Social Science

grandchildren and great-grandchildren with gifts, loans, and babysitting.

Because older people are living longer, four and even five generations of families are becoming more common. Papalia et al. (2009, p. 613) note:

Grandparents and great-grandparents are impor- tant to their families. They are sources of wisdom, companions in play, links to the past, and symbols of the continuity of family life. They are engaged in the ultimate generative function: expressing the human longing to transcend mortality by investing themselves in the future generations.

Guidelines for Positive Psychological Preparation for Later Adulthood: The Strengths Perspective Growing old is a lifelong process. Becoming 65 does not destroy the continuity of what a person has been, is now, and will be. Recognizing this should lessen the fear of growing old. For those who are financially secure and in good health and who have prepared thoughtfully, later adulthood can be a period of

at least reasonable pleasure and comfort, if not luxury.

Some may be able to start small home businesses, based on their hobbies, or become involved in mean- ingful activities with churches and other organizations. Others may relax while fishing or traveling around the country. Still others may continue to pursue such inter- ests as gardening, woodworking, reading, needlework, painting, weaving, and photography. Many older peo- ple have contributed as much (or more) to society as they did in their earlier years. One role model in this area is Jimmy Carter; see Highlight 15.1.

Our lives depend largely on our goals and our efforts to achieve those goals. How we live before retiring will largely determine whether later adult- hood will be a nightmare or will be gratifying and fulfilling. The importance of being physically and mentally active throughout life was discussed in Chapter 14. Here are some factors that are closely related to satisfaction in later adulthood:

1. Close personal relationships. Having close rela- tionships with others is important throughout life. Older people who have close friends are more sat- isfied with life. Practically everyone needs a person to whom one can confide one’s private thoughts or feelings. Older people who have confidants are better able to handle the trials and tribulations of

HIGHLIGHT 15.1

Jimmy Carter: Stumbled as President, Excelled in Later Adulthood

Jimmy Carter (James Earl Carter Jr.) was born October 1, 1924, in the small rural community of Plains, Georgia. Carter graduated from the U.S. Naval Academy in Annapolis in 1946. After seven years as a naval officer, he returned to Plains, where he ran a peanut-producing business. In 1962, he entered state politics. Eight years later, he was elected governor of Georgia. In 1976, he was elected president of the United States. Although he had some noteworthy accomplishments as presi- dent, there were serious setbacks economically and in foreign affairs. Inflation, interest rates, and unemployment rates were at near-record highs. During Carter’s four-year administration, the economy went into a recession. In 1979, more than 50 members of the U.S. Embassy staff in Iran were taken as hos- tages by militants. Despite 14 months of trying, the Carter ad- ministration was unable to secure release of the hostages. After a devastating defeat for reelection in 1980, Carter retired from political life—and left being very unpopular.

But the best was yet to come. He did not throw in the towel. Today he is a professor at Emory University in

Georgia and a leading advocate for Habitat for Humanity, which helps build houses for low-income families. He es- tablished the Carter Center, which sponsors international programs in human rights, preventive health care, educa- tion, agricultural techniques, and conflict resolution. Carter and the Carter Center have secured the release of hundreds of political prisoners. He has become an elder statesman, a roving peacemaker, and a guardian of free- dom. He oversaw the Nicaraguan elections that ousted the dictatorship of the Sandinistas. He brokered a cease- fire between the Serbs and the Bosnian Muslims. He has pressured China to release political prisoners. He was the first former U.S. president to visit Communist Cuba. He has helped set up fair elections in China, Mozambique, Nigeria, Indonesia, and several other developing countries. In addition, he has written 14 books. In 2002, at age 78, he was awarded the Nobel Peace Prize. Clearly, Carter’s ac- complishments in later adulthood surpass his accomplish- ments in his earlier years.

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aging. Through sharing their deepest concerns, people are able to ventilate their feelings and to talk about their problems and possibly arrive at some strategies for handling them. Those who are married are more likely than the widowed to have confidants, and the widowed are more likely to have confidants than those who have never mar- ried. For those who are married, the spouse is apt to be the confidant, especially for men.

2. Finances. Health and income are two factors closely related to life satisfaction in later adult- hood. When people feel good and have money, they can be more active. Those who are active— who go out to eat, go to meetings or museums, go to church, go on picnics, or travel—are happier than those who mostly stay at home. Saving money for later years is important, and so is learning to manage or budget money wisely.

