The losses that confront us in adulthood are many. For most of us, the loss of parents and partners becomes more likely the older we get. For some, the loss of a child can be extremely hard to deal with. How we handle the grief related to each loss depends in part on how old we are at the time.

Loss of One’s Partner in Young Adulthood. Because young adults are just beginning to pursue the family, career, and personal goals they have set, they tend to be more intense in their feelings toward death. When asked how they feel about death, young adults report a strong sense that those who die at this point in their lives would be cheated out of their future (Attig, 1996).

Experiencing the loss of one’s partner in young adulthood can be very traumatic, not only because of the loss itself but also because such loss is unexpected. As Trish Straine, a 32-year-old widow whose husband was killed in the World Trade Center attack, put it, “I suddenly thought, ‘I’m a widow.’ Then I said to myself, ‘A widow? That’s an older woman, who’s dressed in black. It’s certainly not a 32-year-old like me’ ” (Lieber, 2001). One of the most difficult aspects for young widows and widowers is that they must deal with both their own and their young children’s grief and provide the sup­port their children need. But that can be very hard. “Every time I look at my children, I’m reminded of Mark,” said Stacey, a 35-year-old widow whose hus­band died of bone cancer. “And people don’t want
to hear you say that you don’t feel like moving on, even though there is great pressure from them to do that.” Stacey is a good example of what research shows: Young adult widows report that their level of grief does not typically diminish significantly until 5 to 10 years after the loss, and they maintain strong attachments to their deceased husbands for at least that long (Derman, 2000).

Losing one’s spouse in midlife often results in the survivor challenging basic assumptions about self, relationships, and life options (Danforth & Glass, 2001). By the first year anniversary of the loss, the surviving spouse has usually begun transforming his or her perspectives on these issues. The impor­tant part of this process is making meaning of the death, and continuing to work on and revise it over time (Gillies & Neimeyer, 2006).

Death of One’s Child in Young and Middle Adulthood.

Many people believe that the death of one’s child is the one of, if not the worst, type of loss (Woodgate,

2006) . Because children are not supposed to die before their parents, it is as if the natural order of things has been violated, shaking parents to

Dying and Bereavement 521

their core (Rubin & Malkinson, 2001). Mourning is always intense, and some parents never recover or reconcile themselves to the death of their child (Klass, 1996a). The intensity of feelings is due to the strong parent-child bond that begins before birth and that lasts a lifetime (Bornstein, 1995).

Young parents who lose a child due to Sudden Infant Death Syndrome (SIDS) report high anxi­ety, a more negative view of the world, and much guilt, resulting in a devastating experience (Rubin & Malkinson, 2001). The most overlooked losses of a child are those that happen through stillbirth, miscarriage, abortion, or neonatal death (Klass, 1996a; McCarthy, 2002; Rubin & Malkinson, 2001). Attachment to the child begins before birth, espe­cially for mothers, so the loss hurts very deeply. For this reason, ritual is extremely important to acknowledge the death and validate parents’ feel­ings of grief (Kobler, Limbo, & Kavanaugh, 2007). Yet parents who experience this type of loss are expected to recover very quickly. The experience of parents in support groups, such as Compassionate Friends, tells a very different story (Klass, 1996a). These parents report a deep sense of loss and hurt, especially when others do not understand their feel­ings. Worst of all, if societal expectations for quick recovery are not met, the parents may be subjected to unfeeling comments. As one mother notes, par­ents often just wish somebody would acknowledge the loss (Okonski, 1996).

The loss of a young adult child for a middle-aged parent is experienced differently but is equally dev­astating (Rubin & Malkinson, 2001). For example, parents who lost sons in wars (Rubin, 1996) and in traffic accidents (Shalev, 1999) still report strong feelings of anxiety, problems in functioning, and dif­ficulties in relationships with both surviving siblings and the deceased as long as 13 years after the loss.

Death of One’s Parent. Most parents die after their children are grown. But whenever parental death occurs, it hurts. Losing a parent in adulthood is a rite of passage as one passes from being a “son” or “daughter” to being “without parents” (Edwards,

2006) . We, the children, are now next in line. Indeed, the death of a parent often leads the surviving
children to redefine the meaning of their relation­ships with their siblings, children, and other family members (Moss, Moss, & Hansson, 2001).

