Attitudes on Death & Dying: MIDTERM STUDY GUIDE!
Attitudes on Death & Dying: MIDTERM STUDY GUIDE! PSYCH 2588
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This 24 page Study Guide was uploaded by Maya Blair on Saturday March 5, 2016. The Study Guide belongs to PSYCH 2588 at George Washington University taught by Pamela Woodruff in Winter 2016. Since its upload, it has received 235 views. For similar materials see Attitudes Toward Death & Dying in Psychlogy at George Washington University.
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Date Created: 03/05/16
BACKGROUND Life line A comparison of how long you have lived and how long statistically you have left to live Draw a line and mark it off from 0100 by 5. Put a star next to 0 Put a * next to your age Put an X if you are a male beyond 76 Put an X if you are a female beyond 80 What you have shown is how long you have lived and how long you have left to live Thanatology The study of death Greek mythology: 2 brothers 1. Thanatos god of the long sleep (death) 2. Hypnos god of the short sleep (regular sleep) Death related behavior David Bowie studied people crossing the street After interviewing them he found 5 types of people: from AE 1. Risk taking behavior a. The Type A pedestrian very cautious, crossed at the corner, looked both ways, etc. Found that they valued their life b. The Type E pedestrian darted out after cars, didn’t look. Found they had negative views of their life 2. Sex discrimination after death Even in death there is sex discrimination Looked at death notices (looks like an ad, pay by the line) and obituaries (free, biographies) Found that though the death notices, about the same number of men and women die In terms of the obituaries, men are written up MUCH more frequently than women If women are written up, they are defined in terms of their husbands CHILDREN The Child’s Understanding of Death: Developmental Stages Nehy interviewed a large number of children at what age they had a concept of death as permanent Between birth 6 months ➢ Child doesn’t understand itself as a self entity (has no self) Between 6 months 2 years ➢ We learn the concept of all gone ➢ Learn that even though we are sad about separation...parents will come back from wherever the went ➢ How do you see separation as permanent? Between 25 ➢ Children talk about the dead but talk about them as if they are someplace else ➢ Not permanent ➢ We talk about flowers coming back in the spring...confuses children 1 Between 56 ➢ Think people die under certain circumstances (ex. old or war) ➢ Think if they do what they’re told, they’re safe and they won’t get hurt Starting at 10 ➢ Usually understand death as permanent ➢ Universal (happens to everyone) ➢ Individual (me) ➢ Understand the causes Talking with the child about death Don't use euphemisms or metaphors Don’t tell them only old people die Find out what prompted the questions Bring to cemetery and explain what it is Visit hospital, nursing homes, etc. It’s okay for them to see parents crying Never force them to be part of a funeral service unless they want to be Child may feel responsible for the death so they need to be told that nothing they did caused the death The child’s exposure to death TV, video games unrealistic death (may see them come back to life which can confuse them) Pet, roadkill if pet, don’t replace it right away. It’s a good opportunity for grieving. ○ Let them talk about the anima, bury the animal, grieve Images of death With each one the first represents life, the second death 1. Connectionseparation (with the people you love/trust; not with them/can make you worry) 2. Movementstasis (free to run/play; having to stay still) 3. Integritydisintegration (body is whole; hurt, fell down, scrape) The adolescent and death Not until you’re an adolescent until you can review (past) and preview life (thinking about the future) Adolescents tend to have the highest rates of accidents because they see themselves as invulnerable The dying child (telling parents about the diagnosis) Once a diagnosis is made, both parents be present A quiet place w/o interruptions Such a shock...parents may ask the same questions repeatedly Internet: good information and bad information Truth telling Vernick (social worker) and Karon (doctor) NIH, 50 years ago, child should be at least 5 ➢ Better to let the child know the name of the disorder and that sometimes children die of it but we’re going to do all kinds of things to help you ➢ “This is going to hurt, it might hurt, but this is very important that we do this” 2 ➢ Results: children learned through truth telling and ended up being more cooperative Child’s reactions to dying It isn’t until they are much older until they actually focus on dying Up until age 5 they are concerned about separation/abandonment Between 510 there’s more of a concern about the actual procedure (about things being painful) After 10 they can more focus on death itself (become concerned about their own death and other patients that have become their friends) Communicating and interacting with the dying child You don’t stand over them but sit on the bed with them Call them by their first name Wear friendly clothing Role play and role reversal (let the child be the doctor) Interactions that let them express how they’re feeling (coloring, etc) Asking direct questions “is there anything I can do to help your