Death and Bereavement 1

Running head: DEATH AND BEREAVEMENT

Death and Bereavement

Lisa L. Woodward

Death and Bereavement

“A dying man needs to die as a sleepy man needs to sleep, and there comes a time when

it is wrong, as well as useless to resist” (Stewart Alsop, 1973).

Modern hospice care stems from a concept created by a young social worker named

Cicely Saunders in England in 1948. The organization has morphed numerous times and crossed

an ocean but still adheres to the same principle, “you matter to the last moment of your life. . .”

(Bjorkland, 2008, p. 346). Saunders was introduced to a young Polish man dying of cancer,

alone in a foreign hospital with no friends or relatives; he was experiencing anxiety and fear.

Saunders made her way to his room each day, she would sit and let her new friend speak of his

family, he’d share stories and experiences, and in doing so Saunders found his anxiety was

relieved.

After the young man’s death Saunders became a physician and specialized in the

treatment of dying patients. Today hospice organizations around the world exist to ensure

members of all societies can be ministered to, receive palliative care, and offer hope that no one

will die alone. Compiling research on the process of death and dying, developing the ability to

identify stages of death, and knowledge of these stages helps to educate those who provide

medical and respite care. Grief education also benefits family members preparing for the loss of

a loved one or those already in the process of grieving (NHO, 1996).

Elisabeth Kubler-Ross (1969), wrote a book called On Death and Dying, the stages of

death explained by Kubler-Ross are taught in every hospice training program in the United

States. The following excerpt offers a brief explanation of each stage of death as presented by

Bjorkland (2008, p. 328).

Denial. A constructive first defense upon learning of a terminal diagnosis.

Anger. Persistent questioning either in self talk or to family, nurses, and doctors “why

me?” Outbursts and lashing out is a common occurrence in the anger stage.

Bargaining. Patients will sometimes try to make a deal with doctors or with God, “if I

don’t tell anyone then it’s not going to happen.” Trying to make more time to see

children grow up or attend important events.

Depression. As the body declines in physical health and the disease takes over, a type of

mourning begins for the loss of one’s own life and for the loss of relationships.

Acceptance. An understanding and readiness for death accompanied by a quiet,

withdrawn reality of impending death.

Kubler-Ross was clear, these stages except for acceptance do not occur in sequential

order and some may be omitted altogether. Bjorkland (2008, p. 328) included a quote from

Stewart Alsop, which explains beautifully the acceptance stage of death, “A dying man needs to

die as a sleepy man needs to sleep, and there comes a time when it is wrong, as well as useless to

resist.”

As the patient experiences the stages of death, family and loved ones go through many of

the same stages. Often just as the dying patient reaches the psychological acceptance stage of a

terminal illness, the physical act of dying nears the end. Palliative care is provided to make the

patient comfortable and manage pain. For family, medical professionals, hospice staff and

volunteers the process is often agonizing. An article published in the New York Times penned

by Robin Marantz Henig, (2005). Will We Ever Arrive At The Good Death? As the ability to

communicate with the dying patient is lost there in an onset of new trials for those closest to

them. Henig (2005) reports:

The death rattle is what’s so unnerving. People who sit beside someone who is close to

death, someone in a stage the experts call “active dying”: might hear a sound that’s not quite a

snore, not quite a gurgle, not quite a rasp. It doesn’t hurt; it probably isn’t something the dying

person is even aware of. But it sounds terrible. Once the so-called death rattle starts, that’s

usually an indication that the person is not coming back. The sound, made with each intake of

breath, is merely air moving across phlegm “Healthy people can cough it up or spit it out or

swallow it, but a dying person is just not strong enough, so the secretions collect in the upper

airways. As they breathe in and out, it makes that sound - - that sound that we have learned to

fear. To those watching, the person seems to be gasping for breath, asking to be saved.

Sitting, waiting and helplessly watching while a loved one goes through the process of

dying is as overwhelming as it is as painful. When death does occur and the process of grief and

bereavement begin there is no timetable to feeling “normal” again. The Hospice Consortium

created a list for the determinants of grief. A major factor to be considered is “Who the person

was “or rather, who was the person to you? The loss of a distant cousin will be handled

differently from the loss of child. A spouse may be grieved differently than the loss of a parent.

Intensity of attachment is determined by the intensity of love. Security of the attachment

and how much the survivor needed the person for self esteem or “okayness” will be relevant to

the amount of grief experienced. Mode of death is another prominent factor in the grieving

process. Survivors of suicidal deaths have the most difficult time handling their grief, obviously

the accidental death of a child may be more difficult than that the natural death of an elderly

person.

In addition there are four tasks of mourning taught by the Hospice Consortium:

Task 1: TO ACCEPT THE REALITY OF THE LOSS

Task 2: TO EXPERINCE THE PAIN OF GRIEF

Task 3: TO ADJUST TO AN ENVIRONMENT IN WHICH THE DECEASED IS

MISSING

Task 4: TO WITHDRAW EMOTIONAL ENERGY AND REINVEST IT IN

ANOTHER RELATIONSHIP

In particular Task #2 deals with the ways individuals and society try to avoid the painful

feelings of loss, the point hospice tries to stress is that there simply is no adaptive way of

avoiding it by moving away, keeping busy, or strengthening resolve. Recalling and relating

memories of the deceased can be unpleasant and painful. Joining groups and arming oneself

with knowledge in regard to feelings of anger, guilt, loneliness, anxiety and depression and

understanding these are normal feelings and the majority not the minority go through the same

process in their personal experiences with loss.

One important idea to grasp is the distinction between grief and mourning. “Grief is the

internal meaning given to the experience of bereavement.” Mourning entails expressing sorrow

outside of oneself or “grief gone public.” Unfortunately, many people in our society grieve but

do not mourn. Often advice is offered in a cliché’ “carry on” or “keep your chin up.” When

survivors aren’t allowed to mourn, internalized and trapped feelings can cause isolation. Hospice

suggests, “don’t just grieve, mourn too, and be proud of your capacity to do so.” Mourning can

be the catalyst for the healing process (Wolfelt, 2000).

Though countless books have been published on death and grief there is no laundry list to

be checked off or magic wand to wave over a person in the process of death or those near to

them. Education and knowledge are key components and though it may be of little comfort these

stages and feelings are age old and kindred to everyone who was, is, and is yet

References

Bjorkland, B. and Bee, B. (2008). The Journey of Adulthood 6th Edition. Upper Saddle River,

New Jersey: Pearson Education, Inc.

Henig, R. August 7, 2005. Will We Ever Arrive At The Good Death? Retrieved from

NYTimes.com on September 15, 2006.

National Hospice Organization. (1996). Hospice: A Better Way to care for the Dying.

Arlington, VA: National hospice Organization (NHO).

Wolfelt, A. (2000). 5 Dispelling Common Myths About Grief. Retrieved from Centerforloss.com

on February 12, 2010.