The Psychology of DyingThe Psychology of Dying

Kubler-RossKubler-Ross

5 stages:5 stages:– 1) Denial: (and Isolation)1) Denial: (and Isolation)

““the defense mechanism by which a person is the defense mechanism by which a person is unable or refuses to see things as they are unable or refuses to see things as they are because such facts are threatening to the self”because such facts are threatening to the self”

– 2) Anger: 2) Anger: ““blame directed toward another person”blame directed toward another person”

– 3) Bargaining3) Bargaining– 4) Depression4) Depression– 5) Acceptance5) Acceptance

William WordenWilliam Worden

4 Tasks of Mourning:4 Tasks of Mourning:– Task One: To Accept the Reality of the LossTask One: To Accept the Reality of the Loss– Task Two: To Experience the Pain of Grief Task Two: To Experience the Pain of Grief

and to Express the Emotions Associated With and to Express the Emotions Associated With ItIt

– Task Three: To Adjust to an Environment in Task Three: To Adjust to an Environment in Which the Deceased is MissingWhich the Deceased is Missing

– Task Four: To Emotionally Relocate the Task Four: To Emotionally Relocate the Deceased or Other Changed Condition and Deceased or Other Changed Condition and Move On With LifeMove On With Life

LoflandLofland

““dying scripts”dying scripts”Elements:Elements:– SpaceSpace– PopulationPopulation– KnowledgeKnowledge– StanceStance

Em. M. PattisonEm. M. Pattison

3 phases of the dying process:3 phases of the dying process:– 1) acute crisis phase1) acute crisis phase

– 2) chronic living-dying phase2) chronic living-dying phase

– 3) terminal phase3) terminal phase

A. WeismanA. Weisman

3 degrees of denial:3 degrees of denial:– 1) the person denies the facts1) the person denies the facts

– 2) the person accepts the diagnosis but 2) the person accepts the diagnosis but refuses to believe that it is terminalrefuses to believe that it is terminal

– 3) person vacillates beween open 3) person vacillates beween open acknowledgement of death and its repudiationacknowledgement of death and its repudiation

Glaser and StraussGlaser and Strauss

4 contexts of awareness:4 contexts of awareness:– 1) closed awareness1) closed awareness

– 2) suspicion2) suspicion

– 3) mutual pretense3) mutual pretense

– 4) open awareness4) open awareness

Duties of the DyingDuties of the Dying

1) arrange a variety of affairs1) arrange a variety of affairs2) adapt to the loss of loved ones and self2) adapt to the loss of loved ones and self3) manage medical needs and balance 3) manage medical needs and balance emotionsemotions4) plan for future loss4) plan for future loss5) identify and cope with the death 5) identify and cope with the death encounterencounter

Role of the FD With the DyingRole of the FD With the Dying

Prerequisites for the FD:Prerequisites for the FD:– 1) acknowledge one’s mortality1) acknowledge one’s mortality– 2) understand the grief process2) understand the grief process– 3) effective listening and appropriate 3) effective listening and appropriate

responseresponse– 4) commitment to the dying4) commitment to the dying– 5) knowledge of personal limits5) knowledge of personal limits

Social Responses to DeathSocial Responses to Death

variety of socialization processesvariety of socialization processesdemographic normsdemographic normsPreindustrial: high mortality ratesPreindustrial: high mortality rates– small, tightly integrated communitiessmall, tightly integrated communities

Postindustrial: drop in mortality ratesPostindustrial: drop in mortality rates– death is distanced, sanitizeddeath is distanced, sanitized

Death of a ParentDeath of a Parent

natural eventnatural eventunfinished emotional businessunfinished emotional businesslittle/no allowance for untimely, violent, or little/no allowance for untimely, violent, or unexpected deathunexpected deathallow the adult child to express the allow the adult child to express the feelings of lossfeelings of losssupport groupssupport groups

Death of a SpouseDeath of a Spouse

secondary lossessecondary losses

social issuessocial issues

support groupssupport groups

Death of a ChildDeath of a Child

parents and siblings aren’t the only ones parents and siblings aren’t the only ones who mourn the loss of a child, but the who mourn the loss of a child, but the parental grief response is the most parental grief response is the most complexcomplex

friends may avoid the parentsfriends may avoid the parents

““service guilt”, “survivor’s guilt”service guilt”, “survivor’s guilt”