The death of a parent deprives people of many important things: a source of guidance and advice, a source of love, and a model for their own parent­ing style (Buchsbaum, 1996). It also cuts off the opportunity to improve aspects of their relationship with the parent. Expressing feelings toward a parent before he or she dies is important. In some cases, the death of a parent has a negative effect on the adult child’s own marital relationship (Henry, 2006).

The loss of a parent is perceived as very sig­nificant; no matter how old we are, society allows us to grieve for a reasonable length of time. For young adult women transitioning to motherhood, losing their own mother during adolescence raises many feelings, such as deep loss at not being able to share their pregnancies with their mothers and fear of dying young themselves (Franceschi, 2005). Middle-aged women who lose a parent report feel­ing a complex set of emotions (Westbrook, 2002); they have intense emotional feelings of both loss and freedom, they remember both positive and negative aspects of their parent, and they experience shifts in their own sense of self.

The feelings accompanying the loss of an older parent reflect a sense of letting go, loss of a buf­fer against death, better acceptance of one’s own eventual death, and a sense of relief that the par­ent’s suffering is over (Moss et al., 2001). Yet, if the parent died from a disease such as Alzheimer’s that involves the loss of the parent-child relationship along the way, bodily death can feel like the second time the parent died (Shaw, 2007). Whether the adult child now tries to separate from the deceased parent’s expectations or finds comfort in the memo­ries, the impact of the loss is great.

Death of One’s Child or Grandchild in Late Life. The loss of an adult child in late life is something that many older adults experience, and others continue to feel the loss of a child from many years before (Rubin & Malkinson, 2001). Older bereaved parents tend to re-evaluate their grief as experienced shortly after the loss and years and decades later. Even more

than 30 years after the death of a child, older adults still feel a keen sense of loss and have continued dif­ficulty coming to terms with it (Malkinson & Bar – Tur, 2004-2005). The long-lasting effects of the loss of a child are often accompanied by a sense of guilt that the pain affected the parents’ relationships with the surviving children.

Clearly, the loss of a child has profound, lifelong effects. The meaning of the loss changes somewhat over time (Neimeyer, Keese, & Fortner, 2000), but the feelings of distress may never go away. Indeed, many parents view the relationship to the deceased child as either the closest or one of the closest rela­tionships they ever had (Ben-Israel Reuveni, 1999).

The loss of a grandchild results in similar feel­ings: intense emotional upset, survivor guilt, regrets about the relationship with the deceased grandchild, and a need to restructure relationships with the surviving family. However, bereaved grandparents tend to control and hide their grief behavior in an attempt to shield their child (the bereaved parent) from the level of pain being felt.

Death of One’s Partner in Late Life. Experiencing the loss of one’s partner is the type of loss in late life we know most about. The death of a partner differs from other losses. It clearly represents a deep personal loss, especially when the couple has had a long and close relationship (Moss et al., 2001). In a very real way, when one’s partner dies, a part of oneself dies too.

There is pressure from society to mourn the loss of one’s partner for a period of time, and then to “move on” (Jenkins, 2003). Typically, this pressure is manifested if the survivor begins to show inter­est in finding another partner before an “accept­able” period of mourning has passed. Although Americans no longer specify the length of the period, many feel that about a year is appropriate. The fact that such pressure and negative com­mentary usually do not accompany other losses is another indication of the seriousness with which most people take the death of a partner.

Older bereaved spouses may grieve a great deal for a long time (Hansson & Stroebe, 2007); in one study grief lasted for at least 30 months (Thompson et al., 1991). Given that, you might wonder whether having a supportive social network might help peo­ple cope. Research findings on this topic are mixed, however. Some studies find that social support plays a significant role in the outcome of the grieving process. For example, during the first 2 years after the death of a partner, some data show that the quality of the support system rather than simply the number of friends is especially important for the grieving partner. Survivors who have confidants are better off than survivors who have many acquain­tances (Hansson & Stroebe, 2007). In contrast, other studies find that having a supportive social network plays little role in helping people cope. For example, Miller, Smerglia, and Bouchet (2004) reported that the type of social support available to a widow had no relation to her adjustment to widowhood. It may be that there is a complex relationship between the bereaved person and social supports, depending on whether he or she wants to have contact with others, who in the social network is wanting to provide support, and whether that support is of high quality.

