Using PowerPoint incorporate what you have learned about grief, grieving, coping with dying, and death in childhood as you write your book. 

To create a children’s book that discusses the issues of death and dying in some form. Your book should be intended for a specific age range(5yrs), and the writing and pictures should reflect that age range. Incorporate what you have learned about grief, grieving, coping with dying, and death in childhood as you write your book. Examples of previous books are posted under supplemental resources. You can create your book using powerpoint (to see examples google making a Children’s Book Project (Due at the End of Week 4)

The second part of this project is to write a one page summary describing how you decided on your specific approach, the creative process, why you chose the specific age range, and anything else you would want your reader to know.

-I chose the age 5 because many people say children don’t understand death at that age so I wanted to learn more.

Death and Dying Psychology

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Created a Children’s book using powerpoint which describes a particular age group

Writing shows high degree of attention to logic and reasoning of points well developed thoughts. The writing clearly leads the reader to the conclusion and stirs thought regarding the topic. Content indicates synthesis of ideas, in-depth analysis of original thought and support for the topic.

Writing is coherent and logically organized with transitions used between ideas and paragraphs to create coherence. The writing sufficiently expresses coherent ideas from original thinking supported by firm evidence. Main points well developed with quality supporting details and reflects.

Writing is coherent and logically organized, but some points are misplaced or stray from the topic. Some transitions are used inconsistently. Main ideas reflecting some critical thinking is presented without detail or development.

Writing lacks logical organization. It shows some coherence but ideas lack unity. Many or serious errors are present. Main ideas reflect little critical thinking is presented without detail, development, or ideas are vaguely presented.

Book uses age appropriate words for the age group selected

Writing shows high degree of attention to logic and reasoning of points well developed thoughts. The writing clearly leads the reader to the conclusion and stirs thought regarding the topic. Content indicates synthesis of ideas, in-depth analysis of original thought and support for the topic.

Writing is coherent and logically organized with transitions used between ideas and paragraphs to create coherence. The writing sufficiently expresses coherent ideas from original thinking supported by firm evidence. Main points well developed with quality supporting details and reflects.

Writing is coherent and logically organized, but some points are misplaced or stray from the topic. Some transitions are used inconsistently. Main ideas reflecting some critical thinking is presented without detail or development.

Writing lacks logical organization. It shows some coherence but ideas lack unity. Many or serious errors are present. Main ideas reflect little critical thinking is presented without detail, development, or ideas are vaguely presented.

Used age appropriate pictures and content

Writing shows high degree of attention to logic and reasoning of points well developed thoughts. The writing clearly leads the reader to the conclusion and stirs thought regarding the topic. Content indicates synthesis of ideas, in-depth analysis of original thought and support for the topic.

Writing is coherent and logically organized with transitions used between ideas and paragraphs to create coherence. The writing sufficiently expresses coherent ideas from original thinking supported by firm evidence. Main points well developed with quality supporting details and reflects.

Writing is coherent and logically organized, but some points are misplaced or stray from the topic. Some transitions are used inconsistently. Main ideas reflecting some critical thinking is presented without detail or development.

Writing lacks logical organization. It shows some coherence but ideas lack unity. Many or serious errors are present. Main ideas reflect little critical thinking is presented without detail, development, or ideas are vaguely presented.

Book adequately explains a coping concept of death or dying to children

Writing shows high degree of attention to logic and reasoning of points well developed thoughts. The writing clearly leads the reader to the conclusion and stirs thought regarding the topic. Content indicates synthesis of ideas, in-depth analysis of original thought and support for the topic.

Writing is coherent and logically organized with transitions used between ideas and paragraphs to create coherence. The writing sufficiently expresses coherent ideas from original thinking supported by firm evidence. Main points well developed with quality supporting details and reflects.

Writing is coherent and logically organized, but some points are misplaced or stray from the topic. Some transitions are used inconsistently. Main ideas reflecting some critical thinking is presented without detail or development.

Writing lacks logical organization. It shows some coherence but ideas lack unity. Many or serious errors are present. Main ideas reflect little critical thinking is presented without detail, development, or ideas are vaguely presented.

Usage of correct grammar, usage, and mechanics in APA format.

Essay is free of distracting spelling, punctuation, and grammatical errors; absent of fragments, comma splices, and run-ons. Meets most criteria of APA formatting requirements.

Essay has few spelling, punctuation, and grammatical errors allowing reader to follow ideas clearly. Very few fragments or run-ons. Meets some of APA formatting requirements.

Essay has several spelling, punctuation, and grammatical errors allowing reader to follow ideas clearly. Very few fragments or run-ons. Meets few of APA formatting requirements.

