Dying and Bereavement

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Dying and Bereavement
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• Most people in Kuwait die in hospitals.
• Socio-cultural definitions of death
• Different cultures view death in divers ways.
• Customs and expectations differ in rituals of
  bereavement and mourning.
• Within a culture there is a diversity in the view
  of death, mourning and bereavement.

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• There are at least 10 ways in which death can be
  viewed
• Death as an image or an object.
• Death as a statistic .
• Death as an event.
• Death as a boundary.
• Death as a state of being.
• Death as an analogy.
• Death as fear and anxiety.
• Death as a reward or punishment.

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• Legal and Medical Definitions
• The traditional definition of clinical death was
  a lack of heartbeat and respiration.
• Today, brain death is the most used definition
• No spontaneous movement to stimulation.
• No respiration for 1 hour.
• Lack of response to pain.
• No eye movement, blinking or pupil responses.
• No postural activity, swallowing or yawning.
• No motor reflexes.
• No change in any of those in 24 hours.

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• Thinking About Death , Personal Aspects
• How do we think about death?
• Impersonal death
• Death of a stranger, does not touch us
  personally.
• Interpersonal death
• Loss of someone who matter to us, constitutes a
  disruption of some part of our selves.
• Intrapersonal death
• Ones own death, most crucial for health
  professionals to grasp.

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• A Life Course Approach to Dying
• Young adults shift from formal operational
  thinking to post formal makes it possible to
  integrate feelings and emotions with their
  thinking about death, lessening their feelings of
  immortality
• Middle aged adults begin thinking about their own
  death as they deal with the death of their
  parents
• Oldest adults are generally less anxious about
  death
• Dealing With Ones Own Death
• Reactions to impending death can vary in its
  development, especially with different causes of
  terminal illness.
• Diseases such as cancer may have a terminal phase
  in which a patient may be able to predict and
  prepare for death.
• Some diseases that do not have a terminal phase
  may create a condition in which a persons death
  could occur at any time.

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• Stages of Dying
• Denial
• Anger
• Bargaining
• Depression
• Acceptance
• Order of these stages is unpredictable.
• Importance in any particular case is
  unpredictable.

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• 1. Denial shock and disbelief
• A primary primitive defense mechanism.
• A predictable reaction to sudden overwhelming
  news of any sort.
• Range of responses
• Rejection of the physicians verdict .
• Completely repressing any memory of the
  conversation on the likelihood of death.

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• 2. Anger hostility and resentment
• Natural response to the threat posed by our own
  critical illness or that of a loved one.
• Individuals natural response to unmet needs for
  protection or nurturance.
• Critically ill patients have a right to be angry.
• Patients anger is valid regardless of it being
  inappropriately expressed.

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• 3. Bargaining looking for a way out
• An effort to retain control in a powerless
  situation.
• Vows to survive only until a personal landmark or
  anniversary.
• Striking deals with physicians to accept
  treatment only under certain circumstances.

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• 4. Depression
• No longer able to deny, patients experience
  sadness and loss.
• A universal response among terminal patients.
• Even psychologically healthy individuals
  experience depression during the course of a
  terminal illness.
• Clinical depression
• Demand medical intervention.
• Neurovegitative symptoms.
• Anhedonia inability to experience pleasure.
• Psychomotor retardation speak slowly

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• 5. Acceptance
• Acceptance of the inevitability of death with
  peace
• Most patients fail to achieve a truly
  clear-headed acceptance of their death.

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• Death Anxiety
• Terror management theory
• Continuation of ones life is the primary motive
  behind all behaviors, Therefore, fear of dying is
  consistent with this motive.
• Death anxiety includes pain, body malfunction,
  humiliation, rejection, etc.
• Each of these factors can be assessed in any of
  the three levels public, private and
  unconscious.
• Death anxiety maybe lower in older adults due to
  integrity and a positive life review.
• Emotional problems are predictable of higher
  death anxiety

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• Learning to Deal With Death Anxiety
• Adolescents engage in more risk-taking behavior
  which suggest less death anxiety.
• Reduction of death anxiety can be achieved by
  contemplating ones own death by writing ones
  own obituary, planning ones own funeral, etc
• Death education strives to address death anxiety
  by presenting factual information about death.

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• Surviving The Loss
• The Grieving Process a condition caused by
  losing someone.
• Bereavement is the state or condition caused by
  going through loss.
• Grief is the sorrow, hurt, anger, guilt,
  confusion and other feelings that arise after
  suffering a loss.
• Mourning is the way in which we express our
  grief.
• Mourning rituals can be fairly standard across a
  culture, grief varies greatly.

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• People must do several things during grief.
• Acknowledge the reality of the loss.
• Work through the emotional turmoil.
• Adjust to the environment where the deceases is
  absent.
• Loosing the ties with the deceases.
• Its important to remember that grief is a
  process, we must avoid several mistakes
• We must not underestimate the length of time
  people need to deal with the various issues.
• One year is needed and two years may be required.

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• Risk Factors in Grief
• Rosenblatt reports that people still feel the
  effects of the death of family members 50 years
  after the event.
• The length of time didnt diminish the depth of
  emotions experience.
• Religiosity has been investigated as a source of
  support for people following the loss of a loved
  one.
• The results are mixed as to whether this factor
  provides help or not.

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• Coping with Grief
• Two processes have been proposed to explain
  grief
• 1. The Four Component Model lists
• The context of the loss.
• The continuation of subjective meaning associated
  with loss.
• The changing representations of the loss
  relationship over time.
• The role of coping and emotion-regulation
  processes.
• 2. Dual Process Model
• The dual process model of coping with bereavement
  (DPM) lists 2 types of stressors
• Loss-oriented stressors (those having to do with
  the loss itself)
• Restoration-oriented stressors

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• Normal Grief Reactions
• Coming to terms with bereavement is called grief
  work.
• Grief work consists of coping, affect, change of
  relationship.
• Many people experience anniversary reactions
  which are changes in behavior related to feelings
  of sadness on the date of the loss.
• Traumatic grief involves
• Symptoms of separation distress preoccupation
  with the deceased to the point that it interferes
  with everyday functions.
• Symptoms of traumatic distress mistrust, anger
  and detachment from others.

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• Is It Normal to Grief ?
• Grief is vital in order to accept a deep loss and
  carry on with your life.
• If one doesnt grieve at the time of death, or
  shortly after, one may keep the grief bottled up
  inside.
• This may cause emotional problems or physical
  illness later on, working through grief can be a
  painful process, but it make all the difference
  to future emotional and physical well-being.

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• Normal Grief Reaction
• Stage 1 hours to day
• Denial, disbelief
• Psychological numbness
• Stage 2 weeks to months
• Sadness
• Physical anxiety reactions
• Poor sleep
• Lost appetite
• Guilt feelings
• Experience of presence
• Preoccupation with memories of the deceased
• Social withdrawal

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• Stage 3 weeks to months
• Symptoms resolve
• Social activities resumed
• Memories of good times
• Abnormal Grief
• Abnormally intense grief
• Prolonged grief
• Delayed grief
• Inhibited and distorted grief

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• ? Good Luck ?