How to Write Psychology Term Papers - Fear Of Death Paper In Apa Style

Summary: This Term Paper with apa format on Fear Of Death

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This paper discusses a subject that often makes people uncomfortable -- death and dying. A long-standing taboo against talking about death is changing, but slowly. Because of this reluctance to talk about the unknown experience of dying, euphemisms and metaphors are used to distance people from the event of death -- A desire to maintain distance from death creates a distance from those who are dying, creating social death before physical death. Individuals' fear of death and death anxiety play a role in how comfortable they are in talking to those who are dying.

The fear of death is widespread; although Kalish (1976) pointed out that it is not as widespread as might commonly be believed. Experts are uncertain about whether the fear of death is learned or innate (Decker, 1980). Some argue that it is learned and, thus, can be unlearned. Others argue that death fear is a mainspring of human existence. Decker (1980) concurred with Kalish that the data do not indicate that the fear of death is terribly widespread.

Research cited by Belsky (1984) indicated that death preoccupations are not infrequent, but such preoccupations are equally associated with both positive and negative moods. Death preoccupation, by itself, does not necessarily depress people.

Some research focuses on the correlates of death fear. It appears that having a rich and satisfying life does not have a strong relationship with either death anxiety or the lack of it. Age may be related to fear of death, as may suffering, depression, religious needs, and transcendent experiences, although the findings on these variables are not completely consistent across different studies (Kalish, 1976).

Death anxiety has some effects, as well. Vickio and Cavanaugh (1985) found that increasing death anxiety leads to greater anxiety about aging, and that more exposure to death leads to more comfort about dying.

Research cited by Patterson (1981) indicated that fear of death is strongest between the ages of 40 and 55, and that fear of death is lower for elderly people. Kalish (1976) argued that this is because elderly people place less value on their own lives than on the lives of younger people; elderly people see impending death as a given; and, elderly people are used to loss. For some of these same reasons, death anxiety is lower when people are communicating with a dying older person than when they are communicating with a dying younger person. The loss of the older person is more readily accepted because their social value is perceived to be lower.

Troll (1982), however, concluded that there are few age differences in death anxiety, but that there are gender differences. She found that women are more accepting of death, whereas men see death as the enemy. This may reflect the cultural importance of men's roles in our society. Men are socialized to be breadwinners, providers, and so forth, and for that reason they anticipate a great loss when they die.

Fear of and anxiety about death may be a particular problem for health care workers who must deal with death on a regular basis. Fear of and anxiety about death lead to a reluctance to make eye contact or to touch or even to have a conversation with a dying patient. Although death education does not reduce fear of death, education can help to reduce denial and permit the expression of previously repressed fears. Death education can help to reduce death anxiety, although anxiety initially increases due to death education. This type of education helps health care students understand the process of dying and to feel more confident in being able to care appropriately for a dying patient.

One's death anxiety may influence how aware one is of impending death, but death anxiety is probably a relatively unimportant factor in this respect. Glaser and Strauss (1966), who did some of the most interesting participant-observation research on hospitals and on other health care contexts, identified four awareness contexts for dying:

• Closed
• Suspicion
• Mutual pretense
• Open

They found that there was still a wall between interactants, even when impending death was acknowledged. Mutual pretense is a common reaction. The following rules governing mutual pretense are interesting.

• Dangerous topics should be avoided (this includes the patient's disease or prognosis).
• A pretense that the dying will share in the future should be maintained, should the topic arise.
• Small talk and safe topics are acceptable.
• Things that are said about death should be ignored.
• The situation should be kept normal.

McKenzie also pointed out that sometimes only one person would keep up the mutual pretense, whereas the other person may be willing or eager to discuss the approaching death. Not all dying people, of course, want to know that death is rapidly approaching. Schulz and Aderman (1980) found that awareness of impending death does lead to depression, and that patients should not be given more information than they want. Almost all of the subjects in their research, however, did want to know if they were going to die. Seale (1991) also found that most patients and their families want to know. A problem arises, however, because physicians prefer to wait for patients to ask questions, whereas patients prefer to wait for doctors to initiate discussions about their prognoses (Seale, 1991). Traditionally, physicians were reluctant to communicate a prognosis of death to patients. In 1966, Verwoerdt took a rather progressive approach when he offered physicians a set of questions to help them decide whether patients should be told about prognoses of death:

• What are the patient's emotional and intellectual reserves?
• How much does the patient already know?
• How much does the patient want to know?
• When is the patient sure that the doctor knows?
• How should the doctor proceed if the patient knows but will not admit the knowledge?
• What is the personal meaning of the illness to the patient?