Spelling, punctuation, and grammatical errors create distraction, making reading difficult; fragments, comma splices, run-ons evident. Errors are frequent. Fails to follow APA formatting requirements.

Module 1
Introduction to Death & Dying

INTRODUCTION

Module 1: Part 1

What is this course about?
• If you don’t want to talk about death, dying, grief,

and beliefs, rituals, or practices surrounding
death for the next three months, this may not be
the course for you.

• This course will involve reading, discussion, and
both research and reflective writing.

This course, continued..
• This course deals with some heavy stuff, stuff

that we don’t normally talk about in society.
Some topics (and readings or videos) may make
you feel uncomfortable – feel free to vocalize
this to me

Some Facts about Death in the United
States
• More than 2 million people die in the US each year
• Heart disease is the leading cause of death
• In 1900 the average life expectancy was 47 years, today

it is 77 years
• Lowest life expectancy today is in Africa (54 years)
• Females outlive males almost everywhere
• Alzheimers disease has become 8th leading cause of

death in US
• Motor vehicle accidents are the most common fatal

accidents, for the elderly falls are the second most
common type of injury fatality

• Seriously and terminally ill people were alone almost 19
hours a day according to a hospital study

Death in the U.S. continued….
• Homicide rates have been highest in southern states
• A Suicide attempt is most likely to be fatal when made by

an elderly man
• Less than 100 bodies have been placed in cryonic

suspension and no attempts have been made to
resuscitate

• A death or other loss experience is most often the
earliest childhood memory recalled by adults

• 1 in 4 individuals in the US now choose cremation
• Belief in an afterlife has increased in the US in recent

years

Exploring our Attitudes, Beliefs &
Feelings Towards Death & Dying
• A big part of this course will be exploring our

own attitudes. Why?
o Because most of us do not want to face the reality of

death
o We often pretend that death doesn’t exist, and avoid

discussing it
o We don’t want to face the fact that some people want

to die
o The biological drive is for survival
o The goal of modern medicine is to preserve and

extend life

Thinking about Death

• Research has found most people have not
thought much about their own deaths.

• Most people also think that their own deaths
are a long way off.

Is this true for you?

Some Euphemisms for Death
• A Euphemism is a metaphor or phrase to hide

disturbing or unpleasant ideas:
o Passed away
o Departed
o Worm food or dead meat (to refer to the dead body)
o Checked out
o Bit the big one
o Kicked the bucket
o Croaked
o Pushing up daisies

Death Anxiety
• Feeling tense, distress, unwell, or apprehensive when

thinking about or faced with death
• Anxiety, denial and acceptance are common

experiences surrounding death
• Women score higher on death-anxiety scales
• Older people score slightly lower
• Women are more likely to be involved in hospice and

caregiving situations
• Death anxiety higher in adolescence and early adulthood
• Level of religiosity does not appear to reduce fear of

death
• Feeling abandoned increases a sense of vulnerability

and can lead to a spike in death anxiety , as does
exposure to death, life-threatening illness, and accidents

Accepting & Denying Death
• Denial is a (Freudian) defense mechanism used

to protect our own ego, it is a coping strategy
• Other type of denial are selective attention,

selective response, compartmentalizing,
deception, and resistance.

• The occurrence of denial and acceptance is
neither bad or good, but has to be looked at
within the context in which it is occuring.

What is Death?
• In Western thought, death is the end of life or

something that begins after the end of life
• Scientifically, death is lack of vital signs such as

respiration, pulse and heartbeat, failure to
respond to stimuli, low body temp, stiffness and
eventually decomposition

• According to many spiritual and religious
traditions, death occurs when the soul has left
the body

• Death is a concept

Brain Death & Vegetative States

• At this point, the body’s regulatory processes
are still functioning or kept functioning, but
the person is unresponsive – are they alive or
dead?

• Often it is up to family members and
physicians to determine if the person is dead
and should be removed from life support

The Harvard Criteria
• The Opinion of the Harvard Medical School Faculty on

determining brain death (1968):

• Unreceptive and unresponsive: no awareness is shown

for external stimuli or inner need, unresponsive to even
normal painful stimuli

• No movements and no breathing: complete absence of
spontaneous respiration or muscular movement

• No reflexes: usual reflexes cannot be elicited such as
constricting the pupils when a light is shined in the eye

• A flat EEG: indicating no electrical activity in the brain
• No circulation to or within the brain

Conditions that Resemble Death:
Altered State of Consciousness
• Consciousness: All the sensations,

perceptions, memories, and feelings you are
aware of in any instant
o Waking Consciousness: Normal, clear, organized,

alert awareness
• Altered State of Consciousness (ASC):

Awareness that is distinctly different in quality
or pattern from waking consciousness