3. Interests and hobbies. Psychologically, people who are traumatized most by retirement are those whose self-image and life interests center on their work. People who have meaningful hobbies and interests look forward to retirement in order to have sufficient time for these activities.

4. Self-identity. People who are comfortable and re- alistic about who they are and what they want from life are better prepared to deal with stresses and crises that arise.

5. Looking toward the future. A person who dwells on the past or rests on past achievements is apt to find the older years depressing. On the other hand, a person who looks to the future generally has interests that are alive and growing and is therefore able to find new challenges and new sat- isfaction in later years. Looking toward the future involves planning for retirement, including decid- ing where one would like to live, in what type of housing and community, and what one looks for- ward to doing with his or her free time.

6. Coping with crises. If a person learns to cope ef- fectively with crises in younger years, these cop- ing skills will remain useful when a person is older. Effective coping is learning to approach problems realistically and constructively.

Grief Management and Death Education In the remainder of this chapter, we will discuss re- actions to death in our society, including social work

roles in grief management and guidelines for relating to a dying person and to survivors.

Death in Our Society: The Impact of Social Forces People in primitive societies handle death better than we do. They are more apt to view death as a natural occurrence, partly because they have shorter life ex- pectancies. They also frequently see friends and rel- atives die. Because they view death as a natural occurrence, they are better prepared to handle the death of loved ones. Spotlight 15.3 illustrates the cultural-historical context of death and bereavement.

In our society, we tend to shy away from thinking about death. The terminally ill generally die in institutions (hospitals and nursing homes), away from their homes. Therefore, we are seldom exposed to people dying. Many people in our society seek to avoid thinking about death. They avoid going to funerals and avoid conversations about death. Many people live as if they believe they will live indefinitely.

We need to become comfortable with the idea of our own eventual death. If we do that, we will be better prepared for the deaths of close friends and relatives. We will also then be better prepared to relate to the terminally ill and to help survivors who have experienced the death of a close friend or relative.

Funerals are needed for survivors. Funerals help initiate the grieving process so that people can work through their grief. (Delaying the grieving process may intensify the eventual grief.) For some, funerals also serve the function of demonstrating that the per- son is dead. If survivors do not actually see the dead body, some may mystically believe that the person is still alive. For example, John F. Kennedy was assas- sinated in 1963 and had a closed-casket funeral. Because the body was not shown, rumors abounded for many years that he was still alive.

The sudden death of a young person is more dif- ficult to cope with, for three reasons. First, we do not have time to prepare for the death. Second, we feel the loss as more severe because we feel the per- son is missing out on many of the good things in life. Third, we do not have the opportunity to obtain a sense of closure in the relationship; we may feel we did not have the opportunity to tell the person how we felt about him or her, or we did not get the op- portunity to resolve interpersonal conflicts. (Because the grieving process is intensified when closure does

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not occur, it is advisable to actively work toward closure in our relationships with others.)

Children should not be sheltered from death. They should be taken to funerals of relatives and friends and their questions answered honestly. It is a mistake to say, “Grandmother has gone on a trip and won’t be back.” The child will wonder if other significant people in his or her life will also go on a trip and not come back; or the child may be puzzled about why grandmother won’t return from the trip. It is much better to explain to children that death is a natural process. It is desirable to state that death is unlikely to occur until a person is quite old, but that there are exceptions—such as an automobile acci- dent. Parents who take their children to funerals al- most always find the children handle the funeral better than they expected. Funerals help children learn that death is a natural process.

It is generally a mistake for survivors to seek to appear strong and emotionally calm following the death of a close friend or relative. Usually such peo- ple want to avoid dealing with their loss, and there is a danger that when they do start grieving they will experience more intense grief—partly because they will feel guilty about denying that they are hurting, and partly because they will feel guilty because they de-emphasized (by hiding their pain and feelings) the importance of the person who died.

Many health professionals (such as medical doc- tors) find death difficult to handle. Health profes- sionals are committed to healing. When someone is found to have a terminal illness, health professionals are apt to experience a sense of failure. In some cases, they experience guilt because they cannot do more, or because they might have made mistakes that contributed to a terminal illness. Therefore, do not be too surprised if you find that some health professionals do not know what to say or do when confronted by terminal illness.

