Watch the video of Zach Sobeich who is diagnosed with a terminal illness.? 1. What attitudes does he show towards the prospect of dying?? 2. Does he demonstrate death anxiety?? 3. What att

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