DEATH & DYING: FINDING MEANING AT THE END OF LIFE

Health Psychology PSYC-314 David King November 13, 2014

# of people that died in the last minute (worldwide)

How Will You Die?

https://www.youtube.com/watch?v=0YOVclqkjZA (2:22)

Video uploaded by copyright owner.

so…

Why are we (still) talking about death?

Thoughts from the Dalai Lama “Death is a part of all our lives. Whether we like it or not, it is bound to happen. Instead of avoiding thinking about it, it is better to understand its meaning. We all have the same body, the same human flesh, and therefore we will all die. If from the beginning your attitude is 'Yes, death is part of our lives,' then it may be easier to face.”

By UCSB Campaign (http://www.ia.ucsb.edu/campaign/) [Public domain], via Wikimedia Commons

Thoughts from the Dalai Lama “Death is a part of all our lives. Whether we like it or not, it is bound to happen. Instead of avoiding thinking about it, it is better to understand its meaning. We all have the same body, the same human flesh, and therefore we will all die. If from the beginning your attitude is 'Yes, death is part of our lives,' then it may be easier to face.”

"Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need.“ ~ Atul Gawande, author of Being Mortal Video uploaded by copyright owner.

Discussion “We treat the inevitability of death as a disease for which a cure must be found.” – anon.

◦ Should aging and death be treated as ‘diseases’ to be cured, or things to be accepted? ◦ Does “anti-aging” = “anti-dying”? Where does it end?

Hard-Wired to Survive Public Domain

Regardless of our biological complexity, we’re all hard-wired to survive…

Sigmund Freud Amoeba eats 2 paramecia.

Life Instincts / Libido

And Hard-Wired to Die… “The aim of all life is death...inanimate things existed before living ones.” (Freud 1920)

Death Instincts (Thanatos/Mortido)

By Jaime Ardiles-Arce (photographer). Krater by Euphronios (painter) and Euxitheos (potter). (Wikipedia:Contact us/Photo submission) [Public domain]

Public Domain

Alfredo Duarte Viveros on Oct, 18 2010 (http://suite101.net/article/las-calaveritas-literarias-a28001)

The Self-Consciousness Factor

consciousness of self = consciousness of mortality

Death is a Mystery Perhaps THE greatest mystery of life.

Life vs. Death How do we make sense of it all?

By Nanna Rún 2008 (http://www.flickr.com/photos/nannars/2503507120/)

What is an Appropriate Death?

By Robert Lawton (Own work) [CC-BY-SA-2.5 (http://creativecommons.org/licenses/by-sa/2.5)], via Wikimedia Commons

By Wuhazet - Henryk Żychowski (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) By Diane A. Reid (Photographer) [Public domain or Public domain], via Wikimedia Commons

By Rachel Tobey (http://tobey11.deviantart.com/gallery/?offset=24)

Achieving An Appropriate Death 4 Main Requirements for the Patient: (Weisman & Hackett, 1961) 1. 2. 3. 4.

Reduction of conflicts (inner & outer). Compatibility with ego ideal (*think Maslow). Continuity of relationships is preserved & restored. Fulfillment of prevailing wish(es).

“A death someone might choose for himself had he a choice.” (Weisman)

Achieving An Appropriate Death Although often beyond reach, still important to aim for a death that is humane & dignified. Varies according to… ◦ ◦ ◦ ◦ ◦

Individual differences, personality, coping. Personal experiences/history. Contextual factors (e.g., social support). Cultural and social norms. etc.

Stages of Adjustment to Dying Elisabeth Kübler-Ross Five-Stage Theory of Dying 1. Denial 2. Anger

3. Bargaining 4. Depression

5. Acceptance http://www.ekrfoundation.org/bio/elisabeth-kubler-ross-biography/

Death Acceptance A ‘giving in’ and realizing inevitability of death.

Appreciation for little things in life. Not always happy; sometimes just not sad. Takes time to reach this stage. “Now I’m lying here waiting to die. I never paid any attention to clouds before. Now I see everything from a totally different perspective: every cloud outside my window, every flower in the vase. Suddenly, everything matters.”

Kübler-Ross’ Five-Stage Theory Advantages: ◦ Does describe a range of reactions to death; Points out counseling needs. ◦ Has broken down barriers and taboos.

Criticisms: ◦ People often regard stages as right way to die; Order not universal. ◦ Does not fully acknowledge the importance of anxiety.

Dying is a complex and individual process, subject to no rules and few regularities.

Discussion Take some time to consider what kinds of thoughts and emotions you might experience as you approach death.