The Grieving Process Nearly all of us are currently grieving about some loss that we have had. It might be the end of a ro- mantic relationship, or moving away from friends and parents, or the death of a pet, or failing to get a grade we wanted, or the death of someone.

It is a mistake to believe that grieving over a loss should end in a set amount of time. The normal grieving process is often the life span of the griever. When we first become aware of a loss of great im- portance to us, we are apt to grieve intensively—by crying or by being depressed. Gradually, we will have hours, then days, then weeks, then months when we will not think about the loss and will not grieve. However, there will always be something that reminds us of the loss (such as anniversaries), and we

SPOTLIGHT ON DIVERSITY 15.3

The Cultural-Historical Context of Death and Bereavement

Cultural customs concerning the disposal and remembrance of the dead, the transfer of possessions, and even expressions of grief vary greatly from culture to culture. Often, religious or legal prescriptions about these topics reflect a society’s view of what death is and what happens afterward.

In ancient Greece, bodies of heroes were publicly burned as a symbol of honor. Public cremation is still practiced by Hindus in India and Nepal. In contrast, cremation is prohib- ited under Orthodox Jewish law, as it is believed that the dead will rise again for a “last judgment” and the chance for eter- nal life. To this day, some Polynesians in the Tahitian Islands bury their parents in the front yard of their parents’ home as a way of remembering them.

In ancient Romania, warriors went laughing to their graves, expecting to meet Zalmoxis, their supreme god.

In Mayan society, which prospered several centuries ago in Mexico and Central America, death was seen as a gradual transition. At first a body was given only a provisional burial. Survivors continued to perform mourning rites until the body

decayed to the point where it was thought the soul had left it and transcended into the spiritual realm.

In Japan, religious rituals expect survivors to maintain contact with the deceased. Families keep an altar in their homes that is dedicated to their ancestors; they offer them cigars and food and talk to the altar as if they were talking to their deceased loved ones. In contrast, the Hopi (Native American tribe) fear the spirits of the deceased and try to for- get, as quickly as possible, those who have died.

Some modern cultural customs have evolved from ancient ones. The current practice of embalming, for example, evolved from the mummification practice in ancient Egypt and China about 3,000 years ago that was designed to pre- serve a body so that the soul could eventually return to it.

Today, Muslims in Bali are encouraged to suppress sad- ness, and instead to laugh and be joyful at burials. In contrast, Muslims in Egypt are encouraged to express their grief with displays of deep sorrow.

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will again grieve. The intense grieving periods will, however, gradually become shorter, occur less fre- quently, and decrease in intensity.

Two models of the grieving process will be pre- sented here: the Kübler-Ross (1969) model and the Westberg (1962) model. These models help us to un- derstand the grief we feel from any loss.

The Kübler-Ross Model This model posits five stages of grief:

1. Stage One: Denial. During this stage, we tell our- selves, “No, this can’t be. There must be a mis- take. This just isn’t happening.” Denial is often functional because it helps cushion the impact of the loss.

2. Stage Two: Rage and Anger. During this stage, we tell ourselves, “Why me? This just isn’t fair!” For example, terminally ill patients resent that they will soon die while other people will remain healthy and alive. During this stage, God is some- times a target of the anger. The terminally ill, for example, blame God as unfairly imposing a death sentence.

3. Stage Three: Bargaining. During this stage, peo- ple with losses attempt to strike bargains to re- gain all or part of the loss. For example, the terminally ill may bargain with God for more time. They promise to do something worthwhile or to be good in exchange for another month or year of life. Kübler-Ross indicates that even ag- nostics and atheists sometimes attempt to bargain with God during this stage.

4. Stage Four: Depression. During this stage, those having losses tell themselves, “The loss is true, and it’s really sad. This is awful. How can I go on with life?”

5. Stage Five: Acceptance. During this stage, the person fully acknowledges the loss. Survivors

accept the loss and begin working on alternatives to cope with the loss and to minimize its impact.

The Westberg Model This model is represented graphically in Figure 15.1.

