Chapter 19:
Dealing with Death and Bereavement
DEVELOPMENTAL PSYCHOLOGY
Source: Papalia & Martorell (15th ed.), Santrock (17th ed.), Boyd & Bee (7th ed.)
The Meaning of Death and Dying
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Cultural Context
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Cultural aspects of death include care of and behavior
toward the dying and the dead, the setting where
death usually takes place, and mourning customs and
rituals.
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Some cultural conventions, such as flying a flag at
half-mast after the death of a public figure, are
codified in law.
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Expressions of grief, anger, and fear are common
across cultures, and most cultures have socially
sanctioned ways of expressing these emotions within
the context of mourning or funeral practices.
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Mortality Revolution
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Advances in medicine and sanitation, new treatments
for many once-fatal illnesses, and a better-educated,
more health-conscious population have brought
about a mortality revolution.
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Women today are less likely to die in childbirth, infants
are more likely to survive their first year, children are
more likely to grow to adulthood, young adults are
more likely to reach old age, and older people often
can overcome illnesses they grew up regarding as
fatal.
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Such social conventions as placing the dying person
in a hospital or nursing home and refusing to openly
discuss their condition reflected and perpetuated
attitudes of avoidance and denial of death.
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Thanatology
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Study of death and dying.
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Facing Death and Loss
Factors Preceding Death
Terminal Drop (Terminal Decline)
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A frequently observed decline in cognitive abilities
near the end of life.
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While more highly educated people generally perform
better on cognitive tests, they show similar rates of
decline as do less-educated people.
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Dementia accelerates the rate of decline in all people.
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Areas of decline include memory capacity, perceptual
speed, visuospatial abilities, and everyday cognition.
Near-Death Experiences (NDE)
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Often involves a sense of being out of the body or
sucked into a tunnel and visions of bright lights or
mystical encounters.
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The commonly reported altered sense of time, flying
sensations, and light reported by some people are
theorized to originate in the right hemispheric
temporo-parietal junction (TPJ).
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The spiritual dimensions often reported, along with
the sounds, music, and voices, are believed to result
from the left hemispherical TPJ.
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Emotions and life review are thought to originate from
the hippocampus and amygdala.
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Some people who experience NDEs report spiritual
growth as one consequence, and the degree of
spiritual transformation is related to the depth of the
NDE.
Care of the Dying
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Hospice Care
▪
Personal, patient- and family-centered care
for a person with a terminal illness.
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Palliative Care
▪
Care aimed at relieving pain and suffering
and allowing the terminally ill to die in
peace, comfort, and dignity.
Not everyone goes through all five stages and not
necessarily in the same sequence.
Terror Management Theory (TMT)
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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, or thoughts
of death, are made salient.
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One common response to thoughts of death is to
become more committed to a cultural worldview.
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Another implication of TMT is that high self-esteem
should buffer people against anxiety and fear over
death.
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Seeking comfort from loved ones is a common
response in humans undergoing threat and is a
regulatory strategy to reduce anxiety.
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When death is made salient, those people who are
willing and able to would be predicted to engage in
behaviors to increase attachment, such as enhanced
commitment, attraction, forgiveness, and intimacy.
Patterns of Grieving
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Grief
▪
Emotional response experienced in the
early phases of bereavement.
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Bereavement
▪
Response to the loss, due to death, of
someone to whom one feels close and the
process of adjustment to the loss.
Class Grief Work Model
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Shock and Disbelief
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Immediately following a death, survivors
often feel lost and confused.
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As awareness of the loss sinks in, the initial
numbness gives way to overwhelming
feelings of sadness and frequent crying.
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May last several weeks.
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Preoccupation with the Memory of the Dead Person
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May last 6 months to 2 years or so.
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Survivor tries to come to terms with the
death but cannot yet accept it.
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Resolution
▪
The bereaved person renews interest in
everyday activities.
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Memories of the dead person bring fond
feelings mingled with sadness rather than
sharp pain and longing.
Variations of Grieving
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In the recovery pattern, the mourner goes from high
to low distress.
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In the delayed grief pattern, there may be moderate
or elevated initial grief, and symptoms gradually
worsen over time.
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In the chronic grief pattern, the mourner remains
distressed for a long time.
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Chronic grief may be especially painful and
acceptance most difficult when a loss is
ambiguous, as when a loved one is missing
and presumed dead.
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In the final pattern, known as resilience, the mourner
shows a low and gradually diminishing level of grief in
response to the death of a loved one.
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Confronting One’s Own Death
5 Stages of Grief (Kübler-Ross)
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Denial
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Anger
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Bargaining for extra time
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Depression
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Acceptance
Reviewer by: Paris (@sikolohijaMD on twt) | NOT FOR SALE
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Responses to Death Across the Life Span
Infancy and Childhood
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Generally, although many feel uncomfortable doing
so, most parents begin to talk about death with their
children at around the age of 3 years.
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Learning about death involves understanding it is
irreversible, universal (happens to everyone),
nonfunctional (involves the cessation of all life
function), and inevitable.
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Children can better understand death if they are
introduced to the concept at an early age and are
encouraged to talk about it.
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Children who have had experience with the death of
a loved one have a more realistic view of death than
children who have not experienced such an event.
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With respect to bereavement, if children are old
enough to love, they are old enough to grieve.
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Infants and very young children may respond to the
death of a parent initially with crying, despair, and,
eventually, pathological detachment.
