Lecturer: Dr. Joana Salifu Yendork , Department of Psychology - - PowerPoint PPT Presentation

College of Education School of Continuing and Distance Education

2014/2015 – 2016/2017

Lecturer: Dr. Joana Salifu Yendork, Department of Psychology Contact Information: jyendork@ug.edu.gh

Session Overview

• Ageing comes with the experience of witnessing death of
• thers and preparations towards one’s death. In this session,

death will be discussed from different perspectives. Issues surrounding how death is defined legally and medically will be

• explored. Lastly, coping strategies for grief will be explored.

Slide 2

Session Outline

The key topics to be covered in the session are as follows:

• Definition of death
• Stages of death and death anxiety
• Bereavement and grieving

Slide 3

Reading List

• Read Chapter 13 of Recommended Text – Adult development

and aging, Cavanaugh & Blanchard-Fields (2006).

Slide 4

DEFINITION OF DEATH

Topic One

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Sociocultural definitions of death

• Different cultures have different meanings for death

– Images or object (e.g., tombstone, sympathy card, etc) – Statistics (e.g., mortality rates, life expectancy tables, murder rates, etc.) – Events (e.g., funeral, memorial service, family gathering) – A state of being (e.g., as time of waiting, being with God) – An analogy (e.g., dead-end street, you’re dead meat, etc.) – A mystery (e.g., what is like to die?) – A boundary (e.g., you can’t come back, what do I do now) – A thief of meaning (e.g., I feel cheated, I have much left to do) – A basis for fear and anxiety (e.g., will dying be painful, who will care for my children, etc.) – Reward and punishment (e.g., heaven awaits the just, the wicked will go to hell, etc.)

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Legal and medical definitions of death

• Modern medical definitions focus on concept of “brain

death”

– No spontaneous movement in response to any stimuli – No spontaneous respiration for at least 1 hour – Lack of responsiveness to even the most painful stimuli – No eye movements, blinking, or pupil responses – No postural activity, swallowing, yawning or vocalizing – No motor reflexes – A flat electroencephalogram (EEG) for at least 10 minutes – No change in any of these criteria when the are tested again 24 hours later.

• All 8 criteria should be met before a person is declared brain

dead

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Legal and medical definitions of death

• Brain death

– Strong definition = absence of both cortical and brain stem functions and reflexes, total unconsciousness

• Persistent vegetative state occurs when

cortical functioning ceases while brain stem activity continues.

• Due to persistent vegetative state,

family members can face difficult ethical issues

– Other conditions which might produce this state must be ruled out, e.g., coma, hypothermia, drug overdose – Inability to live on one’s own, without use of supportive technology for cardiovascular function

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Ethical issues

• Bioethics: the study of the interface between human

values and technological advances in health and life sciences.

– Grew from two bases: respect for individual freedom and the impossibility of establishing any single version of morality by rational argument or common sense – Emphasise minimising harm over maximizing good and importance of individual choice

• An important issue in bioethics in death and dying is

euthanasia: the practice of ending life for reasons of mercy.

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Euthanasia issues: ending life

• Euthanasia can be carried out in two ways:
• Active vs. Passive Euthanasia

– Active euthanasia involves the deliberate ending of a person’s life through an intervention or action, which may be based on a clear statement of the person’s wishes or a decision made by someone else who has the legal authority to do so. – Passive euthanasia involves allowing a person to die by withholding available

• treatment. More of an issue as life sustaining technology has developed to

more sophisticated levels

• Voluntary vs non-voluntary Euthanasia

– Voluntary: A person wants to die and says so. May include cases of asking for help with dying (assisted suicide), asking for medical treatment to be stopped, refusing to eat. – Non-voluntary: The person cannot make a decision or cannot make their wishes known. Includes cases where the person is in coma, too young (e.g., a baby), the person is mentally retarded, etc.

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Euthanasia issues: ending life

• Terri Schiavo case (March, 2005) – withholding of

nourishment from a woman in persistent vegetative state for 15 years – US Supreme Court upheld husband’s right to have feeding tube removed

• Legal issues – some countries and jurisdictions allow active

euthanasia under medical supervision (e.g., the Netherlands)

• Canadians can leave a DNR (“do not resuscitate”) document

to prevent use of extraordinary measures, but active euthanasia is illegal – Sue Rodriguez case, amyotrophic lateral sclerosis (ALS)

• Hitler’s “euthanasia” programs for undesirable persons!

