Midterm 1 Material Flashcards
What is the study of death called?
thanatology
How is death defined?
“Irreversable loss of circulation, respiration and/or brain function”
Other cultures may have different definitions though
What was Freud’s take on death?
We have “life instincts” (Eros/libido)
and “death instincts” (Thanatos/Mordito)
What is the Paradox of Mortality?
We are hardwired to survive and also to die
Despite being hardwired to die, our own mortality causes a lot of anxiety
What did psychoanalysis get right about death?
That death anxiety can be both conscious and unconscious
How does the understanding of death develop in children aged 3 and 5?
Nonfunctionality is nonfunctional, but death is not seen as final or universal
early childhood is marked by “Magical thinking” about death
What is magical thinking? How does it apply to children’s understanding of death?
That one’s own thoughts and feelings influence the rest of the world
Children believe that they are responsible for tragic events that they experience
How do children aged 5-10 understand death?
they begin to understand that death is final and eventually, universal
Understanding of Irreversibility and universality emerge, with some understanding of causality
How do people understand death from the ages of 10-16?
it is not until this phase that universality is fully understood
more complex and abstract understanding of death
What is the causality sub-concept of death?
that there are internal and external factors that can lead to someone’s death
What is the applicability sub-concept of death?
That some things can die and some things cannot
What is the universality sub-concept of death?
That everyone will eventually die
What is the nonfunctionality sub-concept of death?
that something that is dead cannot function or interact with anything
What is the irreversibility sub-concept of death?
That once someone is dead, they cannot be alive again
What are some ways that children develop their understanding of death?
- Direct experiences with death
- parental communication about death
- portrayals of death in media and the arts
How did 6 year old children understand death as applied to Plants and Animals?
They understand that the concepts of death also apply to plants amd animals, but not objects.
- Death was more often seen as final and universal in animals than plants
- The death of a flower seen as more final than the death of a weed
What is seen in the understanding of death in adulthood?
More sophisticated understanding of the biological reality of death
this often coexists with a belief in the afterlife for the mind or soul
Do children/ young adults think about the possibility of dying often? Why/why not?
No, very little thought is given
this is because they project their death to be so far into the future that it has very little reality
average child disbelieves very strongly that it will die
What is Mortality Salience?
The awareness that one’s death is inevitable
How does mortality salience change throughout life?
it increases with age
What is Thanatophobia?
The clinical fear of death
What is necrophobia?
The fear of dead or dying persons and/or things
What does death anxiety play a significant role in?
The number of mental disorders from PTSD and Depression to OCD and depression
What are the 4 factors that play a role in death anxiety?
- Death is seen as a radical transformation and separation
- Death is understood as the annihilation of the self
- Death is a threat to the realization of life’s basic goals and propensities
- Death is a threat to the meaningfulness of life
what feeling is death anxiety associated with?
the feeling of being at the mercy of external forces beyond one’s control
What are some factors that affect the degree of death anxiety that one feels?
- Age/gender
- religiosity
- mental health
- reduced sense of control
- pessimism
- lack of meaning in life, low self esteem
- lack of purpose in life, regret
What is the relationship between mortality salience and death anxiety in older adults?
Greater mortality salience, less death anxiety
Greater mortality salience does not always lead to death anxiety
How does death anxiety differ between younger and older adults?
Young adults: more fear of the state of death
Older Adults: more likely to fear the dying process
Can death anxiety increase again in older adults?
Yes, this tends to occur in adults 80+. living in nursing homes
How does death anxiety differ in men and women?
Women often report greater death anxiety than men
- Second spike in the 50’s
- by age 60, concern over mortality between men and women is essentially the same
- Menopause could possibly explain this
What ways can people cope with death?
Some deny it, divert it or displace it
- may do what religion tells them to do
- might seek endless wealth or power
Other’s self actualize their lives with meaning and purpose
Some Overcome it entirely in creativity and connection
others “refuse the loan of life to avoid the debt of death”
What are the two routes presented in terror management theory?
When presented to a threat to our mortality…
- We deny the threat/try to prolong life
- Proximal defenses; occur when thoughts of death are conscious - Adhere more strongly to our world views and defend self esteem
- distal defenses
What are ways in which increasing mortality salience can affect human behavior?
- more positive self bias
- greater defense of one’s country, culture, views, values
- more conservative views on life
- more discriminatory views on life
- pursuit of a higher social class/status
How does death anxiety effect political views?
political views are typically reinforced after the loss of a loved one
- this affected conservatives more
Death anxiety tends to make people lean farther right than usual
Are there any positive effects to death reminders?