mother?” Don’t try to be an authoritarian figure 1. Interpersonal functions (Carl Rogers) adult → child a. Empathy trying to image their situation b. Respect having respect for them as an individual c. Genuineness being yourself w/ child 2. Types of communication (that children display) child → adult a. Direct language call things what they are “I have a sickness called Leukemia” b. Verbal symbolic language euphemisms c. Nonverbal symbolic language body posture, tone of voice, facial expressions Spinetta; isolation of the dying child Withdrawal of the child Clinical psychologist Heard that dying children start to withdraw from others, but it was all anecdotal Wanted to test it, so set up an experiment ➢ 25 children with leukemia ➢ 25 children w/o life threatening illnesses ➢ Ages 610 ➢ Created a diorama...box w/ steel floor and flooring that looked like the hospital ➢ Had 4 dolls: doctor, nurse, mother, father ➢ All 50 children tested not in their hospital room ➢ Would say “look at this little friend in the hospital. Now here comes the nurse. Where does the nurse go when she is in the room? Here comes Momma, where does she usually go?” ➢ Took it away and measured where all the dolls were placed ➢ “If you could have daddy anywhere in the room where would he be? Where would the nurse be” ➢ Takes them out and measures ➢ In every instance, dolls were further away for those of the terminally than the control group 3 Personal space (psychosocial distance) How close you want someone to be to you A stranger → farther Someone you love → closer to you But this experiment showed that dying children didn’t want the parents close AND parents and medical staff weren’t getting close since there was nothing they could do DEATH TERMS Freud 1. Life instinct Eros ➢ Life force: hunger, sleep, sex ➢ Preserves us and our species 2. Death instinct Thanatos ➢ Most of the time directed outward ➢ Bullying, yelling, fighting, killing ➢ Occasionally this force turns inward and we commit suicide Social death Treating someone as if he or she were already dead People talk in front of them, make decisions for them We do this with old people too! Glasser and Strauss types of awareness 1. Closed awareness patient doesn’t know he’s dying and everyone hides it from him 2. Suspected awareness patient suspects he’s dying but never asks to confirm it 3. Mutual pretense awareness everyone knows but no one talks about it 4. Open awareness everyone knows and talks about it (considered the best situation) Glasser and Straussdying trajectories 1. Lingering trajectory someone who dies over weeks or months (cancer, AIDS, etc). Gives patient time to say goodbye 2. Expected quick trajectory heart attack, danger period over a couple of hours but sometimes nothing can be done a. Pointed trajectory patient is exposed to a risky procedure like heart surgery b. Danger period trajectory question of surviving a stressful experience c. Crisis trajectory the patient is not in acute danger, but life might be threatened at any moment d. Will probably die trajectory focus on comfort and wait for death 3. Unexpected quick trajectory in and out surgery the same day, and you die → no one expects it Interventions with the dying patient 1. Physical pain trying to keep them medicated so that they’re comfortable 2. Emotional pain medication (psychological pain like depression) 3. Social pain when you help the person finish working on relationships (if you haven’t spoken to your sister) 4. Spiritual/philosophical pain Hospital chaplain (“why is God doing this to me?”) 4 5 STAGES OF DYING Elisabeth KublerRoss 1969 introduced the 5 stages of dying These are psychological responses to dying (ways of coping) These stages are not set in stone or inevitable, but some textbooks authors presented them this way Interwoven is hope. Beginning it’s hope for a recovery or cure. Then it might be hope for a period that the illness is in remission. Next hope might be that you don’t have pain. Lastly, hope that what they learned from the illness will help someone else 1. Denial Not me, can’t be true Fueled by anxiety, runs its course in a short time Functions as a buffer to the unexpected and shocking news Gives them time to mobilize other reactions 2. Anger Why me? Rage, envy, resentment Can be at God, doctor, nurse, family member, friend Feeling frustration Can be both rational and irrational Feelings of envy (seeing others do what they can’t do anymore) 3. Bargaining “Just let me live until…x” Process is usually with God, but can be with the doctor, friend, or family member Payoff is that they are ready to die HOWEVER once we reach the “just let me live until…” they usually still aren’t ready and we don’t keep our bargain 4. Depression You realize you’re not getting better Less responsive Reactive depression for things that you’ve had or done in the past but that you won’t be able to anymore (ex. “I’ll never have another dog, or go to Spain”) Preparatory depression for things that you wanted but never achieved (Ex. going to Paris) 5. Acceptance Not a happy stage Basically void of feelings Just because you accept something doesn’t mean that you like it HOSPICE CARE Background In early times : A waiting place or resting place for travelers, then for religious pilgrims from the 6th century → the middle ages Supported the people who went on the crusades Provided a temporary like shelter for the crusaders