Some of these questions, such as Number 3, are undoubtedly difficult questions for the physician, who cannot, after all, read the patient's mind.

Recall that the data indicate that most patients want to know about their own prognoses, but they feel that other people probably would not be able to handle information about their own impending deaths (Kalish, 1976). Much evidence indicates that patients figure out that they are approaching death even if they are not told. There are so many nonverbal factors that give the true story away that it may be difficult to hide such information from patients. Indeed, Erickson and Hyerstay (1974) presented a rather convincing argument along these lines. They suggested that the dying person who is not told about his or her terminality is placed in a double bind because family, friends, and health care providers emit incongruent verbal and nonverbal messages to the patient. It is rather ridiculous to believe that such a large group of people could carry out such a charade about an extremely important topic. The patient is then placed in the position of appearing paranoid or defensive if he or she does not believe what he or she has been told. Erickson and Hyerstay explain the destructive implications of this double-binding behavior by drawing parallels to schizophrenic double binds, and they argue that the truth is better revealed than concealed.

Consistent with this line of reasoning, most physicians today favor a gentle but honest approach to telling patients about terminality. Patients generally prefer this, as well. Families of terminally ill patients appreciate being told and having the patient told when the news is broken in private, and with respect and sensitivity (Seale, 1991). Family members also appreciate having any and all of their questions answered and prefer having more information about their loved one's condition rather than less (Seale, 1991). This approach provides patients with some time to review their life, to make final arrangements, and to get ready for death.

Seale (1991) found that it is not only the family and patient who prefer that the patient be aware of impending death. Physicians and nurse’s report being able to provide better quality care when the patient is aware. When the patient knows, health care professionals feel more open around the patient and are free to answer any and all questions.

It typically is the physician's responsibility to make decisions about the patient's dying trajectory; that is, how long the patient has left and how to announce this to others. Hospital personnel treat the patient in accordance with this trajectory, and miscalculations upset both the staff and family members. With time, the physician typically becomes more explicit and precise in his or her communication about the patient's impending death.

Sudnow (1967) discovered that physicians are sometimes overly pessimistic in their predictions about impending death because it looks better for them if they have predicted the death in advance. Physicians also believe that it will be easier for the family if they have some time to prepare. Sudnow observed one instance in which impending death was announced after the patient's death had already occurred. A short time later the actual death of the patient was announced. Of course, physicians also look bad if they predict death and it does not occur. Sudnow cited some examples of staff and family dissatisfaction when death does not occur as predicted.

Bibliography:

• Belsky, J. (1984). "The psychology of aging". Monterey, CA: Brooks/Cole.

• Decker, D. L. (1980). Social gerontology, Boston: Little Brown.

• Erickson, R. D., & Hyerstay, B. J. (1974). "The dying patient and the double-bind hypothesis". Omega, 5, 287-298.

• Glaser, B. G., & Strauss, A. L. (1966). Awareness of dying. Chicago: Aldine.

• Kalish, R. A. (1976). Death and dying in a social context. In R. H. Binstock & E. Shanas (Eds.), Handbook of aging and the social sciences (pp. 483-507). New York: Van Nostrand.

• Patterson, S. L. (1981). On death and dying. In F. J. Berghorn & D. E. Schafer (Eds.), the dynamics of aging (pp. 83-99). Boulder, CO: Westview Press.

• Seale, C. (1991). "Communication and awareness about death: A study of a random sample of dying people". Social Science and Medicine, 32, 943-952.

• Schulz, R., & Aderman, D. (1980). "How the medical staff copes with dying patients: A critical review". Perspectives on Death and Dying, 2, 134-144.

• Sudnow, D. (1967). Passing on. Englewood Cliffs, NJ: Prentice-Hall.

• Troll, L. E. (1982). "Continuations: Adult development and aging". Monterey, CA: Brooks/Cole.

• Verwoerdt, A. (1966). Communication with the fatally ill. Springfield, IL: Thomas.

• Vickio, C. J., & Cavanaugh, J. C. (1985). "Relationships among death anxiety, attitudes toward death, and experience with death in nursing home employees". Journal of Gerontology, 40, 347-349.

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