What is an Altered State of
Consciousness (ASC)?
• Altered State of Consciousness (ASC):

Changes that occur in quality and pattern of
mental activity

• “a state in which the individual clearly feels a
qualitative shift in his pattern of mental
functioning, that is, he feels not just a
quantitative shift (more or less alert, more or
less visual imagery, sharper or duller, etc.)
but also that some quality or qualities of his
mental process are different” (Tageson, 1982)

Examples of Altered States
• Sleep-state: Sleeping State-absence of REM, with slow,

brain wave patterns
• Lethargic State: characterized by a pronounced slowing

down of mental activity, as, for example in profound
depression or induced by hypoglycemia or fatigue

• Stupor: characterized by greatly reduced ability to
perceive incoming stimuli

• Coma: marked by a complete inability to perceive
incoming stimuli

• Drug-Induced State: alterations in brain activity due to
drugs or alcohol can cause death like experiences

Other Meanings of Death
• Death is a form of continuation or transition to

another state
• Death is a form of waiting, often for a final

judgment
• Death is part of a cycle
• Death is a form of recycling
• Death is nothing or nothingness
• Death is a transition from one life to another

ATTITUDES TOWARD DEATH

Module 1: Part 2

• Everything can be taken from a man but one
thing: the last of the human freedoms – to
choose one’s attitude in any given set of
circumstances, to choose one’s own way”
~Victor Frankl, ‘Man’s Search for Meaning’

What is an Attitude?

• Attitude: Degree of like or dislike for an
object, place, or person. Judgments related
to emotion (affect) cognition (thinking) or
behavior about a person, place or thing.

• Death attitude: beliefs, opinions, and
emotions related to death

• You attitude toward death can change,
especially through experiences and
education

Different Types of Death Attitudes

• Attitudes toward My Own Dying
• Attitudes toward my own Death: look forward

to it? Value life highly and dread death?
• What will happen to me after my death?-

Beliefs about judgment, etc
• Attitudes toward the deaths of others:

Includes death, dying, bereavement

Western Attitudes Toward Death (Aries)
• Tame Death: Death is familiar and simple, it is regarded as

inevitable and no attempts are made to evade it
• Death of the self: death produces great anxiety due to

belief in reward or punishment in a future state
• Remote and Imminent Death: have an ambivalent attitude
• Death of the Other: focus is on survivors, breaking of

relationships, desire to be rejoined with loved one(s)
• Forbidden Death: Death is seen as dirty or indecent and

dying persons are isolated from the rest of a community.
Emotions are hidden, mourning viewed as morbid

Terror Management Theory

• Ernest Becker –The Denial of Death(1973):
believed death anxiety is at the root of severe
mental illness.

• Society functions to give us the idea that life
continues- preventing severe death anxiety.

• Terror Management Theory says we try to
control our own death anxiety.

Ars Moriendi

• The Art of Dying: a Practice that focuses on
what one should do to die well.

• Closely tied to what is considered a good life.
• In your thoughts, what would be a good

death?
• What is considered living well?

THE DEATH SYSTEM

Module 1: Part 3

Who & What is Part of the Death
System?
• People

o Funeral Directors
o Emergency Personnel
o Doctors
o Florists
o Life Insurance Agents
o Cemetery workers
o Lawyers
o Clergy
o Scientists

Who & What Cont’d
• Places that are part of the death system

o Funeral homes
o Cemeteries
o Hospitals
o Historic battlefields
o Places of mass death (Ground Zero)
o Nursing Homes
o Places where tragic death has occurred
o Soldiers/Military

Times Associated with Death

• Memorial Day
• Day of the Dead (Mexican Tradition)
• Anniversaries of Tragic events
• Samhain (Halloween)
• Urs ceremonies in Sufism
• Death Anniversaries of relatives

Objects Associated with Death
• The Hearse
• Death certificates
• Obituary section of the newspaper
• The noose, gallows
• The electric chair
• Nuclear missiles
• Bombs/armament of all kinds
• Chemicals
• Alcohol, Cigarettes, cars sometimes viewed as

death objects

Symbols of Death

• A black armband
• Dark colors/black (in US culture)
• Type of music

o Bag pipes
o Drumbeats
o Low hymns

Functions of the Death System
• Preventing Death

o Firefighters, police, health care and law enforcement
workers may work to prevent death

o Campaigns against heart disease, AIDS etc
o Who receives prevention efforts (less prevention for

minorities, women)
• Caring for the Dying

o Hospice, families, hospitals
o Providing comfort when death becomes imminent

Functions cont’d
• Disposing of the dead

o Includes funerary practices
o Transportation of death bodies from one place to

another
o The actual burial or other means of disposing of

physical remains

• Social Consolidation after Death
o Bringing people together
o Coping with the loss of an individual or many
o Providing support

Functions..

