17.4: Life Review, Successful Life, and a Good Death
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Learning Objectives
By the end of this section, you will be able to:
- Explain the process and purpose of life review
- Identify factors that contribute to life satisfaction
- Identify factors that predict a good death
Sondra is seventy-five years young. She’s in good health and enjoys traveling, taking long walks, and spending time with neighbors and members of her synagogue. She lost her partner five years ago to heart disease and misses him terribly, but her faith and social supports provide comfort. She’s optimistic about the future and wants to make the most of each day. She often thinks about sayings she has heard: “The unexamined life is not worth living,” and “In the end, we regret only the chances we didn’t take.”
Statements like these contain a common theme—that life is something to be studied, perhaps with the idea of coming to some kind of conclusion or even making changes if we don’t like what we discover. Sondra is engaging in a life review and considering factors that describe a “good” life and what that means. She may also come to explore the notion of a “good death.”
Life Review
A life review is exactly what it sounds like—a thoughtful examination of our own life. You learned about one aspect of this topic in Chapter 16 Social and Emotional Development in Late Adulthood (Age 60 and Beyond), in relation to Erikson’s ego integrity versus despair task. Erikson viewed this end-of-life evaluation as important for overall psychological well-being, even if its outcome exposed regrets. When we discover regrets, we can try to resolve them and take the end of our life in a more fulfilling direction.
For some people, a life review includes engaging in legacy activities , such as creating an artifact that represents their life and for which they want to be remembered. Examples include a photo album, scrapbook, cookbook, or letters written to loved ones. Participating in life review and legacy activities is associated with improvements in emotional distress, death preparedness, and perceived quality of life (Allen, 2009; Allen et al., 2014; Grewe, 2017; Ingersoll-Dayton et al., 2019; Keall et al., 2015; Pinquart & Forstmeier, 2012; Shin et al., 2023). When family members participate too, they report benefits such as an increased sense of meaning (Allen et al., 2014) and improved communication (Allen, 2009).
Similar to life review is reminiscence , the act of recalling and sharing memories and stories, typically pleasant ones. We often do this on an informal or short-term basis and to enhance social connections, happiness, and self-esteem (Keall et al., 2015; Shin et al., 2023), although it can also be a therapeutic activity. Studies of reminiscence therapy find it can bring improvements in perceived quality of life, emotional well-being, and contentment, as well as affirmation of relationships, particularly if couples participate together, and decreased anxiety about death (Ingersoll-Dayton et al., 2019; Pinquart & Forstmeier, 2012; Shin et al., 2023).
Link to Learning
It can be a pleasant experience to do reminiscence or life review activities with others, regardless of age.
- Learn more about different reminiscence therapy activities and games , such as the “Grab Bag” storytelling game and “Calendar Flashback.”
- Read about reminiscence therapy activities specifically for people with dementia.
- Explore suggestions for creating a legacy through legacy activities , such as journaling and letter-writing.
- Legacy activities can also be done collaboratively with others; find more ideas for group legacy activities that can be done with people of any age.
A Successful Life
How do we define a successful life? First, we must distinguish a successful life from life satisfaction and ego integrity. Someone experiencing life satisfaction is content with their current circumstances. Someone who feels they’ve had a successful life looks positively at their past as a whole. That doesn’t mean their life has been without disappointments and setbacks. Rather, given a realistic appraisal of both positive and negative events, the person integrates these into a whole that reflects feelings of competency (Filip et al., 2020; Haber, 2006; van der Kaap-Deeder et al., 2021; Van Hiel & Vansteenkiste, 2009). They may also come to terms with and learn from negative experiences or release regrets (Haber, 2006).
What makes a successful life is highly individual, since any two people are likely to define it differently (Figure 17.19). However, research has identified some common themes and elements associated with feelings of success. Some studies asked people open-ended questions about whether they felt their lives had been successful. Other research used structured inventories such as the Meaning in Life Questionnaire, which asks respondents to rate on a 7-point scale statements like “My life has a clear sense of purpose” and “I am always looking for something that makes my life feel meaningful” (Steger et al., 2006).