When one’s partner dies, how he or she felt about the relationship could play a role in coping with bereavement. One study of spousal bereavement measured how the surviving spouse rated the mar­riage. Bereaved older widows/widowers rated their relationships at 2, 12, and 30 months after the death of their spouses. Nonbereaved older adults served as a comparison group. The results are summarized in Figure 13.8. Bereaved widows and widowers gave their marriages more positive ratings than non­bereaved older adults. A marriage lost through death left a positive bias in memory. However, bereaved spouses’ ratings were related to depression in an interesting way. The more depressed the bereaved spouse, the more positive the marriage’s rating. In contrast, depressed nonbereaved spouses gave their marriages negative ratings. This result suggests that depression following bereavement signifies positive aspects of a relationship, whereas depression not connected with bereavement indicates a troubled relationship (Futterman et al., 1990).

Several studies of widows document a tendency for some older women to “sanctify” their husbands (Lopata, 1996). Sanctification involves describing

Dying and Bereavement 523

Severity of depression

deceased husbands in idealized terms, and serves several functions: validating that the widow had a strong marriage, is a good and worthy person, and is capable of rebuilding her life. European American women who view being a wife as above all other roles a woman can perform are somewhat more likely to sanctify their husbands (Lopata, 1996).

Getting older bereaved spouses to talk about their feelings concerning their loss reduces feelings of hopelessness, intrusive thoughts, and obsessive – compulsive behaviors (Segal et al., 1999). Cognitive – behavioral therapy is one especially effective intervention to help bereaved people make sense of the loss and deal with their other feelings and thoughts (Fleming & Robinson, 2001). A key to this process is helping people make meaning from the death (Neimeyer & Wogrin, 2008).

Unmarried heterosexual couples and gay and lesbian couples may experience other feelings and reactions in addition to typical feelings of grief. For example, family members of the deceased may not make the partner feel welcome at the funeral, making it hard for the partner to bring closure

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to the relationship. Gays whose partners died of AIDS may experience increased personal concern, such as contracting AIDS themselves, and have dif­ficulty dealing with their feelings (Goodkin et al., 1997). For gay partners who were also caregivers, the loss impacts one’s sense of identity in much the same way as the death of a spouse; making sense of the death becomes the primary issue (Cadell & Marshall, 2007). Lesbian widows also report similar feelings (Bent & Magilvy, 2006).

Death is not as pleasant a topic as children’s play or occupational development. It’s not something we can go to college to master. What it represents to many people is the end of their existence, and that is a very scary prospect. But because we all share in this fear at some level, each of us is equipped to pro­vide support and comfort for grieving survivors.

Death is the last life-cycle force we encounter, the ultimate triumph of biological forces that limit the length of life. Yet the same psychological and social forces that are so influential throughout life help us deal with death, either our own or someone else’s. As we come to the end of our life journey,

we understand death through an interaction of psychological forces, such as coping skills and intel­lectual and emotional understanding of death, and the sociocultural forces expressed in a particular society’s traditions and rituals.

Learning about and dealing with death is clearly a developmental process across the life span that fits well in the biopsychosocial framework. Most appar­ent is that biological forces are essential to under­standing death. The very definition of death is based on whether certain biological functions are pres­ent; these same definitions create numerous ethical dilemmas that must be dealt with psychologically and socioculturally. Life-cycle forces also play a key role. We have seen that the same concept—death— has varied meanings beyond the mere cessation of life depending on people’s age.

How a person’s understanding of death develops is also the result of psychological forces. As the ability to think and reflect undergoes fundamental change, the view of death changes from a mostly magical approach to one that can be transcendent and transforming. As we have seen, people who are facing their own imminent death experience certain feelings. Having gained experience through the deaths of friends and relatives, a person’s level of comfort with his or her own death may increase.

