Psyc 222 Developmental Psychology II

1. Psyc 222 Developmental Psychology II Unit 9: Death, Dying and Bereavement Dean Owen, Ph.D., LPCC Spring 2011

2. I am standing upon the seashore. A ship at my side spreads her white sails to the morning breeze and starts for the blue ocean. She is an object of beauty and strength. I stand and watch her until at length she hangs like a speck of white cloud just where the sea and sky come to mingle with each other. Then someone at my side says: "There, she is gone!" .

3. Gone where?" Gone from my sight. That is all. She is just as large in mast and hull and spar as she was when she left my side and she is just as able to bear her load of living freight to her destined port. Her diminished size is in me, not in her. And just at the moment when someone at my side says: "There, she is gone!" there are other eyes watching her coming, and other voices ready to take up the glad shout: 'Here she comes!“ And that is dying.Henry Van Dyke

4. How we die Death fundamentally occurs when there is sufficient damage to one or more body systems the continued life function is not possible.

5. How we die The bodily systems can be damaged by two basic processes…… Disease (Chronic or Acute) Injury (Chronic or Acute) Chronic: Slow onset, continuous, and usually progressive….. Acute: Rapid Onset

6. How we die Disease: Genetic predisposition to develop dysfunction body systems… Infection: Body is invaded by organisms from outside the body.

7. How we die Injury: Inflicted damage or trauma…..

8. How we die Homicide/Suicide

9. How we die For about 20% it is a gentle process many time eased by the use of drugs to mask the pain and destructive event occurring.

10. How we die In childhood and adolescence the cause is unintentional injury…accidents In adulthood the cause is primarily cardiovascular or cancer

11. Three Phases of Death 1. Agonal phase: Coming from the Greek word agon which means struggle: The agonal phase refers to gasps and muscle spasms during the first moments in which the regular heartbeat stops. 2. Clinical death: This refers to a brief period in which cardiac function, circulation, breathing and brain functioning stop but resuscitation is still possible. 3. Mortality: At this phase the individual passes into permanent death.

12. Defining Death For much of history the absence of a heartbeat and respiration signaled death……doctors carried a mirror to be held up to the mouth and nose of an individual to detect respiration…. Deep Coma could produce symptoms that were similar to death…There were cases where individuals spontaneously recovered consciousness so there was general fear of premature burial……The safety coffin…..

13. Defining Death Since basic cardiac and respiratory function can be supported by machines, a new definition has become more widely used….Brain death: the cessation of neurological activity in the brain and brain stem.

14. Defining Death Persistent Vegetative State A condition of deep unconsciousness (coma) in which there is no cortical activity but sub cortical (brain stem) activity remains.

15. Is there a “Good Death” • Definition: There is no single definition of what constitutes a good death. The definition of a good death will vary for each patient. In 1997 The Institute of Medicine (IOM) defined a good death as: • A decent or good death is one that is: • free from avoidable distress and suffering for patients, families, and caregivers; • in general accord with patients' families' wishes; • and reasonably consistent with clinical, cultural, and ethical standards.

16. Is there a “Good Death” Factors important for a good death include: Control of symptoms Preparation for death Opportunity for closure or "sense of completion" of the life Good relationship with healthcare professionals A central concept to a 'good' death is one that allows a person to die on his or her own terms relatively pain free with dignity. An appropriate death is often considered to be one that occurs naturally and in old age, one that follows the natural order of things e.g older members die before younger ones. Perhaps the best definition an appropriate death is a death that someone might chose for him or herself if he/she had the choice. Also known as: Appropriate death, desired death, dignified death

17. Considering a Good Death in Ghana • Sjaak van der Geest Professor of Medical Anthropology at the • University of Amsterdam studied what residents in Kwahu- • Tafo, a rural town in Southern Ghana, considered to be a Good • Death. For the Southern Ghanaians the characteristics of a • Good Death included: • A good death was a peaceful death. • "Peaceful" in this community meant: • The dying person had finished up all of his or her business. • The dying person had made peace with others before his or • her death. • The dying person was at peace with his or her own death. • A good death is one that does not occurs as a result of: • Violence, Accident, Fearsome disease, Foul means

