CHAPTER 19
DEATH, DYING, AND BEREAVEMENT
RESOURCES-AT-A-GLANCE
Detailed Outline
Learning
Objectives
Instructor’s Resources
Test Bank
MyPsychLab Connections
Chapter Introduction pp. 466-467
PowerPoint Slides
1-4
Sketchnote Video
Death and Afterlife Beliefs
The Experience of Death pp. 467-468
Death Itself
Where Death Occurs
19.1
19.2
PowerPoint Slides
5-9
MC 1-15
FI 75–77
SA 90
ES 1
Watch
Hospice, p 468
Understanding of Death
19.3
SA 91–95
ES 106–109
Criticisms and Alternative Views
19.7
19.8
FI 83–85
SA 96–98
Responses to Impending Death
19.9
ES 110–111
Alternative Perspectives
19.12
19.14
19.15
PowerPoint Slides
37–45
Rituals, p. 484
Theoretical Perspectives on Grieving
pp. 479–482
Freud’s Psychoanalytic Theory
Bowlby’s Attachment Theory
19.10
19.11
PowerPoint Slides
29–36
MC 53-65
FI 86–88
SA 99-100
ES 112
Watch
Death and Afterlife Beliefs:
Grieving Part 1, p. 480
CHAPTER OVERVIEW
For most people, death happens in late adulthood. However, many younger individuals contract fatal
diseases or may die in accidents. Thus, like most developmental events, the timing and mode of a
particular individual’s death affect its meaning and its effects on others.
Medical personnel distinguish between clinical death, brain death, and social death. In the industrialized
world, death most often occurs in hospitals. For the terminally ill, hospice workers and facilities provide
an alternative form of care.
Kübler-Ross’s five stages of dying (denial, anger, bargaining, depression, and acceptance) have been
widely studied. Research suggests that not all dying individuals go through these stages. Critics of
Kübler-Ross suggest that her stages may be culture-specific and that the process of adjusting to
LEARNING OBJECTIVES
After completing Chapter 19, students should be able to answer the following questions:
19.1 What are the characteristics of clinical death, brain death, and social death?
19.2 How do hospice and hospital care differ with respect to their effects on terminally ill patients?
19.3 What are the characteristics of children’s and adolescents’ ideas about death?
19.4 How do young, middle-aged, and older adults think about death?
19.5 What factors are related to fear of death in adults?
19.6 How do adults prepare for death?
19.7 How did Kübler-Ross explain the process of death?
19.8 What are some other views of the process of dying?
19.9 How do people vary in the ways they adapt to impending death?
KEY TERMS
INTEGRATED CHAPTER TEACHING NOTES
THE EXPERIENCE OF DEATH (pp. 467-468)
MyPsychLab Connections
Watch: Hospice, p. 468
Most of us may think of the word death as if it describes a simple phenomenon. In fact, death is a
process, as well as a state, and physicians have different labels for different aspects of this process.
Death Itself
LO 19.1 What are the characteristics of clinical death, brain death, and social death?
There are three aspects of death:
▪ The term clinical death describes the few minutes after the heart stops, breathing stops, and there is
not evidence of brain function. During this time rescue is still possible.
When Death Occurs
LO 19.2 How do hospice and hospital care differ with respect to their effects on terminally ill
patients?
Until recently, the great majority of adults died in hospitals. As a result of rising health care costs and
changing views about the process of dying, just under half of all deaths in the United States occur in
hospitals these days. The decline in hospital deaths is largely attributable to changing beliefs about what
constitutes a “good death.” One outcome of these changing beliefs is hospice care, an approach to caring
for the dying that emphasizes individual and family control of the process.
Hospice care emerged in England in the late 1960s and in the United States in the early 1970s. The
philosophy that underlies this alternative setting or approach to the dying patient has several aspects:
▪ Death should be viewed as normal.
Discussion Launcher (Learning Objective 19.2, pp. 467-468)
Why is the emphasis on palliative care rather than life-prolonging measures in a hospice-care situation?
Three different types of programs evolved from these guidelines:
▪ Home-based programs are the most common type of hospice care. One central family caregiver—
most frequently the spouse—provides hour-to-hour care with the assistance of specially-trained
nurses or other staff.
▪ Special hospice centers house a small number of patients in the last stages of a terminal disease in a
homelike setting.
