13: Coping with Death and Loss
- Page ID
- 259273
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)- Learning Objectives:
- Become familiar with cultural and psychological conceptualization of death and loss.
- Understand the role of Existential Therapy in addressing anxieties about death and meaning of life.
- Explore Kübler-Ross’ Five Stages of Grief and application to coping with terminal illness and loss.
- Learn the risks for suicide and how to recognize them in oneself and others
- Become familiar with the debate on physician-assisted suicide and the associated moral, religious, and legal concerns.
Keywords: Existential therapy, death anxiety, Five stages of grief, terminal illness, suicide, euthanasia, Death with Dignity law
In this module we broach a difficult topic for many. As we all will face the end of life (at least as we know it on earth), death is not a subject any of us can skirt or ignore. We all must discover a way to cope with the prospect. It is not only our own death that concerns us but the death of loved ones. Death brings with it a cruel and utter finality following a lifetime both long and fleeting, depending on perspective. Historically, people have attempted to make sense of death and loss through artwork, writing, and in fictional depictions (such as the iconic Grim Reaper figure). Many turn to religion and beliefs about an afterlife to assuage fears of the unknown. In Mexico, the Day of the Dead is celebrated every year (beginning October 31st) to honor those who have passed from this life. Rather than shying away from death, families celebrate their ancestors, build alters, and visit cemeteries to adorn graves with flowers. In the poem below, poet and philosopher Kahlil Gibran whose masterful work, The Prophet (1923), still enchants readers, composed one of the most enrapturing poems on death:
You would know the secret of death.
But how shall you find it unless you seek it in the heart of life?
The owl whose night-bound eyes are blind unto the day cannot unveil the mystery of light.
If you would indeed behold the spirit of death, open your heart wide unto the body of life.
For life and death are one, even as the river and the sea are one.
In the depth of your hopes and desires lies your silent knowledge of the beyond;
And like seeds dreaming beneath the snow your heart dreams of spring.
Trust the dreams, for in them is hidden the gate to eternity.
Your fear of death is but the trembling of the shepherd when he stands before the king whose hand is to be laid upon him in honour.
Is the shepherd not joyful beneath his trembling, that he shall wear the mark of the king?
Yet is he not more mindful of his trembling?
For what is it to die but to stand naked in the wind and to melt into the sun?
And what is it to cease breathing, but to free the breath from its restless tides, that it may rise and expand and seek God unencumbered?
Only when you drink from the river of silence shall you indeed sing.
And when you have reached the mountain top, then you shall begin to climb.
And when the earth shall claim your limbs, then shall you truly dance.
Reading 1: Existential Therapy
(“Existential Therapy” by www.goodtherapy.org)
What are your expectations of death? Have you ever imagined final thoughts, feelings, or visions? As in the poem above, do you trust that there is an eternity or afterlife to follow? You may be aware of numerous stories of individuals who were pronounced clinically dead (i.e. heart has stopped) yet miraculously brought back to life. They describe similar experiences of having passed over into the afterlife through a bright tunnel, horizon, or other portal. Some say their spirit lifts from the physical body and they can observe what is happening around them as if hovering above. Others describe a brief visit to Heaven seeing loved ones only to be told their time is not up and they must return to earth. Some of these experiences have been documented in movies and books like, Miracles from Heaven.
The fears surrounding death can be considered part of an existential crisis. In such a crisis, individuals question whether their life has true meaning or value. He may contemplate the end and whether he has accomplished what he was put on earth to do. In the reading above, explore the philosophical, spiritual, and psychological influences on existential therapy, a style employed by Otto Rank, a psychoanalyst and close associate of Sigmund Freud. How might a therapist help someone cope with anxieties about death and the unknown? What specific mental illnesses is existential therapy particularly useful in addressing.
Reading 2: The Five Stages of Grief
(“The Five Stages of Grief: An Examination of the Kübler-Ross Model” by Christina Gregory, PhD for www.psycom.net)
In times when death must be faced head-on, as in the case of terminal illness, how does one come to grips with the demystification of when and how we will expire? No longer a mystery, but a given, are there ways in which individuals typically face such dire news? Is there a right or wrong way to grieve one’s own limited time left on earth? Learn about the 5 stages of grief devised by Swiss-American psychiatrist, Elisabeth Kübler-Ross, in 1969. Which of the stages do you think would be most difficult to confront? What does the model suggest about how people navigate end-of-life matters?
Reading 3: Risk of Suicide
(“Risk of Suicide” by the National Alliance on Mental Illness, www.nami.org)
I took a deep breath and listened to the old bray of my heart. I am. I am. I am. - Sylvia Plath
In 2014, illustrious and wildly successful comedian and actor, Robin Williams, took his own life. This sent shockwaves throughout the world as people viewed him as extremely accomplished and seemingly happy. Would you know the warning signs of someone who is suicidal? As you may have guessed, the signs are often subtle and can be missed if unaware. This is not to say that when a suicide occurs, anyone connected to the victim should harbor guilt. Suicide is ultimately an act of free will that a deeply troubled individual will choose as an immediate solution to a problem; however, if fortunate enough, loved ones can identify signs early enough to intervene. In this reading, review common warning signs of suicide. Consider if you’ve ever observed these signs in yourself or someone you know. What steps should you take if you notice any of the warning signs?
“Dying is not a crime.”
-Dr. Jack Kevorkian
This is a picture of Brittany Maynard , who at the age of 29 years old was dying of Stage IV brain cancer and fought for the right to end her own life on her terms. Her disease was considered medically incurable with a likely painful ending. She chose to relocate to Oregon -- one of a few states that legalized assisted suicide. With the assistance of her doctor, she ended her life on November 1, 2014.
Reading 4: Whose Right to Die?
(“Whose right to die?” by Ezekial J. Emanuel, 3/1997 for www.theatlantic.com”)
Currently, there are only five states and the District of Columbia that have legalized euthanasia or instituted Death with Dignity laws including: California, Colorado, Oregon, Vermont, and Washington. Whether or not other states with follow suit is a heavily debated issue. There are medical, religious, moral, and humanistic considerations which some say contradict such an approach to terminal illness. Further, what are the limits to its legal application? Could someone with severe clinical depression and intractable suicidal ideation be eligible for euthanasia as an alternative to suicide? In the thought piece above, the author offers a critical perspective on reasons why physician-assisted suicide may not be the right answer in many cases. As you consider his suggestions, think about your own beliefs. Can you think of arguments both for and against this controversial technique to assert some control over terminal illness?
Reflections
- In your family of origin, how is the concept of death addressed or discussed? Consider rituals, phrases, or beliefs that have been passed down.
- Is there any visual media, music, poetry, or other artistic creation which particularly resonates with your ideas on death and loss? What do you think the artist is reflecting and conveying about their own fears and hopes?
- In Kahlil Gibran’s poem on death, what do you think was meant by the phrase, “If you would indeed behold the spirit of death, open your heart wide unto the body of life”?
- How might the unique demands and concerns of our modern world contribute to an existential crisis?
- Knowing Kubler-Ross’ five stages of grief, and its often variable and cyclical progression, how might you support someone who has recently experienced loss?
- Using the ideas endorsed in Existential Therapy, what are some ways you might minimize some of your own anxieties surrounding death and loss?
- What are seven of the most common warning signs of suicide?
- Do you think the explosion of social media has complicated or enhanced the ability to help those who are suicidal? Explain.
- How might you intervene in the case of a person who is suicidal and has a plan and the means to complete the act?
- If doctors told you there were only 6 more months to live, what would you do with the time remaining? Would you consider physician-assisted suicide if that time was projected to be extremely painful?