• Making Sense of Death
o Designed to reduce anxiety, awkwardness or grief

associated with death
o “they lived a good life” “they are in a better place”

“they are with God now”
• Killing

o Capital punishment
o Killing for food

War as a Function

• Is War a part of our human nature?
• Is war a necessity?
• What is the function of war?

o Killing and being killed are possible outcomes
o Assertion of power
o Acquiring land/goods

Functions continued

• Sacrifice
o Tradition of blood sacrifice, human sacrifices
o Common in biblical accounts, Incan and Aztec

rituals
o Ancient Egypt and China
o Human sacrifice practices have largely died out

Natural Disasters: When death comes
without warning
• 2004 Tsunami: estimated death toll 200,00 to

300, 000
• Hurricane Katrina, 2005
• Major Goal of the Death System: Care for

injured/dying, locate those trapped/injured,
identify victims, dispose of remains

• Social consolidation, making sense of death:
these two conditions often go unmet in mass
disasters

Diseases

• Are diseases a natural part of the death
system?

• Plagues and infectious disease have always
been a part of the life cycle

• What would happen if we didn’t have
disease?

Death Education & Research
• Thanatologists: the study of death among

human beings
• It is an interdisciplinary study: nursing,

psychology, medicine, sociology, social work,
veterinary science and others

• sometimes nicknamed “Deathniks”
• The need to come to terms with death
• The awareness that unresolved grief was a

factor in mental health problems
• The need to address issues related to terminal

and life-threatening illness (cancer, AIDs etc.)

Terms & Concepts
• Life expectancy: estimated number of years

remaining in a person’s life at a particular time
• Longevity: average number of years between

birth and death
• Cause of death: determined by a physician and

recorded on the death certificate
o Degenerative biological conditions (Alzheimers,

diabetes, heart disease)
o Disease (infections, cancer, the flu)
o Socioenvironmental (accident, suicide, murder)

Terms & Concepts cont’d

• Mortality rate: a measure of the proportion of
people who have died within a particular
time-period to the number of people in the
population (16 out of a 1,000 or 100, 000
population)

• Crude death rate (CDR): total number of
deaths divided by the number of people in the
population (does not control for age)

• Age-standardized mortality rate (ASMR)
makes adjustment for age (some populations
have a lower life expectancy, which effects
mortality rates)

Causes of Death in US

• In 1900 Pneumonia and the Flu were the
number 1 cause of death.

• By the 1990s Cardiovascular disease was the
number 1 cause

Infection –Based Causes of Death
Worldwide

• Acute Respiratory Infections
• AIDs
• Diarrheal Disease
• Tuberculosis
• Malaria
• Measles

Life Expectancy and Longevity

• Life Expectancy: estimated number of years

remaining in a person’s life at a particular
time.

• Longevity: average number of years between
birth and death- based on lives that have
ended.

• Japan has the top longevity

What will be the cause of our death?
• It depends upon our age
• No one can really predict
• We can still take preventative measures to

reduce risk of dying from certain things,
especially car accident, heart disease, AIDs

Causes of Death -Youth

  • Module 1
  • Introduction
  • What is this course about?
  • This course, continued..
  • Some Facts about Death in the United States
  • Death in the U.S. continued….
  • Exploring our Attitudes, Beliefs & Feelings Towards Death & Dying
  • Thinking about Death
  • Some Euphemisms for Death
  • Death Anxiety
  • Accepting & Denying Death
  • What is Death?
  • Brain Death & Vegetative States
  • The Harvard Criteria
  • Conditions that Resemble Death: Altered State of Consciousness
  • What is an Altered State of Consciousness (ASC)?
  • Examples of Altered States
  • Slide Number 18
  • Other Meanings of Death
  • Attitudes toward Death
  • Slide Number 21
  • What is an Attitude?
  • Different Types of Death Attitudes
  • Western Attitudes Toward Death (Aries)
  • Terror Management Theory
  • Ars Moriendi
  • The Death system
  • Who & What is Part of the Death System?
  • Who & What Cont’d
  • Times Associated with Death
  • Objects Associated with Death
  • Symbols of Death
  • Functions of the Death System
  • Functions cont’d
  • Functions..
  • War as a Function
  • Functions continued
  • Natural Disasters: When death comes without warning
  • Diseases
  • Death Education & Research
  • Terms & Concepts
  • Terms & Concepts cont’d
  • Slide Number 43
  • Causes of Death in US
  • Infection –Based Causes of Death Worldwide
  • Life Expectancy and Longevity
  • What will be the cause of our death?
  • Causes of Death -Youth