• Shock and Denial. According to the Westberg model, many people, when informed of a tragic loss, are so numb, and in a state of such shock, that they are practically devoid of feelings. It could well be that when emotional pain is unusu- ally intense, a person’s response system experi- ences “overload” and temporarily “shuts down.” The person feels hardly anything and acts as if nothing has happened. Such denial is a way of avoiding the impact of a tragic loss.

• Emotions Erupt. As the realization of the loss be- comes evident, the person expresses the pain by crying, screaming, or sighing.

• Anger.At some point, a person usually experiences anger. The anger may be directed at God for caus- ing the loss. The anger may be partly due to the unfairness of the loss. If the loss involves the death of a loved one, there is often anger at the dead per- son for what is termed “desertion.”

• Illness. Because grief produces stress, stress-related illnesses are apt to develop, such as colds, flu, ulcers, tension headaches, diarrhea, rashes, and insomnia.

• Panic. Because the grieving person realizes he or she does not feel like the “old self,” the person may panic and worry about going insane. Night- mares, unwanted emotions that appear uncontrol- lable, physical reactions, and difficulties in concentrating on day-to-day responsibilities all contribute to the panic.

• Guilt. The grieving person may blame himself or herself for having done something that

Loss/Hurt Healed/New

Strengths

Shock and denial

Emotions erupt

Affirming reality

Anger

Hope

Illness Reentry difficulties

Panic Depression and loneliness

Guilt

FIGURE 15.1 Westberg Model of the Grieving Process

© Ce ng ag e Le ar ni ng

20 13

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contributed to the loss, or feel guilty for not doing something that might have prevented the loss.

• Depression and Loneliness. At times, the grieving person is apt to feel very sad about the loss and also to have feelings of isolation and loneliness. The grieving person may withdraw from others, who are viewed as not being supportive or understanding.

• Reentry Difficulties. When the grieving person makes efforts to put his or her life back together, reentry problems are apt to arise. The person may resist letting go of attachments to the past, and loyalties to memories may hamper the pursuit of new interests and activities.

• Hope. Gradually, hopes of putting one’s life back together return and begin to grow.

• Affirming Reality. The grieving person puts his or her life back together again, and the old feeling of having control of one’s life returns. The reconstructed life is not the same as the old, and memories of the loss remain. However, the recon- structed life is satisfactory. The grieving person resolves that life will go on.

Evaluation of Models of the Grieving Process Kübler-Ross and Westberg note that some people continue grieving and never do reach the final stage (the acceptance stage in the Kübler-Ross model, or the affirming reality stage in the Westberg model). Kübler-Ross and Westberg also caution that it is a mistake to rigidly believe everyone will progress through these stages as diagrammed. There is often considerable movement back and forth among the stages. For example, in the Kübler-Ross model, a person may go from denial and depression to anger and rage, then back to denial, then to bargaining, then again to depression, back to anger and rage, and so on.

How to Cope with Grief The following suggestions are given to help those who are grieving:

• Crying is an acceptable and valuable expression of grief. Cry when you feel the need. Crying releases the tension that is part of grieving.

• Talking about your loss and about your plans is very constructive. Sharing your grief with friends, family, the clergy, a hospice volunteer, or a pro- fessional counselor is advisable. You may seek to become involved with a group of others having

similar experiences. Talking about your grief eases loneliness and allows you to ventilate your feel- ings. Talking with close friends gives you a sense of security and brings you closer to others you love. Talking with others who have similar losses helps put your problems into perspective. You will see you are not the only one with problems, and you will feel good about yourself when you assist others in handling their losses.

• Death often causes us to examine and question our faith or philosophy of life. Do not become concerned if you begin questioning your beliefs. Talk about them. For many, a religious faith pro- vides help in accepting the loss.

• Writing out a rational self-analysis on your grief will help you to identify irrational thinking that is contributing to your grief (see Chapter 8). Once any irrational thinking is identified, you can re- lieve much of your grief through rational chal- lenges to your irrational thinking.

• Try not to dwell on how unhappy you feel. Be- come involved and active in life around you. Do not waste your time and energy on self-pity.

• Seek to accept the inevitability of death—yours and that of others.

• If the loss is the death of a loved one, holidays and the anniversaries of your loved one’s birth and death can be stressful. Seek to spend these days with family and friends who will give you support.

