Crlef, ueaLh And uylng

vlvlenne S. Caguloa-Cleofas, Mu,llA

Learnlng Cb[ecLlves
1o know Lhe deflnlLlon of deaLh, LhanaLology, grlef, mournlng and bereavemenL
1o know Lhe dlfferenL reacLlons Lo deaLh
1o know Lhe aLLlLudes Lowards deaLh -llfe cycle
1o know Lhe dlfferenL Lypes of grlef
1o know how Lo deal wlLh grlef

1hanato|ogy
SLudy of Lhe experlences of dylng and bereavemenL

Death
ueflnlLlon: Lhe absoluLe cessaLlon of vlLal funcLlons
u?lnC: Lhe process of loslng Lhese funcLlons
uylng, and Lhe lndlvldual's awareness of lL, lmbues humans wlLh values, passlons, wlshes and
Lhe lmpeLus Lo make Lhe mosL of Llme

Cood ueaLh: one LhaL ls free from avoldable dlsLress and sufferlng for paLlenLs, famllles and
careglvers and ls reasonably conslsLenL wlLh cllnlcal, culLural and eLhlcal sLandards

8ad ueaLh: characLerlzed by needless sufferlng, a dlshonorlng of paLlenL or famlly wlshes or
values, and a sense among parLlclpanLs or observers LhaL norms of decency have been offended

8eacLlons 1o ueaLh
1lmely
unLlmely
lnLenLlonal
unlnLenLlonal
SublnLenLlonal

LllsabeLh kubler-8oss (lmpendlng deaLh)
SLage 1: Shock and uenlal
SLage 2: Anger
SLage 3: 8argalnlng
SLage 4: uepresslon
SLage 3: AccepLance





8eacLlons 1o ueaLh
Mardl PorowlLz
CuLcry
uenlal and lnLruslon
Worklng 1hrough
CompleLlon

8eacLlons 1o ueaLh

1herese 8ando's 6 8s
8ecognlze Lhe loss
8eacL
8ecollecL and 8e-experlence
8ellnqulsh
8ead[usL
8elnvesL

ALLlLudes 1oward ueaLh Across 1he Llfe Cycle
CPlLu8Ln
!ean lageL
re-schoo| (< S y.o.) - an|m|st|c
er|operat|ona| stage
a Lemporary absence, lncompleLe and reverslble, llke deparLure or sleep
SeparaLlon from prlmary careglver ls a maln fear
S - 10 y.o. - lnevlLable human morLallLy
ConcreLe operaLlonal Lhlnklng
ueaLh ls a flnal reallLy LhaL happens Lo old people noL chlldren
usually have acLlve fanLasles of vlolence and aggresslon domlnaLed by Lhemes of deaLh
and kllllng

Ado|escents
lormal concreLe operaLlons
ueaLh ls lnevlLable and flnal buL may noL accepL posslblllLy of Lhelr own deaLh
CreaL poLenLlal for lsolaLlon and wlLhdrawal

uberty
unlversal, lnevlLable, lrreverslble






Iohn 8ow|by
hase 1 : roLesL
hase 2 : uespalr
hase 3 : ueLachmenL

Lr|ck Lr|ckson

?oung adulLs - focus on mlsslng Lhe chance Lo marry
Mlddle age - frusLraLed ln Lhelr plans Lo en[oy hard earned pleasure
Clder age - confronL lncreaslng reallLy of Lhelr own morLallLy , lnLegrlLy vs despalr

Spousa| 8ereavement

among Lhe mosL sLressful of all llfe experlences
Clder adulLs have more favorable ouLcome
uepresslve sympLoms peak wlLhln Lhe flrsL few monLhs buL decllne slgnlflcanLly wlLhln a year

Gr|ef

emoLlonal &/or psychologlcal reacLlon Lo any loss, noL llmlLed Lo deaLh


Mourn|ng

rocess by whlch grlef ls resolved
socleLal expresslon of posL bereavemenL behavlor and pracLlces

8lLuals for mournlng

Wake, lnLernmenL
8lLuals for dlsposlng Lhe body
8lLuals for lnvocaLlon of rellglous ceremonles
8lLuals for perlodlc offlclal remembrances
luneral
prevalllng dlsplay of bereavemenL







