This book distils the collective wisdom of foremost scholars and practitioners who together have nearly a millennium of experience in the death and dying movement. It bears witness to the evolution of the movement and presents the insights of its pioneers, eyewitnesses, and major contributors past and present. The authors intend the book for all who have been interested or actively engaged in the movement through the years, and especially for those relatively new to the field as students or practitioners who share these convictions and passions and will carry on, extend, and creatively transform the efforts discussed here. They trace the development of thanatology as an interdisciplinary field of study and organizational and practice developments in response to the diverse needs of dying, bereaved, suicidal, and traumatized individuals, families, and communities. Topics covered in the book include: hospice and palliative care, funeral practice, death education, and caring of the dying, suicidal, bereaved, and traumatized. A unique feature of the book is a detailed chronology that includes many, though of course not all, of the most important milestones of the last 60 years. It is intended to serve as an overview as well as the foundation for understanding this burgeoning field and as a guide for readers who wish to understand in detail its short, but rich, history.
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This chapter focuses on the contributions of phenomenology and existentialism to recent developments in the death and dying field: Phenomenology calls for descriptive and interpretive analyses of experiences of facing mortality, dying, and grieving as foundations for all theories about them. Existentialism stresses the importance for caregiving of attuning to the singularities of the lived experiences of unique individuals living near the boundaries of life and death. Existential phenomenologists seek wisdom about how to live with personal mortality, dying, and bereavement. Stoicism, ancient and contemporary, promotes one form of authentic response to personal mortality. Existentialism promotes an alternative authentic response to personal mortality. Existential phenomenologists are interested in what bereavement and grieving mean in the living of them. Deaths of our loved ones happen, and we find ourselves in bereavement, a state of having lost, or deprivation.
This chapter summarizes the major strains of psychology that were important in setting the foundation for death studies by psychologists, and highlights some of the most important contributions made by psychology to the field. Psychology, often regarded as an offshoot of philosophy and biology, traces its origin to Wilhelm Wundt who was what we today would call an experimental psychologist. A parallel track to that of experimental psychology is the development of the psychodynamic approach led by Sigmund Freud. A third school of 20th-century psychology is humanistic/existential psychology. It also focuses on the ability of the human being to mature and develop his or her own positive mental health. William Worden is the first clinical psychologist to differentiate between counseling and therapy early in the development of the field of thanatology. Psychology is made up of developmental, experimental, social, clinical, counseling, cognitive, and many other areas that defy simple classifications.
This chapter sketches from the United Kingdom of the most significant sociological perspectives for understanding death, dying, and bereavement within the English-speaking world and Europe. It also sketches some themes in research since the 1980s that illustrate sociological perspectives on how modern societies engage with dying people, and with the dead. The end of a person’s social life and social identity may precede the end of his or her physical life: sociologists term this “social death”. The concept of social death illuminates what happens after, as well as before, physical death. Death is increasingly visible in the mass media, from movies, to soaps, to the news. Just as palliative care has made dying a less terrifying event for Westerners dying of cancer but has made rather little impact outside the English-speaking world or with other diseases, so sociological knowledge of death and dying has focused on first-world cancer dying.
Over the years, health care professionals from many disciplines have contributed to the knowledge base supporting palliative and end-of-life care. This chapter presents a brief description of the nurses who led the development of nursing as a profession as a context for other nursing leaders who contributed to the science and practice of palliative and end-of-life care. It describes nurse leaders whose sustained work influenced end-of-life care in seven major areas: uncovering and combating the conspiracy of silence, making meaning for children and adults as they live with the chronicity of a life-threatening illness, promoting team-based collaborative approaches to care, managing pain and symptoms of children and adults, integrating bereavement as part of patient-centered and family-focused dying care, conducting research, and educating nurses to improve care of people at the end of life.
The dying process and the time following death can and should be an intimate, personal process. This chapter discusses many of the legal issues associated with dying and death, and focuses on legal aspects of end-of-life decision making, significant court cases, highly influential and relevant state and federal laws, and associated research. Each of the cases or laws reviewed has had a significant impact on the public’s perception and understanding of end-of-life decision making, on legal developments that have implications for the options available to people who are dying and their loved ones, and/or have been the focus of significant and biased debate. As technology continues to advance and people live longer, the chapter suggests that some areas that may lead to legal involvement could revolve around “rationing” of health care dollars, decision making when people have dementia and other progressive conditions that will affect decision-making abilities.
This chapter explores the development of thinking about the ethics of care of the dying and the bereaved within the broader contexts of the history of thinking about the responsibilities of physicians and the emergence of medical/health care ethics in the last several decades. It discusses the history and substance of four fundamental principles recognized as central to a principle-based approach to health care ethics, introduces the idea of respect for persons as the basis for understanding end-of-life ethics as encompassing not only life and death decision making but all aspects of caregiving, and contrasts the principle-based approach with a narrative-based approach to an ethics of care at the end-of-life. Codes of ethics from the 1970s onward have added respect for the patients’ autonomy to the duties of nonmaleficence and beneficence. Nurses, social workers, and others have defined their roles, in part, as advocates for patients.
This chapter reviews the process of mourning and how thinking about people’s adaptation to loss has developed over the past 100 years. Any survey of this type would obviously begin with Sigmund Freud, the father of psychiatry. Many of Freud’s patients also showed grief symptoms that resembled symptoms of depression. Freud saw grief as necessary after losing a loved one to death. In the 1960s, John Bowlby began publishing groundbreaking work on attachment theory. Attachment theory has provided a key foundation for much of our thinking on bereavement, grief, and mourning, and continues today. Therese Rando is a Rhode Island psychologist whose clinical practice and research have long focused on bereavement. The chapter also looks at the various theories of grief that have been proffered over the past 100 years is a bit like the fable of the blind men and the elephant.
- Go to chapter: The Psychologization of Grief and Its Depictions Within Mainstream North American Media
This chapter suggests that the pathologization/psychologization of grief within the psy-disciplines has had an impact on the way in which mourning is understood and managed in day-to-day life. The psychologization and pathologization of grief is situated within several other cultural and historical movements that have been part of the shifting understanding of mourning as a medical entity. These contexts include the rise of modernism and the focus on the psychological self as a site of meaning and the subsequent fear of death and grief. The looping of grief begins with the psy-disciplines’ construction of it as an individualized, psychologized, and private event. This construction then gets relayed to the public through various representations in mainstream media, including film, television, and newspapers. In contemporary North American culture, television and film are mediators in which people get introduced, immersed, and identify with narratives and themes of their culture.
This chapter discusses how the individual’s lifestage development affects the response to death loss, and notes the circumstances under which grief may best provoke growth. Developmental biology as well as psychological and social contexts impact death understandings. The experience of loss and death at different times in childhood means understandings vary as a result of the physical and cognitive developments that have occurred. Age and development also affect the way one is perceived to grieve. The death of a young child often provokes parents to feel guilty for failing to protect her. Maturational losses occur in conjunction with rapid growth during this time. Maturational losses are also common for elementary school-aged children. The maturational losses of changing teen identities may be part of what makes adolescence so vulnerable a time to experience another’s death.