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A life course approach to dying

• Young adults tend to have intense feelings toward death;

a sense of being cheated. Because they are just beginning to pursue family, career and personal goals.

• Middle-aged adults begin to confront their own mortality

and undergo a change in their sense of time lived and time until death

– Arise from witnessing death of parents

• Older adults are less anxious and more accepting of

death

– May result from achievement of ego integrity

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DEALING WITH DEATH AND DEATH ANXIETY

Topic Two

Slide 13

Dealing with one’s own death: Kubler- Ross

• The work of Kubler-Ross revealed that when people are faced with

imminent death (as in terminal illnesses), they exhibit five different emotions that represent how they deal with death

• Although initially presented as sequence, research later showed that these

emotions can overlap and can be experienced in different order.

– People grief at different rate of time

• Delayed grief can occur when people suppress the emotions of the death and years later,

get depressed.

– People may switch back and forth between the stages with necessarily following the order – It is possible to get stuck in a specific stage

• Cultural differences, age, gender, race, and personality change the way

people grieve.

• Everyone copes with loss in a different way
• Also, these emotions may also be expressed by those dealing with the loss
• f a love one

Slide 14

Dealing with one’s own death: Kubler-Ross

• Stage 1: Denial & Isolation (shock)

– Denial and/or shock are often a person’s initial reaction followed by numbness. – There may also be a feeling of isolation or helplessness. – These feelings are an attempt to avoid reality by saying or thinking, “It is all a bad dream and will go away.” – Protect individual from being overwhelmed and buys us time to be able to cope with the loss.

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Dealing with one’s own death: Kubler- Ross

• Stage 2: Anger (suffering)

– May occur once grieving person faces reality – Anger is a natural reaction, an outlet for resentment at being a victim.

• Anger could be directed towards God, doctors, family etc

– There may be envy of others who have not experienced such a loss. – The person often takes out the anger on those close by – friends and family or towards the deceased, health care workers or self. – “Why me? How? Now?...”

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Dealing with one’s own death: Kubler- Ross

• Stage 3: Bargaining (suffering)

– The person seeks to postpone the loss by making promises, often to God, to be a better person. – “I’ll do this if you only do…” – Provides temporary escape and hope as well as allows time to adjust to reality

• Stage 4: Depression (suffering)

– Occurs when reality really sinks in – The numbness, anger, and rage felt previously are now replaced with a sense of great loss. – Feelings of great loneliness, isolation, helplessness, sadness as well as decreased sleep and appetite are characteristics of this stage.

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Dealing with one’s own death: Kubler- Ross

• Stage 5: Acceptance (recovery)

– Facing reality in a constructive way

• Accepting the fact that nothing can change the reality

– It allows for action. – Learning from our mistakes and remembering the good times.

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Fear of death

• Death anxiety is multidimensional and has several

components

– pain, body malfunction, humiliation, rejection, nonbeing, punishment, interruption of goals, and negative impact on survivors (Fortner & Neimeyer, 1999). – These components can be assessed on three levels: public, private and con-conscious

Slide 19

Fear of death and some of its correlates

• Generally, people fear most the process of dying and the

unknown

• Self-efficacy beliefs are important predictors of death anxiety
• Personality & demographic variables:

– Lower ego integrity, more physical problems, and more psychological problems are predictive of higher levels of death anxiety in older adults (Fortner & Neimeyer, 1999).

• Religiosity can be an important factor in moderating fear of

unknown

• Previous experience with death of a loved one
• Feelings of purpose and accomplishment can help lower fear
• Less social support and greater external locus of control

Slide 20

Expression of death anxiety

• Avoidance of situations that remind us of death

– Refusing to attend funerals, not visiting dying friends, being too busy to help a dying person

• Challenging death through putting one’s self in

dangerous situations, e.g., skydiving, auto racing, rock climbing, war

• Other ways include:

– changing lifestyles, dreaming and fantasizing, using humour, displacing fear or anxiety onto something else such as work, and becoming a professional who deals with death (Kalish, 1984).

Slide 21

Age differences in fear of death

Slide 22

Coping with the fear and avoidance of death

• Koestenbaum (1976) proposes several exercises and

questions to increase one’s death awareness.

• Exercises: Doing a personal obituary
• Decide on final scenarios – end state care, hospice care,

funeral choices, burial or cremation, etc.

• Contemplating being dead: Buddhist meditation

exercises –imagining yourself as a corpse and meditating

• n what will happen to it…not fun, but important to

integrating one’s death and life with peace?

