3 reactions to death

1. anxiety

2. acceptance
3. denial 

usual metaphors to death

"kick the bucket"

"pass away"

iatrogenic

doctor caused

"the death system"
institutions that deal with death 

funeral home

hospital

church

police, etc.

functions of death rituals

1. laying out/cleaning of corpse
(wash/dress, African culture=midwife's job)

2. decomposition of corpse
(embalming, cremation, cannobolism)

3.display of the corpse 

Pre-Christian Era
(Ancient Greeks, Romans, Jews) 

-bury the dead outside the city
-individual graves w/ permanent markers
- funeral procession

Pre-Christian Metaphors

-death as a journey
( to die is to go "home")

-being eaten by the earth in death

Christian Civilization

changed the meaning of the corpse to being holy,
buried the corpse inside the city,
ate meals at the graves of the deceased,
Jesus's death lowered the fears of death
but

had mass graves w/ no permanent markers 

Momento Mori
(medieval death culture) 

"remember you will die"

the dance of death
(medeival death culture) 

included all members of society in the center of town,
imitates skeleton dance of the deceased,
death is the great leveler 

macabre images
(medieval death culture)

dried out skeletons

skulls

bones 

transi tomb
(medieval death culture) 

reserved for the royalty,
but their bodies on display in advanced emaciated stages with worms on the limbs and frogs to indicate that the body is no more than food for worms & frogs,
wore death masks 

the American way of death

individualized tombstones

churchyards = graveyards
(Puritans-> graveyard NOT connected to church) 

Puritan metaphor of death

"king of terrors"
death is reguarded as a human sin

ritual was expensive with leather gloves & funeral rings 

Puritan tombstone

skull over top of "momento mori"

name(s) & dates of the deceased

epitaph (to taunt the living)

no personal commemorations

The Beautiful Death

1. neutralization of the corpse

2. material commemoration
(dead buried outside the city)

3. death symbolized as a part of nature,

or natural change 

Undertaker

developed during the Civil War to find the bodies of the deceased for the families, make a casket for the body, & take the body to the family

Sheol

placement of the dead

lament

cry of ager aimed at God

fatal illness metaphor

help one achieve control over fatal illness

primative metaphor of illness

source of illness is outside the body
(i.e. a demon) 

biblical metaphors

illness is result of punishment for sin

plague metaphor

1. mass epidemic

2. self-punishment
3. bodily disfigurement
4. foreign origin 

attack sickness

sudden onset (i.e. seizures, epilepsy)

pent-up emotions peak + wish to kill

40% of deaths are heart related

Type 'A' Personality

1. insecurity
2. hyperagressive
3. chronic time urgency
4. free-floating hostility
5. self-destruction

-constant struggle to acheive more in less time 

-primary cause of heart attack
-ambitious & when level-off become self-harming
-opinionated & impatient 

HIV-AIDS

transimissible infection with behavioral risk factors leading to chronic fatal illness unless caught early and effectively treated

usually choose cremation
(to cleanse/purge themselves by fire) 

plague metaphor

AIDS dreams

-death is always present before we die

-expressed inate presence of death

Cancer

-like the crab-> moving sideways at night w/ pincers up & ready to attack

-patients-> feel like vitims

-dreams-> cutting down of trees,
walking across a field as a stranger 

Cancer
Tumor-Type 

-2 defenses: denial & projection

-preoccupied with the "thing" inside of them(tumor), say they're fine but just have this thing iside of them 

Cancer
Non-Tumor Type 

flooded w/ pain & weakness
(no preoccupation w/ "thing" inside of them)

-2 defenses: inflation & deflation 

Psychoanalytic Type A
(Sigmund Freud)
Adult Tumor Type 

1. early childhood trauma- loss of trust in parent(s)
2. lifelong need for control
3. concer onset in specific organ that person tried to control (i.e. smoking=lungs, sex=cervical)

4. tumor smbolizes lost object 

5. attitude towards the loss
a. if surrender loss-> treatment=receptive
b. if hang on to loss-> reject/resist treatment 

Type A
Adult Tumor Type
(Carl Jung) 

1. trauma between birth & age 7 -> experienced isolation
2. personal relationship helps overcome early crisis

3.  loss of ^relationship
a. extraversion
b. intraversion- inhibited sense of self
4. onset occurs 6-18mo after a second loss

Understanding the dying process

diagnosis made by doctor must have no intent to decieve and be said clearly so it can be understood, but must be in a hopeful manner. must be said in a neutral zone (i.e. not in examining room

terminal diagnosis

1. information

2. treatment- even if just pain control
3. prognosis- outcome

(doctor must change the nature of hope- patient wanting a meaningful, pain-free death) 

middle knowledge

a combination of 
awareness
denial &
acceptance 

when visiting a patient

Conscious: 
-give the intent to stay & sit closely
-talk, let patient talk, & don't change the subject or manipulate the patient

-use active listening & try to understand
Unconscious:
-assume patient can hear you
(there's evidence that the unconscious have awareness) 

Split-Off Phase

-happens w/in 7 days of death

-acts differently

-unconscious moment when patient is

getting ready to die 

Leave Taking Ritual

indirect way of saying goodbye before death
(often gift-giving) 

Dreams of the dying patient

purpose: to bring out knowledge of death

threshold pattern: same dream repeated 3x before death, involves struggling & trying to resolve/solve problem 

Personal Dreams

1. agression
     a. objective

     b. subjective

2. foreground/background

     a.radience, creativity
     b. nightmarish

     c. void (depression, blocking of background) 

Symbolistic Dreams

1. ascent of self

2. crossing water (a time of major transition)

3. pent-up emotions

4. terror (victimization)

5. baron land

6. crime- guilt

Ancestral-Familial Dreams

family

- father

-grandmother

-ancestors 

Children's Death

1. no stages
2. innate knowledge of death

3. acceleration of consciousness (thinking=sharper)

 4. acceptance

5. vison of light

Kubler-Ross Theory of Death

1. Denial- rejection of diagnosis, refusal to accept reality

2. Anger- serves to affirm sense of uniqueness, have worth "why me?"

3. Bargaining- trying to negotiate a deal w/ Doctor/God
agree to do something in exchange for more time

4. Depression- reactive depression, prepratory grief
5. Acceptance- overcoming negativity, need for sleep

(general consensus for no order of stages)

reconstruction of stages of death

-primary denial (pre-diagnosis)

-adaptive denial (at diagnosis)
-advanced denial (near death) 

4 types of death

-natural

-accidental

-homicidal

-suicidal

Palliative Care

a specialty in medicine where patients receive control of:

1. pain
2. side effects
3. socio-psychological needd

4. spiritual needs

Hospice

a program of caring for the termial patient in the home or a home-like setting with an interdiscipline worker with the goal of facilitating a pain-free death

1/3 referred in last week of life

shown increase in Alztheimer's patients

"bromton's coktail"

Hospice

a program of caring for the termial patient in the home or a home-like setting with an interdiscipline worker with the goal of facilitating a pain-free death

1/3 referred in last week of life

shown increase in Alztheimer's patients

"bromton's coktail"

The Good Death

(goal of hospice)

1.natural
2. dignified (needs respected, patient affirmed)

3. acceptance

4. readiness (voluntary aspect)

5. no regrets

6. legacy (life story shared, provides continuity)

7. closure (for dying NOT grief)
8. peaceful
 

SUDEP

Sudden
Unexpected
Death
in
EPilepsy