Discussion Launcher (Learning Objective 19.2, pp. 467-68)
Given what you have just read and your own philosophical assumptions, do you think you would choose
hospice care for yourself, or urge it on a spouse or parent in the last stages of a terminal illness? Why or
why not?
Critical Thinking Question (Learning Objectives 19.1-19.2, pp. 467-468)
What are the advantages and disadvantages of hospice care, and how would you blame them in making a
decision about this option for yourself or a loved one?
THE MEANING OF DEATH ACROSS THE LIFESPAN (pp. 469-474)
MyPsychLab Connections
Watch: Death, Grief, and Mourning, p. 472
Children’s and Adolescents’ Understanding of Death
LO 19.3 What are the characteristics of children’s and adolescents’ ideas about death?
(3) that it means a cessation of all function. Young children’s ideas about death are rooted in their lack of
understanding of life.
Discussion Launcher (Learning Objective 19.3, p. 469)
Give examples of preschooler’s ideas about death.
At about school age, just after the time Piaget described as the beginning of concrete operations, most
Discussion Launcher (Learning Objective 19.3, p. 469)
Give examples of school-aged children’s attitudes about death.
Adolescents understand the finality of death better than children do, and, in an abstract sense, they
understand that death is inevitable. Unrealistic beliefs about personal death may contribute to adolescent
suicide. Typically, teens who attempt suicide claim to understand that death is final, but many tell
Discussion Launcher (Learning Objective 19.3, pp. 469-470)
List factors that may influence an adolescent’s attitude about death.
Feature Box Activity (Learning Objective 19.6, p. 470)
Developmental Science in the Classroom: Copycat Suicide and the Internet
Ask students to brainstorm possible ways to prevent copycat suicides among teens.
The Meaning of Death for Adults
LO 19.4 How do young, middle-aged, and older adults think about death?
Early Adulthood
Research examining young adults’ views on death has been guided by a theoretical concept similar to the
Discussion Launcher (Learning Objective 19.4, pp. 470-471)
Give examples of behavior of young adults that support the notion of unique invulnerability.
Here again, actual experience with death makes a difference. The sudden loss of a loved one appears to
shake a young adult’s belief in unique invulnerability and, as a result, is often more traumatic for younger
than for older adults. In fact, such losses frequently lead to suicidal thoughts in young adults.
Analyses of public reactions to the deaths of relatively young celebrities, such as Princess Diana,
crocodile hunter Steve Irwin, actor Heath Ledger, and Cory Monteith, provide additional insight into
Discussion Launcher (Learning Objective 19.4, p. 471)
Why do you suppose young adults seem to have the need to preserve the sense of unique invulnerability?
What eventually happens to cause them to accept death as final, inevitable, and universal?
Middle and Late Adulthood
In middle and late adulthood, an understanding of death goes well beyond that simple acceptance of
finality, inevitability, and universality. A death changes the roles and relationships of everyone else in a
Discussion Launcher (Learning Objective 19.4, p. 471)
When you think of your own age, do you think of time since birth, or time until death, or both? If you
think in terms of time until death, can you remember when you switched to this view?
Death as Loss
The most pervasive meaning of death for most adults is that of loss. Which of the many potential losses
that are feared or dreaded the most seem to change with age?
▪ Younger adults are more concerned about loss of opportunity to experience things and about the loss
of family relationships.
▪ Older adults worry more about the loss of time to complete inner work.
Discussion Launcher (Learning Objective 19.4, p. 472)
Why do you suppose there is such a difference in how young adults and older adults view death as loss?
Fear of Death
LO 19.5 What factors are related to fear of death in adults?
Fear of Death across Adulthood
Research suggests that middle-aged adults are most fearful of death.
▪ For young adults, the sense of unique invulnerability probably prevents intense fears of death.
▪ In middle-age, belief in one’s own immortality begins to break down, resulting in increasing anxiety
Older adults do not become less preoccupied with death—the elderly think and talk more about death than
do those at any other age. Predictably, these discussions lead to less fear and anxiety about death among
older adults. Older adults are more likely to fear the period of uncertainty before death than they are to
fear death itself.
Discussion Launcher (Learning Objective 19.5, p. 472)
Why do you think talking more about death relieves the fear and anxiety?
