operational stage (12+)

developmental issues: abstract logic, moral reasoning

children use formal operations and utilize abstract reasoning, they can use deductive reasoning

piagets post-formal operational stage (emerging adulthood)

- reflective, realistic, and contextual

- provisional

- realistic

- open to emotions and subjective

- able to deal with: uncertainy, inconsistency, contradiction, imperfection, and compromise

assimilation

the process of taking in new information into our already existing schemas

accommodation

changing or altering our existing schemes in light of new information

equilibration

the process of striking a balance between assimilation and accomodation

closed awareness

the dying person is not aware of their impending death, although others may know

suspected awareness

the person suspects his or her progonosis, but this suspicion is not verified by those who know

mutual awareness

both the patient and others are aware of the situation; but people sidestep direct communication

open awareness

death is acknowledged and discussed openly

denial

the first stage of dying (same as grief)

anger

the second stage of dying (same as grief)

bargaining

the third stage of dying (same as grief)

depression

the fourth stage of dying (same as grief)

reactive depression

a response to disruption caused by the disease

preparatory depression

related to the awareness that one is dying and must prepare for death

acceptance

the fifth stage of dying (same as grief)

hope

not a specific stage of dying, but rather a process seen throughout all the stages where the dying person _________ for "some cure" or "remission" of the causes for the illness;; usually true even through stage five (acceptance)

mind-body interventions

i.e. psychotherapy and support groups, meditation, hypnosis

systems-oriented approaches

i.e. acupuncture and acupressure, herbal medicne and diet approaches, homeopathic or naturo pathic medicine

manual healing method

i.e. chiropratic treatment, massage therapy, reflexology

trajectory one (the dying trajectory)

this trajectory has steady progression and usually a clear terminal phase (i.e. cancer)

the dying trajectory: trajectory two

a trajectory with gradual decline, punctuated by period of acute deteriation and some recovery, with seeminlgy unexpected "sudden" death (i.e. organ failure)

trajectory three (the dying trajectory)

prolonged gradual decline or "dwindling" (i.e. dementia)

energy surge (also known as premortem surge, terminal lucidity, or terminal rally)

a deathbed experience reported as a sudden, inexplicable period of increased energy and enhanced mental clarity that can occur hours to days before death, varying in intensity and duration

hospice care at home

most common type of care, includes routine visits from a team (usuaully, a nurse, doctor, social worker, chaplain, or volunteer) that ensure comfort and dignity

continuous hospice care

24/7 hospice care to manage the patients acute symtpoms and avoid hospitalization until routine services can resume

inpatient hospice care

if symptoms cannot be managed at home. inpatient care provides 24/7 support until the person can return home or dies

respite care

when patients spend a short time in a medicare-certified inpatient hospice setting so their primary caregivers can take a break

why do we shield children from the fact of life which is death?

a. we believe they will be harmed or unable to handle the pain of grief

b. we hold that they have no concept of death and would not understand it

gradually, by example, and by explanations

how best do you teach a child about death?

seperation (from their mother or family)

what did children ages 0-5 fear most in the studies by Natterson and Knudson?

bodily mutation (especially if surgery is required)

what did children ages 6-9 fear most in the studies by Natterson and Knudson?

death itself

what did children ages 10+ fear most in the studies by Natterson and Knudson?

significance, death

how does ivan initially respond to the possibility of his death : he denies its ___________ and struggles to accept that _______ could happen to him

career, meaningful life

how does ivans illness change his worldview? it forces him to question his successful ___________, social status, and seemingly ________________ _____

terror, ending

how does ivan demonstrate death anxiety? ivan experiences __________ as he realizes his life is ____________.

avoid

how do ivans colleagues respond to his impending death? they largely ___________ his suffering, focusing on professional advancement and social obligations

gerasim, death

how does social support affect Ivan near the end of his life? _________ offers compassion and honest acknowledgment of ________, helping Ivan feel less isolated

honest conversations, distress

how does denial influence Ivan's experience of dying? his denial and others avoidance prevent ______________ ________________, intensifying his isolation and __________

values, relationships, life choices

what does Ivan's regret reveal about mortality? awareness of death can prompt people to reassess their ____________, _____________, and ______ ______.

fear, resistance, peace

how does Ivan's attitude toward death change? he moves from _____ and ___________ toward insight, compassion and a final sense of _______

status, conventional achievement

how does Tolstoy challenge society's view of a successful life? he questions whether _________ and ____________ ______________ provide genuine meaning or prepare us for death

mortality, compassion, love

how does Ivan's experience illustrate meaning-making at the end of life? confronting _____________ leads him to reconsider his life and recognize the importance of _______________ and ____.