6. Death, dying and bereavement

Question 1

What are the challenges of chronic illness?

Answer 1

• Adjusting to symptoms and disability (and learning about them and treatment)
• Maintaining a reasonable emotional balance
• Preserving sense of competence
• Sustaining relationships
• Preparing for uncertain future

Question 2

Use the social cognitive transition model of adjustment to show what happens when expectation isn’t confirmed?

Answer 2

• Protective buffering (denial) - hold onto our assumptions and expectations
• To adapt, there is discomfort and threat
• After a while (with some support from people around you) people adjust
• Assumption will be adjusted, and you never really go back to normal

Question 3

What is the psychological impact of long-term conditions (LTC)?

Answer 3

• 2-3 times more likely to develop depression
• If you have 3+ conditions, you are 7 times more likely to have depression
• Mental health problem increases the risk of physical ill health
• Co-morbid depression (depression + other illness) doubles the risk of CHD in adults
• Adults with physical and MH problems are less likely to be employed

Question 4

How many years younger to people with MH problems e.g. schizophrenia and bipolar disorder die than the general population?

Answer 4

16-25 years younger

Question 5

What does the common sense model of illness self-regulation describe?

Answer 5

The processes of internal adaptation in someone when they experience a discontinuity in their physical sense
- interpretation - coping - appraisal -

Question 6

What is concrete and abstract thinking?

Answer 6

• Concrete - thinking on the surface. Concrete are the implicit things that we have absorbed from the world around us - no effort required.
• Abstract - thinking in depth. Abstract are the explicit things that we are told directly and have to consider - effort required.

Question 7

Is psychological distress inevitable after given bad news about health?

Answer 7

• No

* Growth is possible and associated with less distress in the short-term + better overall physical and mental health

Question 8

What percentage of people die in hospital, and what percentage of people would actually like to die in hospital?

Answer 8

• Reality - 57%

* % that would like to - 3%

Question 9

What is palliative care for?

Answer 9

• Providing terminally ill people with compassionate care
• Addressing medical, psychological, social and spiritual aspects of dying
• Relieving/managing symptoms rather than curing disease

Question 10

In a study conducted by Higginson et al., what percentage of seriously ill people wanted to prioritise improving quality of life or extending life?

Answer 10

• Quality of life - 60-80%

* Extending life - 2%

Question 11

List the sequence of 5 reactions of a person facing death (as described by Kübler-Ross)?

Answer 11

1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance

Question 12

What does the stage of denial involve?

Answer 12

• Person won’t believe this is happening
• May lie and tell themselves it’s temporary
• Psychological defence to cushion the impact of the source of grief

Question 13

What does the stage of anger involve?

Answer 13

• Why me?
• Generalised rage at the world
• Isolated and furious
• Thoughts of unfairness and betrayal
• Outbursts of anger in unrelated situations

Question 14

What does the stage of bargaining involve?

Answer 14

• Person thinks they can fix things by doing certain things
• May feel guilt and it’s their responsibility to fix things
• Attempt to strike bargains with God, spouses or parents e.g. “I’ll be a good person, if i get another chance”

Question 15

What does the stage of depression involve?

Answer 15

• Person is absorbed in the intense emotional pain
• Overwhelmed with feelings of helplessness and sadness
• Anticipatory grief - grieving for the loss before it actually happens

Question 16

What does the stage of acceptance involve?

Answer 16

• “This did occur, but I have great memories”

* Loss is accepted and we work on alternative to coping with and minimising the loss

Question 17

What are the weaknesses of the stage theories?

Answer 17

• Do not account for variability in people and their responses
• Focus on emotional responses and neglect cognitions
• Fail to consider social, environmental or cultural factors
• Pathologies people who do not pass through stages
• Acceptance might not be achieved

Question 18

What is bereavement?

Answer 18

Situation of a person who has recently experienced the loss of someone significant in his or her life

Question 19

What does bereavement involve?

Answer 19

Changes in orientation towards loss or restoration (can oscillate from one to the other).

Loss:
• Preoccupation
• Thinking and yearning for the person lost
• Seeking out places as reminders or searching for the person

Restoration:
• Adjustments to lifestyle
• Coping with day-to-day life
• Building a new identity
• Distracting away from painful thoughts

Question 20

What percentage of people usually adjust to bereavement by the second year?

Answer 20

85%

Question 21

Does everyone have a large sense of distress and disorganisation early on in the loss of a person?

Answer 21

No, 15-50% of people just have minimal grief

Question 22

What does the duration of severity of a person’s grief depend on?

Answer 22

• How attached they were to the deceased person
• Circumstances and situation of the death
• How much time they had to work through anticipatory mourning

Question 23

What increases the likeliness of chronic grief (depression, anxiety, PTSD)?

Answer 23

• Sudden or unexpected death
• Death of a child
• High level of dependency in the relationship
• Person who is in bereavement has a history of psychological problems, poor support and additional stress