Amy Chan (amychan@uow.edu.

au)

Acknowledgement: Some of these lecture slides are based on

lecture materials previously prepared by Professor Patrick Heaven. 1

 Define the crucial features of end of life

 Outline developmental differences in conceptions
of death
 Appreciate psychological research on attitudes
about death and dying
 Describe and appraise a theoretical model on the
emotional needs of the dying person
 Become familiar with psychological research on
grief and bereavement

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Prenatal Conception to birth

Infancy and toddlerhood Birth‒2 years

Early childhood 2‒6 years

Middle childhood 6–11 years

Adolescence 11‒18 years

Early adulthood 18‒40 years

Middle adulthood 40‒65 years

Late adulthood 65 years‒death

Leading causes of death vary across the life span:

 Prenatal death through miscarriage
 SIDS is a leading cause of infant death in
Australia
 Accidents or illness cause most childhood
deaths
 Most adolescent and young adult deaths
result from suicide or motor vehicle accidents
 Middle-aged and older adult deaths usually
result from chronic diseases

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 Increase understanding of physical, psychological
changes in dying
 Enhance awareness of medical, funeral service,
memorial service options
 Promote understanding of social, ethical issues
 Improve communication with others about death-
related concerns
 Help students prepare for their professional roles
 Foster appreciation of how lifespan development
interacts with death, dying, and bereavement issues

 A normal part of the human lifespan

 Can occur at any age

 Thanatology: the study of death and dying

 Biological characteristics
 Irreversibility (Finality): cannot be undone
 Non-functionality: cessation of all life functions
(physiological, psychological, behavioural capacities)
 Universality: inevitable process that occurs to all
living things
 Causality: brought about by distinct causes leading
to cessation of life functions
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 Cognitive developmental perspective: focusses on
conceptions of death
 E.g., Age-related differences in children’s understanding
of biological aspects of death
 Influence of context (e.g., culture, family) on this
understanding

 Clinical perspective: focusses on bereavement and

emotional aspects of death
 Attitudes toward death
 The dying process
 The experience of grief and bereavement

 Death as a taboo subject in some

cultures
 assumption about potential
traumatic impact on children 
“protection” from death education
 BUT… Not all cultures associate death
with mourning or sadness
 E.g., Dia de los Muertos (Day of the
Dead) in Latin America: recognises
and celebrates death as natural part
of the human experience

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 Piaget (1929)
 Emerging understanding around 6-7 years
 Understanding of death solidifies around 9-
10 years

 Proposal regarding children’s initial

conceptualisation
▪ Life   motion; death  inactivity
▪ Confusion between fantasy and reality

 Before ~5 years
 Death = temporary state, reduction of life, sleep
 egocentric thinking  assume responsibility; expect
reversibility of death

 ~5 years
 Understand finality and irreversibility of death
 Poor understanding of universality of death

 ~9 years
 Understand universality of death
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 Substantial improvement between 4 and 6 years in
understanding of death components (Nguyen &
Gelman, 2002; Rosengren, Gutiérrez, & Schein, 2014)

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 What determines 5-year-olds’ likelihood of

attributing biological and psychological
properties to both living and dead things?
E.g.
 Family religiosity (Rosengren et al., 2014)
 Culture: E.g., Mexican American children more likely
than European American children (Gutiérrez,
Rosengren, & Miller, 2014)

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  Death anxiety scale (Templer, 1970) –
e.g.,
 “I am very much afraid to die”
 “It doesn’t make me nervous when people
talk about death.”

