Death and dying;
بسم الله الرحمن الرحيم
(كل نفس ذائقة الموت) صدق الله العظيم
بسم الله الرحمن الرحيم
(لموت ولوكنتم في بروج مشيدة) صدق الله العظيم
Death is the inevitable biological process that ends life and associated with psychological and environmental components. Health related behavior is of two types,the first is health promoting behaviors is when individuals behave in ways that maintain their physical fitness and act like prophylactic measures against fatal illnesses, while the second is the health compromising behaviors where the individuals ignorant behaviors lead to the development of illness like smoking ,alcohol consumption, substance abuse ,fatty diet ,sedentary life style, promiscuity. In developed countries heart diseases and cancer are among the leading causes of death after the end of twentieth century, followed by injury and accidents which refer to the modernization of life style, changes in diet, increase the psychological stresses of daily living.
However, people die in so many different ways but primarily it is of two type sudden and tragic death and the predicted death .Elisabeth kubler-Ross (1969)found that terminally ill patients often experienced five stages as they coped with impending death as follows;
1-Denial ; the patient refused to accept that the illness was terminal.
2-Anger ; the patient resisted the idea of dying and feel angry on others even relatives he wonder (why me?).
3-Bargaining ;the patient negotiate with God about prolonging his time to live.
4-Depression ;the patient began to grieve
5-Acceptance ;not all but most of the patients resigned a sense of peacefulness by accepting their fate.
These stages are not typically present in all patients ,in our Muslims cultures dying patients usually invest their religious beliefs in enhancing their morals as death in Islamic religion is a move to the after death math where the believer can be rewarded for his/her good deeds. In cases of sudden death, there will be no time for these stages in the dead person but it will be more traumatic and lead to prolonged or pathological grief process.
Grief process;
Bereavement is the normal reaction to loss of a loved one by death; the bereaved person passes through stages last till the end months.
1-Shock ;it is the immediate reaction to the bad news within hours to days ,the bereaved person feels numb and unable to express the grief.
2-Denial ; last from days to weeks as the bereaved person refuses to believe the idea of loosing the diseased one forever.
3-Grief process take place, expressing feelings of sadness, despair, depression and anxiety symptoms may prevail, associated sleep disturbances, bouts of weeping, loss of appetite, loss of weight, death wishes, guilt feelings or blaming others
4-Pseudo hallucinations about the voice and scene of the diseased one and feeling his/her presence.
5-Acceptance; of the permanent loss and acting through the grief ,like solving death related problems, the inheritance, pension ,making adaptation in residence and job.
6- Resolution; going back to the normal life style before death and regaining social and occupational functioning usually before six months.
This normal psychological process can be complicated or prolonged by the effects of many factors ,the pathological grief is maintaining the same early symptoms for more than six months or failure to reach to the stage of resolution, presence of pseudo hallucinations, or clinical depression as sever and persistent or elongated.
Factors complicating normal grief:
-sudden death specially for young age groups.
- Violent death like suicide and killing lead to sever guilt feelings and anger ,drive to revenge.
-previous psychiatric record.
-lack of social and family support.
Severity of grief depends on the emotional attachment of the diseased to the bereaved person ,he /she must be a key figure in the bereaved person's emotional life.
The above stages of development are important subject to study in order to understand people's behaviors and reactions to life adversities.
Psychology of death and dying;
Death is becoming recognized as the central dynamism underlying the life, vitality, and structure of the social order. Death is the corner of our religions, philosophies, political ideologies, arts and medical technologies. It is the barometer by which we measure the adequacy of social life, such as when we compare cross-cultural death and life expectancy rates to gauge social progress, compare national homicide rates to infer the stability of social structures, or compare death rates of different social groups to social demands. In fact, perhaps the very first evidence of humanity is based on funerary evidence: the discovery of the remains of first man , whose deformity and yet relative longevity indicate that he had probably been supported by others, and who was buried in a fetal position and covered with flowers. Death exposures can similarly crystallize and invigorate individuals' own life pathways. In his study of patients having had brushes with death, cardiologist Michael Sabom(, 1976) found that for the 43 percent who had near death experience ,the experience did more to change the depth and direction of their approach to life than had any other life event. Whether we acknowledge it or not, most of us fear death. Death remains a great mystery, one of the central issues with which religion and philosophy and science have wrestled since the beginning of human history. Even though dying is a natural part of existence, human culture is unique in the extent to which death is viewed as a taboo topic. Rather than having open discussions, we tend to view death as a feared enemy that can and should be defeated by modern medicine and machines. Our language reflects this battle mentality, we say that people "combat" illnesses, or (in contrast) "fall victim" to them after a "long struggle." Special type of language also gives us distance from our discomfort with death. People who die are "no longer with us", have "passed", gone "to meet their Maker", bought the farm, kicked the bucket", and so on. Some of the discomfort with the death and dying process has come about because death has been removed from common experience. Typically, we no longer die at home surrounded by family and friends, but in hospitals and other health care facilities.This lack of personal experience with death and dying only adds to our sense of trepidation and fear. HYPERLINK "http://www.mentalhelp.net/poc/view_doc.php?type=news&id=129034&cn=174" Family Caregivers Share Experiences of Dying Patients HYPERLINK "http://www.mentalhelp.net/poc/view_doc.php?type=news&id=128159&cn=174" After Violent Death, Bereaved Should Decide Whether to View Body HYPERLINK "http://www.mentalhelp.net/poc/view_doc.php?type=news&id=127121&cn=174" Advance Directives Help Assure End-of-Life Wishes Are Honored HYPERLINK "http://www.mentalhelp.net/poc/view_doc.php?type=news&id=126921&cn=174" End-of-Life Care Planning Eases Stress for Relatives
Bereavement
Bereavement is a distressing but common experience. Sooner or later most of us will suffer the death of someone we love. Yet in our everyday life we think and talk about death very little, perhaps because we encounter it less often than our grandparents did. For them, the death of a brother or sister, friend or relative, was a common experience in their childhood or teenage years. For us, these losses usually happen later in life. So we do not have much of a chance either to learn about grieving - how it feels, what are the right things to do, what is 'normal' - or to come to terms with it. In spite of this, we have to cope when we are finally faced with the death of someone we love.
