Throughout the animal kingdom, most animals display instinctive behavioral
characteristics when faced with the death (or impending death) of another.
For example some birds expel from the nest, one suspected of dying.
Some animals pine while others make characteristic sounds for predictable
periods of time. The human being is more complex in terms of abstract
behavior (integrating thinking, emotion, memory, and reaction- both voluntarily
as well as involuntarily). Thus a number of factors influence our
dealing with death. The conditions and time involving death; our
relationship with those dying; what we remember from our personal experiences;
our perception of what is expected from us; our sense of our own physical
condition; our cultural and religious beliefs; our age; our personality
and evolved mental state; our emotional and cognitive development; and
our socioeconomic status.
Predictably we generally expect to go through three states of reactions
to the death of someone. Grief, mourning, and bereavement.
However while grief is a subjective feeling, and mourning being a process
whereby grief is resolved, we have come to use the terms grief and mourning
interchangeably. Bereavement literally is the state of being deprived
of someone by death and thus reflects a state of mourning. So grief,
being a subjective feeling, is often manifested as a state of shock and
frequently expressed as a numbness and sense of bewilderment. Grief is
often displayed via expression of sighing and crying; feelings of weakness;
decreased appetite; difficulties in concentrating, breathing and perhaps
even talking. Dreaming of the deceased is not uncommon, nor is the
anger of feeling “being abandoned”. Self reproach and the phenomenon
known as “survivor guilt” is common.
Forms of denial often recur throughout the period of bereavement.
We tend to not want to accept the loss. Sometimes the sense of the
deceased person’s presence may be so intense that it constitutes an illusion
Many believe that the state of bereavement occurs in four stages.
Stage I characterized by the acute despair, numbness, immediate denial,
and outbursts of anger. This stage may last moments to days with
periodic relapses. Stage II includes intense yearning and searching
for the deceased, along with some physical restlessness and preoccupation
with the deceased. This period should last several months, normally.
The next Stage (III) is exemplified by disorganization and despair as the
reality of the loss sinks in. Apathy, withdrawals and listlessness
are fairly common during this stage, along with the reliving of memories.
This stage may last months. Stage IV is a time of reorganization,
when the pains of grief begin to recede, and memories include senses of
joy as well as sadness.
Traditionally, grief can last to up to a year, especially as the calendar
runs its gamut of holidays, anniversaries and other special times of remembrance.
The acute symptoms of grief gradually lessen within a few months to the
point where a grieving person can eat, sleep and return to normal, daily
However, a survivor may experience some persistent symptoms of grief
for longer than a year, perhaps even two. Eventually, however,
normal grief resolves.
For some people the course of grief and mourning is abnormal.
One of the indicators is the ineffectiveness in carrying out the normal
daily routines and maintaining the normal interpersonal relationships.
People more at risk at experiencing “abnormal grief” reaction would include
those who suffer a loss suddenly; those who suffer a loss through horrific
circumstances; those who are socially isolated; those who feel an extreme
sense of guilt over the loss; and those who had an extreme dependence on
the deceased. In those cases of extreme grief, professional consultation
is usually quite beneficial.
In the final analysis, the ultimate feeling in dealing with the grief
response should revolve around the fact that one was blessed with the opportunity
to have had a relationship with the deceased and therefor a rich experience
that can live on in memory.
This, then, is looking at death from the clinical or biomedical perspective
of the survivor. There is another perspective of death that is emerging
and that is a philosophical perspective of death as being either a “good
death” or a “bad death”. From this perspective, what constitutes
a “good death” would be whether or not certain behavioral needs were satisfied
by certain "people" involved in the ”death”. The "people" being the
patient, the practitioners, and the survivors. The behaviors being:
1) pain and symptom management (meaning treating these symptoms,
especially pain, up to the end, as opposed to the premise that it
is futile to treat);
2) clear decision making (meaning that the patient management can still
involve some decision-making sharing, especially if the patient can be
relatively free of pain);
3) the patient’s preparation for death (meaning their understanding
of the events leading to and immediately following, death);
4) completion (meaning the patient’s dealing with religious/faith issues
and/or resolving personal conflicts or personal expressions with family
5) contributing to others (meaning the desire to somehow contributing
to the well-being of others if so desired); and finally
6) affirmation of the whole person (meaning treating the patient as
an individual through the life he/she lived as opposed to treating the
patient as someone who has a terminal affliction).
Having this philosophical perspective of death and attempting to ensure
these qualities may create the “good death” atmosphere and perhaps, then,
the survivor can, relatively faster, enter a more healthful, coping period