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by: A. Lorenzo Lucino Jr, M.D-Ph.Dc






      One area of adult development that is different from other stages of development that retains a sense of finality and irreversibility is the stage of death and dying. Death is a rather universal human quality in that it has physiological causes and consequences, as well as a psychological aspect to it , which is shared and felt in all cultures of human civilization. That said, death is not just a physiological processes of human anatomical failure, but also a psychological reality that results in the loss of self, the eventual cessation of thoughts, the procurement of memory, acquisition of new memory, emotional experiences, basically all things that makes life worth living. It is the state that is devoid of life, devoid of emotional feelings, and aspects that are studied in the field of psychology. There are multiple phases of death and dying, and these are necessary for the individual who is dying to accept death. As well as those that are closely related to the one dying, to give a sense of permanence and acceptance to the notion of death.


   In the anatomical and physiological sense, death is the state when the body ceases all afferent and efferent senses, there is cessation of the neural activity, which results in the eventual multi-systemic collapse of the organ systems of the human body (De Graff, 2002).


   When one thinks about the anatomic death, one cannot help but wonder to ask, “what does an individual who is dying going through?”. How does one embrace, let alone accept the fact that one is dying and will ultimately lead to the termination of life, as one knows it? This is answered by Bjorklund and Bee in what they describe as the four meanings of death. The four meanings are death as an organizer of time, death as a punishment, death as transition and death as a loss (Bjorklund and Bee, 2008). These four meanings of death are seen in most adults and play a role in an individual’s concept of death in relation to the self, which leads to one developing a sense of anxiety of death, which is the emotional fear of death (Bjorklund and Bee, 2008). Bjorklund and Bee teach us that this anxiety towards death is due to the “fear of the loss of experience, sensation, relationships; fear of the pain or suffering or indignity often involved in the process of death, fear that one will not be able to cope well with such pain or suffering, fear of whatever punishment may come after death and a fundamental fear of the loss of self,” (Bjorklund and Bee, 2008, p. 325).


   How adults cope with death is essential, in fact, it is necessary. It is evident that coping with death is necessary and that this psychological buffer against the morbidity of bereavement. Coping with death is not only important for adults who are dying, but also those who personally know someone who is dying or dead, this also applies for children who are bereaved of a parent (Black, 1998). Psychiatrist and child developmental specialist, Dr. Dora Black, emphasizes that coping with death, especially the death of a parent is necessary as it can reduce morbidity after bereavement and any lack in family support can lead to a child’s vulnerability to psychiatric disorders later in life (Black, 1998). Dr. Black indicates that children who experience a loss of a parent or primary caretaker are more opt to develop psychiatric disorders later in childhood, specifically a five-fold increase as compared to the general population. Studies indicate that adults who were bereaved of a parent during their childhood were more likely to develop depression, anxiety, and attempt suicide as compared to the general population (Black, 1998).


   As seen in cases of pediatric-adult cases of bereavement, there are psychiatric consequences with the loss of a family member. This illustrates to us that it is indeed important to go through proper phases of death, which is provided in the Kubler-Ross Model. There are five phases of death reactions, which are denial, anger, bargaining, depression and acceptance of death (Bjorklund and Bee, 2008).


   The reaction towards an impending doom is natural, and sometimes one’s religious faith can help cope in that regard. In a study by Splitka, Minton and Sizemore, it was noted that there are two types of religious expression involved in coping with death, intrinsic committed religious expression and extrinsic-consensual religious expression. In their hypothesis, which was substantially supported, the intrinsic committed faith was positively associated with viewing death in terms of an afterlife of reward and courage. And negatively with a variety of undesirable death views. Extrinsic-consensual faith viewed death in terms of loneliness-pain, indifference, unknown, forsaking dependents and natural end (Spilka et al, 1977). Interestingly Bjorklund and Bee also discuss religiosity and death and talk about similar results, specifically, they say that there are two forms of religiosity, extrinsic and intrinsic religiosity.


   Data results indicate that extrinsic religiosity was helpful and effective during early years of life as well as middle-adulthood to create bonds with other like-minded extrinsic religious people; whereas intrinsic religiosity became effective in coping with death for those who were elderly (Bjorklund and Bee, 2008). Whatever the nominal religious faith, either one being Roman Catholic, Protestant, Muslim, Buddhist, Hindu etc, it is evident that religion, does in fact play a role in one’s acceptance of death and affects the level of fear of death.