• You may feel that you have nothing to live for and may even think about suicide. Understand that many people who encounter severe losses feel this way. Seek to find assurance in the fact that a sense of purpose and meaning will return.

• Intense grief is very stressful. Stress is a factor that leads to a variety of illnesses, such as headaches, colitis, ulcers, colds, and flu. If you become ill, seek a physician’s help, and tell him or her that your illness may be related to grief you are experiencing.

• Intense grief may also lead to sleeplessness, sexual difficulties, loss of appetite, or overeating. If a loved one has died, do not be surprised if you dream the person is still alive. You may find you have little energy and cannot concentrate. All of these reactions are normal. Do not worry that you are going crazy or losing your mind. Seek to take a positive view. Eat a balanced diet, get ample rest, and exercise moderately. Every person’s grief is individual—if you are experiencing unusual

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physical reactions (such as nightmares), try not to become overly alarmed.

• Medication should be taken sparingly and only under the supervision of a physician. Avoid trying to relieve your grief with alcohol or other drugs. Many drugs are addictive and may stop or delay the necessary grieving process.

• Recognize that guilt, real or imagined, is a normal part of grief. Survivors often feel guilty about things they said or did, or feel guilty about things they think they should have said or done. If you are experiencing intense guilt, it is helpful to share it with friends or with a professional counselor. It might also be helpful to write a rational self- analysis of the guilt (see Chapter 8). Learn to for- give yourself. All humans make mistakes.

• You may find that friends and relatives appear to be shunning you. If this is happening, they proba- bly are uncomfortable around you, as they do not know what to say or do. Take the initiative and talk with them about your loss. Inform them about ways in which you would like them to be supportive.

• If possible, put off making major decisions (chang- ing jobs, moving) until you become more emotion- ally relaxed. When you’re highly emotional, you’re more apt to make undesirable decisions.

Application of Grief Management Theory to Client Situations Most people are grieving about one or more losses— the end of a romantic relationship, the death of a pet, or the death of a loved one. Social workers may take on a variety of roles in the areas of grief management and death education: They can be in- itiators of educational programs in schools, churches, and elsewhere for the general public. They can be counselors in a variety of settings (in- cluding hospices, nursing homes, and hospitals) in which they work on a one-to-one basis with the ter- minally ill and with survivors. They can be group facilitators and lead grief management groups (in- cluding bereavement groups for survivors) in settings such as hospitals, hospices, mental health clinics, and schools. They may also serve as brokers in linking individuals who are grieving, or who have unrealistic views about death and dying, with appro- priate community resources.

In order for social workers to be effective in these roles, they need to become comfortable with the idea

of their own eventual deaths. They also need to de- velop skills for relating to the terminally ill and to survivors. The following sections present some guidelines in these areas. The material is useful not only for social workers but also for anyone who has contact with a dying person or with survivors.

How to Relate to a Dying Person First, you need to accept the idea of your own eventual death and view death as a normal process. If you cannot accept your own death, you will prob- ably be uncomfortable talking to someone who is terminally ill and will not be able to discuss the con- cerns that the dying person has in an understanding and positive way. The questions in Highlight 15.2 will help you assess your attitudes toward the reality of death.

Second, tell the dying person that you are willing to talk about any concerns that he or she has. Let

When a person’s spouse dies, he or she is apt to feel sad, lonely, and isolated. Gradually, the grieving person reaches out to others.

Ph ot od isc /G et ty Im ag es

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HIGHLIGHT 15.2

Questions About Grief, Death, and Dying

Arriving at answers to these questions is one way to work toward becoming more comfortable with your own eventual death.

1. Which of the following describe your present concep- tion of death? a. Cessation of all mental and physical activity b. Death as sleep c. Heaven-and-hell concept d. A pleasant afterlife e. Death as being mysterious and unknown f. The end of all life for you g. A transition to a new beginning h. A joining of the spirit with an unknown cosmic

force i. Termination of this physical life with survival of the

spirit j. Something other than what is on this list

2. Which of the following aspects of your own death do you find distasteful? a. What might happen to your body after death b. What might happen to you if there is a life after

death c. What might happen to your dependents d. The grief that it would cause to your friends and

relatives e. The pain you may experience as you die f. The deterioration of your body before you die g. All your plans and projects coming to an end h. Something other than what is on this list