Religious Beliefs
A person’s religious beliefs are linked to fear of death. Adults who are religious are less afraid of death
than are those who describe themselves as less religious. In some instances, however, researchers have
found that both those who are deeply religious and those who are totally irreligious report less fear of
death. Thus, the most fearful may be those who are uncertain about or uncommitted to any religions or
philosophical tradition. In addition to framing death as a transition rather than an end, religious beliefs
Discussion Launcher (Learning Objective 19.5, pp. 472-473)
Ask students to volunteer to share some of the death stories from their religious beliefs that have helped
them cope with their own deaths and those of loved ones.
Personal Worth
Fear of death is also linked to one’s sense of personal worth or competence. Adults who feel they have
achieved the goals they set out to achieve, or who think of themselves as not too discrepant from the
person they wanted to be, are less fearful than are those who are disappointed in themselves. Adults who
Discussion Launcher (Learning Objective 19.5, p. 473)
What do you think? Is fear of death merely one facet of despair?
Preparation for Death
LO 19.6 How do adults prepare for death?
Preparation for death occurs on a number of other levels as well. At a practical level, regardless of age,
most adults agree that it is important to make preparations for death. According to most people, in
addition to purchasing life insurance and making a will, such preparations should include directives
regarding end-of-life care, often called a living will. Most people agree that advance funeral planning can
help bereaved family members deal with the many decisions they must make in the hours and days
Discussion Launcher (Learning Objective 19.6, pp. 473-474)
What would you want to do to prepare for your imminent death?
Feature Box Activity (Learning Objective 19.6, p. 474)
No Easy Answers: Saying Goodbye
Ask students to volunteer to share goodbye stories they have experienced.
Critical Thinking Question (Learning Objectives 19.3-19.6, pp. 469-474)
What role do age and fear of death play in people’s decisions about death preparations, such as living
wills and prepaid funeral arrangements?
THE PROCESS OF DYING (pp. 475-479)
Kübler-Ross’s Stages of Dying
LO 19.7 How did Kübler-Ross explain the process of dying?
Kübler-Ross proposed that those who know they are dying move through a series of steps, or stages,
arriving finally at the stage she called acceptance:
1. Denial: Many people, confronted with a terminal diagnosis, react with some form of denial, a
Discussion Launcher (Learning Objective 19.7, pp. 475-476)
Give examples of each of the stages.
Criticisms and Alternative Views
LO 19.8 What are some other views of the process of dying?
Kübler-Ross’s model has provided a common language for those who work with dying patients, and her
Methodological Problems
Because of methodological problems, Kübler-Ross’s observations might be correct, but only for a small
subset of dying individuals.
Discussion Launcher (Learning Objective 19.8, p. 476)
If you wanted to discover whether there really are widely shared stages in people’s reactions to dying,
what kind of study would you have to do? How might you study stages of dying in those who die from
something other than a disease with a clear terminal diagnosis?
Cultural Specificity
Kübler-Ross wrote the five stages of dying as if they were universal human processes. Cross-cultural
Discussion Launcher (Learning Objective 19.8, pp. 476-477)
Give examples of cultural differences in attitudes toward dying.
The Stage Concept
The most potent criticism centers on the issue of stages. Many clinicians and researchers have not found
that all dying patients exhibit these five emotions at all, let alone in a specific order. Only depression
Discussion Launcher (Learning Objective 19.8, p. 477)
Give examples of themes that may be part of the dying process.
Charles Corr offers another alternative he calls a “task-based” approach. He suggests the following four
tasks with which the dying person needs to cope:
▪ Satisfying bodily needs and minimizing physical stress
Responses to Impending Death
LO 19.9 How do people vary in the ways they adapt to impending death?
Individual variations in responding to imminent death have themselves been the subject of a good deal of
research interest in the past few decades. Findings raise questions about whether attitudes and behavioral
choices can influence the course of a terminal disease. The most influential research along these lines has
been the work of Steven Greer and his colleagues. They studied women three months after they were
diagnosed with breast cancer and classified their attitudes into one of the following five groups:
▪ Denial (positive avoidance): Rejection of evidence about the diagnosis and insistence that surgery
was just precautionary.
