DEATH : A SOCIAL PSYCHOLOGICAL PHENOMENON

By K Hogben

Death always has been and always will be an integral part of human existence, as natural and predictable as being born. But whereas birth is a time of celebration, death has become a dreaded and unspeakable issue that is evaded, ignored, and denied by our youth-worshipping, progress-orientated society. Perhaps it is because that in spite of all our technological advances, we are able only to delay death, but no less than other, non-rational animals, cannot escape it. Rich or poor, famous or unknown, good or evil, death strikes indiscriminately and it is perhaps this inevitable and temporally unpredictable quality that makes death so frightening to so many. This fear manifests itself in a plethora of emotions, thoughts, actions and reactions from both the terminally ill individual and his or her family, as well as in the ideas and attitudes of modern society towards death.

In general, the death of an elderly individual is considered less tragic than the death of a person of any other age group. This is the case whether the person responding is male or female, is young, middle-aged, or elderly, is black, Mexican-American, Japanese-American, or Anglo-American (Kalish and Reynolds, 1976).

Kalish (1969) proposes a number of reasons as to why this attitude appears to be so prominent in America. First, elderly individuals are likely to have diminished social

responsibilities and fewer social roles which limits the dependence of others on them; therefore, their absence will have less impact on those they leave behind and will not be so likely to require role substitutes.

Secondly, because elderly people today tend to constitute most of the deaths, many of us seem to look on death as the normal concomitant of age and are not especially shocked by it. In addition, we tend to assume that elderly people are going die soon, relatively speaking, so we tend to be better prepared when it does happen.

Third, the younger generation's style of living often removes them from contact with the elderly both physically and psychologically. This can contribute to the attitude that elderly people have already led the life they were entitled to.

By reflecting on the reasons why the deaths of the elderly are perceived as less tragic, we can understand why the deaths of other age groups are more difficult to accept. Middle-aged people have substantial responsibilities and may have many people depending on them. Often the first question asked about a middle-aged person who has just died relates to what is being done about the spouse and dependant children. In the event of an unexpected death, both the practical and psychological effects are on the family are much greater. The individual is much less likely to have

made plans for survivors, so that financial and legal matters are often in a state of confusion. More important psychologically, the survivors have had no time to deal with the death, no time to process and incorporate what is happening, no time for reminiscing, and no opportunity to work out unfinished business (Feifel, 1977).

Considered the most tragic of deaths in our society is that of the young adult (Kalish and Reynolds, 1976). They have not been able to make use the lengthy schooling they undertook, their deaths are often sudden and unexpected, and they are seen as having been deprived of their birthright. Pine (1972) describes the way that close family members often recreate among themselves the events that lead up to the death in an attempt to provide the dying with a social context, and probably also in an effort to 'make sense' of the death. A sudden, unexpected death, standing by itself, is so jarring that people need to put it into historical and social perspective.

In the case of the terminally ill individual, the dying process produces an immense range of emotional reactions, from guilt and anger to fear and anxiety, in both the individual and the close family members. The loss of a family member may be the single most upsetting and feared event in the life of an individual. College students listed this as their greatest fear among fifty possible causes of

fear, with their own deaths listed near the middle of their rankings (Geer, 1965). Death of a spouse was found to be the most significant life-change in terms of the amount of stress produced (Rahe, McKean, and Arthur, 1967).

The terminally ill individual and family members often feel that there is something they should be able to do. Up until recently the answer was in terms of more technology. Now, there is an increasing recognition of the importance of human relationships, and very likely the most significant are relationships with close family members (Feifel, 1977).

Augustine and Kalish (1975) carry the matter a step further by hypothesising that two of the three most important conditions that must be available for an appropriate death (for a person to die as much as possible the way he or she wants to) are open communication and warm personal relationships. They further point out that it is virtually impossible to have a warm personal relationship with a dying individual without being able to relate to that individual in terms of his or her dying.

Psychological disruption (Weisman, 1972) arises when the dying process severs emotional attachments between the terminally ill individual and close family members. The most commonly observed response is the cycle of anger and guilt. Family members feel anger toward the dying person for abandoning them, for the demands that his or her dying makes

upon their emotional resources, time, money, energies, and for other circumstances. Usually the anger is repressed, since the are conscious that the dying person did not choose his or her situation and that the losses suffered by the dying individual are in many ways much greater than their own losses. They may feel guilty because of their anger, and this guilt intensifies their anger which, in turn, intensifies their guilt forming a vicious circle.

Regardless of psychological disruption, the anticipated losses that face the family of the dying individual cause many to go through anticipatory bereavement. Anticipatory bereavement is a kind of psychological rehearsal for death that occurs when the family members realize that their emotional investment in the individuals presence, and the satisfactions and warmth that they have received through their attachment to him or her are soon to be ended. In this fashion, they work through a part of the distress of loss and are better able to handle the death when it actually occurs (Feifel, 1977).