GuiltGuilt

Composed of:Composed of:– RegretsRegrets– MisgivingsMisgivings– Unresolved past conflicts with the childUnresolved past conflicts with the child– Every aspect of the relationship and childcareEvery aspect of the relationship and childcare

Secondary LossesSecondary Losses

child may have filled a “gap”child may have filled a “gap”child as well as friendchild as well as friendsense of status/self-esteem/purposesense of status/self-esteem/purposecontinued guilt can give rise to continued guilt can give rise to complicationscomplicationschanged identitychanged identitycamily structure is alteredcamily structure is altered

Parental AngerParental Anger

feel that core identities have been ripped feel that core identities have been ripped outoutworld no longer makes senseworld no longer makes senserage at those perceived to have a role in rage at those perceived to have a role in the deaththe deathfeelings of betrayalfeelings of betrayalanger directed toward survivorsanger directed toward survivors

Coping With Other PeopleCoping With Other People

Need to be aware that there are people in Need to be aware that there are people in their lives from whom they will never get their lives from whom they will never get the support they would have expected or the support they would have expected or desire.desire.

Parental FearParental Fear

Fear of losing other children or any close Fear of losing other children or any close person causes bereaved parents to person causes bereaved parents to overprotect.overprotect.

““New Me in a New World”New Me in a New World”

The image of the child exists within but is The image of the child exists within but is no longer physically available as an no longer physically available as an external reality.external reality.Create a new internal picture of who they Create a new internal picture of who they are in the outside world.are in the outside world.Their loss and grief accompany them Their loss and grief accompany them everywhere they go.everywhere they go.

Painful RemindersPainful Reminders

seasonal remindersseasonal remindersunexpected “moments”unexpected “moments”continual acknowledgment of the child at continual acknowledgment of the child at family eventsfamily eventscan still feel connectedcan still feel connected

Linking Objects and Continuing Linking Objects and Continuing BondsBonds

helps maintain continuity of a relationshiphelps maintain continuity of a relationship

provide support for grieving parentsprovide support for grieving parents

FD ResponsibilitiesFD Responsibilities

reinforce that their feelings are acceptable reinforce that their feelings are acceptable and normaland normalpoint out to them society’s inability to point out to them society’s inability to comprehend their losscomprehend their losswell-meaning people’s commentswell-meaning people’s commentscreate an atmosphere of security, comfort create an atmosphere of security, comfort and accessibilityand accessibility

High Divorce Rate MythHigh Divorce Rate Myth

1999: 72% still married1999: 72% still married 28%: 16% ended due to death of 28%: 16% ended due to death of

spousespouse12% ended in divorce12% ended in divorce

Grieving parents do experience some Grieving parents do experience some marital strain and have to make marital strain and have to make readjustments in their marriages.readjustments in their marriages.

Death of a SiblingDeath of a Sibling

greater chance of healing if parents greater chance of healing if parents remain in their livesremain in their livesparents grieve openlyparents grieve openlyparental grief is sharedparental grief is sharedsiblings may experience shame or siblings may experience shame or embarrassmentembarrassmentpreteens and teens are particularly preteens and teens are particularly sensitive sensitive

Replacement ExpectationsReplacement Expectations

parents may inappropriately place parents may inappropriately place expectations on childrenexpectations on childrenparents may consciously or unwittingly parents may consciously or unwittingly communicate that surviving children take communicate that surviving children take on the dead sibling’s roleon the dead sibling’s roleparents may deify the dead childparents may deify the dead childparents may focus on the dead child to the parents may focus on the dead child to the exclusion of the surviving siblings exclusion of the surviving siblings

Surviving Adult SiblingsSurviving Adult Siblings

least acknowledged by societyleast acknowledged by societyfacing the death of someone in their own facing the death of someone in their own generation…..personal confrontation with generation…..personal confrontation with their own mortalitytheir own mortalityFD should be available to themFD should be available to them

Implications for Funeral DirectorsImplications for Funeral Directors

1) society’s perception of the death may 1) society’s perception of the death may not “track” with the individual’s responsenot “track” with the individual’s response2) be sensitive to conflict between what is 2) be sensitive to conflict between what is expected and what they feelexpected and what they feel3) provide information about resources3) provide information about resources4) small library of books, tapes etc.4) small library of books, tapes etc.5) provide clear, complete and accurate 5) provide clear, complete and accurate communicationcommunication