Greer checked the survival rates of these five groups after five, ten, and fifteen years. Only 35 percent of
those whose initial reaction was either denial or fighting spirit died of cancer, compared with 76 percent
Discussion Launcher (Learning Objective 19.9, pp. 477-478)
Why do you think it was helpful for cancer patients to have a “fighting spirit”? Why might it be less
appropriate for patients with other illnesses, such as heart disease?
Another important ingredient in an individual’s response to imminent death is the amount of social
Discussion Launcher (Learning Objective 19.9, pp. 478-479)
Why do you suppose the amount of social support is an important variable in an individual’s response to
imminent death?
Critical Thinking Question (Learning Objectives 19.3-19.9, pp. 475-479)
In what ways is Kübler-Ross’s model helpful to health care professionals who work with terminal
patients, and in what ways might the model interfere with their responses to the needs of patients?
THEORETICAL PERSPECTIVES ON GRIEVING (pp. 498-502)
MyPsychLab Connections
Watch: Death and Afterlife Beliefs, Grieving Part 1, p. 480
Freud’s Psychoanalytical Theory
LO 19.10 How did Freud’s psychoanalytic theory view grief?
From the psychoanalytical perspective, the death of a loved one is an emotional trauma. As with any
trauma, the ego, or mind, tries to insulate itself from the unpleasant emotions such losses induce through
the use of defense mechanisms, including denial and repression. Freud believed that defense
Discussion Launcher (Learning Objective 19.10. pp. 479-480)
Give examples of sublimation and identification that might help relieve feelings of grief.
Bowlby’s Attachment Theory
LO 19.11 What are the theories of Bowlby and Sanders regarding grief?
John Bowlby and other attachment theorists argue that intense grief reactions are likely to occur at the
loss of any person to whom one is attached. Their theories predict that the quality of attachment to the
loved one should be related in some way to the experience of grief. The stronger the attachment between
a mourner and a lost loved one, the deeper and more prolonged the grief response.
Discussion Launcher (Learning Objective 19.11, pp. 480-481)
Think about a loss in your own life. (Even losing a pet causes grief.) Do Bowlby’s and Sanders’s stages
seem to fit your experience?
Alternative Perspectives
LO 19.12 What theories of grief have been proposed by critics of psychoanalytic and attachment
theories?
A growing set of “revisionist” views of grieving give a rather different picture from that of either Freud or
the attachment theorists.
▪ Contrary to psychoanalytic hypotheses, avoiding expressions of grief neither prolongs the experience
In contrast, other revisionist theorists and researchers, such as psychologists Camille Wortman and
Roxanne Silver, contend that for some adults, grieving simply does not include all these elements. They
do, however, identify at least four distinct patterns of grieving:
▪ Normal: Relatively great distress is felt immediately following the loss, with relatively rapid
recovery.
The dual-process model takes a different approach to grief. Psychologists Margaret Stroebe and Henk
Schut, developers of the model, propose that bereaved individuals alternate between an emotional state in
Critical Thinking Question (Learning Objectives 19.10-19.12, pp. 479-482)
How can the theories discussed in this section be integrated into a comprehensive explanation of the
process of grieving?
THE EXPERIENCE OF GRIEVING (pp. 483-488)
MyPsychLab Connections
Watch: Death and Afterlife Beliefs: Remembering and Honoring the Dead across Cultures, p. 483
Psychosocial Functions of Death Rituals
LO 19.13 How do funerals and ceremonies help survivors cope with grief?
Funerals, wakes, and other death rituals provide several psychological functions:
▪ They help family members manage their grief by giving them a specific set of roles to play. These
provide shape to the first numbing hours and days. Friends and acquaintances, too, have guiding
Discussion Launcher (Learning Objective 19.13, pp. 483-484)
Do the various funerals or death rituals you have participated in seem to have served the purposes
described in the text?
The Process of Grieving
LO 19.14 What factors influence the grieving process?
The ritual of a funeral, in whatever form it occurs, can provide a structure and comfort in the days
immediately following a death. Handling the grief after that structure is gone presents several issues.
Age of the Bereaved
Children express feeling of grief very much the way teens and adults do—through sad facial expressions,
Discussion Launcher (Learning Objective 19.14, p. 484)
Why does knowing a loved one is in danger help us cope with the loss? What is different if a person dies
suddenly, such as in an accident?