Module 2: Grief & Coping

Part 1: The Dying Process

Trajectories of Dying
(Glaser, Strauss, & Benoleil (1966, 1968)

• Considered caregivers predictions of certainty of
death and timing of death

• Four types of death expectation based on
certainty and time:
• Certain death at a known time
• Certain death at an unknown time
• Uncertain death but a known time when certainty will

be established
• Uncertain death and an unknown time regarding

when the question will be resolved

Awareness Contexts

• Closed Awareness: when the person who is
dying doesn’t realize it

• Suspected Awareness: person may begin to
suspect their situation

• Mutual Pretense: everyone knows, but no
one shares or communicates regarding the
knowledge of death

• Open Awareness: willingness to discuss the
fact that death is near

Stages of Dying
by Kubler-Ross
• Example of Western Theory of Dying
• Five stages

• Denial – “It can’t be true.”
• Anger – “Why me?”
• Bargaining – “If you just let me live I promise I will

________.”
• Depression – The person is less responsive and

thoughts are pervaded by a sense of loss
• Acceptance – A final state of rest and letting go, void

of feelings and emotions

Shortcomings of Stage Theory, Applied
to the Stages of Kubler-Ross
• The existence of the stages has not been demonstrated
• No evidence has been presented that people actually do

move from Stage 1 through Stage 5
• The limitations of the method have not been

acknowledged
• The line is blurred between description and prescription
• The totality of the person’s life is neglected in favor of the

supposed stages of dying
• The resources, pressures, and characteristics of the

immediate environment can also make a tremendous
difference

Copyright © Allyn & Bacon 2007

Corr’s Developmental-Coping Model
of the Dying Process
• Primary focus: empowerment for the dying

person and those who are intimately involved in
caregiving

• Four challenges
• Physical – satisfy bodily needs, reduce stress)
• Psychological – feeling secure and in control
• Social – keep attachments to individuals, groups and

causes
• Spiritual – meaning, connection, transcendence, and

hope

Phases of Dying
• The Pre-diagnostic phase – many will ignore

indicators of dying
• The acute phase – try to understand the disease

and cope
• The Chronic Phase : managing symptoms,

prevention and management
• Recovery Phase- If death does not occur, coping

with the crisis
• Terminal Phase-new decisions such as

preparing for death, discontinuing interventions,
face ongoing challenges

Partial Models of the
Dying Person’s Situation
• Restricted Activity
• Limited Energy
• Damaged Body Image
• Contagion
• Disempowerment
• Attributional

Incompetency
• Ineffectuance
• Stress Response

Overload
• Time Anxiety

• Performance Anxiety
• Loss and Separation
• Disengagement
• Journey
• Closing the Book
• Endangered Relationship
• Struggling Brain
• Storying

GRIEF, BEREAVEMENT & MOURNING

Part 2

Defining Terms: Bereavement
• An objective fact:

• We are bereaved when someone close to us dies
• “Close” is not easily defined

• A change in status:
• Such as when a child becomes an orphan, a wife

a widow, a husband a widower
• An outcome of a large-scale social phenomena:

• Those surviving a natural disaster or a war

Defining Terms: Grief
• Grief is one response to bereavement; how one survives
• Grief affects all spheres of life

• On a physical level
• Acute grief: tightness in throat, shortness of breath,

lack of muscle power, empty feeling in abdomen
• Prolonged stressor: Increased risk of cardiovascular,

infectious, & inflammatory disorders, & weakened
immune system

• On a personal and interpersonal level
• Confusion, attention, concentration, memory, anxiety,

and rage which may repeatedly return in waves

Defining Terms: Mourning
• Mourning is the culturally patterned expression of the

bereaved person’s thoughts and feelings
• Can reflect local, regional, national, ethnic, and

religious cultures at particular points in history
• Examples:

• During World War I widows dressed in black with veils
covering their heads

• During World War II families put a gold star in their
window if they had lost a loved one

Types of Grief
• Normal Grief – stays within the bounds of a particular

culture
• Complicated Grief – once called “pathological” or

“abnormal,” the most common feature is that the
bereaved person does not move from the shock and
pain of loss toward a return to a fulfilling life

• Traumatic Grief – severe and disabling responses to
sudden and often violent death

• Anticipatory Grief – how people cope with expected loss

Types of Grief
• Resolved Grief – movement toward recovery from the

most debilitating effects of grief
• Unresolved Grief – the debilitating effects of grief have

continued longer than would be expected (difficult to
define)

• Hidden Grief – hiding any signs of grief in order to
appear as “normal” as possible

• Disenfranchised Grief – occurs when society does not
recognize a person’s right to grieve. Examples: health
care professionals, foster parents, gay partner