Self-determination theory (Deci & Ryan, 2000) provides a framework for identifying some components of a successful life by emphasizing the value of intrinsic goals over extrinsic goals. Intrinsic goals such as autonomy and competence are believed to contribute more to lifelong personal growth (Deci & Ryan, 2000; Van Hiel & Vansteenkiste, 2009) and therefore are more relevant for defining a successful life. According to self-determination theory , these goals are characterized by autonomy or the freedom to make our own choices, competence or our achievement of personal goals, and relatedness or our feeling of being connected to others (Deci & Ryan, 2000; van der Kaap-Deeder et al., 2021; Van Hiel & Vansteenkiste, 2009). Let’s look at these a little more closely.
Autonomy and Competence
The themes of autonomy and competence come up in Erikson’s psychosocial stages and Bandura’s concept of self-efficacy. In self-determination theory, however, autonomy primarily refers to the freedom to make our own choices, not necessarily the ability to perform tasks without assistance. Both autonomy and competence appear to be associated with achieving ego integrity (Filip et al., 2020) and better mental and physical well-being (Chen et al., 2015; Van Hiel & Vansteenkiste, 2009). However, autonomy isn’t equally valued across cultures, which raises the question of whether it’s truly associated with successful psychosocial outcomes. Some research has shown that in collectivistic cultures, being able to choose our own life experiences and make important decisions isn’t strongly linked to having a positive view of our life (Choi et al., 2023; Lambert et al., 2022). However, other research suggests this connection is more complex. Cross-cultural studies indicate that Chinese, European, South American, and North American teenagers and adults all associate autonomy with well-being regardless of whether their larger culture values personal choice (Chen et al., 2015).
Feelings of competence don’t come only from success. After being diagnosed with terminal cancer, computer science professor Randy Pausch delivered a life lessons speech known informally as “The Last Lecture.” In it he described a situation in which his childhood football coach had pushed him hard during one practice, making him drill repeatedly:
And when it was all over, one of the other assistant coaches came over and said, yeah, Coach Graham rode you pretty hard, didn’t he? I said, yeah. He said, that’s a good thing. He said, when you’re screwing up and nobody’s saying anything to you anymore, that means they gave up. ... Your critics are your ones telling you they still love you and care (Pausch, 2007, p. 5)
Rather than interpreting criticism as a sign of failure and becoming discouraged, Pausch realized this feedback provided an opportunity to increase his competence and was able to use that insight throughout his life to achieve his goals and increase his chances of evaluating his life as successful.
Relatedness
Relatedness, the feeling of being connected to others, is also commonly viewed as part of a successful life (Figure 17.20). Our relationships include not only contact with others, but also the emotional connections we build and the extent to which we feel other people understand us. For example, in the excerpt from Pausch’s speech, the coach’s words sent the message that Pausch was respected, valued, and worthy of an honest opinion. This broad definition matters because it accounts for the variety of bonds in adult lives. Isolation, physical or emotional, may prevent people from feeling they have lived successful lives, perhaps because it makes them more likely to dwell on negative life events without being able to get reassurance from others (van der Keep-Deeder et al., 2022).
“Mr. J.” was a fifty-three-year-old terminally ill man being interviewed for Kübler-Ross’s research regarding the themes of grief when he said the following:
You know, it’s a wonderful feeling, but everywhere I have been and all through my life, people have liked me. I am profoundly thankful for that. I am humbly thankful. I have never gone out of my way, I don’t think, to be a do-gooder. But I can find any number of people in this city who could point out times on various jobs that I helped them out. . . . But by the same token everybody I have ever known has helped me. I don’t believe I have an enemy in the world. (Kübler-Ross, 1969, p. 135)
Mr. J looked back with satisfaction not only on what he had done for others, but also on what others had done for him. He clearly felt he had been successful at establishing connections throughout his life.