   In a personal point of reflection, dealing with death has always been a sensitive issue. Death has tremendously affected my life three times already. The first, the death of my paternal grandmother in 1995. This shocked me because of my father’s reaction to her death. My father, who throughout my memories of childhood and young adult life was always a stern, reserved, reticent man who showed very little emotions. Watching him break down in tears  the summer of 1995 when I was 12 years old surprised me. I had never seen this emotion he strongly displayed. The second instance of death occurred 3 years later in 1998 when news came on the passing of my maternal grandmother. The third and most traumatizing for me was the unexpected demise of my best friend, Robert M, who hanged himself. This was a very low point in my life. I lived as a different person to mourn for my friend over 6 months. I still have days where a great sadness consumes me.

   
   Reading the 5 stages of death and dying by Kubler-Ross, I couldn’t help but analyze the fact that I showed symptoms as described. Bjorklund and Bee indicate that farewells were necessary for the acceptance of a death; this was the case for me. Robert passed away on November 19, 2007, literally the day that classes were closed for Thanksgiving Break. The campus held a memorial service in his honor on the 29th of November. In attendance were his mother, father, friends, and professors that knew him. The event allowed me to truly bid farewell to Robert and accept his death and start the ending phase of the grieving process. So in hindsight view, it’s interesting that one is able to analyze this now and understand the psychology involved (Bjorklund and Bee, 2008).    When the one dying finally passes, the farewell and the funeral procession is rather important for the family of the deceased. These so called rituals are necessary for the grieving process and helps the bereaved come to terms with the death of the loved one. It is important to note that death and dying is composed of dichotomy of the one dying and the family and friends of the one dying. The dying individual and the bereaved family members all have to deal with the aspect of acceptance. The dying individual proceeds with farewells, and emotional feelings with loved ones, so as to allow the dying to disengage and thus reach a “point of acceptance” (Bjorklund and Bee, 2008, p. 329).


   Rituals are almost similar in the fact that it helps with the acceptance of death, which in this case, is solely for those who are still living. Bjorklund and Bee discuss about the Bowlby Theory of grieving, which includes the stages of numbness, yearning, disorganization, despair and reorganization (Bjorklund and Bee, 2008). The kinds of rituals groups of people have for the dead varies across cultural lines, ranging from Jewish in shiva rituals, to Catholic prayers for the dead, to Protestant prayerful rituals, to Islamic reserved mourning etc. All of these, despite differences in techniques, play a role in the metamorphosis of mourning into acceptance and eventual progression of life that we have. Bjorklund and Bee best ends it with the saying in page 342, in regards to death and dying, “Let us go forth and celebrate life!” (Bjorklund and Bee, 2008, p. 342).


   In regards to the topic of death and dying, this issue is of great importance for the proper counseling of patients that are experiencing the trauma of bereavement. To be effective in this field of interest, namely in psychology and in cases, psychiatry, one has to understand the environmental factors that plays a role in the manifestation of the psychological, psychiatric symptoms of the patient. Death, as a natural process, is not just the physical state of death, but in the study of psychology. It allows one to understand that there are mixed emotional feelings involved; to the one dying and those around. The feasibility one has in understanding these said processes, the better one can address the patient dying. Although at times difficult to separate the self emotionally, we try to our best to handle each situation with care. Our facial expressions, empathy and condolences are all we can give once the anatomical architecture has failed. It is this gesture that becomes meaningful to those who have lost a loved one.




 
Reference:


Bjorkland, B., R. & Bee., H., L. (2008). The Journey of Adulthood (6th ed).
     Upper Saddle    River, NJ: Pearson Hall.

Black, Dora. (1998). Bereavement in childhood. British Medical Journal (Vol. 316).
     Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1112822/

Spilka, Bernard., Stout, Larry., Minton, Barbara., Sizemore, Douglas. Death and Personal
     And Personal Faith: A Psychometric Investigation. Journal for the Scientific Studyof Religion (Vol. 16).
     Retrieved from: http://www.jstor.org/pss/1385748

Van De Graaff (2002). Human Anatomy 6th ed. McGraw-Hill Higher Education.


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