18. Considering a Good Death in Ghana A good death is one that occurs without much pain. A good death comes naturally after a long and well-spent life. A good death takes place in the home, surrounded by children and grandchildren. A good death is a death which is accepted by the relatives. For these residents of this rural community in Ghana the epitome of a Good Death is a peaceful one that occurs at home, surrounded by children and grandchildren. Common Requirements of a Good DeathTheir requirements of a Good Death are very similar to those wished for by people in the United States, or in the United Kingdom Perhaps there are some common characteristics of a good death that defy many cultural and national boundaries. Source: Van der Geest, S. (2006).

19. Remoteness of Death During earlier times: Most deaths occurred at home People of all ages cared for the sick and old and were present at the moment of death. Family members prepared the deceased for burial. Burial was typically conducted by family and friends. Because higher mortality rates for all people, death a common event in most communities.

20. Remoteness of Death Today: Most non accidental deaths occur in hospitals. Lower mortality rates and better health care mean many young people grow into young adults with little or no personal experience with death and loss. When death occurs, others from hospitals and funeral homes perform the necessary activities of preparing the body for burial and conducting the burial. For most modern people in western cultures, death is a rare event that occurs mostly on TV, in movies or in far away places.

21. Development of a Death Concept in Childhood • Children in middle childhood typically acquire an understanding of death. • Once very basic ideas of biology are known…plants and animals are alive for a while and then they cease to exist the concept is transferred to humans….and is composed of five ideas: • Permanence: Death if forever • Inevitability: All living things will die • Cessation: All living functions cease • Applicability: Death applies only to living things • Causation: Death is caused bodily failure or damage

22. Adolescent concepts of death Adolescents appear to have a cognitive or logical understanding of death but often fail to appreciate its reality in their own lives. Teenagers often explore alternative ideas about death incorporating ideas from religion, philosophy or even from ideas communicated in popular culture and media. Teenagers often engage in high risk behaviors and do not take death personally. The myth of personal immortality is present and slowly is abandoned with maturity and life experience.

23. The concept of death in adulthood Early Adulthood: Death is rarely a consideration or thought for most during these years as the focus is yypically upon career, family, and home. Middle Adulthood: Most become aware that life is finite and begin to accept that they will someday Older Adulthood: As death nears most individuals in this age group will consider the dying process more than the state of being dead.

24. Death Anxiety Generally, individuals with a sense of spirituality or a deep faith in a higher force will experience less fear of death. Older adults with the ability to regulate negative emotion and a sense of symbolic immortality are less anxious about death than younger individuals. Across cultures, women are typically more anxious about death than are men.

25. Helen Kubler-Ross and the stages of grief Although these ideas were first suggested as stages in the process of dying, they have since been applied to other kinds of loss. 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

26. A Place to Die Only about 1 in 4 Americans die at home. Even with high quality equipment and paid staff, attending to and caring for a dying person is very demanding and difficult. Deaths in hospitals typically occur in emergency rooms and are typically result of an acute or sudden event. There is frequently anger and confusion among the surviving family members. Other hospital deaths occur in intensive care units (ICUs) which is especially depersonalizing because of the use of machines to support body systems at the end of life. Doctors are trained to cure and preserve life……

27. A Place to Die Deaths in nursing homes are common. High quality terminal care is lacking due primarily to the extreme cost of equipment and qualified staff. Too many patients receive too little attention and many die without having their needs met. Patients in nursing homes often become “invisible” if family members are not fully invested in their care.

28. Hospice The hospice concept attempts to provide palliative or comfort related care in an attempt to meet the dying person’s physical, emotional, social and spiritual needs at the end of life. The hospice concept reduces suffering for the dying and provides valuable support to the family during the times leading up to death.

29. Questions or comments ??