Such personal experience may also come about by sharing rituals, defined through sociocultural forces. People observe how others deal with death and how the culture sets the tone and prescribes behavior for survivors. The combined action of forces also deter­mines how they cope with the grief that accom­panies the loss of someone close. Psychologically, confronting grief depends on many things, includ­ing the quality of the support system we have.

Thus, just as the beginning of life represents a complex interaction of biological, psychological, sociocultural, and life-cycle factors, so does death. What people believe about what happens after death is also an interaction of these factors. So, as we bring the study of human development to a close, we end where we began—what we experience in our lives cannot be understood if one uses only a single perspective.

Concept Checks

1. What are the major components of a life-span view of loss through death?

2. What are grief and bereavement, and how do people experience them?

3. What is abnormal grief?

4. How do people cope with different types of loss?

Dying and Bereavement 525

SOCIAL POLICY IMPLICATIONS

As you may have surmised from the text, the topic of euthanasia can be extremely controversial. Although the concept of disconnecting someone from life support, a form of active euthanasia, has gained fairly wide acceptance since the mid- 1970s when it was first made legal, other types of euthanasia have not. For example, discontinuing food and hydration for someone, a form of passive euthanasia, can be highly controversial. Despite the U. S. Supreme Court ruling that such action is legal when brain death can be certified, removing food and hydration tends to be much more emotional than disconnecting life support. Coupled with the complications of certifying that a person is actually brain dead, the argument for passive euthanasia is typically complex. This was clearly the case in 2005 regarding the case of Terri Schiavo in Florida that was highlighted earlier in this chapter.

The important social policy issues facing the country include the extent to which the govern­ment can and should intervene in a private family decision, and the certainty with which physicians can make a declaration of brain death. The lat­ter issue is key, for without it there may never be enough information for families to make an
informed choice, irrespective of the government’s position on whether it will allow that choice to be made. It is likely that these issues will become more important as medical technology continues to advance and the line between life and death blurs even more.

Such certifications have much riding on them. Organ transplants usually depend on the death of the donor, so the correctness and timing of the death declaration is crucial (kidney transplants are a notable exception, as many living donors give one of their kidneys to a person in need). Some people criticize the use of life support in these cases to keep donors “alive.” Some religions advocate for “natural death” but nevertheless permit some forms of intervention.

Clearly, more serious discussion and debate is needed in order for society to come to grips with the interface between life and death. Beliefs about what death represents vary a great deal from culture to culture and person to person. But one thing is cer­tain: the moral and ethical issues surrounding death must be confronted. Only by doing so will each per­son be in a position to make better decisions about what is best for him or her.

Summary

13.1 Definitions and Ethical Issues

How is death defined?

• Death is a difficult concept to define precisely. Different cultures have different meanings for death. Among the meanings in Western culture are images, statistics, events, state of being, analogy, mystery, boundary, thief of meaning, basis for anxiety, and reward or punishment.

What legal and medical criteria are used to determine when death occurs?

• For many centuries, a clinical definition of death was used: the absence of a heartbeat and respiration. Currently, whole-brain death is the most widely used definition. It is based on several highly specific criteria, including brain activity and responses to specific stimuli.

What are the ethical dilemmas surrounding euthanasia?

• Two types of euthanasia are distinguished.

Active euthanasia consists of deliberately ending someone’s life, such as turning off a life-support system. Physician-assisted suicide is a controversial issue and a form of active euthanasia. Passive euthanasia is ending someone’s life by withholding some type of intervention or treatment (e. g., by stopping nutrition).

13.2 Thinking about Death: Personal Aspects

How do feelings about death change over adulthood?

• Young adults report a sense of being cheated by death. Cognitive developmental level is important for understanding how young adults view death.

• Middle-aged adults begin to confront their own mortality and undergo a change in their sense of time lived and time until death.

• Older adults are more accepting of death.

How do people deal with their own death?

• Kubler-Ross’s theory includes five stages: denial, anger, bargaining, depression, and acceptance. Some people do not progress through all these stages, and some people move through them at different rates. People may be in more than one stage at a time and do not necessarily go through them in order.