Crusaders were trying to take Jerusalem back for the Christians (killed Muslims and Jews) 5 Later: hospice became a catchall place for orphans, widows, homeless, incurably ill In the 19th century: developed as a place for dying patients (but didn’t catch on) no interest HOWEVER this model adopted by Dame Cicely Saunders, MD Dame Cicely Saunders, MD ● She was the one who was hellbent on pain control (Heroin and cocain) ● Was a nurse, social worker, then doctor ● Saunders opened St. Christopher’s ● 1974, National Cancer Institute gave funding for a hospice in New Haven, CT. This worked so well that this is when the movement started to go on here Main objectives 1. Pain management ○ Keep patient lucid but control the pain ○ Don’t let the pain build up 2. Relieve other symptoms ○ Treat for depression, insomnia, constipation from the pain medication, etc Palliative care ➢ Pain management ➢ Idea is to maintain the patient’s quality of life through symptom relief and by keeping them comfortable ➢ Goal = to die at home (80% of hospice patients achieve this) ➢ You do NOT don’t have to be dying to receive palliative care Other Hallmarks of Hospice Care 1. Let patients live meaningfully 2. Pain control 3. Supportive environment 4. Caregivers who listen 5. Increase communication within the family Types of Hospice Care Home Care Inpatient care ● 80% ● 20% ● 1st home is examined by hospice worker ● If you can not be managed at home ● Then they train the family how to give an ● Visitors at any time injection, how to feed them, how to bath ● Animals can be brought in them, etc ● Can bring personal things (rug, table, ● Staff: hospice nurse is the primary person lamp) but there is a physician, physical therapist, ● Patient and the family are considered a dietitian, volunteers, etc. unit ● Once again, the main goal isPAIN MANAGEMENT 6 AIDS (Acquired Immune Deficiency Syndrome) Overview ● 1981 became known to medical community and general public ● Early 1900s transitioned from animals → humans Book: Tinderbox ○ As more European countries were colonizing, there were two things being taken out that had to travel long distances: rubber and ivory ○ At this time, there were no regular roads. So they went through jungle and made roads. Now people who normally didn’t travel, could travel ○ These people traveling were exposed to new people ○ There really is a SIMION (a monkey form) of this virus (green monkey are the ones that had them the most) ○ Chimpanzees kill monkeys and eat them ○ Some people eat chimps (bushmeat ), they would butcher the meat, and there was lots of blood (could get in cuts etc) ○ Went to Haiti because of the economic conditions (well trained in the medical field were offered jobs in Haiti and they carried the virus there) Statistics ● Over a million people have it → 25% don’t know they’re carrying it ● Might be some time between getting the virus and showing symptoms (as long as 9 years) ● 15,000 deaths per year ● 50,000 new cases per year ● PANDEMIC b/c so many people worldwide have contracted it and died from it ● No current cure Ways to Control ● Limit sexual partners ● Circumcision Results/Symptoms ● Immune system low: can get thrus ● Weight loss ● Leaves the person helpless: disabling, disfiguring, can’t control bodily functions ● Blindness & dementia ● Isolation (social death before physical death) ● Exposed to persecution and harassment ○ Some see it as disgusting or disgraceful. Hard to fight off the disgrace (ex. liver = alcohol, but babies can be born with it) By turning the sick into aliens, it has become easier for people to look away (just like the homeless) 7 AUTOPSY AND POSTMORTEM (Autopsy = post mortem) Autopsy: Greekauto “to see for yourself” Postmortem: Latin for “after death” Only 2% of people are autopsied (1960 it was 50%!) Reasons and purposes ● Procedure that seeks to identify the cause of death ● Ways to find out death ● Primarily only going to be done if there’s been study of the death or illness ● For an autopsy to be done you need permission ○ When you become dead you become a possession, a piece of property ○ Exceptions: even if the family want it to be done, the law takes over ■ Murder ■ Suicide ■ Accident ■ Unattended death (although state/city may see no reason if there is nothing suspect about the death) Procedure 1. External examination ➢ Looking for anything unusual, discolored, lumpy, etc 2. Dissection and examination of organs ➢ 2 methods → Virchow: emove one by one → Rokitansky: slice them all out at one time, then start working with them ➢ Yincision. Start at shoulders, middle, and go down from there ➢ With each organ you measure, weigh, and look for any abnormalities 3. Microscopic examination of issue ➢ Where you have seen any abnormalities, you are going to take out little slices, mount them on slides, and then stain them ➢ Now can be examined under a microscope 4. Toxicology and cultures ➢ Looking for drugs (both legal and illegal) ➢ Bladder can be drained (pee) ➢ Blood sample from the heart ➢ Takes up to 6 weeks ➢ Cultures to look for bacteria or fungus ➢ Genetic testing Overview ● Dissection takes between 24 hours ● About 25% are partial autopsies (just the heart or just the brain) ● Gives cause of death ● Learn about disease/injury ● Gives genetic information ● Form of quality control ○ Was the diagnosis correct? Did the physician make a mistake or miss something? ● Can show the