Death ,Dying and

Bereavement
By Dr Shehla Effendi
Asst professor
department of psychiatry

 The harder the conflict, the more

glorious the triumph. What we
obtain too cheap, we esteem too
lightly; it is dearness only that
gives everything its value. I love
the man that can smile in trouble,
that can gather strength from
distress and grow brave by
reflection. 'Tis the business of little
minds to shrink; but he whose
heart is firm, and whose
conscience approves his conduct,
will pursue his principles unto
death." |
-Thomas Paine

Death can take the

power of metaphor
Some view death as
deserved punishment for
what are perceived as
immortal or sinful life
styles

Is there any near

death experience?
People view it as:
Feeling of peace and quiet
Entering a dark tunnel
Witnessing being of light
Returning to life to complete
unfinished business
A deep sadness leaving the new
dimensions

Impending Death
It is the reactions of the dying
people to the death by
Kubler Ross:
Shock and denial
Anger
Bargaining
Depression
Acceptance

I always read the last

page of a book first so
that if I die before I finish
I'll know how it turned out.
Nora Ephron

Shock and denial

Refusal to believe
Deny the fact
May do doctor shopping
Effective communication of the
doctor help in reassuring that
they will not be abandoned.

Anger
Why me?
Angry at God ,fate, friend
and family.
Blame /displacements
An empathic non defensive
response can defuse patient
as patients want to control
situation where they are
absolutely out of control.

BARGAINING
Negotiations to doctor,
friends and God.
Revise religious rituals
Give charity
Compliant, non
questioning to get the
best of care.

DEPRESSION

ACCEPTANCE
Death Is inevitable
Mood can be neutral to
euphoric
Fear not death , remember
those who have gone
before you and those who
will come after..
But not me!

Family interventions
Develop alliance with
them and allow family to
talk.
Try to help members to
talk and communicate
effectively.
Avoid conflicts .

Attitudes towards
death across life
cycle

Up to the age of 5: animistic

thinking.
b/w 5-10 concrete operations
fear that parents will die and
they will be abandonment.
9-10; conceptualize death as
can happen to him as well.

 Adolescents may be
preoccupied with the issues
related to body image and
environment.
Young adults feel
threatened by the potential
isolations.
Middle aged feel frustrated .
Older people accepts the
reality of mortality.

Grief mourning and

bereavement
Grief : the subjective feeling
precipitated by the death of a
loved one.
Mourning : process of resolving the
grief.
Bereavement: state of being
deprived of loved one by death
and refers to being in the state of
mourning.

Stages of grief
Stage 1
Denial ,numbness, shock,
disbelief, sighing and sense of
unreality. (hrs to days)
Stage 2
Anger, sadness, fatigue, guilt,
dreams thoughts, anhedonia and
introversion. (weeks to 6 mnths)

Stage3
Think about past with
pleasure regains interest,
forming new relationship.
(Weeks to months)

 All men and women are born, live

suffer and die; what distinguishes
us one from another is our dreams,
whether they be dreams about
worldly or unworldly things, and
what we do to make them come
about... We do not choose to be
born. We do not choose our
parents. We do not choose our
historical epoch, the country of our
birth, or the immediate
circumstances of our upbringing.
We do not, most of us, choose to
die; nor do we choose the time and
conditions of our death. But within
this realm of choicelessness, we do
choose how we live. Joseph Epstein
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