Grieving
People grieve after loss, but most powerfully after the death of someone we love. The normal grief will resolve usually in a matter of 6 months and hs three stages if it is last more than 6 months or the symptoms still sever (not resolved) it will be called pathological or unresolved grief ,It is not just one feeling, but a whole succession of feelings, which take a while to get through and which cannot be hurried, people most often grieve for someone that we have known for some time. However, it is clear that people who have had stillbirths or miscarriages, or who have lost very young babies, grieve in the same way and need the same sort of care and consideration, the first few hours or days following the death of a close relative or friend, most people feel simply shocked, as though they cannot believe it has actually happened. They may feel like this even if the death has been expected, this sense of emotional numbness can be a help in getting through all the important practical arrangements that have to be made, such as getting in touch with relatives and organizing the funeral. However, this feeling of unreality may become a problem if it goes on too long. Seeing the body of the dead person may, for some, be an important way of beginning to overcome this. Similarly, for many people, the funeral or memorial service is an occasion when the reality of what has happened really starts to sink in. It may be distressing to see the body or attend the funeral, but these are ways of saying goodbye to those we love. At the time, these things may seem too painful to go through and so are not done. However, this can lead to a sense of deep regret in future years, soon though, this numbness disappears and may be replaced by a dreadful sense of agitation, of pining or yearning for the dead person. There is a feeling of wanting somehow to find them, even though this is clearly impossible. This makes it difficult to relax or concentrate and it may be difficult to sleep properly. Dreams can be very upsetting. Some people feel that they see their loved one everywhere they go - in the street, the park, around the house, anywhere they had spent time together. People often feel very angry at this time - towards doctors and nurses who did not prevent the death, towards friends and relatives who did not do enough, or even towards the person who has, by dying, left them. Another common feeling is guilt ,people find themselves going over in their minds all the things they would have liked to have said or done. They may even consider what they could have done differently that might have prevented the death. Of course, death is usually beyond anyone's control and a bereaved person may need to be reminded of this. Some people may feel guilty if they feel relieved that their loved one has died after a painful or distressing illness. This feeling of relief is natural, understandable and very common. This state of agitation usually strongest about two weeks after the death, but is soon followed by times of quiet sadness or depression, withdrawal and silence. These sudden changes of emotion can be confusing to friends or relatives, but are part of the normal process of grief. Although the agitation lessens, the periods of depression become more frequent and reach their peak between four and six weeks later. Spasms of grief can occur at any time, sparked off by people, places or things that bring back memories of the dead person. Other people may find it difficult to understand or be embarrassed when the bereaved person suddenly bursts into tears for no obvious reason. At this stage it may be tempting to keep away from other people who do not fully understand or share the grief. However, avoiding others can store up trouble for the future, and it is usually best to start to return to one's normal activities after a couple of weeks or so. During this time, it may appear to others as though the bereaved person is spending a lot of time just sitting, doing nothing. In fact, they are usually thinking about the person they have lost, going over again and again both the good times and the bad times they had together. This is a quiet, but essential part of coming to terms with the death. As time passes, the fierce pain of early bereavement begins to fade. The depression lessens and it is possible to think about other things and even to look again to the future. However, the sense of having lost a part of oneself never goes away entirely. For bereaved partners there are constant reminder of their new singleness, in seeing other couples together and from the deluge of media images of happy families. After some time it is possible to feel whole again, even though a part is missing. Even so, years later you may sometimes find yourself talking as though he or she were still here with you. These various stages of mourning often overlap and show themselves in different ways in different people. Most recover from a major bereavement within one or two years. The final phase of grieving is a letting-go of the person who has died and the start of a new sort of life. The depression clears completely, sleep improves and energy returns to normal. Sexual feelings may have vanished for some time, but now return - this is quite normal and nothing to be ashamed of.In addition, people from different cultures deal with death in their own distinctive ways. Over the centuries, people in different parts of the world have worked out their own ceremonies for coping with death. In some communities death is seen as just one step in the continuous cycle of life and death rather than as a 'full stop'. The rituals and ceremonies of mourning may be very public and demonstrative, or private and quiet. In some cultures the period of mourning is fixed, in others not. The feelings experienced by bereaved people in different cultures may be similar, buttheir ways of expressing them are very different.