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Adolescence
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While they are capable of a mature understanding of
death, it is not something they typically think much
about unless they are directly faced with it.
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Often teens may turn to peers for such support.
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At the same time teens must process their own grief,
they are often also asked to take on more adult
responsibilities, such as helping take care of younger
siblings or providing emotional support to a surviving
parent.
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The bereavement process can lead to academic
problems, especially for juniors and seniors in high
school and mental health issues, particularly
depression, conduct disorder, and increased
likelihood of substance abuse.
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Bereaved teens who attend religious services more
frequently or who use religion as a coping strategy are
less likely to abuse substances and are more likely to
have higher self-esteem and succeed academically
than their less religious peers.
Adulthood
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People who develop terminal illnesses in their
twenties or thirties must face issues of death and
dying at an age when they normally would be dealing
with issues such as establishing an intimate
relationship.
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Middle-aged and older adults may prepare for death
emotionally as well as in practical ways by making a
will, planning their funerals, and discussing their
wishes with family and friends.
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Generally, distress is greater when the discrepancy
between how long they want to live and how long they
think they have left is large.
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decline, greater anger, more anxiety and depression,
and feelings of yearning after the death of a spouse.
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People who are able to maintain healthy, secure
attachments to other people in their lives and use
them for social support after a spouse’s death are
likely to show more resilience.
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For women, the main consequences of widowhood
are likely to be economic.
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Widowed men are more likely to become socially
isolated after the death of a spouse than are widows.
Losing a Parent in Adulthood
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Majority of bereaved adult children still show an
impact on their wellbeing and experience emotional
distress after 1 to 5 years, especially following loss of
a mother and most strongly in daughters.
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It can push adults into resolving important
developmental issues: achieving a stronger sense of
self and a more pressing, realistic awareness of their
own mortality, along with a greater sense of purpose,
responsibility, commitment, and interconnectedness
to others.
Losing a Child
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Parents who have lost a child are at heightened risk
of being depressed or hospitalized for mental illness
and show poorer health-related quality of life.
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The stress of a child’s loss may even hasten a
parent’s death, most frequently via heart disease.
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Parents whose child dies a traumatic death generally
grieve more than those whose child dies of an illness
or disorder or those who experience a stillbirth or
neonatal death, and mothers tend to grieve more than
fathers.
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Many parents hesitate to discuss a terminally ill child’s
impending death with the child, but those who do so
tend to achieve a sense of closure that helps them
cope after the loss.
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Parents who used spiritual beliefs to help them cope
with their child’s death showed less grief, depression,
and, for mothers, less posttraumatic stress and
greater personal growth.
Mourning a Miscarriage
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Families, friends, and health professionals tend to
avoid talking about such losses, which often are
considered insignificant compared with the loss of a
living child.
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Common responses, which are generally reported
with greater intensity in women, include grief,
depression, guilt, isolation, and sadness.
Medical, Legal, and Ethical Issues
Suicide
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The most common methods used were ingestion of
pesticides, hanging, and firearms.
Men commit suicide at higher rates than do women.
Suicide rates are also higher in stigmatized groups
such as refugees, migrants, LBGTQ+ people, and
prisoners.
More than half of completed suicides are by gunshot,
and gun deaths via suicide outnumber those by
homicide.
Significant Losses
Surviving a Spouse
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Because women tend to live longer than men and to
be younger than their husbands, they are more likely
to be widowed.
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Bereavement has been associated with cognitive
declines and depression and anxiety.
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Bereavement also entails higher risks of disability,
drug use, insomnia, hospitalization, and even death.
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Higher relationship quality during the marriage has
been associated with an increased risk of cognitive
Reviewer by: Paris (@sikolohijaMD on twt) | NOT FOR SALE
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Euthanasia (“good death”)
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Passive Euthanasia
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Withholding or discontinuation of lifeprolonging treatment of a terminally ill
person in order to end suffering or allow
death with dignity.
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Generally legal.
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Active Euthanasia (Mercy Killing)
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Deliberate action taken to shorten the life of
a terminally ill person in order to end
suffering or to allow death with dignity.
Advance Directive
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Document specifying the type of care wanted by the
maker in the event of an incapacitating or terminal
illness.
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May take form of a living will.
Durable Power of Attorney
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Legal instrument that appoints an individual to make
decisions in the event of another person’s
incapacitation.
Having a plan of action when death is imminent leads to
improved end-of-life care and results in higher levels of family
satisfaction and reductions in stress, anxiety, and depression in
family members of the terminally ill patient.
Assisted Suicide
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Suicide in which a physician or someone else helps a
person take their own life.
Finding Meaning and Purpose in Life and Death
Life Review
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Reminiscence about one’s life in order to see its
significance.
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Awareness of mortality may be an impetus for
reexamining values and seeing one’s experiences
and actions in a new light.
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Some people find the will to complete unfinished
tasks, such as reconciling with estranged family
members or friends, and thus to achieve a satisfying
sense of closure.
“Time is relative. When we are young, the wide swath of the future
stretches ahead. Near death, the end contracts and narrows. Within a
limited life span, no person can realize all capabilities, gratify all
desires, explore all interests, or experience all the richness that life
has to offer. The tension between the possibilities for growth and a
finite time in which to do the growing defines human life. By choosing
which possibilities to pursue and by continuing to follow them as far
as possible, each person contributes to the unfinished story of human
development.”
Reviewer by: Paris (@sikolohijaMD on twt) | NOT FOR SALE