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BEREAVEMENT AND GRIEVING

Topic Three

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Bereavement, grief and mourning

• Bereavement: The state or condition caused by loss through

death

• Grief: The sorrow, hurt, anger, guilt, confusion, and other

feelings that arise after a loss.

– People suffer grief at the loss of anything. It doesn’t just have to be death

• Mourning: Concerns the ways in which people express grief.

– Influenced by culture – E.g., in some culture, mourning may involve wearing of black clothes, attending funerals, observing official period of grief. For others, drinking, wearing white, and marrying the deceased spouse’s sibling

• Loss is generally associated with grief and the intensity of the

grief depends on the loss

Slide 25

Life-span view on loss through death

• People of different ages die in different ways

– Children die from acute diseases and accidents, young adults die mainly from accidents, and the old die mainly from chronic diseases such as heart disease and cancer – older adults’ dying trajectory is longer, and they are more likely to die in isolation than any other age group (Kastenbaum, 1999).

• Many of the concerns of dying people have to do with their age

– Difference comes in the extent to which people feel cheated, or possibly angry – Younger people feel cheated in that they are losing what they might attain whereas

• lder people feel cheated in that they are losing what they have
• The community also view the death of an older person as less tragic that

that of a younger person

• Besides the age of the person, other factors that influence how death of

person is viewed include gender, income level, expectedness of the loss, previous experience with loss, perceived social support, ethnicity and cognitive appraisal of the loss (is the loss a blessing, challenge, punishment? etc)

Slide 26

The grieving process

• Grief has no specific stage processes in which one can follow,

it’s an individual experience

• Grief is an active process and may involve

– Acknowledging the reality of the loss: one must overcome the temptation to deny the reality of the loss. – Working though the emotional turmoil: finding effective ways to confront and express the complete range of emotions rather than avoiding or repressing them. – Adjusting to the environment where the deceased is absent: This involves defining new patterns of living that adjust appropriately and meaningfully to the fact that the deceased is not present – Loosening ties to the deceased: Involves freeing oneself from the bonds of the deceased and re-engaging with one’s social network. Thus, finding effective means to say goodbye.

Slide 27

The grieving process

• Time taken to grief may differ from person to person

– About a year or two is needed for recovery

• Cultural differences in grieving and bereavement
• People don’t recover but learn to live with the loss

Slide 28

Types of loss and grief

• The kind of reactions to death is sometimes determined by

the age and the nature of relationship with the deceased person

• Loss of Parents

– Loss of parents is the most expectable bereavement, but still very difficult – Loss of a parent reminds people of their own mortality. – A parent’s death may deprive people of many important things: a source of guidance and advice, a source of love, and a model for their

• wn parenting.
• Even for adult children for whom the death of a parent is

anticipated, the breaking of the tie between parent and child can result in sadness and upset.

Slide 29

Types of loss and grief

• Loss of a Spouse

– Associated with strong rise in depression for some time, 1-2 years as typical for older adult spouses

• Young adult spouses tend to show more intense grief

reactions immediately after the death than older spouses

• Quality of bond, social support available, other factors can

moderate these effects

• Seems to be worse in some ways for men, who may have

less social support, harder time talking about this

Slide 30

Types of loss and grief

• Loss of a Child

– Seems most “unnatural,” probably hardest to fully resolve; seen as a great tragedy – The loss is especially traumatic if occurs suddenly (e.g., sudden infant death syndrome, automobile accident) – Mourning is always intense; some parents never recover from the loss. – Attachment formation may be a strong factor in mourning the loss of a child (e.g., losses due to stillbirths)

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Sample Questions

• Differentiate between active and passive euthanasia.
• Differentiate between voluntary and involuntary

euthanasia.

• List and explain Kubler Ross’ stages of death.

Slide 32

References

• Baltes, P. B. (1987). Theoretical propositions of life-span

developmental psychology: On the dynamics between growth and decline. Developmental Psychology, 23, 611– 626.

• Baltes, P. B., Lindenberger, U., & Staudinger, U. M. (1998).

Life-span theory in developmental psychology. In R. M. Lerner (Ed.), Handbook of child psychology, Vol. 1. Theoretical models of human development (5th ed., pp. 1029–1143). New York: Wiley.

• Ghana Stattistical Services (2013). 2010 population and

housing report: The elderly in Ghana. Retrieved from http://www.statsghana.gov.gh/docfiles/publications/2010p hc_the_elderly_in_Gh.pdf

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