Children and adolescents ;
Children may not understand the meaning of death until they are three or four years old, they feel the loss of close relatives in much the same way as adults. It is clear that, even from infancy, children grieve and feel great distress. However, they have a different experience of time from that of adults, and may go through the stages of mourning quite rapidly. In their early school years, children may feel responsible for the death of a close relative and so may need to be reassured. Young people may not speak of their grief for fear of adding extra burdens to the grown-ups around them. The grief of children and adolescents, and their need for mourning, should not be overlooked when a member of the family has died. They should usually, for instance, be included in the funeral arrangements.Bereavement following a suicide; It can be particularly hard to deal with the death by suicide of known person ,as the grieving process will be complicated with different emotions which are:
Anger with the person for taking their own life.
Rejection by what they have done.
Confusion as to why they did it.
Guilt - most people take their own life as an act of desperation. How could the person not have noticed how they were feeling?
Worries about whether they suffered.
Relief that you no longer have to be there to support them or deal with their suicidal thoughts and urges.
shame by what they did - particularly if your culture or religion sees suicide as sinful or disgraceful.
Reluctance to talk to other people about it because: the stigma of suicide in your culture; and the feeling that other people are more interested in the drama of the situation rather than the feelings or the person who has died.
Worries about thoughts of suicide that the person may have had yourself.
Isolation - it can help to talk to other people who have lost a loved one through suicide. An autopsy is usuallydone after any unexpected death. If this goes against your religious or cultural beliefs, you need to make the Coroner and any professionals involved, aware of this as soon as possible. Others may find it hard to understand why the bereaved person has to keep talking about the same things again and again, but this is part of the process of resolving grief and should be encouraged. If you don't know what to say, or don't even know whether to talk about it or not, be honest and say so. This gives the bereaved person a chance to tell you what he or she wants. People often avoid mentioning the name of the person who has died for fear that it will be upsetting. However, to the bereaved person it may seem as though others have forgotten their loss, adding a sense of isolation to their painful feelings of grief. Practical help with cleaning, shopping or looking after children can ease the burden of being alone. Elderly bereaved partners may need help with the chores that the deceased partner used to handle - coping with bills, cooking, housework, getting the car serviced and so on. It is important to allow people enough time to grieve. Some can seem to get over the loss quickly, but others take longer. So people don't expect too much too soon from a bereaved relative or friend - they need the time to grieve properly, and this will help to avoid problems in the future.
Unresolved grief
There are people who seem hardly to grieve at all. They do not cry at the funeral, avoid any mention of their loss and return to their normal life remarkably quickly. This is their normal way of dealing with loss and no harm results, but others may suffer from strange physical symptoms or repeated spells of depression over the following years. Some may not have the opportunity to grieve properly. The heavy demands of looking after a family or business may mean that there just isn't the time, the problem is that the loss is not seen as a 'proper' bereavement. This happens often, but by no means always, to those who have had a miscarriage or stillbirth, or even an abortion. Again, frequent periods of depression may follow. The early sense of shock and disbelief just goes on and on. Years may pass and still the sufferer finds it hard to believe that the person they loved is dead. Others may carry on being unable to think of anything else, often making the room of the dead person into a kind of shrine to their memory. Depression that occurs with every bereavement may deepen to the extent that food and drink are refused and thoughts of suicide arise. If some one is unable to resolve the grief help can be arranged through their GP or one of the valuable voluntary or religious organizations. For some, it will be enough to meet people and talk with others who have been through the same experience. Others may need to see a bereavement counselor or psychotherapist, either in a special group or on their own for a while. Bereavement turns our world upside-down and is one of the most painful experiences we endure. It can be strange, terrible and overwhelming. In spite of this, it is a part of life that we all go through and usually does not require medical attention. Occasionally, sleepless nights may go on for so long as to become a serious problem. The doctor may then prescribe a few days' supply of sleeping tablets If the depression continues to deepen, affecting appetite, energy and sleep, antidepressants may be helpful; see our leaflet on antidepressants for more information. If the depression still does not improve, the general practitioner may well arrange an appointment with a psychiatrist. If someone is unable to resolve their grief, help can be arranged through their GP or one of the valuable voluntary or religious organizations. For some, it will be enough to meet people and talk with others who have been through the same experience.
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