effectiveness of new drugs, new techniques, new technology 8 DOCUMENTS OF DEATH Death certificate ● Gives us health statistics ○ How we know how many suicides, how many deaths from pneumonia, and age! ● Uses (must be sent) ○ If you are going to be disposed of in any way ○ To receive any benefit (life insurance, pensions, Social Security, etc) ○ If a house or car is jointly owned must turn in a death certificate to transfer it to the survivor Disposal of the remains ● Deciding what is to be done with the dead body ● Must fill out form ● State your relationship on form ● Question examples ○ Would you allow an autopsy? Do you want funeral home to pick up body? Would you allow organs to be harvested? Obituary ● Need to contact someone (like a funeral home) to verify the death (they wouldn’t want to publish it if it was just a joke) ● Starts with age and cause of death. Goes on to describe the person’s education, employment, contribution to community ● Can be edited/published Death notice ● Pay by the line (costs more if published on the weekend) ● Could be a black and white or color picture ● You write the death notice ● May tell you about funeral or memorial service Least will and testament ● Will the written instrument ● Testament where you say what you want ➢ Testateintestate ○ You die and you have a will that can be found ○ You die but you don’t have a will ➢ Testatortestatrix (referring to yourself) ○ Male who made the will ○ Female who made the will ➢ Executorexecutrix ○ Male appointed to carry out what is in the will ○ Female appointed to carry out what is in the will 9 Harvesting the dead Can only do one of the following 1. Organ donation ➢ Have 15 minutes between the time someone is declared dead to put on ice to go to recipient ➢ Almost 50 parts of us can be donated ➢ Could accidently transmit something (people who receive transplants have low immune systems) 2. Body donation ➢ Can donate your whole body ➢ Medical students ➢ Dental students dissect heads: Jaw, teeth, feet, etc ➢ Surgeons will practice new surgical techniques ➢ Body farm : people donate their body to be locked in a car for 3 months, or buried for 6 months etc. Graduate students then go and see the effects of the bodies at different times. When the maggots come, how fast the maggots multiply, what happens if it rains, etc. ○ Valuable forensic information! THE HISTORY OF THE FUNERAL Iraq, 60,000 years ago ● Found tools and stones ● Means they thought there was an afterlife Egyptians ● In the beginning of the culture, there was no formal disposal of bodies they were simply buried in the sand ● Found that when the wind blew the sand away, the bodies were preserved...gave the idea to the Egyptians that you could preserve a body ○ Began to think that the body would travel ● Pharaoh the most elaborate but people of wealth were similar ● Process ○ Body put on a wooden table w/ sides that came up a little bit. Table on a slant for drainage ○ 6 of the important organs would be removed and put in canopic jars (earthen vessels) each with the head of different gods (heart NOT one of the organs that was removed) ○ Salts in the jars to preserve ○ Would remove the brain by putting something medial in the nose, turned round and round until the brain was liquid. Tipped the corpse until the liquid came out the nose ○ Body then put on a table with 200 lbs of salt + fragrant oils. Salt reverses osmosis (water comes out of the body and would drip down the table). This is for 40 days. Then another 200 lbs would be put on for 30 days longer. ○ Once the body was ready they would put jewels in the navel, eye and nail caps may be placed on body ○ Final step: wrap ○ If you were an important person you would also be mummified with dogs, cats, horses, slaves, servants, and other objects like chariots ● Did not leave one written record of the process 10 ● About 100,000 of these mummies were used as firewood in locomotives Greeks ● Had families prepare the bodies ● Perfumes/spices rubbed into the skin to mask smell ● Thought that the soul could leave the body more quickly if it were burned so they did both ground and cremation Romans ● Adopted much from the Greeks ● Had an Undertaker (someone who was designated to do the operation) ○ Would rub the body with oils etc ○ Hired mourners Hebrews ● Burial suppose to take place within 24 hours ● Body was washed and then put in a simple shroud (garment that looks like a poncho) ● Body put on a plank or simple wooden box ● Would go into a seplica (sepulchre) (a hole that’s cut in rock or a natural formation aka: tiny cave) ○ Concern about being buried alive so for three days someone would go in and smell (if the body was really dead it would start smelling) before sealing it Christians ● Very simple customs in the beginning ● Body washed, rubbed with alcohol, fragrant oils ● Would be wrapped in strips of cloth (rather than shroud) ● Used sepulchres ● During the crusades: Boiled to get the bones, than bones sent to family ● In the middle ages in Europe: cremation started to be used because cremation took too much firewood Leonardo da Vincivenous injection ● 15th century ● Did hundreds of anatomical drawings ● In the beginning he would pay models (costly) ● Probably has 3 dozen drawings of the right hand ● Decided to do something less costly → paid someone to grave rob a fresh body ○ Then needed to preserve the body for a few months ○ Injected alcohol in the veins/arteries ○ He was the first person to do tcirculatory/venus embalming ○ He was doing this so that it wouldn’t stink but by doing this he showed that you can preserve a body for at least a few months by pushing out the old clotted blood and replacing it with a preservative ➢ Embalming as we know it today first took place during the American Civil War ➢ Done at the direction of president Lincoln → Understood that loved ones would want their people back 11 → Used a hand pump to push the clotted blood and pushed in a solution filled with arsenic → This arsenic discolored the skin of the deceased ➢ Became a danger to preserve the body with arsenic b/c if it rained, the body would leak the arsenic and seep into the water and cause people problems ➢ By the 1900s the US government said you could no longer embalm with arsenic...now we use ormaldehyde US19th century ● Family involved in the burial but then had to hire people because they couldn’t do all the jobs (ex. build the coffin) Embalming ● First took place during the American Civil War ● Done at the direction of president Lincoln ○ Understood that loved ones would want their people back ○ Used a hand pump to push the clotted blood and pushed in a solution filled with arsenic ○ This arsenic discolored the skin of the deceased ● Became a danger to preserve the body with arsenic b/c if it rained, the body would leak the arsenic and seep into the water and cause people problems ● By the 1900s the US government said you could no longer embalm with arsenic...now we use formaldehyde Today ● 50,000 licensed embalmer ● There are individual schools for mortuary science (closest to us is in PA) however some schools have schools within the school FUNERAL DIRECTORS 27,000 funeral homes 50,000 licensed embalmers Individual schools for mortuary science (or some schools have a school within them) Business courses, anatomy, physiology 2 licensing exams: national and state During classes you also have to work in a funeral home to get the craft/experience of it At first thought it wasn’t for a woman b/c you have to move bodies around 1990s 3 large corporations (2 American, 1 Canadian) started buying up funeral homes Wanted to have all the same carpeting, furniture, etc Didn’t work, today most have been sold back to families To create a beautiful memory picture Body removal ● Body picked up ● Normally they don’t have any advertising on the van that picks up the corpse ● 2 people needed for a removal ● Someone must identify the body (ex. a family member) ● Funeral home takes over all the paperwork (i.e. death certificate) 12 Preneed or at need ● Preeneed all the funeral arrangements have been made ahead of time (money has been set aside b/c you don’t want to burden family members or perhaps someone else knows you’re going to die and make all the arrangements) ● At need making arrangements right after the death has occurred Embalming ● Goal: to look as lifelike and at peace as possible ● Funeral directors say they want to create ovely memory picture” ● Body starts to break down within minutes ● Anaerobes (the ones that don’t need the oxygen) begin multiplying...they have the strongest odor ● Room: must have a secure lock, usually no windows or must be frosted over, good ventilation ● Takes about 2 hours ● Body kept at 38 degrees ● Today the funeral director has a full waterproof bodysuit, shoe covers, splash guard over the face, and latex gloves ● Formaldehyde they use is dangerous → High rates of colon, brain, and kidney cancer ● Rigamortis after death the body stiffens, then it wears off (depends on temperature how long it takes to go into rigor and then how long it takes to go off) 1. Body put on table 2. Sprayed w/ disinfectant, scrubbed with disinfectant soap 3. Wash hair 4. Take wads of cotton soaked in fenal and pushed into all the holes, dry cotton put in the ears. Prevents flies and maggots from entering or liquids from leaking out from below. 5. Must manipulate arms and legs to break up rigamortis. (After death the body stiffens, then it wears off. Depends on temperature how long it takes to go into rigor and then how long it takes to go off) 6. Massage forehead, cheeks, hands 7. Placement ○ Hands: right over left, ball of cotton put under the top hand so it’s curved a little bit as it rests ○ Head: turn 15 degrees to the right ○ Breasts: sew them or duct tape them together ○ Eyes: plastic eyecaps put under your eyes...glued in place ○ Mouth: Barbed things stuck in so that it doesn't gape open. Cotton in cheeks. ○ Lips: set your expression with lips straight across (not grinning and not frowning) 8. Embalming fluid: use the jugular artery and vein: put a tube in each one. Pump formaldehyde in and tries to bring skin color back to normal. Clotted blood pumped out. Once they have finished this, they tie off these two blood vessels. Start massaging you to get the formaldehyde distributed 9. Jab abdomen with trocar to take out fluid that has accumulated and then put in embalming fluid 10. Body washed again (conditioner on the hair, cream on the face/hands, dissolves nose/ear hairs 11. Now ready for make up, dressing, and casketing (see below) Restorative art ● Work with clay and cutting and various substances to redo side of face (ear) ● Make you look like you used to look 13 Make up ● There is makeup made for dead bodies however you can bring in the deceased