PSYC 3570 Chapter Notes - Chapter 4: Irish Mythology, Grief Counseling, Hearse
17 Oct 2018
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Psychology of Death and Dying Chapter #4: Dying – Transition from Life
“Dying”: Primped and Medicalized
- The rules have changed since American Psychologist Herman Feifel (1959) called
attention to society’s taboo ridden attitude that prevented in-depth discussion of death,
dying, and grief
o Death education, hospice care, grief counseling, and media coverage have
challenged the taboo with a fair degree of success
o We are perhaps as evasive as ever when “dying” would seem to be the
appropriate word
▪ These substituted terms are branded as denial response
- Much of the time we primp dying – this is accomplished by various linguistic maneuvers
o “Expiration date” has become a readily available metaphor
o Most common and once common euphemisms for dying are ways of primping
the hearse
o The stark reality is not denied but made more presentable by a comparison with
more familiar and less threatening processes
- The medicalization of dying is quite a different matter
o The passage from life has become increasingly under the surveillance of the
medical bureaucratic complex
o Dying is seldom heard, even though end of life communication and regulation
have proliferated
o There are practical reasons for devising an alternative rhetoric
▪ Dying is too vague and general to describe all the distinctive pathways to
death
o Medicalization also serves the purpose of insulating physicians and bureaucrats
from moral realities
- A steady barrage of substituted terms has the potential to narrow perspective and
downsize the mortal move
- Patients are often fearful when contending with a life-threatening condition
o Professional care-givers have their own share of anxiety
- Today there are significant changes taking place in the conditions of both life and death
The moment of death: is it vanishing?
- The moment when life passes into death has long been charged with passionate
meanings
o Irish folklore – a death was marked by a spirit known as the banshee which
pierced the air with a keening lament
o Lugbara – it was a designated member of the community who uttered the cere a
whooping kind of melody that was sounded only at the moment of a death
o Christian deathbed – regarded as the climax of the Christian drama with
salvation and damnation suspended in the balance
- Last words have often been seized upon as emblems of meaning
- These examples demonstrate the impulse to draw meaning from the last moment of life
o It could be inspiring to hear that the person “passed away peacefully”
o A positive memory image might also help the survivors come to terms more
easily with their own mortality
- What is happening today?
o The women whose mother died in a geriatric facility had an experience that is
becoming increasingly common
The slipping away
- This is how many aged people ended their lives in geriatric facilities from about the
middle of the 20th century onward
- Our traditional ideas about the dying process are becoming less descriptive of today’s
(why is this so?)
o Medical advances help people survive longer with conditions that formerly had
been considered terminal
▪ Person now has a “life threatening” or “life limiting” condition
▪ Has become more difficult to determine when the progression of a long-
term illness should be considered dying
o There is still a tendency for physicians to experience a patient’s death as their
own failure and therefore distance themselves
o Alzheimer’s disease and related dementias more often accompany people in
their last phase of life
▪ Afflicted individuals might not seem present at their deaths
o Sedation can reduce awareness – communication is also impaired and the
passage from life becomes less conspicuous
▪ There is also a zone of indeterminacy in which a person might be unable
to respond to the family or staff member, yet still be cognizant of the
situation
o Often the person dies alone – families might have visited but not happen to be
there at the last moment
▪ Being with a minimally responsive patient is seldom a high priority for
hospital systems
▪ Rahn (2001) and others have documented the limited amount of
personal contact a hospitalized patient is likely to experience
- The “moment of death” is still being nurtured by compassionate health-care providers
- Valentine (2008) reports that few of the terminally ill patients in her study were known
to have offered last words
o Some patients “took charge of their own dying and leave-talking” and recovered
their own characteristic selfhood
- In this chapter, we consider dying not so much as an abstraction but as an experience
that takes many forms, depending on the nature and management of the illness, the
social support system available, and the unique person whose life is in jeopardy
o How and when we die is influenced by societal practices as well as physical
disorders
o It has been found that hospitalized patients are more likely to die when
members of either an understaffed nursing or medical service have excessive
demands on their time and energies
Dying as transition (115)
- Dying is one of many transitions that we experience in our lives which means we can call
upon what we already know from other transitional situations
o We are already “practicing death” with bedtime rituals in childhood and in other
temporary separations of daily life
- Some transitions are long awaited (old enough to get drivers licence) and some may
have been dreaded (do I actually have to support myself)
o Many transitions are tinged with ambivalence (im kind of ready to get married,
sort of, sort of not)
- The transition from life includes:
o Interactions that can either be disturbing or be comforting
o Communications can either inform or confuse
o Self-evaluations that can either undermine or strengthen one’s sense of identity
- No two people bring the same thoughts, feelings, accomplishments, and illness related
experiences
- The quality of life during the final illness depends much on the quality and availability of
the individual’s most valued relationships
What is dying, and When does it begin?
Individual and interpersonal responses
- The knowledge that ‘I am dying’ can transform the individual’s view of self and world
- Most of us choose not to consider our own mortality until we are forced to by some
brush with death or ill-health
o Others spend their lives trying to be comfortable with their own mortality
through living constantly in the full light of the knowledge that we are all dying
so long as we are living
- Other terminally ill people have different experiences to report, but the feeling that
“how I live now is not as I lived before” is hard to escape
o Friends and relatives also are reflected, and their responses in turn affect the
terminally ill person
- We often treat people differently when they are perceived as dying, even if we are not
aware of this difference
- Classic study by LeShan (1982) found that nurses delayed going to the bedside of a dying
patient as compared with other patients on their unit
o Nurses were surprised when told of this differential response pattern and
resolved to respond promptly to terminally ill patients but returned
Onset of the dying process: Alternative Perspectives
- The point when dying begins depends on our frame of reference
- The proposition that we die from the moment we are born might be useful in
developing a personal philosophy of life but it also encourages evasion in those
unwilling to accept this fact head on
- It is true that programmed cellular death expresses itself in the life course from
perinatal phase onward
- King Charles I (1977) suggested that aging might be regarded as slow dying and dying as
fast aging
Document Summary
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