Mode of Death
How an individual dies also contributes to the grief process of those who are in mourning.
▪ Widows who have cared for spouses during a period of illness prior to death are less likely to become
depressed after the death.
▪ A death that has intrinsic meaning, such as that of a young soldier who dies defending his country, is
Discussion Launcher (Learning Objective 19.14, pp. 484-485)
Give examples of how each of the modes of death contributes to the grief process.
Widowhood
LO 19.15 How does grief affect the physical and mental health of widows and widowers?
Feature Box Activity (Learning Objective 19.15, p. 486)
Research Report: Ethnicity and the Widowhood Effect
Share examples of the widowhood effect.
Widowhood and Physical Health
The experience of widowhood appears to have both immediate and long-term effects on the immune
system. (The term widowhood applies to both men and women; widow refers to women and widower to
Widowhood and Mental Health
In the year following bereavement, the incidence of depression among widows and widowers rises
substantially, while rates of death and disease rise only slightly. During a two-and-half-year-long study,
they found no differences between the widowed and non-widowed on global measures of physical or
mental health. They did note a rise in depression among the widowed immediately following the loss and
then a decline within a year after bereavement. Other researchers found that older adults whose spouses
Discussion Launcher (Learning Objective 19.15, pp. 486-487)
Explain why each of the factors listed may impact the incidence of depression following widowhood.
Complicated Grief
Some psychologists argue that complicated grief, depression-like symptoms following the death of a
Discussion Launcher (Learning Objective 19.15, p. 487)
Give examples of culturally determined aspects of grief.
Preventing Long-Term Problems
Some research suggests that the “talk-it-out” approach to managing grief can be helpful in preventing
grief-related depression. It seems to be especially helpful when feelings are shared with others who have
had similar experiences, such as a support group. Participating in support groups, or even jointly
recalling relevant events with close family members, can facilitate the formation of a coherent personal
Critical Thinking Question (Learning Objectives 19.13-19.15, pp. 483-488)
Given what you have learned in this section, what kinds of factors would lead you to make different
predictions about how long a person who has lost a loved one will grieve?
Written Assignment (Chapter 19, pp. 466-488)
LECTURE ENHANCER
Culture and Approaches to Death
Different cultures have different perceptions of death. For some, it might be considered the ultimate
reward for having lived a good life, and for others it might be seen as merely the next step in the journey.
Regardless of how the culture approached the concept of death, there will be rituals that mark the passing
of the individual—perhaps to celebrate what that person’s life has meant or to bid that person well as she
or he begins the next leg of the journey.
The rituals that a culture (or subculture) engages in to mark the death of one of its members can tell us a
If we are raised in a cultural environment that believes that death represents the end or the finality of our
existence, we are likely to perceive death as a thief or to face death with anger, frustration, or fear.
Literary references to death give us some idea of cultural perceptions. Consider the following phrases
and their cultural implications:
1. death as a statistic, such as mortality rates or life expectancy figures
It stands to reason that the beliefs one has about death can have an important effect on how one will
The timing of one’s death seems to effect our perceptions. The death of a 3-year-old, for example, may
result in comments from individuals such as, “Oh, what a horrible tragedy,” or “He really did not even
have a chance to live.” The death of a 95-year-old woman, however, may result in comments such as,
“She lived a full life,” or “She deserves a good rest.” Younger adults facing death might feel cheated in
that they are losing what life they might have attained while an older adult may feel cheated because he is
losing what he has worked so hard to attain. Clearly, the feelings one has about one’s own death is
influenced by many things including:
▪ religious and/or cultural beliefs about death
Two final issues that are important to mention are “grief” and “mourning.” What is an appropriate
amount of grief? What is appropriate in terms of mourning? Hopefully you realized right away that there
INSTRUCTOR RESOURCES
Media
▪ MyPsychLab—MyPsychLab contains a variety of engaging activities and assessments that aid in
teaching and learning, including the following tools:
o Writing Space. A single place to create, track, and grade writing assignments, provide writing
resources, and exchange meaningful, personalized feedback with students quickly and easily. For
Fall 2014 courses, Writing Space for the 7th edition will contain new auto-graded writing
▪ MyPsychLab Connections
o Watch: Hospice, p. 468
o Watch: Death, Grief, and Mourning, p. 472