Could motivate people to…
build supportive relationships, improve their physical health, adopt more open minded and growth oriented behaviors.
prioritize positive goal setting and living up to positive standards and beliefs
What is mindfulness and how does it apply to mortality salience?
Definition: Non-judgmental observation of the present moment
Higher trait mindfulness is associated with less defensive responses to mortality salience
How does meditation affect responses to increased mortality salience?
Defensive responses were not found in those who meditated regularly and in Buddhist monks
Think: the Buddhist/meditation study
What is DTA and what does an increase in it lead to?
DTA: Death Thought Accessibility
First, people deny threats, which decreases DTA
Then, it rebounds, which leads to defense of one’s worldview and self-esteem
What is humility and how does it affect death anxiety?
Humility: characterized by a willingness to accept the self and life without comforting illusions. Also Characterized by low self-focus
Higher humility associated with reduced defensive responses to increased mortality salience
- Including: lower moral disengagement, reduced need for self enhancement
What is meaning management Theory?
The search for meaning is a primary motive; we are driven to make meaning in life
death anxiety is conquered through meaning
What is the meaning maintenance model?
similar to meaning management theory
adds that when people’s sense of meaning is threatened, they reaffirm alternative representations as a way to gain meaning
explains why people invest in their self esteem and other sources of meaning when presented with a threat
What did Wong and Tomer suggest what we should do to best manage thoughts and feelings regarding death?
Avoid death anxiety by reducing threats
approach life enhancing and meaning making goals
How do people who are close to facing death respond?
Near death cancer patients and death row inmates showed more positive responses in their blog posts/last words
What is the correlation between death anxiety and death acceptance?
small to moderate, negative correlation
Describe Approach-Oriented death acceptance:
positive feelings towards death, may even look forward to its occurrence
Describe escape oriented death acceptance:
Death is viewed as an escape from pain and suffering
Describe Neutral death acceptance:
Neither look forward to death, nor accept it
Which type of death acceptance is most highly correlated with well being in older Adults?
approach oriented
Describe Kubler Ross’ 5 stages of dying:
DENIAL: cannot accept circumstances
- often leads to isolation
- used by nearly all patients in some form
- can serve an important function in the beginning
ANGER: expressed towards those who are closest
- towards a deity, chance, the universe, etc.
- Feelings of envy
BARGAINING: negotiation for more time or a longer life
- once again usually involves some diety
DEPRESSION: over the recognition of mortality
- Reactive: Towards jobs, hobbies, mobility
- Preparatory: family, relationships
ACCEPTANCE: 3 types of death acceptance
What are advantages to the Kubler Ross model?
- Dispels the myth that there is only one singular appropriate response to death
- has broken down social/cultural barriers and taboos
- allows counsellors to identify needs
What are some criticisms of the Kubler Ross model?
- Did not consider pre-existing literature
- Other Clinicians and researchers unable to find evidence for the order and universality of these 5 stages
- may be interpreted as the right way to die
How might denial be useful for someone who is dying?
can serve as a safety net to preserve self esteem, maintain relationships and prevent chaos at certain points in the process
What is Pattison’s 3 phase descriptive model?
- Acute Phase - anxiety at its highest
- Chronic living-dying phase - anxiety reduced, questions about unknown are asked, acceptance begins
- terminal phase: death is accepted, person withdraws emotionally and socially
What are Shneidman’s stages of “death work”?
- Psychological: preparation to meet one’s end; coming to terms with dying
- Social: enabling oneself to help loved ones in the preparation for survival
What did Weisman and Hackett suggest are the 4 main requirements for an appropriate death?
- reduction of inner and outer conflicts
- compatibility with ego ideal
- continuity of relationships is preserved and restored
- fulfillment of prevailing wishes
What is edgework? ;) (not the freaky edging)
behavior that explores the limits of safety and convention; voluntary risk taking
What are some common experiences with Near death experiences? (don’t need to name them all)
- Hearing someone pronounce them dead/some auditory experience
- Seeing themselves and others from outside their body
- Feelings of peace
- coming back into their body
Do NDE’s differ for those who believs in an afterlife vs those who do not?
No:
“Those who believe in a life after death and those who do not will find nothing in NDE studies to contradict either belief.”
What is a psychological explanation for NDE’s?