8ereavement
SLaLe of belng deprlved of someone by deaLh and belng ln Lhe sLaLe of mournlng

8ereavemenL
! SLages accordlng Lo 8owlby
SLage 1 : early phase of acuLe despalr
(numbness and proLesL)
SLage 2: phase of lnLense yearnlng
and searchlng

SLage 3 : phase of dlsorganlzaLlon
and despalr
SLage 4: phase of reorganlzaLlon

8ereavement |n ch||dren

SympLoms lndlcaLlng ma[or depresslve dlsorder exceedlng usual bereavemenL
CullL relaLed Lo lssues beyond Lhose surroundlng Lhe loved one
reoccupaLlon wlLh deaLh oLher Lhan LhoughLs of belng dead
A chlld's grlef can be lnfluenced by hls or her age, personallLy, developmenLal sLage,
earller experlences wlLh deaLh, hls or her relaLlonshlp wlLh Lhe deceased
?ounger Lhan 2 yo - loss of speech dlffuse dlsLress
?ounger Lhan 3 yo - eaLlng, bowel and bladder dysfuncLlons, sLrong feellngs of sadness,
fear, anxleLy
School aged - phoblc, hypochondrlacal, wlLhdrawn, psuedomaLure, school performance
suffers
AdolescenLs - behavloral problems, somaLlc sympLoms erraLlc moods Lo sLolclsm

Symptoms |nd|cat|ng ma[or depress|ve d|sorder exceed|ng usua| bereavement

CullL abouL Lhlngs oLher Lhan acLlons Laken or noL Laken by Lhe survlvor aL Lhe Llme
of deaLh
Morbld preoccupaLlon wlLh worLhlessness

Marked psychomoLor reLardaLlon
rolonged marked funcLlonal lmpalrmenL
PalluclnaLory experlences



Gr|ef

uuraLlon
CulLural
ulcLaLed by socleLy
ln chlldren depends on supporL sysLem
lonellness

AnLlclpaLory Crlef
Annlversary 8eacLlons

Norma| Gr|ef
Uncomp||cated Gr|ef

ldenLlfylng wlLh Lhe deceased Laklng on LralLs/ possesslons
hear fleeLlng, LranslenL volce
denlal of cerLaln aspecLs of Lhe deceased

atho|og|ca| Gr|ef
belleves he ls Lhe dead person or dylng of Lhe same dlsease
perslsLenL, lnLruslve complex audlLory halluclnaLlons
dead person sLlll allve


Norma| Gr|ef
- dlsbellef, denlal shock
rofound sadness survlval gullL lnLacL self esLeem
Sense of unreallLy wlLhdrawal
Anger and lrrlLablllLy

atho|og|ca| Gr|ef
uenlal delayed or absenL grlef
uepresslon lmpalred self esLeem sulcldal
rogresslve soclal lsolaLlon
PosLlllLy paranold reacLlons







Gr|ef
mood flucLuaLlons
waves, washes over
Llme llmlLed

Depress|on
mood dlsLurbance ls pervaslve, unremlLLlng
hopeless


Crlef

A normal albelL, lnLensely palnful sLaLe LhaL ls responslve Lo supporL, empaLhy and passage of
Llme

Self-reproach common
Survlvor gullL

Ma[or Depress|ve D|sorder

oLenLlally a medlcal emergency LhaL requlres lmmedlaLe lnLervenLlon Lo foresLall a
compllcaLlon llke sulclde

DIIILkLN1IA1ING 8LkLAVLMLN1 from
MAICk DLkLSSICN
DIIILkLN1IA1ING 8LkLAVLMLN1 from
MAICk DLkLSSICN
DIIILkLN1IA1ING 8LkLAVLMLN1 from
MAICk DLkLSSICN
8lology Cf Crlef
Acute Gr|ef
dlsrupLlon of blologlcal rhyLhms
lmpalred lmmune funcLlonlng
decreased lymphocyLe prollferaLlon
lmpalred funcLlonlng of naLural klller cells







