Cognitive Changes, the Dying Process, and Self-Concept

Cognitive Aging, Crystallized Intelligence, and Dementia

• Crystallized Intelligence Dynamics:

  • Crystallized intelligence reflects global ability and general knowledge acquired across the lifespan.

  • Longitudinal observation indicates that crystallized intelligence increases and improves as individuals age.

  • Changes or maintenance in crystallized intelligence do not function as a direct cause of mortality; individuals will inevitably die from other medical conditions or physiological failures.

• Epidemiological Incidence Rates of Dementia:

  • Age $65$: Approximately $5\%$ to $8\%$ of individuals begin to suffer from dementia or cognitive impairment.

  • Over Age $75$: The rate of incidence increases to between $15\%$ and $20\%$ of the population.

  • Over Age $85$: The incidence escalates significantly to between $75\%$ and $50\%$ of individuals.

• Pathology and Course of Alzheimer's Disease:

  • Alzheimer's disease represents the incurable manifestation of dementia.

  • The disease operates as a terminal condition: if an individual does not succumb to another fatal etiology, Alzheimer's disease will eventually become the direct cause of death.

  • Clinical pathology is characterized by progressive deterioration across multiple domains, including:

  • Systematic erosion of intellectual faculties.

  • Fundamental degeneration of personality.

  • Widespread, irreversible degeneration of brain cells.

  • The condition involves an agonizing, gradual decline that is exceptionally challenging for families and observers to witness.

  • The foundational literature on this subject remains the definitive and primary reference framework for understanding this decline.

The Psychological Stages of the Dying Process

• Stage 1: Denial:

  • Core Definition: Denial is an unconscious defense mechanism designed to prevent the conscious awareness of a catastrophic or fatal event.

  • Clinical Scenario: A patient undergoes a comprehensive battery of medical diagnostics and is subsequently informed by the physician: "You need to get these things in order."

  • Implication of Clinical Language: This medical phrasing serves as explicit notification that the individual possesses very limited remaining lifespan.

  • Internal Cognitive Dialogue: The immediate psychological response seeks to invalidate the reality:

  • "It just can't be."

  • "It can't be here."

  • "There must be something wrong."

  • "Let's do the test again."

  • Functional Objective: All initial cognitive reactions aim entirely at repelling and denying the diagnosis.

• Stage 2: Anger:

  • Transition into Anger: Following denial, the individual transitions into an intense state of anger.

  • First Step of Acceptance: In many respects, experiencing anger constitutes the genuine first step toward psychological acceptance.

  • Underlying Reality: Experiencing anger is predicated on the psychological reality that the individual has begun to register that the diagnosis is real and unavoidable.

• Stage 3: Bargaining:

  • Negotiation for Time: Individuals attempt to negotiate or bargain for additional time (described as attempting to "bargain for more gods" or more days).

  • Milestone Attachment: Bargaining typically centers on surviving long enough to reach specific milestones:

  • Desiring to witness specific relational outcomes: "I always wanna be here to see so-and-so happy."

  • Desiring to reach developmental markers of offspring: "I wanna be able to watch my kids graduate."

  • Establishing personal target deadlines: "Whatever my date is."

  • Temporal Awareness: As individuals draw closer to their final moments, they develop an acute realization that their remaining personal time has nearly expired.

• Stage 4: Acceptance:

  • Preparation for the Inevitable: Individuals reach a cognitive and emotional threshold where they prepare themselves for the certainty of mortality.

  • Final State: The process resolves into a stable state of psychological acceptance.

End-of-Life Decisions and Bereavement Dynamics

• Decisions Regarding the Voluntary Termination of Life:

  • End-of-life decisions have garnered widespread media attention globally and across different sovereign nations.

  • Historical precedent includes medical practitioners who performed voluntary termination of life prior to its emergence into mainstream public discourse.

  • Clinical contexts driving termination decisions include:

  • Terminal illness diagnoses.

  • Intractable, total physical suffering and pain.

  • Cases where patients progress completely beyond therapeutic medical hope.

• Bereavement Foundations:

  • Bereavement is defined as confronting the profound loss of someone loved.

  • It represents an inescapable, universal life event that all humans ultimately encounter.

Questions & Discussion: Manifestation of Grief

• Question: Do individuals who exhibit intense, externalized manifestations of grief—such as wailing, weeping, and crying out loud—process bereavement more effectively than individuals who internalize their emotions and keep their grief to themselves?

• Answer: No. Empirical observation demonstrates that individuals process grief and bereavement in profoundly different manners. Expressing overt distress does not correlate with superior psychological recovery. Individuals naturally adopt whichever coping strategy functions best for their specific psychological constitution.

The Dual Concept of Self: Public Self versus Private Self

• Core Theoretical Distinction (Referenced on Slide Number $132$):

  • The Public Self:

  • The dimension of human identity that an individual consciously and openly reveals to society.

  • Encompasses the specific traits, behavioral characteristics, philosophical beliefs, and personal values that an individual is willing to disclose to external parties.

  • The Private Self:

  • The concealed internal dimension of human identity that an individual actively attempts to hide from external scrutiny.

  • Encompasses private cognitions, personal reservations, and unexpressed thoughts that an individual deliberately shields from public awareness.

• Course Logistics and Study Protocol:

  • Students absent from instruction must coordinate with an assigned study partner to ensure complete duplication of lecture notes.

  • Absent peers must be notified to prepare materials and secure shared notes covering the immediate next week through a period of two months.