chapter 17 the final challenge: death and dying. learning objectives how is death defined? why is...
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CHAPTER 17
THE FINAL CHALLENGE:DEATH AND DYING
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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.
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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
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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
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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
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• 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.
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Theories of Aging and Death
• Programmed Theories
– Maximum life span (species specific)
– Hayflick Limit
• Damage Theories
– Free radicals
• Interaction of the two – or more
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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?
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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
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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
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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
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• 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.
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Learning Objectives
• What is the infant’s understanding of separation and death?
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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
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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?
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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
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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
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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
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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?
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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
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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?
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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
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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
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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
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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
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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
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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
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Learning Objectives
• What are the major themes of lifespan development that have been covered throughout the text?
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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