Death and Dying

The Meaning of Death and Dying

Defining death and dying is a difficult task. Traditionally, death is defined as the absence of a heartbeat. Advancements in medical care make this definition problematic. Today we have machines that can keep a person's heart beating and lungs breathing when they are not able to anymore. We need a more comprehensive definition of death.

Medically speaking, a person has to meet certain criteria to be declared dead. Across cultures, death and dying can take on different definitions and meanings entirely.

Examples of Death and Dying

Death is a natural occurrence in life. It will be experienced by all of us. People die every day in many different ways: suicide, overdoses, homicide, genocide, and war. According to the Center for Disease Control (CDC), the leading cause of death in America is heart disease. The ways in which a person dies can greatly impact the people they leave behind.

Processing the death of a loved one who died by suicide can cause feelings of confusion and sometimes guilt. When a loved one dies due to a chronic illness, the family knows exactly why the person died and likely had time to prepare for their passing. In any case, the process of grieving the death of a loved one looks different for each person in their unique circumstances.

Death and Dying Process

There are many ways that the death and dying process occurs. Holding a funeral or a wake helps loved ones face the reality of their loss and comfort each other. Attending a funeral or spreading a person's ashes are meaningful ways to honor and remember the deceased, which is an important part of processing a loss. Writing your will and making health decisions ahead of time can help a person feel at peace and help their family deal with loss.

Basic Principles of Death and Dying

Death and dying are not easy concepts to grasp. Children have to learn about death and dying from their parents and life experiences. Death is typically understood to possess three basic principles:

1. Permanence: people cannot come back to life after they die.

2. Universality: all living things will eventually die.

3. Non-functionality: The functions of a living being cease after death.

Children learn about death and grasp these concepts in the order listed above. First, they discover death's permanence. Once a person has died, they are gone. Young children are not yet old enough to understand and accept that all of the people they care about will die someday (universality).

Preschool children tend to believe that people who die are simply less alive than they were before. Around age 9, children begin to understand that life stops when someone dies. The person who died is gone because they are no longer functioning.

Fig. 2 Children and death, pixabay.com.

The number of experiences and encounters with death a child or teen has faced also determines how well they understand death. Older adults who have lost more friends and family members than adolescents or young adults usually have a more mature understanding of death. This does not mean that older adults have overcome their own fears about dying, though; they may still experience death anxiety.

The Stages of Death and Dying

Contrary to popular belief, terminally ill patients often have a positive outlook on the remaining days of their lives. This may be due to processing their terminal illness and working their way through the stages of death and dying. Elizabeth Kubler-Ross (1969) outlined 5 stages of grief and loss by interviewing 200 people with terminal illnesses. She found that people tend to experience five emotional reactions toward death, ending with acceptance.

Stage 1: Denial

When someone first learns that they have a terminal illness or that someone they know has died, they may become shocked and feel like what they were just told isn't true. They may isolate themselves to avoid dealing with the information, or keep their diagnosis to themselves.

They might think, "Not me! This must be a mistake! This can't be happening." This stage is normal and can help us cope with the initial shock. It becomes a concern if it is prolonged or extreme.

Stage 2: Anger

Soon the experience of denial, numbness, or shock transitions to anger. “Why me? What did I do wrong? There is so much I still want to do. Why did they leave me?” The individual may feel angry, envious, full of rage, or resentful. These feelings are often expressed toward family members, close friends, and even doctors.

When a person is in this stage, it is best for those who interact with them to not take it personally. Even though anger has taken over their thoughts and feelings, people in this stage need others to listen, sympathize, and empathize with them. Support from others is crucial in helping us make it through the stages of grief.

Stage 3: Bargaining

Once the anger and initial shock begin to subside, people often start trying to find a way out of their illness or their grief. Their thoughts may sound like, “This is happening to me, but if I go through all of the treatments I will get better." "My friend has died, but if I'm a really good friend from now on I won't lose any other friends." Those who believe in God may try to strike a deal with God: "If you heal me, I will be good for the rest of my life." People in this stage may make promises they are unlikely to keep, such as "If I'm cured, I will never smoke again."

Stage 4: Depression

When the pleas and bargains end up failing, depression is the next stage. The person may become consumed by despair and hopelessness. The depression is either reactive (in response to a loss that already happened), or it is preparatory (in response to a future loss, even one that might not happen). The person may have thoughts like, "My life didn't mean anything. I didn't get to do all the things that I wanted to do. This sucks! Nothing I do will change the outcome."

Stage 5: Acceptance

The last stage is acceptance and coming to terms with reality. This does not necessarily mean the person becomes happy. They will likely still feel a wide range of negative emotions, but they will hopefully begin to experience some positive ones as well.

A person in the acceptance stage can shift their focus onto their family and friends. Nonverbal displays of affection are very common in this stage. Family and friends try to show how much they love and care about each other.

Death and Dying in Psychology

Psychologists study death and dying for several reasons. One common reason is to better understand and treat death anxiety. Psychologists also want to know how to effectively counsel individuals through grief and bereavement.

Bereavement can involve some very intense emotions, and may resemble symptoms of major depressive disorder. Grief can feel like anguish, loneliness, disorientation, and sometimes even meaninglessness. The loss of a partner or spouse, the loss of a parent, and the loss of a child are some of the most difficult forms of bereavement. There are four tasks required of those who are grieving or bereaved:

1. Acknowledge the loss.

2. Process the pain.

3. Adjust to a world without the lost loved one.

4. Move forward while maintaining connections to the past.

Fig. 3 Funerals and grief, freepik.com.

Bereavement or grief usually lessens and resolves with time. It is a normal response to loss. There are times, though, that bereavement is more severe or long-lasting than expected and may require additional support. This type of bereavement is called complex bereavement disorder or prolonged grief disorder, and is experienced by 10-12 percent of bereaved individuals.

Complex bereavement disorder includes at least one of the following symptoms for longer than is typically expected:

• Frequent preoccupation with the deceased.

• A persistent and intense yearning for the deceased.

• Intense feelings of emptiness or loneliness.

• Frequent desire to join the deceased in death.

• Consistent thoughts that life is unfair or meaningless without the deceased.

You also have to have experienced at least two of the following symptoms for at least one month:

• Intense reactions to memories, or indeed anything that reminds you of the deceased.

• Ruminating about the circumstances or consequences of the death.

• Lasting feelings of disbelief or inability to accept the loss.

• Difficulty trusting or caring about others.

• You either avoid any reminders of the deceased, or actively seek out reminders to feel closer to the deceased.

• Intense anger or bitterness about their death.

• Feeling shocked or numb since the death of the loved one.

Complex bereavement disorder can be treated with psychotherapy, for example, cognitive-behavioral therapy. If the symptoms are especially severe, antidepressant medications may also be effective.