own makeup ● Everyone must get makeup Dressing ● Put on plastic shirt and underwear ● Then can put on regular clothing (can bring deceased clothing however the funeral home will try to sell you theirs. Funeral home is also easier to put on the person. I.e. velcro, etc) ● Socks ● Plead for you not to put shoes on them b/c very hard ● Jewelery (but not buried with it) ● Hair: beauticians who want parttime work. Like to work from a photograph Casketing ● Ready to go into casket ● Funeral home will help you with death notice/obituary and will submit them so that the newspaper knows that they are real ● Will suggest ushers to help seat people at the funeral ● Pallbearers (carries casket) ● Viewing: could be the day before or the hour before the funeral ● Service: funeral directors can get you music, help you organize the bearing, procession of cars to the cemetery. Hole must be 6 ft down so that no animals can get in ● Normally will be a few chairs for the most immediate family, everyone else stands. Cascate over the hole. Graveside service: member of the clergy says something. ● Now they want you to leave. B/c once the cascate is in the hole, some people get hysterical and jump into the hole CREMATION Becoming more frequently used in the US Common for decades in Europe (less land available) Rate in US: 35% Funeral homes have in their garages the crematorium or separate businesses that have just a crematorium CONS: Carbon monoxide released into the air when burned (not environmentally friendly) Cremains “bake and shake” → you bake the body and then you put the bones in the cremulator 1. Put in rigid container before cremation (wood or cardboard but NO metal) ➢ Temperature from 1,400 1,800 degrees (left w/ bone fragments and ash) 2. Bone fragments put in a cremulator (looks like a food processor). Grinds them to ash. 3. Need box to put ashes in ➢ Can bring your own box or one that they try and sell you 4. Figure out what to do with ashes ➢ Could scatter ➢ Burry (must be 6 feet down) ➢ Columbarium : a building or wall designated just for ashes. Walls have spaces up and down to put your loved ones. Looks like an atrium inside. Can sit. Might have potted plants. 14 THE CEMETERY Ground burial ● New Orleans you can’t do a ground burial b/c it is 5 ft below sea level Mausoleum ● Little houses ● Represent wealth ● Very sturdy lock ● Inside there are shelves so when other family members die, caskets can be added ● For people of GREAT GREAT wealth, they have something bigger than a house Tombstone, headstone, grave marker ● Originated to hold down the spirIts of the dead ● Name, DOB, date of death, might also have a symbol Epitaphsinscription (optional) ● RIP, beloved mother/son/daughter/husband/brother/, etc. ● Expensive because you have to pay for each number/letter/punctuation BURIALS DIY Funeral 45 states + DC allow Don’t have to deal with a funeral home Have to get certain papers from state/county/city Can transfer body in a van or station wagon Green Funeral Buried wrapped in biodegradable cloth or paper Designated areas in each state Don’t have any markers → simply put in the ground Release a lot of nitrogen which is good for the earth Burial Pods Put into the ground in a fetal position and buried with a tree...nitrogen released and helps the tree grow Burial at sea Navy, marines, couldn't get the ship back to shore in a short period of time 1. Coffin w/ holes drilled in it 2. Put sand/rocks 3. Casket tipped out from under flag and dropped into the sea EXCEPTION: for famous admirals the crew would agree to give up some of their rum → put admiral in the rum to keep him preserved until they got back to shore Cryonics Means “to freeze” First proposed in 1964 but not carried out until 1967 15 Purpose is to at some future time, reanimate it and cure whatever caused the death Cannot freeze a body before a death occurs (that’s murder!) 1. First thing to do, start chilling it 2. Then put an anticoagulant into the circulatory system (keeps blood from clotting) 3. Then profuse the body with glycerol (oily substance used in lotions and minimizes the formation of ice crystals) 4. Wrapped in heavy duty aluminum foil 5. Put into a sleeping bag (must be long enough to close over the head) 6. Stored ➢ Large storage tank will hold 6 bodies which are hung like a bat (feet at top, head at bottom) ➢ OR in a tank of liquid nitrogen (at the top is room for 6 heads, these people don’t have enough $ for the whole body to freeze. But they believe that their head can be put on a clone at a later time) Funeral directors think this is science fiction They have reanimated a dog but it didn’t last for that long $28,000 for head and $120,000 for body Burial in space (orbit) Celestis (celestrial...the heavens): this company is in Texas and for $4,800 they will take 2 ash samples and send the ashes into space Put into a titanium capsule with ID number and name, etc Spare vial of ashes is there in case the rocket explodes the first time Go up 400 miles above the earth, can’t guarantee how long you’ll stay in orbit, when you come back to earth you just burn up Mummify Available through one business: Summum Mummification Services in Salt Lake City Utah $56,000 + shipment back and forth They embalm, wrap, seal, and put you into a modern day sarcophagus Alaklyn Hydrolysis Resomation (rebirth) You have a stainless steel pressure cooker which is filled with lye (alkalin) Pressure cooker goes up to 300 degrees at 60 lbs per square inch After 3 hours you’re left with the bones which are very soft (drain fat down the sewer) They are then put in a cremulator (thing that looks like a food processor) comes out looking like a very fine ash People say you aren’t polluting the atmosphere like with cremation BUT you’re putting all that fat down the drain Plastination Beginning of chapter 2 Bodyworks Preserve bodies by replacing water and fat with certain plastics First ones were stolen from China (without permission from family) 16 Spontaneous Memorialization When you’re driving along and you see flowers Might see memorabilia along the side of the road This is where someone has died suddenly (usually from an accident but they could have been murdered) People bring these flowers, stuffed animals, and notes to the site BEREAVEMENT A state involving loss; something being taken from you ○ Often this state of loss is something like not getting into a college of your choice, having your wallet stolen, having a fire consume your possessions Usually think about it as it involves another person ○ Death of someone close to you ○ Almost always means a change in status ○ In an instant, you become a widow, singleparent, orphan, etc. GRIEF How a person is affected by a loss Refers to a complex emotional and physical set of responses Trouble eating/sleeping Sorrow, sadness, confusion, anger, guilt, denial Eric Lindemann, Coconut Grove Fire (1942) ○ Psychologist based out of Harvard ○ Started study on how people respond to body disfigurements (burns, amputations, scarring) ○ For 2 years he did detailed interviews with these people ○ Then the restaurant Coconut Grove caught on fire ○ 492 people died, 101 lived ○ Lindemann concerned about the survivors ○ Ended up interviewing ALL 101 survivors → full population! ○ Realized that the responses were similar to those with body disfigurements ○ Common responses ■ Somatic distress ■ Shortness of breath ■ Preoccupation with an image of the deceased (vs how they used to look) ■ Sense of unreality ■ Strong feelings of guilt ■ Irritable ■ Lack of concentration ■ Powerless ■ Abandoned Grief is the price we pay for love ○ If we never loved them we wouldn’t feel grief MOURNING Overt expression of grief 17 Determined by culture and religion ○ In Ancient Egypt they streaked mud on their faces ○ Jews tore clothing ○ Aboriginal people of Australia wore clothing inside out ○ Western you wear black clothing Behavior ○ Wake ○ Sit at home ○ Celebration drink, dance, sing GRIEFWORK THEORY FREUD Freud’s theory helps us focus on the emotional needs of bereaved people Emphasis on intrapsychich → how we deal with these thoughts that are inside of us Others have focused on the interpersonal context of griefwork how it affects our relationships with other people. For example, a widow who doesn’t get an invitation to dinner parties that she used to attend ● Grief is a very adaptive response to loss (AKA: it’s normal) ● Work of grief is difficult and timeconsuming (thought it was up to 2 years, but we now know it can be for the rest of your life) ● Can be released from work/school for up to a week if the person was close to you ● Goal: accept the reality of death and so liberate oneself from the strong attachment you had to the lost love objectemancipation from the bondage of the deceased ) ○ We had an emotional investment to this person ○ The person is now dead ○ We have to detach from the dead person and now emotionally involve ourselves in other relationships (his daughter said this about the children she studied) 1. Griefwork is carried out through a long series of confirmations with the reality of the loss ○ An empty space in the bed next to you ○ The scent of the person 2. Process is complicated by a survivor's resistance to letting go of the attachment ○ Not giving away the clothes ○ Leaving the bedroom exactly as it was 3. The failure of griefwork results in continued misery ○ Grief is misery and dysfunction ○ If it goes on for a long time, pathological grief can develop STAGES OF GRIEF 1. Shock/shock+denial ➢ Can last a few hours or a few days ➢ Important that someone be with the bereaved ➢ Emotional support of another person ➢ Sometimes they are so numb that they don’t cry 2. Disorganized ➢ Confused ➢ Helpful to have someone listen them them because they need to repeat things over and over 18 3. Anger ➢ Needs to be expressed ➢ Might be through jogging, or playing music, anything that will get it out 4. Guilt ➢ Takes many forms ➢ Having wished that the person would die ➢ Might feel guilt if you benefit from the death ➢ Causation guilt that you could have prevented the death (“if only…”) ➢ Survivor guilt “why did I live? Why did they die?” ➢ Moral guilt “this is a punishment for something I’ve done” ➢ Cultural guilt a good wife takes care of her husband, if he dies, you haven’t taken care of him ➢ Wait 2 years before you do anything that involves finances 5. Relief ➢ Don’t have to see them in pain ➢ Don’t have anymore care responsibilities ➢ Can return to normal routine (don’t have to stop by the hospital every night) 6. Reestablishment ➢ Always going to be a gap ➢ Working through is never complete ➢ Many people say that powerlessness is the biggest feeling they have BROKEN HEART SYNDROME (1967) ● Can affect your functioning ● Death of a spouse or someone else who was loved may