3. If you could choose, what age would you like to be when you die?

4. When you think of your own eventual death, how do you feel? a. Depressed b. Fearful c. Discouraged d. Purposeless e. Angry f. Pleasure in being alive g. Resolved as you realize death is a natural process

of living h. Other (specify)

5. For what, or for whom, would you be willing to sacrifice your life? a. An idea or moral principle b. A loved one c. In combat d. An emergency where another life could be saved e. Not for any reason

6. If you could choose, how would you prefer to die? a. A sudden, violent death b. A sudden but nonviolent death c. A quiet and dignified death

d. Death in the line of duty e. Suicide f. Homicide victim g. Death after you have achieved your life goals h. Other (specify)

7. If it were possible, would you want to know the exact date on which you would die?

8. Would you want to know if you had a terminal illness? 9. If you had six more months to live, how would you

want to spend the time? a. Satisfying hedonistic desires such as sex b. Withdrawing c. Contemplating or praying d. Seeking to prepare loved ones for your death e. Completing projects and tying up loose ends f. Considering suicide g. Other (specify)

10. Have you seriously contemplated suicide? What are your moral views of suicide? Are there circumstances under which you would take your life?

11. If you had a serious illness and the quality of your life had substantially deteriorated, what measures do you believe should be taken to keep you alive? a. All possible heroic medical efforts should be taken b. Medical efforts should be discontinued when there is

practically no hope of returning to a life with quality c. Other (specify)

12. If you are married, would you prefer to outlive your spouse? Why?

13. How important do you believe funerals and grief rituals are for survivors?

14. If it were up to you, how would you like to have your body disposed of after you die? a. Cremation b. Burial c. Donation of your body to a medical school or to

science d. Other (specify)

15. What kind of funeral would you prefer? a. A church service b. As large as possible c. Small with only close friends and relatives present d. A lavish funeral e. A simple funeral f. Whatever your survivors want g. Other (specify)

16. Have you made a will? Why or why not? 17. Were you able to arrive at answers to most of these

questions? Were you uncomfortable in answering these questions? If you were uncomfortable, what were you feeling, and what made you uncomfortable? For the questions you do not have answers to, how might you arrive at answers?

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the person know that you are emotionally ready and supportive, that you care, and that you are avail- able. Remember, the person has a right not to talk about concerns if he or she so chooses. Touching or hugging the dying person is also very helpful.

Third, answer the dying person’s questions as honestly as you can. If you do not know an answer, find someone who can provide the requested infor- mation. Evasion or ambiguity in response to a dying person’s questions only increases his or her concerns. If there is a chance for recovery, this should be men- tioned. Even a small margin of hope can be a com- fort. Do not, however, exaggerate the chances for recovery.

Fourth, a dying person should be allowed to accept the reality of the situation at his or her own pace. Rel- evant information should not be volunteered, nor should it be withheld. People who have terminal ill- nesses have rights to have access to all the relevant information. A useful question thatmay assist a dying person is, “Do you want to talk about it?”

Fifth, if people around the dying person are able to accept the death, the dying person is helped to accept the death. Therefore, it is therapeutic to help close family members and friends accept the death. Remember, they may have a number of con- cerns that they want to discuss, and they may need help to do this.

Sixth, if you have trouble with certain subjects involving death, inform the dying person of your limitations. This takes the guesswork out of the relationship.

Seventh, the religious or philosophical viewpoint of the dying person should be respected. Your own personal views should not be imposed.

How to Relate to Survivors These suggestions are similar to the suggestions on relating to a dying person. It is very helpful to be- come accepting of the idea of your own death. If you are comfortable about your own death, you will be better able to calmly listen to the concerns being ex- pressed by survivors.

It is helpful to initiate the first encounter with a survivor by saying something like, “I’m sorry,” and then touching or hugging the person. Then convey that if he or she wants to talk or needs help, you’re available. Take your lead from what the survivor expresses. You should seek to convey that you care, that you share his or her loss, and that you’re available if he or she wants to talk.

It is helpful to use active listening with both sur- vivors and persons who are terminally ill. In using active listening, the receiver of a message feeds back only what he or she feels was the intent of the sen- der’s message. In using this approach, the receiver does not send a message of his or her own, such as asking a question, giving advice, expressing personal feelings, or offering an opinion.