8lology Cf Crlef
AcuLe Crlef
MorLallLy raLe for wldows and wldowers followlng Lhe deaLh of a spouse ls hlgher Lhan
LhaL ln Lhe general populaLlon
Wldowers appear Lo be aL rlsk longer Lhan wldows

ueallng WlLh Crlef
hyslclan responses
ofLen reflecL underlylng aLLlLudes Loward deaLh
ueaLh as a personal fallure or LhreaL Lo personal lmmorLallLy
medlcal Lralnlng focuses almosL enLlrely on Lhe conLrol and eradlcaLlon of dlsease aL Lhe
expense of care and comforL of Lhe person wlLh Lhe dlsease

Awareness of own aLLlLudes Loward deaLh and dylng
unconsclous feellng of omnlpoLence and power of prevenLlng deaLh
some go lnLo Medlclne because of own unconsclous fears of deaLh

ueallng WlLh Crlef
CompasslonaLe care
Pallmarks of ApproprlaLe Care
vlslLlng Lhe paLlenL regularly
malnLalnlng eye conLacL
Louchlng approprlaLely
llsLenlng Lo whaL Lhe paLlenL have Lo say
belng wllllng Lo answer all quesLlons ln a respecLful way

reparlng Lhe famlly for Lhe probablllLy LhaL a loved one wlll dle
Lncourage Lhe famlly's venLllaLlon of feellngs

Crlef 1herapy
regularly scheduled sesslons where grlevlng people are encouraged Lo Lalk abouL
feellngs of loss and abouL Lhe person who has dled
aLLachmenL Lo Lhe LheraplsL provldes Lemporary supporL unLll a sense of confldence
abouL Lhe fuLure develops
Death and 8ur|a| Customs
ChosL roLecLlon 8lLuals
mosL are pracLlced Lo proLecL Lhe llvlng
Appease Lhe splrlLs LhoughL Lo have caused Lhe person's deaLh
ShuLLlng Lhe eyes of Lhe dead person
Coverlng Lhe face of Lhe dead
Carry Lhe dead ouL of Lhe house feeL flrsL
Mlrrors were covered
lamlly phoLographs Lurned face down
CemeLerles
1ombsLones Lo welgh down Lhe dead
Mazes aL Lhe enLrance of anclenL Lombs
8eaLlng on Lhe grave, flrlng of guns, funeral bells and walllng chanLs
8odles lle wlLh Lhelr heads Lo Lhe WesL and Lhelr feeL Lo Lhe LasL
I|||p|no ract|ces]k|tua|s
1he Wake or vlgll
Pouse, funeral parlor, church
usually lasLs for 3-7 days or longer
24 hours
novenas, prayers, mass everyday
nearesL kln slLs beslde Lhe coffln

1he 8equlem Mass/luneral
Walk behlnd Lhe funeral car
SLop aL Lhe church afLer mass relaLlve wlll make a speech
Crave slLe
Pouse of Lhe famlly
Chlldren are passed over Lhe coffln
40 uays
Superst|t|ous 8e||efs
leed Lhe mourners, buL don'L walk Lhem Lo Lhe door when Lhey leave.
uon'L sweep Lhe floor whlle Lhe body ls sLlll lylng ln sLaLe or else oLher deaLhs ln Lhe famlly may
follow
no Lears should fall on Lhe dead or Lhe coffln as lL would make a person's [ourney Lo Lhe
afLerllfe dlfflculL
When someone sneezes aL Lhe wake, plnch hlm
uurlng Lhe wake Lhe dead person's relaLlves musL noL Lake a baLh.
lood from Lhe wake should noL be broughL home because lL's belleved LhaL Lhe dead Louches
all of lL
AfLer a funeral servlce, guesLs should noL go dlrecLly home. 1hls way Lhe splrlL of Lhe dead won'L
follow Lhem Lo Lhelr house
When carrylng a coffln ouL for burlal, lL should be carrled head flrsL as lL prevenLs Lhe soul of Lhe
dead from comlng back
lamlly members should wear black or whlLe, colors are prohlblLed
Weddlngs, blrLhdays, and oLher soclal acLlvlLles should noL be celebraLed for one year
1he wldow, chlldren, and lmmedlaLe famlly members are prohlblLed from carrylng Lhe coffln or
else Lhey wlll become lll and dle
Whlle Lhe caskeL ls on lLs way Lo Lhe cemeLery or Lhe church, relaLlves who preferred Lo sLay aL
home should noL have a gllmpse of Lhe caskeL or else someone ln Lhe famlly would dle.


Lnd of LecLure