5.5 Critical Issues Concerning Death and Bereavement

Denial, Anger, Bargaining, Depression, & Acceptance

Kübler-Ross’ Five Stages of Grief

Hospital Care

Personal, patient- and family-centered, compassionate care for the terminally ill, which offer a specialized type of palliative care for people whose life expectancy is 6 months or less

Palliative Care

Aimed at relieving pain and suffering and allowing the terminally ill to die in peace, comfort, and dignity Terminal Drop/Decline

Terminal Drop/Decline

A frequently observed decline in cognitive abilities near the end of life

Clinical Death

Few minutes after the heart stopped pumping

Brain Death

A person no longer has reflexes or any response to vigorous external stimuli and no electrical activity in the brain

Social Death

a sociological and historical concept where a living person or group is treated, ostracized, or rendered as if they were non-existent or dead

Near-Death Experience

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

Grief

The emotional response experienced in the early phases of bereavement

Bereavement

The objective loss, due to death, of someone to whom one feels close and the process of adjustment to the loss

Mourning

Represents the outward, often culturally and religiously influenced, expression of loss

Normal/Common, Anticipatory, Complicated, Disenfranchised, Ambiguous loss, Traumatic, Collective, & Cumulative

Types of Grief

Normal or Common Grief

The most typical type of grief and response to loss, characterized by a range of emotional, physical, cognitive, and behavioral reactions that gradually lessen in intensity over time

Anticipatory Grief

Type of grief that occurs before the actual death, often when a loved one has a terminal illness or is expected to die

Complicated Grief

A severe and persistent form of grief where the intense emotional pain and impairment do not diminish over time, significantly exceeding expected social, cultural, or religious norms

Disenfranchised Grief

Type of grief that is not openly acknowledged, socially supported, or publicly mourned

Ambiguous Loss

Refers to a loss that lacks clarity, closure, or a definitive end

Type 1: Physical Absence with Psychological Presence

Type of ambiguous loss where a loved one physically gone but psychologically present (ex. a missing person, kidnapping, divorce where contact is maintained)

Type 2: Physical Presence with Psychological Absence

Type of ambiguous loss where a loved one is physically present but psychologically absent (ex. dementia, severe mental illness, addiction, chronic vegetative state)

Traumatic Grief

Occurs when hen a death happens under horrific, sudden, or violent circumstances (e.g., accidents, natural disasters, murder, suicide)

Collective Grief

Type of grief experienced by a community, nation, or even the world in response to a public tragedy or large-scale loss

Cumulative Grief (or Bereavement Overload)

Occurs when an individual experiences multiple losses in a relatively short period, without adequate time to process each one before the next occurs

Classic Grief Work Model

Model that involves working out of psychological issues connected with grief

Shock and Disbelief, Preoccupation with Memory of the Dead Person, & Resolution

3 Stages of the Classic Grief Work Model

Shock and Disbelief

First stage of grief that lasts several weeks where people feel lost and confused. As the loss sinks in, sadness and frequent crying overtake

Preoccupation with Memory of the Dead Person

Second stage of grief that lasts 6 months to 2 years where the person tries to come to terms with the death but cannot accept it yet. This diminishes overtime

Resolution

Third stage of grief where the person renews interest in everyday activities. Memories of the dead loved one brings in feelings of fondness and sadness rather than pain and longing

Resilience, Recovery, Chronic Grief, Chronic Depression, & Delayed Grief

Multiple Variations of Grief

Resilience

Where individuals maintain relatively stable physical and psychological health, demonstrating the ability to adapt to the loss without experiencing prolonged periods of significant distress or dysfunction

Recovery

When an individual experience an initial period of significant distress and impairment following the loss, but gradually return to their pre-loss levels of functioning within a reasonable timeframe

Chronic Grief

Characterized by prolonged and severe grief symptoms that persist for an extended period (often years) without significant improvement, leading to long-term functional impairment

Chronic Depression

When individuals experience persistent major depressive symptoms that predate the loss or emerge shortly after and remain chronic, often distinct from the acute pain of grief itself

Delayed Grief

A less common pattern of grief where the initial reaction to the loss is minimal or absent, but significant grief symptoms emerge much later, sometimes months or even years after the bereavement

Terror Management Theory

A human’s unique understanding of death results in common emotional and psychological responses when mortality or thoughts of death are made salient

Dual-Process Model of Grieving

Explains that healthy grieving involves moving back and forth between two types of stressors: loss-oriented coping and restoration-oriented coping

Loss-Orientation

Orientation that involves activities directly related to the loss, such as expressing feelings of yearning for the deceased, crying, or talking about them

Restoration-Orientation

Orientation that involves activities focused on reestablishing roles, engaging in new activities, and preparing for life without the loved one, such as attending to life changes or developing new routines

Unique Invulnerability

The belief that bad things happen to others but not to themselves Suicide

Euthanasia

“Good death”, intended to end suffering or to allow a terminally ill person to die with dignity

Passive Euthanasia

Involves withholding or discontinuing treatment that might extend the life of a terminally ill patient

Active Euthanasia

The deliberate action taken to shorten the life of a terminally ill person. Also known has "mercy killing" and is generally illegal

Advance Directives

A document specifying the type of care wanted by the maker in the event of an incapacitating or terminal illness, contains instructions for when and how to discontinue futile medical care

Living Will

Contain specific provisions with circumstances in which treatment should be discontinued

Durable Power of Attorney

A legal instrument that appoints an individual to make decisions in the event of another person’s incapacitation

Assisted Suicide

Suicide in which a physician or someone else helps a person take his or her own life (person who want to die performs the actual deed)

Numbness, Yearning, Disorganization and Despair, & Reorganization and Recovery

Bowlby's Stages of Grief

Phase of Numbness (Shock and Numbness)

Bowlby's first stage of grief that involves disbelief, emotional detachment, difficulty concentrating, a sense of unreality

Phase of Yearning and Searching

Bowlby's second stage of grief that involves intense emotional pain, pining, crying, restlessness, anxiety, anger, guilt, preoccupation with the deceased, dreams or illusions of the deceased

Phase of Disorganization and Despair

Bowlby's third stage of grief that involves apathy, withdrawal from social activities, increased fatigue, sleep disturbances, loss of interest in previously enjoyed activities, questioning the meaning of life, depression

Phase of Reorganization and Recovery

Bowlby's first fourth stage of grief that involves renewed energy, establishment of new routines, finding meaning, increased interest in life, ability to look to the future, a sense of hope and trust restored

Shock, Awareness of Loss, Conservation/Withdrawal, Healing: The Turning Point, & Renewal

Sanders’ Phases of Bereavement (Integrative Theory of Bereavement)

Shock

Sander's first phase of bereavement that is the immediate impact phase, characterized by confusion, disbelief, and an intense state of alarm

Awareness of Loss

Sander's second phase of bereavement that involves the full reality of the loss becoming apparent, leading to intense emotional and physical reactions

Conservation/Withdrawal

Sander's third phase of bereavement wherein the bereaved feels a profound need to withdraw from external demands and conserve energy

Healing: The Turning Point

Sander's fourth phase of bereavement that signifies a shift from intense distress to a gradual restoration of energy and a renewed capacity to engage with life

Renewal

Sander's fifth phase of bereavement that involves a new sense of self-awareness and the ability to live effectively without the physical presence of the loved one