The intensity of the sense of loss is largely a function of the intensity of the emotional attachments that have been built up over the years. Infants have had less opportunity to develop these attachments, and for the most part, the elderly have been involved in a process of emotional detachment (Parkes, 1972). Becker (1973)

maintains that for children, the sense of loss exists even though the meaning of death is unclear at early ages and the entire situation is repressed as the child matures. To some extent children develop their feelings regarding death from what they hear in their homes, from the tone of voice, the sentence broken off in the middle, the willingness to use the word death instead of euphemisms, or attending a funeral. Furthermore, children pick up and respond to parental body language, decision making, and overt and covert behaviour. It becomes apparent that death anxiety can be communicated to children either directly by the parents or indirectly through the same environment that affects them both. Becker concludes that perhaps the fear of death is an inevitable component of the human condition that inevitably arises out of child-parent relationships, and that perhaps this fear can only be understood in terms of a social learning model.

Although the friends and family of a deceased or terminally ill individual are subjected to psychological and emotional stress, it cannot compare to the anguish of the terminally ill individual. People who are informed they have a limited life expectancy react in different ways. Some seem to be able to cope adequately with the psychic pain that may come in the form of anger, depression, fear, or inappropriate guilt. They adjust emotionally to the point

that they are able to live the final weeks and months of their lives with an inner tranquillity. Other individuals seem unable to handle this pain (Kubler-Ross, 1969).

Dr. Elizabeth Kubler-Ross, perhaps the foremost authority on death and dying has introduced five stages of emotional development (Kubler-Ross, 1972) that provide a very useful guide to understanding the phases that dying individuals go through. They are not absolute; not everyone goes through every stage, in this exact sequence, at some predictable pace. But this paradigm can be a valuable tool in understanding why a patient may be behaving as he or she does.

The first stage, labelled Denial by Kubler-Ross, is characterised by a refusal of the individual to admit his or her impending situation. This is a typical reaction when the patient learns that he or she is terminally ill. It is important and necessary in that it helps cushion the impact of the individual's awareness that death is inevitable.

In the second stage, Rage and Anger, the individual resents the fact that others will remain healthy and alive while he or she must die. Often God is a target for the anger, since he is regarded as imposing, arbitrarily, the death sentence. To those who are shocked at her claim that such anger is not only permissable but inevitable, Kubler-Ross replies "God can take it.". Problem may arise if the

terminally ill individual's friends, family and hospital staff become the targets of frustration.

In the Bargaining stage, terminally ill individuals accept the fact of death but strike bargains for more time. Usually they bargain with God, even those who never talked with God before. They promise to be good or to do something in exchange for another week or month or year of life. What they promise is totally irrelevant, because they don't keep their promises anyway.

During the fourth stage which Kubler-Ross labelled Depression, the individual mourns past losses, things not done, wrongs committed, but then he or she enters a state of preparatory grief, getting ready for the arrival of death. During this phase, the terminally ill individual grows quiet and usually requests to be left alone. According to Kubler-Ross when a dying individual doesn't want to see others this is a sign that he or she has finished his or her unfinished business with them.

The final stage, termed Acceptance, is characterised by the realization that one is close to die but that it is all right. Kubler-Ross describes this stage as neither a happy stage, nor an unhappy stage. It is more or less devoid of feelings but could not be described as resignation, but rather a victory.

The terminally ill individual, by definition, cannot be helped to regain his or her physical well-being. However, he or she can be assisted to live life as fearlessly and fully as possible until his or her death. In order to help terminal individuals in this manner, a more accurate understanding of the factors related to emotional adjustment is required. Such factors include: the amount of discomfort the individual experiences, religious attitudes and beliefs, previous experience with dying persons, financial security, age, sex, and education. Furthermore, it is necessary to have a clear picture of the anxieties of terminal individuals and the way in which these anxieties are related to an individual's age, sex, and religious values (Kubler-Ross, 1969).

From an extensive review of the literature, it may be cocluded that the effects of dying on the family and on the terminally ill individual can be practical and personal, psychological and social, positve and negative, intense and modest, as well as growth producing and personally destructive. These effects are rarely absent, although physical and psycological distance can minimize them, and they will usually diminish with time.

REFERENCES

Augustine, M.J., and Kalish, R.A. Religion, Transcendence, And Appropriate Death. Journal Of Transpersonal Psychology, 1975.

Becker, E. The Denial Of Death. New York, Free Press, 1983.

Geer, J.H. The Development Of A Scale To Measure Fear. Behaviour Research And Therapy, 1965.

Feifel, H. New Meanings Of Death. New York, McGraw-Hill, Inc., 1977.

Kalish, R.A. The Effects Of Death Upon The Family. In Death And Dying, ed. L. Pearson. Cleveland, Case Western Reserve And University Press, 1969.

Kalish, R.A., and Reynolds, D.K. Death And Ethnicity: A Psychocultural Investigation. Los Angeles, University Of Southern California Press, 1976.

Kubler-Ross, Elizabeth, M.D. On Death And Dying. New York, MacMillan, 1969.

Kubler-Ross, Elizabeth, M.D. On Death And Dying. In The Phenomenon Of Death, ed. Edith Wyschogrod. New York, Harper & Row, Inc., 1973.

Parkes, C.M. Bereavement. New York, International Universities Press, 1972.

Pine, V.R. Death, Dying, And Social Behaviour. In Anticipatory Grief, ed. B. Schoenberg. New York, Columbia University Press, 1972.

Rahe, R.H., McKean, J.D., and Arthur, R.J. A Longitudinal Study Of Life-change And Illness Patterns. Journal Of Psychosomatic Research, 1967, 10, 355-366.

Weisman, A.D. On Dying And Denying. New York, Behavioral Publications, 1972.