Brain can enter a “hyper state of perceptual neural activity” at the time of death
- Amygdala, hippocampus, cortex
What are some positive, lasting effects of NDE’s?
- Sense of meaning and purpose
- loss of fear of death
- some people start to believe in an afterlife
- increased self esteem
- more caring/loving
What are some specific methods through which people facing death find meaning?
Values
goals
relationships
sense of purpose and direction
spirituality/religion
reflection of the past
What is reminiscence?
Volitional and non-volitional act of recollecting memories of one’s self in the past
What is Life Review?
Return of memories and past conflicts at the end of life
spontaneous or structured evaluation of one’s life
Define Symbolic Immortality and list its 5 modes
A sense of immortality obtained thru symbolic means
- Biological
- children, culture - Creative
- teaching, mentoring - Transcendental
- spirituality/religion - Natural
- sense of connectedness to nature/earth - Experiential Transcendence
- a psychic state(?) one so intense and all-encompassing that time and death disappear(??)
What is Generativity?
A concern for guiding and establishing the next generation; vs stagnation
What is spirituality?
a “personal quest for understanding answers to ultimate questions about life, meaning and relationships to the sacred or transcendent”
What is the difference between active and passive suicidal Ideation?
ACTIVE: imagining specifics/planning on how to attempt
PASSIVE: no planning
What conditions see the greatest risk of suicidal ideation?
Traumatic brain injuries, sleep disorders and HIV/AIDS
What are 6 factors that play into one’s risk of suicidal ideation?
- Mental illness
- Other psychological factors such as grief, loneliness, guilt
- Life events
- Gender
- attempts higher in women, completion higher in men - Age
- Highest rates seen in middle aged men and women (35-59) and Men 60+ - Ethnicity, minority status and income level
What is the difference between bereavement and mourning?
bereavement is a period of sorrow experienced after a loss
mourning refers to public displays of grief that conform to social and cultural norms
Why does grief occur?
loss causes an injury to our attachment system; threatens our sense of security and safety
Explain grief as it applies to neuroscience
Grief can be seen as a form of learning
the neural basis of an attachment supports the knowledge that a loved one persists, even when they are absent
- Basically, our brain still thinks that they’re gonna come back
“gone-but-also-everlasting theory”
What 5 common areas of the brain activate during grief?
Anterior Cingulate Cortex
- emotion regulation, learning
Posterior Cingulate Cortex
- autobiographical memory
Prefrontal Cortex
- expression of feelings, desires
Insula and Amygdala
- emotion processing, threat detection
What are the main health effects of grief?
Alterations in cortisol, impaired immune function over time
increased risk of anxiety, depressive and stressor related disorders; separation anxiety
impaired sleep, loneliness, substantial loss of coherence, disruption in daily routines
What is the Survivor’s Acceptance?
accepting the reality that our loved one is physically gone
does not necessarily mean being okay with the loss
involves learning to live again
What are the 4 stages of the natural, adaptive response to grief?
- shock and numbness
- yearning and searching
- despair and disorganization
- reorganization and recovery
Describe the integrated stage model graph of Kubler Ross/Bowlby & Parkes:
disbelief starts off high, then quickly drop off
instead of starting high, yearning, anger and depression spike quickly then drop off the same way disbelief does
acceptance starts low, slowly progresses higher and higher with diminishing gains
Explain the empirical support for this stage model:
Frequency of disbelief, yearning, anger, depression and acceptance at multiple points following a loss
the results showed to be very similar to the stage model graph
What is the dual process model?
grief process involves an oscillation between a focus on the relationship with the lost individual (loss orientation) and an alternate focus on everyday tasks (restoration orientation)
What is the “pathways through grief” model?
not crazy important
grief is an open ended experience, varying between individuals
Can there ever be improvement after a loss?
yes, it can also provide relief of escape from a stressful situation
What are the 5 grief trajectories?
- common grief
- spike, followed by a return to normal - chronic grief
- spike without return - chronic depression
-depression was high pre-loss, remains higher - depressed-improved
- depression was high pre-loss, ends up lower - resilient
- depression always low
What is anticipatory grief?
