DEATH AND DYING
OUTLINE FOR FINAL EXAM
Bereavement/Grief/Mourning
I. Bereavement.
– Secondary losses.
II. Grief.
A. Evidence for a Biological basis.
1. Grief is universal.
2. Grief reactions are uniform across cultures and human history.
2. Grief reactions are found in other species.
B. Theories of grief.
1. Attributes of a good theory.
a. Explain the core components of grief:
1'. Distress.
– Undoing.
– After Death Communications (ADCs).
2'. Resignation.
3'. Shock.
4'. Recovery.
– Which we will call mourning.
b. Answer the question of WHY we grieve.
2. Reinforcement theory.
– B. F. Skinner.
– Extinction.
– Frustration effect.
3. Attachment theory.
– John Bowlby (1907 - 1990).
– Grief is the price we pay for commitment.
a. Protest.
b. Despair.
c. Reorganization.
III. Mourning.
A. Characteristics.
B. Theories.
1. Grief work.
– Sigmund Freud.
a. Terms.
1'. Libido.
2'. Cathexis.
3'. Decathexis.
b. Process.
– Withdrawal and reinvestment.
– Obsessive reviews.
2. Worden’s Task theory.
– Describes uncomplicated mourning.
a. Accept the reality of the loss.
b. Work through the pain.
c. Adjust to an environment without the deceased.
d. Emotionally relocate the deceased and move on with life.
– Bridging.
– Linking.
3. Dual process model.
a. Terms.
1'. Loss-orientation.
2'. Restoration-orientation.
3'. Oscillation.
b. Assumptions.
4. Meaning reconstruction.
– e.g., Robert Neimeyer.
a. Modernism versus postmodernism.
b. Definition.
– Continuing bonds.
c. Postulates.
1'. Each of us construct a unique world of meaning.
– Assumptive world.
2'. A significant loss can do one of three things to our meaning structure:
a'. Invalidate.
b'. Validate.
c'. Stand as a novel experience.
C. Outcomes.
1. Uncomplicated mourning.
2. Complicated mourning.
– Therese Rando.
a. Definition.
b. Symptoms.1'.Psychological disorders.
2'. Substitute symptoms.
3'. Mummification.
c. Syndromes.
1'. Chronic.
2'. Delayed.
3'. Exaggerated.
– Thanatophobia.
4'. Masked.
– Affective equivalents
a”.Physical symptoms.
– Facsimile illness.
b”.Behavioral symptoms.
D. Influencing factors.
1. Disenfranchised grief.–four types:
a. The relationship is not recognized.
b. The loss is not recognized.
c. The griever is not recognized.
d. The death is not recognized.
2. Social expectations.
3. Value structure.
4. Unfinished business.
– Deathbed promises.
5. Mode of death.
a. Anticipatory grief.
b. Suicide.
c. Homicide.
d. Disasters.
– Survivors twice over.
Stress Disorders
I. Post-traumatic Stress Disorder (PTSD).
A. History.
– Problems:
1. Catastrophic events are not that rare.
2. Not everyone exposed to a catastrophic event will develop a psychological disorder.
B. Diagnostic criteria.
– See handout.
1. Part A – Criteria.
2. Part B – Reexperiencing symptoms (1-or-more).
– Intrusive recollections.
– Traumatic nightmares.
– PTSD flashbacks.
3. Part C – avoidant/Numbing Symptoms (3-or-more).
– Dissociative amnesia.
– Psychic numbing.
4. Part D – Hyperarousal Symptoms (2-or-more).
5. Part E.
6. Part F.
II. Acute Stress Disorder (ASD).
A.Difference from PTSD.
– Time of diagnosis.
– Emphasis on dissociative symptoms.
B. Diagnostic criteria.
– See handout.
1. Part A.
2. Part B – Dissociative symptoms (3-or-more).
a. Reduction of awareness.
b. Derealization.
c. Depersonalization.
3. Parts C-E.
4. Parts F-H.
III. Compassion fatigue.
A. Definition.
B. Outcomes.
IV. Treatment.
A. Normalization.
B. Remove self-blame and doubt.
C. Correct misunderstandings.
– Cognitive-behavioral therapy.
– Cognitive errors.
– See handout.
Suicide
I. Definitions.
A. Suicide ideators.
B. Suicide attempters.
– Parasuicides.
C. Suicide completers.
II. Demographics.
A. Suicide rate.
– Autocide.
– Death by cop.
– Indirect Life-Threatening Behaviors (ILTBs).
– Subintentioned death.
B. Age.
– Adolescents(15 – 24 year-old).
