Death, Dying and Bereavement

Question 1

what do people value as part of self image and what can a long term illness do to this?

Answer 1

Being healthy, able and having a normal physique is central to most people’s self-image and being ill can be a shock to a person’s sense of security.

Question 2

what are some impacts of a long-term condition on people?

Answer 2

o People with LTC are 2-3x more likely to develop depression than the general population.
o Having a mental health problem increases the risk of physical ill health.
o Adults with both physical and MH issues are much less likely to be in employment.
o People with MH problems (e.g. bipolar) die, on average, 16-25 years younger than the general population

Question 3

what does the Self-Regulatory Model describe?

Answer 3

the way in which individuals perceive, conceptualise and cope with the problem of chronic illness to re- establish their state of health

Question 4

what are the 3 main stages of the Self-Regulatory model?

Answer 4

o Interpretation
– patient makes sense of perceived symptoms.
o Coping
– good/bad ways in dealing with the problem.
o Appraisal
– assessment of how successful the coping has been.

“self-regulatory” as the 3 components interrelate to maintain a balance

Question 5

what are the stages of Kübler-Ross’ Stages of Dying?

Answer 5

Denial
Anger
Bargaining
Depression 
Acceptance

Question 6

what do people do at the denial stage?

Answer 6

The person may think “it’s not really happening” or lie to themselves about it happening.
This is used as a psychological defence to cushion bad news.

Question 7

what do people do at the anger stage?

Answer 7

the person may think “why me?” and be furious that this is happening to them.

Question 8

what do people do at the bargaining stage?

Answer 8

the person thinks “if I can do this, I can fix things and make it better”.
They attempt to strike bargains with God, spouses, or parents.

Question 9

what do people do at the depression stage?

Answer 9

The person thinks “my heart feels broken”.
The person is absorbed in the intense emotional pain they feel from having their world torn apart and they may be overwhelmed with emotions.

Question 10

what do people do at the acceptance stage?

Answer 10

the person thinks “I know this has happened but I’ve had a good life”

Question 11

what are the reasons for stage theories of death being embedded in western culture?

Answer 11

o Linear progression gives a sense of conceptual order to a complex progress
– provides a degree of control and predictability.

o A cultural desire to “make sense” of the uncertain.

o The time of development of these theories was at a time of limited literature on death and dying.

o This was applied to several different situations (not just dying but also bereavement).

Question 12

what are the weakness of stage theories of death and dying?

Answer 12

o Stages are prescriptive and place patients in a passive role.

o They do not account for variability in response – people deal with things differently.

o They focus on emotional responses and neglect behaviour.

o They fail to consider social, environmental and cultural factors of a patient.

o The stages criminalise people who do not pass through the stages e.g. acceptance may not be achieved or depression may not occur

Question 13

what is bereavement?

Answer 13

deprivation of someone significant through their death

Question 14

what sort of effect does death have?

Answer 14

a ripple effect

Dying does not occur in isolation, it affects family, friends

Question 15

what affects how we grieve?

Answer 15

cultural customs and norms

Question 16

how does grief change over the years?

Answer 16

grief become more and more minimal but then becomes chronic and links to major depression or PTSD

Question 17

what factors affect the duration of severity of grief?

Answer 17

o Attachment to the deceased person.
o Circumstances of the death.
o How much time they had of anticipatory mourning
– e.g.. in oncology, you can anticipate.

Question 18

when can chronic grief be associated with worsening mental health?

Answer 18

o Death was sudden.
o The deceased person was a child.
o There was a high level of dependency in the relationship.
o Bereaved person has a history of psychological problems, poor support and additional stress.

Question 19

what are the efforts suggested to understand grief better?

Answer 19

o Develop cross-cultural theoretical approaches.
o Empirical testing.
o Continued development of effective psychological interventions to help those in chronic grief.

Question 20

what are the Illness representations?

Answer 20

• identity: what do I have, a cold
• cause: I have been run down lately
• consequence: I can’t go to work now
• timeline: it will go in a few days
• curability/controllability : I will rest for some time

these affect the interpretation of illness and the response to it