Examples of Disenfranchised Grief
• The grieving individual is not regarded as having the

right to grieve (at this time or under these
circumstances) and must keep the sorrow hidden
• When at work, school, or in public places
• Nurses and caregivers
• Lover or companion of an AIDS victim
• When the lost companion was an animal
• When the loss was a stillborn baby
• When the bereaved person or the individual who died is

developmentally disabled

Freud’s Grief-Work Theory
• Grief is an adaptive response to loss
• The work of grief is difficult and time-consuming
• The basic goal is to accept the reality of death and

thereby liberate one’ self from the strong attachment one
had to the “lost object”

• Grief-work is carried out through a long series of
confrontations with the reality of the loss

• The process is complicated by the survivor’s resistance
to letting go of the attachment

• Failure results in continued misery and dysfunction

Interpersonal Applications of
Grief-Work Theory
• Bowlby’s Attachment Theory

• Our basic goal is to maintain the security provided by
the significant relationship

• Stress comes as we try to re-establish the lost
relationship

• In grief-work we must overcome our attachment
• Parkes’ Three Basic Components of Grief-Work

• Preoccupation with thoughts of the deceased person
• Repeatedly going over the loss experience
• Attempts to explain the loss

Other Theoretical Approaches
• Rando’s Task Theory

• Accept the loss
• React to the separation
• Remember and re-experience the lost person and

relationship
• Give up the attachment to the person and the life

that used to be
• Move into the new life but remember the old
• Reinvest emotions and energies in other

relationships and activities

Other Theoretical Approaches
• Stage Theories (such as Kubler-Ross)

• Most agree on the beginning and ending points, but
the middle stages vary by theory

• Little independent evidence to verify the application of
universal stages to the grieving process

• Dual-Process Model (Stroebe and Schut)
• Must work on both:

• Emotional working through the grief
• Adapting to roles and situations in the altered world

Other Theoretical Approaches
• Integrated Individual-Family Model (Moos)

• Considers symptoms of family grief, such as family
isolation, confusion in family roles, changes in who
talks to whom, and cut-off, reconnection or
overprotection of certain family members

• Evolutionary Biology Model of Grief (Archer)
• Views grief in all mammals and social birds
• Views social bonds as advantageous for survival, but

grief as maladaptive

How Do People Recover?
Spousal Bereavement
• Immediate Impact of Spousal Bereavement

• Most women experienced anticipatory grief
• After the death women felt a sense of abandonment
• After the death men felt a sort of dismemberment

• Emotional & Physical Reactions Soon After Bereavement
• Physical symptoms lingered for weeks (pains, poor

appetite, loss of stamina, headaches, dizziness)
• Women had trouble at night, wanted someone to rely on,

and felt the situation was “not fair”
• Men felt guilty and were less likely to express emotions

How Do People Recover?
Spousal Bereavement
• Leave-Taking Ceremonies

• Women found them important and helpful
• Men found them less important and too expensive

• Grief and Recovery: The Widow’s Response
• Obsessional reviews of the circumstances
• Tendency to idealize the husband
• Strong sense that he is still with her

• Grief and Recovery: The Widowers’ Response
• Cuts off obsessional reviews quickly
• Faster social recovery, slower emotional recovery

How Do People Recover?
Spousal Bereavement
• Types of Recovery

• People who did not have the opportunity to prepare
for the spouse’s death suffered more distress

• Time by itself will not facilitate recuperation
• Those who were most disturbed a few weeks after the

death usually were the ones who continued to be
disturbed a year later

• The quality of the marital relationship influences the
grief and recovery process

How Do People Recover?
Spousal Bereavement
• Three Types of Unresolved Grief

• The unexpected grief syndrome (when death comes
without warning, leaving disbelief and intense anxiety)

• The conflicted grief syndrome (when death occurs in
a troubled relationship)

• The chronic grief syndrome (marked by dependency
on deceased spouse)

• Psychosocial Transition
• Vulnerable place of change
• Rites of passage can be helpful

The Family That Has Lost a Child:
Perinatal Death
• Perinatal death – 20 weeks after conception to one month

after birth
• Health care systems are more responsive
• Shadow grief – stays with parents for years (like a shadow)
• Contact the “inner representation” of the dead child may be

experienced for years (keeps parents’ worldview intact)
• Memories, hallucinations, a presence or incorporation of

the child’s characteristics into their own personalities
• Most surviving parents do not divorce
• Grandparents grieve as well

Bereavement in Later Life
• Most older adults cope as well as anyone
• Some deal with bereavement overload

• Accumulation of experience with many losses (family,
friends, pets, lifestyle)

• Risk of illness and death increases following the death of
a loved one (often within 6 months)
• Risk is greater for widowers than widows
• Risk is greatest for young adult widowers
• Higher risk for violent death and suicide
• Stress of grief can weaken immune system

Meaningful Help for
Bereaved People
• Silverman established the Widow-To-Widow Program

prior to the development of professional grief counselors
or peer-support groups
• Grief does not have a final outcome
• Grief can most usefully be regarded as a life transition
• People can help each other

• Helpful things to say to the bereaved
• “He/she will always be alive in your memories.”
• “I’m here if you need somebody to talk to”
• “Tell me how you are feeling”

COPING WITH DEATH

Part 3:

What is coping?

