Lesson 19: Dealing with Death and Bereavement

• Death


  A biological fact, but it also has social, cultural, historical, religious, legal, psychological, developmental, medical, and ethical aspects, and often these are closely intertwined
• Cultural context of death and dying

  • Different customs concerning disposal and remembrance of the dead
  • Transfer of possessions
  • Expression of grief
• Cultural practices concerning death

  • In Greece: bodies of heroes publicly burned (cremation)
  • In Japan: encourage survivors to maintain contact with the deceased, altars at home, and talk to dead loved one
  • In Gambia: dead considered as part of the community
• Practices greatly vary from culture to culture and often are governed by religious or legal prescriptions that reflect a society's view of what death is and what happens afterward
• Mortality Revolution


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


  Study of death and dying
• In the US today, the majority of deaths occur among people aged 65 and older, primarily from diseases such as heart disease and cancer, the top two causes of death
• In the PH (2012 data), top cause of death are ischemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease (COPD)
• Hospice Care


  Personal, patient- and family-centered, compassionate care for the terminally ill person
• Palliative Care


  Relief of pain and suffering, control of symptoms, alleviation of stress, and attempts to maintain a satisfactory quality of life
• The goal of hospice and palliative care is to allow the person to die in peace and dignity, while minimizing any pain and suffering, and it often includes self-help support groups for both dying people and their families
• Even without any identifiable illness, people around the age of 100 tend to experience functional declines, lose interest in eating and drinking, and die a natural death
• Terminal Drop (or terminal decline)


  Specifically to a widely observed decline in cognitive abilities shortly before death, even when factors such as demographics and health are controlled for
• Near-death Experience (NDE)


  Involving a sense of being out of the body or sucked into a tunnel and visions of bright lights or mystical encounters
• NDEs are generally experienced as positive, an effect that has been proposed to occur as a result of the release of endorphins that are released during stressful experiences
• Stages of grief (DABDA)

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
• Not everyone goes through all five stages and not necessarily in the same sequence. A person may go back and forth between anger and depression, for example, or may feel both at once
• Grief


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


  A response to the loss of someone to whom a person feels close; a process of adjustment
• Classic Grief Work Model

  1. Shock and disbelief (first stage)

  2. Preoccupation with the memory of the dead person (second stage)

  3. Resolution (final stage)
• Patterns of grieving

  • Recovery pattern
  • Delayed grief pattern
  • Chronic grief pattern
  • Resilient pattern
• Ways to help someone who has lost a loved one

  • Encourage expression
  • Avoid platitudes
  • Offer practical assistance
  • Practice patience
  • Recommend professional help
• Attitudes about death across the life span

  • Childhood
  • Adolescence
  • Adulthood
• Terror Management Theory (TMT)


  Proposes that humans' unique understanding of death, in concert with self-preservation needs and capacity for fear, results in common emotional and psychological responses when mortality are made salient
• Aspects of Terror Management Theory

  • Cultural Worldview
  • Self-Esteem
  • Attachment Processes
• Widowhood

  More common among women due to their longer life expectancy, leads to significant physical and mental health challenges, including increased risks of various health issues and mortality
• The quality of the marital relationship influences the impact of widowhood on mental health
• Practical issues such as economic strain and social isolation are common consequences of widowhood, differing between genders
• The death of a parent in adulthood is emotionally impactful, affecting well-being and prompting maturation and reevaluation of relationships
• Conflict among siblings may arise, particularly when making end-of-life decisions for a dying parent
• Sibling relationships may either strengthen or weaken following parental death, influenced by factors like family history and shared responsibilities
• Losing a child is an unnatural and devastating experience that often strains marriages
• Parents may experience depression, poorer health outcomes, and heightened grief, particularly if the child's death is traumatic or unexpected
• Discussing a terminally ill child's impending death can provide closure and aid in coping post-loss
• Religious and spiritual beliefs often play a significant role in parents' coping mechanisms
• Miscarriage, affecting 1 in 3 pregnancies, often leads to intense grief, depression, guilt, and isolation, particularly among women
• Recurrent miscarriages exacerbate negative emotional outcomes
• Couples may face an increased risk of relationship breakdown following miscarriage, especially if it occurs later in pregnancy
• Suicide, though no longer criminalized, carries social stigma rooted in religious beliefs and societal norms valuing life
• Globally, suicide rates were approximately 10.5 per 100,000 people in 2016, with higher rates among the elderly and men