CHAPTER 17

THE FINAL CHALLENGE:DEATH AND DYING

Learning Objectives

• How is death defined?

• Why is the definition of death controversial?

• How does the social meaning of death vary across groups?

• What factors influence life expectancy?

• Is it possible to extend life expectancy?

• What is the difference between programmed theories of aging and damage theories of aging? Give an example of each.

Biological Definitions of Death

• Harvard Definition: Total Brain Death

– Unresponsive to stimuli

– No movement or breathing

– No reflexes

– Flat EEG

• Euthanasia: “Happy” or “good” death

– Hastening death of someone suffering incurable illness or injury

Social Meanings of Death

• Modern American: Medical failure

• More traditional societies

– Natural part of life cycle

• Grieving Practices Vary

– By culture: Weeping/partying

– By ethnicity: Wake/Shiva

Life Expectancy

• Expected Age at Death

– U.S.: 76.5 years

– White females: 80 years

– White males: 75 years

– Black females: 75 years

– Black males: 68 years

– Ancient Rome: 30 years

• Male and female life expectancies at birth in selected countries. Life expectancies vary widely from country to country but are generally higher for females than for males.

Theories of Aging and Death

• Programmed Theories

– Maximum life span (species specific)

– Hayflick Limit

• Damage Theories

– Free radicals

• Interaction of the two – or more

Learning Objectives

• What are Kübler-Ross’ stages of dying?

• How valid and useful is the theory?

• What is the Parkes/Bowlby attachment model of bereavement?

• Is there evidence to support this model?

Kübler-Ross’ Stages of Dying

• Common set of stage-like emotions

– Denial, anger, bargaining, depression, acceptance

• Criticisms

– Death is not a stage-like process

– Course of illness not considered

– Individual differences

Attachment Model of Bereavement

• Bereavement: The state of loss

• Grieving: Emotional expressions

– Anticipatory grief

• Mourning: Culturally approved reactions

• Parks/Bowlby Model

– Reaction to separation from a loved one

– Numbness, yearning, despair, reorganization

Patterns of Bereavement

• Dual Process Model– Loss oriented coping: Coping with

emotional blow of loss– Restoration coping: Coping with the

practical challenges of living, and re-energizing

• Patterns of grief differ greatly from person to person. Some people show little grief; many experience disrupted functioning for about a year and then minimal grief in the second year; and about 15% experience chronic and significant psychological problems.

Learning Objectives

• What is the infant’s understanding of separation and death?

The Infant

• Object permanence

• Attachment by 6-8 months

– Separation anxiety at loss

– Protest, yearning, searching, despair

– Behavioral: eating, sleeping, regression

• Less distress if attached to other parent

• Eventual new attachments and recovery

Learning Objectives

• How do children’s conception of death compare to a “mature” understanding of death?

• What factors might influence a child’s understanding of death?

• What is a dying child’s understanding of death?

• How do dying children cope with the prospect of their own death? How do children grieve?

The Child

• The Mature Concept of Death

– Finality, irreversibility, universality, biological causality

• Age 3-5: Universality

– Dead live under altered circumstances

– Reversible – like sleep

• Age 5-7: Finality, irreversibility

• Level of cognitive development, experience

The Dying Child

• Young child aware of impending death

• Adults often secretive

• Same range of emotions as dying adults

• Anxiety revealed in behavior

• Parental control is helpful

• Need support of important others

The Bereaved Child

• Children do grieve

• Express grief differently than adults do

– Misbehavior, strike out, rage

• Lack adult coping skills

– Will use denial, avoidance

• Most adjust successfully

Learning Objectives

• What is the adolescent’s understanding of death?

• Is an adolescent’s reaction to death different from the reactions of a child or adult?

The Adolescent

• Higher levels of understanding

• Concerns of adolescence

– Body image, identity, independence

• May carry on internal dialogue with dead

• Devastated at death of close friend

• Adult-like grieving

Learning Objectives

• How do family members react and cope with the loss of a spouse, a child, and a parent?

• What factors contribute to effective and ineffective coping with grief?

• What can be done for those who are dying and for those who are bereaved to better understand and face the reality of death?

The Adult

• Death of family member difficult

• Death of spouse more expected with age

– More difficult when young (non-normative)

• Elevated levels of stress

• Risk increases for illness and death

• Signs of recovery after 2 years

Loss of a Child

• No loss more difficult

• Experienced as untimely, unjust

• Broken attachments

• Guilt at failure to protect child

• May continue relationship w/dead child

• Marital problems often increase afterward

The Loss of a Parent

• Lasting problems may occur if young

• Less tragic than unexpected death

• Adjustment not as difficult

• Guilt: Not doing enough for parent

• Broken attachment

Grief Work Perspective

• Emotions must be confronted: Detachment

• Psychoanalytic, also popular view

• May be a culturally biased belief

• Grief work may actually cause more distress

• Delayed grief reaction predicted w/out it

– Not supported by research

• Detachment not necessary

Who Copes and Who Succumbs

• Secure infant attachment related to coping

• Low self-esteem related to more difficulty

• Cause of death influences bereavement

• Support system essential

• Additional life stressors detrimental

• Positive outcomes often found

Hospice

• Dying person decides what is needed

• De-emphasize prolonging life

• Pain control emphasized

• Normal setting (home if possible)

• Bereavement counseling for entire family

• Research shows positive outcomes

Learning Objectives

• What are the major themes of lifespan development that have been covered throughout the text?

Major Developmental Themes of Text

• Nature and nurture truly interact

• We are whole people throughout the life span– Developmental domains related

• Development proceeds in multiple direction with both continuity and discontinuity

• There is much plasticity in development

• We are diverse individuals and are active in our own development

• Development is a lifelong process