Dealing With Death

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 or hallucination.

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 functioning.

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 and/or friends);

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).