Identify some unique psychological end-of-life variables. ◦ How would you reflect on your life? ◦ How would you feel to be close to death? ◦ What would be different (psychologically) compared to your younger years?

End-OF-Life Planning & Death Acceptance Perceived control is critical at the end of life.

But much easier for those without terminal illness…

https://www.youtube.com/watch?v=BoISNBkYaCY (3:56)

(Video uploaded by copyright owner.)

Discussion Take some time to consider what kinds of thoughts and emotions you might experience as you approach death.

Identify some unique psychological end-of-life variables. ◦ How would you reflect on your life? ◦ How would you feel to be close to death? ◦ What would be different (psychologically) compared to your younger years?

At the End of Life… ◦ Regrets ◦ Wishes ◦ Reminiscence ◦ Life Review ◦ Generativity ◦ Existential Reflection ◦ Self-transcendence ◦ Spirituality/Religion ◦ etc. …

By Rachel Tobey (http://tobey11.deviantart.com/gallery/?offset=24)

At the End of Life… What is the main factor underlying all of these variables?

MEANING

What is Personal Meaning? “A sense of purpose.” (Oxford University Press) “Having a purpose in life, having a sense of direction, a sense of order and a reason for existence.” (Reker, 1997)

What is Personal Meaning? Sense of Purpose

Values & Goals

Sense of Direction

Reflection on the Past

Sense of Order

Reason for Existence

What is Personal Meaning? From a purely cognitive perspective…

“An integrative organizing principle (or set of principles) which enables one to make sense of one’s inner life and outer environment.” (Meddin, 1998) “An individually constructed cognitive system, that is…capable of endowing life with personal significance and satisfaction.” (Wong, 1989)

What is Personal Meaning? Making sense of one’s inner life & outer environment.

What is Personal Meaning? Endowing life with personal significance & satisfaction.

Finding Meaning Viktor Frankl (1905-1997) Life has meaning under all circumstances, even the most miserable ones. Our main motivation for living is our will to find meaning in life.

Public Domain

Finding Meaning at the End of Life Autobiographical Methods Reminiscence – The process of recollecting one’s past experiences & life events; spontaneous.

Life Review – Return of memories and past conflicts at end of life; spontaneous or structured evaluation/reconciliation of one’s life. Guided Autobiography – Reconstructing the past and integrating it with the present; systematic.

Finding Meaning at the End of Life

Finding Meaning at the End of Life

Finding Meaning at the End of life Cross-Generational Methods Generativity – A concern for establishing and guiding the next generation; vs. stagnation (Erikson). Symbolic Immortality – A sense of leaving behind a legacy, passing along wisdom to the next generation.

Finding Meaning at the End of Life

Finding Meaning at the End of Life Religiosity Following an organized system of beliefs and practices. Extrinsic Religiosity –External and self-serving motivation; based on guilt, fear, social pressures.

Intrinsic Religiosity – Internalized and altruistic motivation; goal of developing meaning/purpose.

Finding Meaning at the End of Life

Finding Meaning at the End of Life

Finding Meaning at the End of Life Spirituality A personal quest for understanding answers to ultimate questions about life, about meaning, and about relationship to the sacred or transcendent. Self-Transcendence – Adjusting one’s self-concept in such a way that recognizes one’s place in the world/universe.

Finding Meaning at the End of Life

Finding Meaning at the End of Life

So What’s the Point? Death Acceptance! Willingness to let go and detach ourselves from events and things that we used to value. The ultimate end-of-life goal.

By Yves Picq (29 January 2009) http://veton.picq.fr (Wikipedia Commons)

What’s the Alternative? Death Anxiety

Tony Marsh Photography (2010) http://www.tonymarshphotography.com

Death Anxiety Abnormal or persistent fear of death or dying. ◦ Common among terminally ill patients. ◦ More likely among elderly in poor physical/mental health.

Clinical range: ◦ Thanatophobia (fear of death). ◦ Necrophobia (fear of death or the dead).

Terror Management Theory Death anxiety and fear of mortality are biggest motivators in life. The terror of absolute annihilation or non-existence produces such great anxiety that we spend our lives trying to make sense of it (often subconsciously). ◦ A motivation for the search for meaning.

Worst Case Scenario?

A sense of meaninglessness.

Existential Vacuum / Neurosis / Crisis

Worst Case Scenario? A penguin’s existential crisis…

http://www.youtube.com/watch?v=0qVWKpAH7OI (1:48)

Learning Objectives Explain psychosocial factors that need to be considered for terminally ill patients and those facing death. Name and describe factors associated with achieving an appropriate death, adjustment to death, death acceptance, and finding meaning at the end of life.