– The elderly.
– the “oldest-old.”
C. Gender.
D. Race.
1. Blacks.
2. Hispanics.
3. Native Americans.
E. Summary.
–The major demographic risk factors include being white, male, over the age of 65, and living alone.
III. Theories.
A. Sociological.
– Emile Durkheim, Le Suicide, 1897.
– Two social dimensions which lead to 4 types of suicide:
1. Social regulation.
a. Anomic suicide.
b. Fatalistic suicide.
2. Social integration.
a. Egoistic suicide.
b. Altruistic suicide.
– Seppuku (hara-kiri).
– Kamikaze.
– Suttee.
B. Psychological.
– Freud.
– Suicide as murder directed inward.
– Eros.
– Thanatos.
C. Biological. (Corr, 2nd, 497 ).
1. Physiological imbalance.
– e.g., a reduction in the neurotransmitter Serotonin.
2. An inherited tendency.
IV. Suicide prevention and postvention.
A. Prevention.
1. Erect physical barriers.
2. Suicide hotlines.
3. Education.
– Suicidal trance.
– Tunnel vision.
4. Know the signs.
a. Verbal direct.
b. Verbal indirect.
c. Behavioral direct.
d. Behavioral indirect.
B. Intervention.1.Always take the threat of suicide seriously.
2. If uncertain about a person’s intentions, ask.
3. Do not provoke the person.
4. Avoid value judgements.
5. Listen.
6. Take specific action.
C. Postvention.
– Suicide survivors.
Developmental Issues
I. Children.
A. Mature View of Death.
1. Universality.
2. Irreversibility.
3. Nonfunctionality.
4. Causality.
5. Noncorporeal Continuation.
B. Nagy’s Developmental Stages.
1. Stage I (3-5 years).
a. Curious about death.
b. View death as separation.
c. View death as diminished life.
2. Stage II (5 to 9 years).
a. Death is personified.
b. Death is final, but....
3. Stage III (9-10 years).
a. There is an adult quality about an adolescent’s responses about death.
b. Themes of universality and inevitability predominate.
c. There is use of elements of the concept of justice and of simile/metaphor.
C. Childhood Bereavement.
1. Characteristics.
a. Seemingly inappropriate responses.
– Grief span.
b. Negative behavior changes.
1'. Dependency, submissiveness, introversion.
2'. Regression.
3'. Maladjustment.
c. Exceptional achievement.
d. Re-grieving.
2. Working with grieving children.
a. Develop open lines of communication.
– Teachable moments.
b. Work at the child’s level.
c. Use correct language.
d. Encourage the expression of grief.
– Creative transformation.
e. Let the child decide whether-or-not to attend the funeral.
D. The dying child. (Bluebond-Langer, 1978, chapter 4).
1. The awareness of death model.
– Myra Bluebond-Langer.
– Disease-related information.
2. Stages of awareness.
a. Stage I – I have a serious illness.
– Exhibition of wounds.
b. Stage II – I have a serious illness and will get better.
c. Stage III – I am always ill and will get better.
d. Stage IV – I’m always ill and will never get better.
e. Stage V – I am going to die.
– Disclosure conversations.
– Disclosure statements.
II. Adults.
– Motifs of meaning.
A. Death as an organizer of time.
B. Death as a fear to be conquered.
1. Acts of preparation.
2. Belief systems.
3. Worth and competence.
C. Death as counterpoint.
Beyond Death
I. Eschatology.
A. Belief in an afterlife.
1.Overall.
2. By age.
3. By gender.
4. By race.
5. By religion.
B. Belief systems.
1. Nothingness.
2. Attenuated life.
3. A special place.
4. A state much like this life.
5. Reincarnation.
– The Bardo.
6. Multiple outcomes.
C. Evidence.
1. Near-death experiences.
– NDEs.
a. Definition.
b. Components.
– autoscopic experience.
c. Explanations.
1'. A glimpse of “the other side.”
2'. Physiological event.
– Ketamine.
3'. Hallucination.
– Sensory deprivation.
– Prenatal memories.
4'. Survival mechanism.
5'. Enabling metaphor.
d. Evidence.
1'. Pro.
– Michael Sabom, cardiologist.
2'. Con.
2. Deathbed escorts/Guardian angles.
– The Lady in Gray.
3. Spiritualism.
– Past life regression.
II. Postself
A. Definition.
B. Ways to “live on.”
1. In the memory of others.
– The “dead-dead.”
2. Through one’s works.
3. In the bodies of others.
4. In the genes of our children.
C. In summary.