It is frequently helpful to share with a survivor pleasant and positive memories you have about the person who has died. This conveys that you sincerely care about and miss the deceased person and also that the deceased person’s life had positive meaning.

ETHICAL DILEMMA

Whether to Insert a Feeding Tube

New technology has made it possible for pa- tients with irreversible brain damage to be kept alive for decades. A key component of keeping someone alive is the insertion of a feeding tube. Once a feeling tube has been in- serted, it is extremely difficult to obtain a court order to have it removed. Some patients

have been kept alive in a chronic vegetative state for 10 to 15 years after a feeding tube has been inserted.

Assume the following: Your mother has a tragic automobile accident, and her brain is deprived of oxygen for 15 minutes. She is in a coma for 30 days, and medical tests indicate that she has suffered irreversible brain damage. It will take a miracle

for your mother to ever regain consciousness. Your mother has not signed a living will, a document in which the signer asks to be allowed to die rather than be kept alive by artificial means if disabled and there is no reasonable expectation of recovery. The attending doctors ask you if you want to give permission for a feeding tube to be inserted. If a tube is not inserted, your mother will starve to death; however, she probably will experi- ence little or no pain, as she is in a coma. If a tube is inserted, she will probably live in a vegetative state for many years.

What do you do? This dilemma is obviously heartrending, but is included

here to help prepare you for a decision you may someday have to make.

EP 2.1.2

Psychological Aspects of Later Adulthood 667

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Relating your memories will often focus the survi- vor’s thoughts on pleasant and positive memories of his or her own.

Continue to visit the survivors if they show inter- est in such visits. It is also helpful to express your caring and support through a card, a little gift, or a favorite casserole. If a survivor is unable to resume the normal functions of living, or remains deeply depressed, suggest seeking professional help. Joining a survivor self-help group is another possible suggestion.

The religious or philosophical viewpoint of survi- vors should be respected. You should not seek to impose your views on the survivors.

How to Become Comfortable with the Idea of Your Own Eventual Death: The Strengths Perspective Perhaps the main reason people are uncomfortable about death is that in our culture we are socialized to avoid seeing death as a natural process. We would be more comfortable with the idea of our own death if we could talk about it more openly and actively seek answers to our own questions and concerns. Comfort with the idea of our own death helps us be more supportive in relating to and understanding those who are dying. If you are uncomfortable about death, including your own eventual death, here are some things you can do to become more comfortable.

Identify what your concerns are and then seek answers to these concerns. Numerous excellent books provide information on a wide range of sub- jects involving death and dying. Many colleges, uni- versities, and organizations provide workshops and courses on death and dying. If you have intense fears about death and dying, consider talking to

authorities in the field, such as professional counse- lors, or to clergy with experience and training in grief counseling.

Taboos against talking about death and dying need to be broken in our society. You may find that tactfully initiating discussions about death and dying with friends and relatives will be helpful to you, and to people close to you.

It is probably accurate that we will never become fully accepting of the idea of our own death, but we can learn a lot more about the subject and obtain answers to many of the questions and concerns we have. In talking about death, it is advisable to avoid using euphemisms such as “passed on,” “gone to heaven,” and “taken by the Lord.” It is much better to be accurate and say the person has died. Using euphemisms gives an unrealistic impression of death and is part of an avoidance approach to facing death. Fortunately, an open communications ap- proach about death is emerging in our society.

Additional ways to become more informed about death and dying are attending funerals; watching quality films and TV programs that cover aspects of dying; providing support to friends or relatives who are terminally ill; being supportive to survivors; talking to people who do grief counseling to learn about their approach; keeping a journal of your thoughts and concerns related to death and dying; and planning the details of your own funeral. Some persons move toward becoming more comfortable with their own death by studying the research that has been conducted on near-death experiences, as described in Highlight 15.3.

Mwalimu Imara (1975) views dying as having a potential for being the final stage of growth. Learn- ing to accept death is similar to learning to accept other losses—such as the breakup of a romantic re- lationship or leaving a job we cherished. If we learn to accept and grow from the losses we encounter, such experiences will help us in facing the deaths of loved ones and our own eventual death.