When a loved one is expected to die, reactions may be anticipated
think: WW2 wives
What does research say about anticipatory grief?
both positive and negative effects
research has found both easing and intensifying of post death grief following anticipatory grief
What type of illness is associated with poorer adjustments in bereavement?
extended illnesses (6+ months)
How does the nature of a death/loss affect grief?
grief typically worsened if the loss is sudden or unexpected
stigmatized death also has major effects
EX: parents who lost children VIA suicide showed much worse mental health vs those who lost children VIA natural causes or accidents
What is ambiguous loss?
when there is lack of clarity over who or what has been lost
EX: infertility, miscarriage, divorce or absent family member, involvement of loved one in drug abuse
What is the relationship between non-death losses and grief?
all kinds of losses compromise our “assumptive world” and may lead to feelings of grief as we attempt to reestablish out assumptions
What are children who’ve lost a parent at higher risk of?
behavioural problems, mental/physical illness, increased stress reactivity, mortality and suicide
What is the widowhood effect?
Older people who have lost a spouse/partner have an increased risk of dying themselves
What do studies suggest the most intense feelings of grief and longest lasting grief occur for?
the loss of a child
Explain how grief affects children:
Children often grieve in spurts because they cannot sustain the intense feelings for long periods
may involve more diverse emotions
EX: irritability and protest, constant crying, a change in sleeping and eating habits, decreased activity and weight loss
Which personality traits are correlated with heightened and complicated grieving responses?
Neuroticism, low extraversion and low openness to experience
especially neuroticism
What is complicated grief?
grief does not progress as expected
- prolonged acute grief with intense yearning and sorrow
- frequent troubling thoughts about the death
- excessive avoidance about reminders of the death
may not be the same as depression
What are some predictors of complicated grief?
violent deaths
sudden deaths
lack of preparation
high levels of anticipatory grief
cultural traumas
more likely to be transgenerational
What is the diagnostic criteria for prolonged grief disorder?
- Death of a loved one who was close in the past year (6 months for children)
- Persistent grief response most days since the death
- intense yearning
- preoccupation with thoughts
regarding the lost one - At least 3 of the following symptoms most days since the death:
- Identity disruption (e.g., feeling as if part of oneself has died).
Marked sense of disbelief about the death. - Avoidance of reminders that the person is dead.
- Intense emotional pain (e.g., anger, bitterness, sorrow).
-Difficulty reintegrating into one’s relationships and activities.
Emotional numbness (absence or marked reduction of emotions).
- Feeling that life is meaningless as a result of the death.
- Intense loneliness as a result of the death.
Gimme some more diagnostic criteria for Prolonged Grief Disorder since its too much for one card
- Disturbance causes clinically significant stress or impairment in social, occupational or other areas of life
- duration and severity of the bereavement exceed social norms
- symptoms not better explained by another condition or medication
how has diagnosing depression changed?
can now diagnose in the first few weeks after a loss, whereas before it had to be at least over 2 months
How does a loss need to happen for PTSD to be diagnosed?
loss must have been violent or accidental
What is cognitive restructuring?
changing negative thoughts that underlie difficult emotions
What is evocative language and how is it used?
Counsellors may use tough words such as “your son is dead” rather than “you lost your son” to encourage a greater acceptance of the reality of the loss
What are memorialization activities/personal grief rituals?
activities aimed at remembering and honoring the deceased
letting go of the deceased
EX: creating a memory book, visiting somewhere
What is narrative therapy?
writing can be used to help the survivor express their feelings and thoughts more freely
What is integrated grief?
a lasting form of grief in which loss related thoughts, feelings and behaviors are integrated into a person’s ongoing function
What are continuing bonds?
the presence of an ongoing inner relationship with the deceased person by the bereaved individual
may be natural and adaptive
What are examples of continuing bonds (don’t need to name all)
-reminiscing or telling stories about the deceased
-looking at photographs of the deceased
keeping possessions belonging to the deceased
-internalizing values and beliefs espoused by the deceased
-taking on characteristics of the deceased
-doing things that the deceased would have liked
-viewing the deceased as a role model to guide behaviour
-engaging in activities to honour or memorialize the deceased (e.g., tattoos)
-attempting to communicate with the deceased
What are post death encounters?
Bereaved individuals often report seeing, hearing or feeling the presence of the deceased
makes people feel more connected to the deceased person, influences beliefs in an afterlife
What does research say about continuing bonds?
Qualitative studies suggest positive and helpful effects
Quantitative studies suggest associations with increased stress at various time points
When are stronger continuing bonds harmful?
When survivors are unable to make sense of the loss in personal, practical existential or spiritual terms
How do continuing bonds affect the loss of a pet?
both comfort and distress reported, but overall more comfort
comfort more likely if individuals also found value in the face of loss