• Emotional reactions to stressful situations
• Cognitive and behavioral efforts to manage

external or internal demands

Types of Coping

• Appraisal-focused coping: how one
understands a stressful situation

• Emotion-Focused Coping: Trying to control
one’s emotional reactions to the stressful
situation

• Problem-Focused Coping: Managing or
remedying the distressing situation

• Religious-based coping: Using God or a higher
power to help understand and react to stressful
situations (ie turning to God, working through
with God’s help)

Who Copes?

• The dying person
• Family members and friends
• Caregivers

  • Module 2: Grief & Coping
  • Slide Number 2
  • Trajectories of Dying�(Glaser, Strauss, & Benoleil (1966, 1968)
  • Awareness Contexts
  • Stages of Dying �by Kubler-Ross
  • Shortcomings of Stage Theory, Applied to the Stages of Kubler-Ross
  • Corr’s Developmental-Coping Model of the Dying Process
  • Phases of Dying
  • Partial Models of the �Dying Person’s Situation
  • Grief, Bereavement & Mourning
  • Defining Terms: Bereavement
  • Defining Terms: Grief
  • Defining Terms: Mourning
  • Types of Grief
  • Types of Grief
  • Examples of Disenfranchised Grief
  • Freud’s Grief-Work Theory
  • Interpersonal Applications of �Grief-Work Theory
  • Other Theoretical Approaches
  • Other Theoretical Approaches
  • Other Theoretical Approaches
  • How Do People Recover? �Spousal Bereavement
  • How Do People Recover? �Spousal Bereavement
  • How Do People Recover? �Spousal Bereavement
  • How Do People Recover? �Spousal Bereavement
  • The Family That Has Lost a Child: �Perinatal Death
  • Bereavement in Later Life
  • Meaningful Help for �Bereaved People
  • Coping with Death �
  • What is coping?
  • Types of Coping
  • Who Copes?

Module 3 Death & Dying
Death in Childhood

Adult Assumptions
About Children and Death
• Children are seldom given the opportunity in

family discussions to talk about death-related
topics

• Adults often have their own fears, doubts, and
conflicts, which often get communicated to their
children

• Freud thought that parents wanted to believe
that their children live in a fairy-tale world safe
from the reality of death

Lessons from the
Research Case Histories
• It is the death of particular people or animals that

enlists the child’s concern

• Death-related experiences, attitudes and

behaviors are part of the intimate flow of life
between children and their parents

• There may be several different orientations

toward death within the same household

Lessons from the
Research Case Histories
• Parents whose own discomfort interferes with

their responses to their children’s death-related
curiosity are likely to perpetuate these anxieties
for another generation

• There is now a transitional generation of parents

who are trying to communicate in an open
manner with their children, although their own
experience was of family silence about death

Stages of Death Comprehension
in Childhood (Nagy)
• Research conducted in 1948/1969, involving

378 children, ages 3 to 10
• Stage 1, ages 3 to 5, Focus on Absence

• Very curious about death and death-related items, like
coffins, the cemetery, and also the funeral

• Death is a continuation of life but in a diminished form
(such as diminished sight or hearing)

• Death is temporary
• Death is departure and separation
• Death aroused anxiety

Stages of Death Comprehension
in Childhood (Nagy)
• Stage 2, ages 5 to 9, Focus on Finality

• Death is represented as a person
• Death is dangerous, invisible, like a skeleton, and

comes out in the dark
• Death has mysterious power
• Belief that death might still be eluded (for example,

you might get killed crossing the street, but not if you
look both ways and be careful about crossing the
street)

• Death is not recognized as universal and personal

Stages of Death Comprehension
in Childhood (Nagy)
• Stage 3, beginning about age 9, Focus on

Personal, Universal, and Inevitable
• Realizes that death is final
• Realizes that death will come to him or her as well
• Discussion of death has a more adult quality
• May add a moral, poetic, or religious dimension

Additional Research Findings
• Children with superior intellectual and verbal ability

demonstrated more advanced death concepts than
others their same age

• No difference in death concepts based on SES

• Gender: boys are more likely to depict violent deaths

than girls

• Younger children seem to focus on separation anxiety

• Older children see death as scary and begin to use
symbols to represent death concepts

Cultural Influences on Children’s
Concepts of Death
• U.S. children depict violent causes of death;

Swedish children depicted chapels, cemeteries,
tombstones, caskets, etc.

