8: Dying, Death and Bereavement Flashcards
(13 cards)
Death
is typically defined as the irreversible cessation of all vital functions, particularly brain activity, breathing, and heartbeat.
Dying
refers to the process of decline leading to death, which may be sudden or prolonged.
Grief
Grief is a natural emotional response to loss, most commonly associated with death but also triggered by other significant life changes, such as divorce, illness, unemployment, or the loss of identity. Loss can be tangible (e.g., the death of a loved one) or intangible (e.g., the loss of safety or independence). The experience of grief varies widely based on individual, relational, cultural, and developmental factors. For children, grief may manifest in behavioural changes, confusion, or anxiety. Adolescents may experience grief as identity-shaping and struggle with feelings of injustice or isolation.
Grief can be acute, chronic, or complicated, depending on the circumstances and the individual’s coping mechanisms. Anticipatory grief can occur when death is expected, while disenfranchised grief refers to loss that is not socially acknowledged or supported (e.g., miscarriage, suicide, or the death of a pet). Bereavement is the state of having experienced a loss, while mourning refers to the outward expression of grief, which is shaped by cultural and religious traditions. The support of family, community, and professionals can significantly affect how individuals move through grief. Human service professionals must be sensitive to the various forms grief can take and the unique needs that arise at different life stages.
Expected death
When a death is expected, such as with terminal illness, loved ones may experience anticipatory grief—a process of mourning that begins before the person has died. This can allow for emotional preparation, time to say goodbye, and a sense of closure. People may feel relief when suffering ends, though this can sometimes be accompanied by guilt. The grieving process may feel more structured, with fewer unanswered questions and a clearer opportunity for support planning, including rituals and farewells.
Unexpected death
In contrast, unexpected deaths can trigger intense shock, disbelief, and confusion. The absence of warning often leaves mourners unprepared and struggling with unanswered questions, guilt, or trauma, especially in cases involving violence, suicide, or young people. These deaths are often associated with complicated grief, where the bereavement process is prolonged or more emotionally disruptive. Sudden losses may also delay acceptance or disrupt the ability to engage in rituals, which are important for processing grief. Support needs tend to be greater in these circumstances, especially when trauma or legal processes are involved.
Elisabeth Kübler-Ross’s five stages of grief
denial, anger, bargaining, depression, and acceptance
remain one of the most widely known models. Originally developed to describe the emotional journey of terminally ill individuals facing their own death, the model has since been widely applied to various types of loss. These stages do not necessarily occur in a set order and may not be experienced by everyone. Instead, they represent common emotional responses that can arise during the grieving process. The model’s influence has been significant in both clinical and popular understandings of grief. Importantly, the Five Stages model is applicable beyond death-related loss. It is often used to understand grief in contexts such as divorce, job loss, chronic illness, infertility, or the diagnosis of a disability. These situations may provoke similar feelings of denial, anger, and sadness as people come to terms with unexpected change or the loss of anticipated futures. While her framework brought attention to the emotional processes of dying, it has been critiqued for its linear and universal assumptions. More recent models acknowledge that grief is dynamic and non-linear.
Worden’s Tasks of Mourning
suggest that bereaved individuals actively work through tasks such as accepting the reality of the loss, processing the pain, adjusting to life without the deceased, and maintaining a continuing bond while finding a path forward.
The Dual Process Model, developed by Stroebe and Schut,
proposes that healthy grieving involves oscillating between loss-oriented and restoration-oriented coping. This model recognises the need for both grieving and adapting to new realities, and that individuals may move back and forth between these two modes. These models reflect a more personalised understanding of bereavement and highlight the role of meaning-making, resilience, and cultural context in how people experience and recover from loss.
Understanding Death Across the Lifespan and Over Time
Children’s understanding of death develops gradually and is closely linked to cognitive development. Young children may see death as temporary or reversible and struggle with the idea of permanence. As they mature, they begin to understand death as universal and irreversible. Adolescents have the cognitive ability to understand abstract concepts about death but may still struggle with emotional regulation and risk-taking, which can influence how they respond to loss. Adults often experience death more personally, through the loss of loved ones or reflections on their own mortality. Older adults may experience increased acceptance of death, particularly when it is viewed as a natural conclusion to life.
societal understandings of death and dying have shifted
Over time, societal understandings of death and dying have shifted. In the past, death often occurred at home and was a more visible part of everyday life. Today, in many Western societies, death has become medicalised and privatised, with many people dying in hospitals or aged care facilities. This shift has led to less public discussion about death and, in some cases, increased fear and anxiety. However, movements like death cafés, advance care planning, and palliative care advocacy are helping to normalise conversations about dying and to return death to a more integrated place within communities.
Pauline Boss and ambiguous loss
The term ambiguous loss emerged from Pauline Boss’s work with families of soldiers missing in action during the Vietnam War. These families experienced profound emotional distress because their loved ones were neither clearly alive nor confirmed dead, leaving them in an ongoing state of grief and uncertainty. Boss observed that traditional grief theories did not adequately capture this experience, as there was no clear point at which mourning could begin or end. Over time, she recognised similar patterns of unresolved loss in other contexts, such as divorce, adoption, immigration, and later, in conditions like dementia. Her work challenged the prevailing psychological emphasis on “closure” and instead introduced a new framework for understanding grief when resolution is impossible.
These early observations led Boss to formalise the concept of ambiguous loss, which she categorised into two distinct types: physical absence with psychological presence, and physical presence with psychological absence. The former includes situations such as natural disasters, missing persons, or incarceration, where loved ones are gone but not definitively lost. The latter is common in cases of dementia, brain injury, or mental illness, where the person remains physically present but is altered or unreachable in meaningful ways. Boss’s theory brought attention to how these unresolved losses can destabilise family roles, identity, and rituals, and how uncertainty itself can be traumatising. Her work laid the foundation for therapeutic approaches that focus on meaning-making, tolerance for ambiguity, and adapting to an ongoing, unclear loss rather than seeking finality.
The Role of Helping Professionals
Helping professionals have a critical role in supporting individuals and communities through death, dying, and bereavement. Their responsibilities may include psychosocial assessments, grief counselling, advocacy, education, and helping clients navigate practical and emotional challenges at the end of life. Professionals may work in various settings, including palliative care, aged care, hospitals, schools, and community organisations. They must be skilled in active listening, emotional regulation, and culturally safe communication. A trauma-informed approach is vital in recognising how past experiences of loss, violence, or marginalisation may affect current experiences of grief.
Ethical practice, reflective supervision, and self-care are also essential in this field, as professionals are often exposed to emotionally demanding work. Vicarious trauma and compassion fatigue are recognised occupational risks. Maintaining professional boundaries, seeking support, and engaging in ongoing learning are important strategies for sustaining one’s capacity to provide empathetic and effective care. By fostering dignity, choice, and respect, helping professionals can make a profound difference in how individuals and families experience and process death and loss.