greatly increase the mortality rate of the survivor! ○ Greif lowers your immune system ○ People lose the will to live: old person dies, husband/wife dies shortly after ○ State of helplessness ○ They give up ○ Behavioral changes: drinking more, sleeping less, neglecting medications, etc RECOVERY FROM GRIEF 1. Death of a spouse ● Situations that result unresolved grief ➢ Unexpected grief syndrome spouse dies without warning → disbelief and anxiety for months or years ➢ Conflicted grief syndrome where grief ends a troubled relationship. You loved him, so much, and then he became a drug addict/alcoholic/abusive, so now you have very negative feelings. Next he dies. Do you see the conflicted grief? ➢ Chronic grief syndrome surviving spouse dependent on their dead loved one and simply cannot take on new responsibilities 2. Death of a child ● Considered a rare and unusual event → parents should not outlive their children ● Knapp Beyond Endurance ➢ Death of a child represents the loss of future dreams, relationships, experiences, and fantasies that have not yet been enjoyed. 19 ➢ Loss of a future ➢ Feelings of sorrow, sadness, anger and bitterness. These feelings are debilitating and hard to resolve ➢ Desire to never forget. Parents concern that their memories are going to fade and so they want to talk about the child! It’s everyone else who doesn’t because they are afraid of upsetting the parents ➢ Parents may feel like their life is no longer justified and there’s no way to continue on without the child ➢ First few months they might feel suicidal (if they kill themselves they’ll be with the dead child) ➢ Neglectful of their health ➢ Search for cause or rational reason ➢ Many parents will turn to religion who have not embraced it before (they can’t think of the child as being extinct, nothingness, etc) ➢ Sense of vulnerability...if it happens to one child, couldn’t it happen to another? ➢ Might create a website or memory book ● Shadow grief a grief that is never totally resolved. Not overt. On the surface, many would say that the griefwork of this parent has been accomplished. However shadow grief reveals itself in the form of emotional dullness. Person unable to respond fully and completely to outer stimulation. Constant and dull ache in the background. May come bubbling up to the surface on occasion in the form of tears. 3. Grief in the elderly ● Bereavement overload ➢ Either a lot of loss at once or one loss followed by another ➢ Loss followed by loss that is death followed by death ➢ Person doesn’t finish grieving one loss before there’s another ➢ Can’t process one grief before there’s another ➢ Most common in the elderly ➢ At one point we saw it in the 80s and 90s with the AIDs epidemic DISENFRANCHISED GRIEF REACTION Grief that is hidden Not recognized by others Individual may be keeping feelings inside 5 situations for disenfranchised grief 1. Relationship to deceased is not socially recognized/Others are unaware that the relationship exists/One that could not be publically acknowledged ➢ Ex. Extramarital affair or perhaps you wanted to keep it secret, samesex relationships 2. Could be that it is not acknowledged by others as a genuine loss ➢ Ex. A miscarriage, abortion, pet, formal spouse 3. Grievers are not recognized ➢ Ex. Children, mentally ill 4. A situation that wasn’t socially sanctioned ➢ Ex. AIDs, suicide, son being killed committing a felony 5. A person may not be entitled to the feelings ➢ A volunteer at hospice 20 ➢ Patient When people feel uncomfortable, they’re unable to give support People with disenfranchised grief may be excluded from funeral rituals, excluded from the care system that helps with grief, and you may find yourself facing legal obstacles (GO TO 15 minutes) Silverman ● Specialist in the area of grief ● 2 decades ago she formed Widow to Widow (but includes men as well) ● Reads through the death notices and gets names and contacts men/women who have recently experienced the death of a spouse ● Believes that grief is NOT an illness ● However, grief is hard work ● Wants to get away from the medical model ● Her model 1. First, grief has no final outcome 2. Bereavement leads to a series of changes over many years 3. Gradually people learn how to deal more resourcefully with grief 4. Should be regarded as a life transition ➢ 1st crisis ➢ 2nd altered relationship that you have with others and yourself ➢ 3rd people can help each other IMMORTALITY Transcending death is there a reality that is independent of ourselves? 1. Physical immortality ➢ Offspring perhaps you consider a child or children that are biological to you as a form of immortality ➢ Organ donation your heart lives on in someone else, your liver ➢ Cryonics being frozen ➢ Corporal Resurrection you come back to life at some point. So strong was this belief that when a person lost part of himself in battle you try to keep the body part around to bury with them for when they actually die ➢ Cloning won’t be the same person 2. Psychological immortality ➢ Belief that there is some sort of consciousness after death ➢ An awareness of self and experiencing 3. Spiritual immortality ➢ The belief in a soul 4. Social immortality ➢ Continuing to exist for others in symbolic ways ➢ People will relate to the symbols to the extent that they related to you ➢ Stories, oral traditions, the groups to whic
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