Having a well-developed sense of identity (that is, who we are and what we want out of life) is an im- portant step in learning to become comfortable with our own eventual death. If we have well-developed blueprints of what will give meaning and direction to our lives, we are emotionally better prepared to ac- cept that we will eventually die.

Ethical Question 15.5 Are you comfortable with the fact that someday you will die? Most people are not. If you are not, what do you need to work on to become more comfortable?EP 2.1.2

668 Understanding Human Behavior and the Social Environment

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Chapter Summary The following summarizes this chapter’s content in terms of the learning objectives presented at the be- ginning of the chapter.

A. Describe the developmental tasks of later adulthood.

Older adults must make a number of developmental psychological adjustments, such as adjusting to re- tirement and lower income and to changing physical strength and health.

B. Present theoretical concepts about develop- mental tasks in late adulthood.

Theoretical concepts about developmental tasks in later adulthood include integrity versus despair, shifting from work-role preoccupation to self- differentiation; shifting from body preoccupation to body transcendence; shifting from self-occupation to self-transcendence; conducting a life review; the im- portance of self-esteem; the significance of having a high level of life satisfaction; the negative effects of low status and ageism; the prevalence of depression

HIGHLIGHT 15.3

Life After Life

Raymond Moody (1975) interviewed a number of people who had near-death experiences. These people had been pro- nounced clinically dead but then shortly afterward were re- vived. Moody provides the following composite summary of typical experiences that have been reported. (It is important to bear in mind that the following narrative is not a representa- tion of any one person’s experience; rather, it is a composite of the common elements found in many accounts.)

A man is dying and, as he reaches the point of greatest physical stress, he hears himself pronounced dead by his doctor. He begins to hear an uncomfortable noise, a loud ringing or buzzing, and at the same time feels himself mov- ing very rapidly through a long dark tunnel. After this, he suddenly finds himself outside of his own physical body, but still in the immediate physical environment, and he sees his own body from a distance, as though he is a spectator. He watches the resuscitation attempt from his unusual vantage point and is in a state of emotional upheaval.

After a while, he collects himself and becomes more ac- customed to his odd condition. He notices that he still has a “body,” but one of a very different nature and with very different powers from the physical body he has left behind. Soon other things begin to happen. Others come to meet and to help him. He glimpses the spirits of relatives and friends who have already died, and a loving, warm spirit of a kind he has never encountered before—being of light— appears before him. This being asks him a question, nonver- bally, to make him evaluate his life and helps him along by showing him a panoramic, instantaneous playback of the major events of his life. At some point he finds himself ap- proaching some sort of barrier or border, apparently repre- senting the limit between earthly life and the next life. Yet, he finds that he must go back to the earth; that the time for his death has not yet come. At this point he resists, for by

now he is taken up with his experiences in the afterlife and does not want to return. He is overwhelmed by his intense feelings of joy, love, and peace. Despite his attitude, though, he somehow reunites with his body and lives.

Later he tries to tell others, but he has trouble doing so. In the first place, he can find no human words adequate to describe this unearthly episode. He also finds that others scoff, so he stops telling other people. Still, the experience affects his life profoundly, especially his views about death and its relationship to life.

No one is sure why such experiences are reported. Various explanations have been suggested (Siegel, 1981). One is that it suggests there may be a pleasant afterlife. This explanation gives comfort to those who dislike seeing death as an absolute end. Another explanation, however, is that these near-death experiences are nothing more than hallucinations triggered by chemicals released by the brain or induced by lack of oxygen to the brain. Scientists involved with near-death research acknowledge that so far there is no conclusive evidence that these near-death experiences prove there is life after death.

Nelson, Mattingly, and Schmitt (2007) suggest that some people may be biologically predisposed to near-death experi- ences. They interviewed 55 Europeans who said they had had such experiences. The researchers found that these research subjects also had these experiences in the transition between wakefulness and sleep. The researchers theorized that such peo- ple may have disturbances in the brain’s arousal system that permit an intrusion of REM sleep elements when they are not quite asleep, bringing on temporary visual hallucinations.

SOURCE: Raymond A. Moody, Jr., 1975, Life After Life. New York: Bantam Books, pp. 21–23. Reprinted by permission of the copyright owner, Mockingbird Books, St. Simon’s Island, GA.

Psychological Aspects of Later Adulthood 669

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Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.

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