A Good Death
We’ve described a “good life.” How do we define a good death ? Many factors are relevant, including experience, relationships, community, culture, and history, and religious and medical resources. Before the twentieth century many people died of acute causes such as infectious diseases, and treatments for conditions like cancer weren’t readily available. Death was generally public, meaning community members were often present helping the patient and family, and the process was managed by relatives instead of professionals (Cottrell & Duggleby, 2016). When professional help was needed, religious figures were often more likely to be called than doctors (Walter, 2003).
Cottrell and Duggleby (2016) describe the modern Western notion of a good death as one that is peaceful, dignified, pain-free, and occurring in old age, at home, with enough time to prepare (such as by drawing up a will), but not so much time that the death is prolonged.
Pain and Suffering
The desire to be free of pain and suffering is a common theme in a good death in Korean (Kim, 2019), Buddhist (Dorji & Lapierre, 2022), Swiss (Borrat-Besson et al., 2022), Chinese (Liu & van Schalkwyk, 2018), and South African cultures (Daniels-Howell, 2022) as well as in diverse populations of elders in the United States (Cain & McClesky, 2019). There is no universal agreement about how this freedom should be accomplished, however.
In one study, Black and Latino adults in the United States viewed medical aid in dying ( MAID ) negatively, perhaps because their religious backgrounds emphasize suffering as spiritually necessary or because they were concerned about this aid being overused with minority populations (Cain & McClesky, 2019). Similarly, Buddhists and Muslims regard death as unavoidable and may reject aid in dying because they feel it violates that aspect of their faith (Dorji & Lapierre, 2022; Nadeem et al., 2017). Given the Christian belief that events are “in God’s hands,” aid in dying may be viewed as going against God’s plan (Daniels-Howell, 2022). Kim (2019) cites data indicating that 90% of Korean elders support end-of-life measures and don’t want to prolong life artificially; however, the Korean culture frowns on suicide, which may affect the way aid in dying is perceived. Judaism emphasizes the value and sacredness of human life, which may lead Jewish doctors to recommend more aggressive medical treatments and Jewish patients and families to request them (Braun et al., 2014). “In defining a good death across research on patients, loved ones, and health care providers, 81% feel that being free of pain is a top priority (Meier et al., 2016).
Autonomy
The related question whether a sense of control or autonomy is associated with a good death doesn’t have a consistent answer either. In collectivistic cultures such as Japan’s, the patient’s specific wishes may not be solicited or heeded (Terunuma & Mathis, 2021), but in more individualistic cultures, respecting the patient’s autonomy and individual preferences is seen as a fundamental part of a good death (Lang et al., 2022; Vanderveken et al., 2019, Borrat-Besson et al., 2022; Cain & McClesky, 2019).
In religious traditions that emphasize the inevitability of death, such as Buddhism and Islam, personal choice in the matter may be viewed as irrelevant (Dorji & Lapierre, 2022; Nadeem et al., 2017). In contrast, Israeli doctors indicated in one study that they feel their primary duty is to preserve life, which may cause them to place less emphasis on patient autonomy in end-of-life decisions (Braun et al., 2014). However, many cultures share the desire to be prepared for death—whether simply emotionally or tangibly, such as by making a will (Borrat-Besson et al., 2022; Dorji & Lapierre, 2022; Liu & van Schalkwyk, 2019; Nadeem et al., 2017) (Figure 17.21).
Respect
A good death can also include respectful treatment after death . In their recent study of COVID-19 pandemic deaths, Hernández-Fernández and Meneses-Falcón (2023) noted that health-care and funeral workers expressed concerns about not being able to treat bodies respectfully after death, partly because of practices intended to prevent the spread of disease (such as spraying the body with disinfectant), but also because the sheer number of deaths during the first year of the pandemic overwhelmed them.