• A contextual theory of dying emphasizes the tasks a dying person must face. Four dimensions of these tasks have been identified: bodily needs, psychological security, interpersonal attachments, and spiritual energy and hope. A contextual theory would be able to incorporate differences in reasons people die and the places people die.

What is death anxiety, and how do people show it?

• Most people exhibit some degree of anxiety about death, even though it is difficult to define and measure. Individual difference variables include gender, religiosity, age, ethnicity, and occupation. Death anxiety may have some benefits.

• The main ways death anxiety is shown are by avoiding death (e. g., refusing to go to funerals) and deliberately challenging it (e. g., engaging in dangerous sports). Other ways of showing it include changing lifestyles, dreaming and fantasizing, using humor, displacing fears, and becoming a death professional.

• Several ways to deal with anxiety exist: living life to the fullest, personal reflection, and education. Death education has been shown to be extremely effective.

13.3 End-of-Life Issues

How do people deal with end-of-life issues

and create a final scenario?

• Managing the final aspects of life, after-death disposition of the body and memorial services, and distribution of assets are important end-of-life issues. Making choices about what people do and do not want done constitutes making a final scenario.

What is hospice?

• The goal of a hospice is to maintain the quality of life and to manage the pain of terminally ill patients. Hospice clients typically have cancer, AIDS, or a progressive neurological disorder. Family members tend to stay involved in the care of hospice clients.

How do people make their end-of-life

intentions known?

• It is essential that people make their wishes known, through either a durable power of attorney or a living will.

13.4 Survivors: The Grieving Process

How do people experience the grief process?

• Grief is an active process of coping with loss. Four aspects of grieving must be confronted: the reality of the loss, the emotional turmoil, adjusting to the environment, and loosening the ties with the deceased. When death is expected, survivors go through anticipatory grief; unexpected death is usually more difficult for people to handle.

What feelings do grieving people have?

• Dealing with grief, called grief work, usually takes at least 1 to 2 years. Grief is equally intense for both expected and unexpected death, but it may begin before the actual death when the patient has a terminal illness. Normal grief reactions include sorrow, sadness, denial, disbelief, guilt, and anniversary reactions.

• In terms of dealing with normal grief, middle-aged adults have the most difficult time. Poor copers tend to have low self-esteem before losing a loved one.

What is the difference between normal and

prolonged grief?

• The four component model proposes that the context of the loss, continuation of subjective meaning associated with the loss, changing representations of the lost relationship over time, and the role of coping and emotion-regulation processes describe the grief process.

• The dual process model of coping with bereavement focuses on loss-oriented stressors and restoration-oriented stressors.

• Prolonged grief involves symptoms of separation distress and symptoms of traumatic distress. Excessive guilt and self-blame are common manifestations of traumatic grief.

How do adults of different ages deal with

loss?

• Young and middle-aged adults usually have intense feelings about death. Attachment theory provides a useful framework to understand these feelings.

• Midlife is a time when people usually deal with the death of their parents and confront their own mortality.

• The death of one’s child is especially difficult to cope with.

• The death of one’s parent deprives an adult of many important things, and the feelings accompanying it are often complex.

• Older adults are usually less anxious about death and deal with it better than any other age group.

• The death of a grandchild can be very traumatic for older adults, and the feelings of loss may never go away.

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• The death of one’s partner represents a deep personal loss, especially when the couple had a long and close relationship. Older widowers often have a difficult time coping, whereas older widows often have a difficult time financially.

Review Questions

13.1 Definitions and Ethical Issues

• What are the various sociocultural meanings of death?

• What are the three legal criteria for death?

• What are the criteria necessary for brain death?

• What is bioethics, and what kinds of issues does it deal with?

• What are the two types of euthanasia? How do they differ?

• How does the cost of medical care in the last year of life relate to euthanasia?

13.2 Thinking about Death: Personal Aspects

• How do cognitive development and issues at midlife influence feelings about death?

• Describe Kubler-Ross’s theory of dying. How do people progress through the different feelings?

• What is necessary for creating a contextual theory of dying?