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 Adolescence
 Develop more abstract conceptions about death than
children
 Personal fable: feelings of uniqueness  beliefs of
invincibility  Death regarded as remote and may be
avoided, glossed over or kidded about
▪ Likely reactions to personal experience of dying (e.g.,
terminal illness): denial, anger
 Deaths of friends, siblings, parents or grandparents bring
death to the forefront of adolescents’ lives

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  Older adults are less anxious about death than
younger and middle-aged adults (Feifel &
Branscomb, 1973)
 Old age is not necessarily associated with
preoccupation with personal death (Feifel &
Nagy, 1980)

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 Middle Adulthood
 Life-threatening disease not surprising
 Fear of death often greater than that in younger or older
adults – why?
 Late adulthood
 Realize death is imminent
 Face an increasing number of deaths in their environment
▪ Older adults are forced to examine the meanings of life
and death more frequently than younger adults
 Less anxious about dying

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Fortner, Neimeyer, and Rybarczyk (2000)

 Having had more physical problems

 History of psychological distress
 Weaker religious beliefs
 Lower life satisfaction (Note: “ego
integrity” in Erikson’s theory)

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 Are low scores on death anxiety low anxiety or

high denial?
 University students over-represented in
samples
 One-shot studies; need longitudinal research;
how do attitudes change over time? Do they
change with context?, etc.
 No link between attitudes and behaviours
usually associated with death or in dealing with
the death of others.

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 Denial

Acceptance Anger

Depression Bargaining

 Not a fixed sequence, rather coping strategies

 Dying people respond in many additional ways 19

PROS
One of the first researchers
to observe systematically how
people approach their own
deaths
Increased public awareness
and affected practices and
policies related to dying
CONS
Largely limited to those who
are aware that they are dying
Less applicable to people
who suffer from diseases in
which the prognosis is
uncertain
Stage-like increments not
substantiated by independent
research
Anxiety levels and situational
factors not taken into account

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 Grief: internal emotional responses to one’s
loss
 What one feels and thinks

 Bereavement: acknowledging the objective

fact that someone has died
 External – involves social expression of grief

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1. Avoidance
 Shock, numbness, denial
 can be adaptive; permits completion of psychologically
difficult tasks
2. Confrontation of death and loss
 Acknowledge permanent separation from the dead person
 Likely to experience deep emotions (e.g., unhappiness and
depression)
3. Accommodation/Restoration
 Construct one’s new identity
 Can support personal growth and self reliance

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 No universal stages

 Different pathways due to

 Personality
 Relationship with the deceased person
 Opportunities to re-establish and continue with
one’s life

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Dual-process model of coping (Stroebe, Schut, &

Boerner, 2010)
 Two main dimensions
 Loss-oriented stressors: focus on the deceased individual –
e.g., reappraisal that suffering has ended
 Restoration-oriented stressors: secondary stressors that
emerge as indirect outcomes of bereavement – e.g.,
changing identity
 Effective coping involves oscillation between coping
with loss and coping with restoration
 Cognitive factors are involved in the severity of grief
– e.g., negative beliefs, self-blame
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 intrinsic

external

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Kastenbaum (2007): children acutely aware;

concerned about separation and loss

Research shows that

 Children grieve
 Express their grief differently than adults do
 Lack some of the coping resources that adults have
 Vulnerable to long-term negative effects (e.g.
Silverman, 2000).

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 Somatic: physical symptoms – e.g.
 Sleeping difficulties, bedwetting, stomach aches

 Intrapsychic: emotional and psychological symptoms – e.g.

 Emotional distress, separation anxiety, guilt, fearing others
will also die
 Behavioural – e.g.,
 Temper tantrums, extreme shyness, being argumentative,
disobedience
 Very young children also likely to repeatedly ask questions
about the deceased (Christ, 2000)

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Oltjenbruns (2001)
 Younger age  lack of language skills  difficult to
express emotions
 Play, drawing, fantasy can be useful alternative modalities
to explore young children’s feelings (e.g., Christ, 2000)
 Characteristics of the deceased (e.g., relationship to
the child, nature of pre-death relationship)
 Family environment (e.g., size, cohesiveness,
coping style, SES)

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 Death is a normal life transition
 Many bereaved individuals feel they cope well; Feel
they have become stronger, wiser, more loving,
better appreciation of life (Tedeschi & Calhoun,
2004).
 Many widows master new skills; become more
independent, engage with new identities and higher
self-esteem (Carr, 2004).

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