Connections
Family relationships and friendships are another common theme across cultures. For example, Swiss, Chinese, and Korean research participants indicated that being with loved ones, especially children and grandchildren, was a high priority during the dying process (Borrat-Besson et al., 2022; Kim, 2019; Liu & van Schalkwyk, 2018). However, this isn’t always possible. During the pandemic, many people died separated from their families, and even if families were present, they were likely wearing masks and other protective equipment, which may have created a sense of distance and increased distress for everyone.
The impact of the person’s death on their family is also relevant. In the Confucian value system common to countries like Korea and China, having a good death includes feeling you have been a good parent and are not a burden to your family (Kim, 2019). For Muslims and others living in India and Uganda, a good death requires ensuring that the surviving family will be financially secure (Krikorian et al., 2020; Nadeem et al., 2017).
The Age of the Deceased
The concept of a “good death” often assumes that death happens in older age. However, that is not always the case. Parents of terminally ill children often experience distress at not being able to alleviate their child’s pain and report not always receiving good communication from medical staff. Health-care workers report avoiding discussions about the child’s impending death in a well-meaning but often unsuccessful attempt to prevent further distress (Daniels-Howell, 2022).
Children have less autonomy and understand death differently than adults, so we can’t assume that adult standards for a good death apply to them. Studies suggest that health-care workers can improve the death experience for sick children and their families by treating the child not as a patient or diagnosis but as a person (including allowing everyday childhood activities such as attending school and playing), communicating clearly with families, and providing as much family time as possible, such as by allowing parents and siblings to participate in the child’s care if feasible (Broden et al., 2020; Daniels-Howell, 2022) (Figure 17.22).
Spirituality and Religion
Religious and spiritual views may also help define a good death, regardless of what that religion is. Many religious and spiritual perspectives regard death as inevitable and controlled by a force outside the individual, and therefore not to be feared (Cottrell & Duggleby, 2016; Krikorian et al., 2020). In Buddhism, for example, death is a natural event to be approached calmly. Performing altruistic acts during life is believed to enhance progression toward enlightenment, so we are constantly preparing for death by being alive (Dorji & Lapierre, 2022). Engaging in specific religion-related practices may also contribute to a good death. In Hinduism, a good death is associated with rituals such as moving from the bed to the floor and fasting. These deeply held traditions are meant to prevent misfortune from happening to the dying person’s family but may be hard to accomplish in hospital settings (Kim, 2019). However, lack of religious or spiritual beliefs does not necessarily indicate a “bad death.” In fact, people at extreme ends of the religiosity continuum (i.e., people who are either very religious or very nonreligious) show similar acceptance of and lack of anxiety about death (Spitzenstätter & Schnell, (2023). People who are agnostic or atheistic tend to regard death simply as the end of existence, with no afterlife to be concerned about, and to regard life as being meaningful and valuable as a result. They may be distressed because they feel the language and rituals surrounding death have unwanted religious overtones, but do not typically adopt religious views in response (MacMurray & Fazzino, 2017).
Concluding Thoughts
Death can be a challenging topic, not only because it’s associated with sadness, but also because it has many complex aspects and intersecting contexts. Dealing with death requires addressing the physical, psychological, social, cultural, and practical needs of the person who’s dying and of their loved ones. Sometimes that calls for difficult conversations. Sometimes we may have to make choices we wouldn’t want for ourselves, but in doing so we are honoring someone else’s wishes. Sometimes we’re called upon to give support to others when we may also need it. Even when we can regard death as the end of pain and suffering, or perhaps the attainment of a spiritual destiny, death is typically distressing.
However, it is an unavoidable part of life. Since we can’t avoid it, we can try to understand some of the factors that affect the way people experience and cope with it. We can understand the options available to those who want to ensure their designated loved ones know what to do before and after their death. We can make ourselves more aware of cultural factors that may influence what people want the end of their lives to look like. We can use this information to help ourselves as well as others. Although it’s hard to be fully prepared for death, we can use this knowledge to approach it with a sense of being informed and prepared for the challenges ahead.
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