• Muslim children seem to grasp the universality
and inevitability of death at an earlier age.

• Muslim children valued praying for the dead
• Cultural influences also include:

• Historical events, like the Columbine shootings
• Scenes depicted in media and digital games

Death in the Family:
Effects on the Children
• Parents’ attention and energy are focused

elsewhere (away from the needs of the surviving
children)

• Bereaved children may express their distress in
ways that seem disconnected from the loss
• Problems in school
• Displaying anger with family or playmates
• Fear of the dark or of being alone
• No obvious signs of sorrow (be brave, no crying)

• Often express memories through activities
shared with the parent who died

Death in the Family:
Children’s Responses
• Focus on a few strong images, scenes or activities
• May begin criticizing the deceased (out of anger)
• Children whose father died: (based on research)

• Tend to be more submissive, dependent, introverted
• Higher frequency of maladjustment, emotional

disturbance, suicidality, delinquent, and criminal behavior
• Perform less adequately in school and on cognitive tests
• Experience more physical symptoms
• Become concerned that the family will fall apart

Post-traumatic Stress Disorder
(PTSD)
• An officially recognized diagnosis since 1980
• Children with PTSD may have:

• Difficulty paying attention and concentrating
• Difficulty in making and keeping friends
• A tendency to be frightened
• Recurring anxious dreams
• A need to express the trauma through play

• Particularly Internet Explorer noted following the
terrorist attacks of 9-11-01

Helping Children Cope
with Bereavement
• Develop and maintain an open communication

pattern with children
• Give children the opportunity to decide about

attending the funeral
• Check out what the child is thinking and feeling –

do not assume that we know what death means
to him or her

Helping Children Cope
with Bereavement
• Encourage the expression of feelings
• Provide convincing assurance that there will

always be somebody to love and look after the
child

• Professional counseling should be considered if
the bereaved children are at special risk

• Select an age-appropriate book or two that
speaks to a child’s sense of loss after a death

The Dying Child: Stages in the
Acquisition of Information
• I have a serious illness.
• I know what drugs I am receiving and what they are

supposed to do.
• I know the relationship between my symptoms and the

kind of treatment I am getting.
• I realize now that I am going through a cycle of feeling

worse, getting better, then getting worse again. The
medicines don’t work all the time.

• I know that this won’t go on forever. There’s an end to
the remissions and the relapses. When the drugs stop
working, I will die pretty soon.

Care of the Dying Child
• Hospice has extended to caring for children
• Attention to the following needs can enhance the care of

a dying child:
• The opportunity to express their concerns through

conversation, play, drawing, or writing
• Confirmation that they are still a normal and valuable

people
• Assurance that family members and other important

people will not abandon the children
• Reassurance that they will not be forgotten

Problems Observed in the
Siblings of Dying Children
• Confusion about the role they are supposed to play in

the family
• Feeling deceived or rejected by parents
• Uncertainty about the future
• Changes in the relationships among siblings
• Feelings of guilt and ambivalence
• Frustrated in not being able to express their feelings and

fears to their parents who are so preoccupied with the
feelings of the dying child and their own feelings

Guidelines for Sharing
A Child’s Death Concerns
• Be a good observer of your child’s behavior
• Do not wait or plan for “one big tell-all”
• Do not expect all of the child’s responses to be obvious

and immediate
• Help the child remain secure as part of the family
• Use simple and direct language
• Be accessible
• Be aware of all the children in the family
• Keep the relationship going

  • Module 3 Death & Dying
  • Adult Assumptions �About Children and Death
  • Lessons from the �Research Case Histories
  • Lessons from the �Research Case Histories
  • Stages of Death Comprehension�in Childhood (Nagy)
  • Stages of Death Comprehension�in Childhood (Nagy)
  • Stages of Death Comprehension�in Childhood (Nagy)
  • Additional Research Findings
  • Cultural Influences on Children’s Concepts of Death
  • Death in the Family:�Effects on the Children
  • Death in the Family:�Children’s Responses
  • Post-traumatic Stress Disorder�(PTSD)
  • Helping Children Cope �with Bereavement
  • Helping Children Cope �with Bereavement
  • The Dying Child: Stages in the Acquisition of Information
  • Care of the Dying Child
  • Problems Observed in the �Siblings of Dying Children
  • Guidelines for Sharing�A Child’s Death Concerns