• What is death anxiety? What factors influence death anxiety? How does it relate to terror management theory?

• How do people demonstrate death anxiety?

• How do people learn to deal with death anxiety?

13.3 End-of-Life Issues

• What are end-of-life issues?

• How do people create a final scenario?

• What is a hospice? How does hospice care differ from hospital care?

• What are the major ways in which people inform others of their end-of-life decisions?

13.4 Survivors: The Grieving Process

• What is meant by grief, bereavement, and mourning?

• What is the process of grief? What are the risk factors associated with grief?

• What are normal grief reactions and grief work?

• How does grief change over time?

• What is the four component model of grief?

• What is the dual process model of grief?

• What are prolonged grief reactions?

• How do adults of different ages deal with different types of loss?

Integrating Concepts in Development

• What effect do you think being at different levels of cognitive development has on people’s thinking about death?

• What parallels are there between the stages of dying and the experience of grief? Why do you think they may be similar?

• How can we use the study of death, dying, bereavement, and grief to provide insights into the psychological development of people across adulthood?

Key Terms

active euthanasia Involves the deliberate ending of a person’s life through an intervention or action, which may be based on a clear statement of the person’s wishes or a decision made by someone else who has the legal authority to do so.

anniversary reaction Feelings of sadness and loneliness on holidays, birthdays, and the anniversary of a loved one’s death.

bereavement The state or condition caused by loss through death.

bioethics The study of the interaction between human values and technological advances in the health and life sciences.

clinical death Definition of death based on lack of

heartbeat and respiration.

end-of-life issues Management issues of the final

phase of life, after-death disposition of the body and memorial services, and distribution of assets. euthanasia Meaning “good death,” the practice of allowing people who have a terminal illness to die. final scenario One’s choices about end-of-life issues, which can be made known to others. grief The feelings that arise after one suffers a loss. grief work The psychological process of coming to terms with bereavement.

grief work as rumination hypothesis Views extensive

grief processing as a form of rumination that may

actually increase distress.

hospice An approach to assisting dying people

that emphasizes pain management and death with

dignity.

mourning The ways in which we express grief. passive euthanasia Allowing a person to die by withholding an available treatment. persistent vegetative state A state in which a person’s brainstem is the only part of the brain that is functioning, a state from which the person does not recover.

terror management theory A theory that addresses the issue of why people engage in certain behaviors to achieve particular psychological states based on their deeply rooted concerns about mortality. whole-brain death Most widely accepted criteria for death involving eight criteria.

Resources

www. cengage. com/psychology/cavanaugh

Visit the companion website, where you will find tutorial quizzes, glossary, flashcards, and more. You can also access the following websites from the companion website. The Hospice Foundation of America provides leadership in the development of hospices and the hospice philosophy. Its website has a variety of information about hospices and related resources. AARP provides information and advocacy about complex end-of-life issues. Its site contains information and resources on a variety of topics related to powers of attorney, living wills, and related topics.

The Compassionate Friends is a national organization dedicated to helping parents deal with the loss of

a child. In addition to providing information and resources, the home page has a link to help you find a chapter in your area.

Readings

Albom, M. (1997). Tuesdays with Morrie. New York: Doubleday. A moving account of the reconnection between a middle-aged man and his former teacher that includes both an excellent example of a final scenario and intergenerational transmission of wisdom. Easy reading.

Kastenbaum, R. (2009). Death, society, and human experience. Boston: Allyn & Bacon. General overview of key issues related to dying, bereavement, grief, and how they fit into society. Moderate difficulty

Kushner, H. S. (1981). When bad things happen to good people. New York: Schocken. A classic book that is very thought provoking. This book was written by a rabbi after the death of his son. Easy reading, but take it slowly.

Nuland, S. B. (1994). How we die: Reflections on life’s final chapter. New York: Knopf. A very important and informative book that provides an excellent discussion of what happens when people die. Great for dispelling myths about dying. Easy reading.

Young, W. P. (2008). The shack. Newbury Park, CA: Windblown Media. A New York Times best-selling novel about coming to terms with the murder of a man’s young daughter and the process of forgiveness. Easy reading.

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