Coping with Death
How do we face our own mortality?
Coping: Definition
• Constantly changing (dynamic) cognitive
and behavioral efforts to manage demands
exceeding the resources of the person.
– This emphasizes that coping behaviors go
beyond routine, adaptive behaviors.
Domains of Coping
• The task of coping can be divided into 3
domains, each of which involves different
skills.
• (1) Appraisal Focused Coping: how one
understands a stressful situation.
– Logical analysis and mental preparation
– Cognitive redefinition – accept the basic reality
of a situation but restructure it to find
something favorable.
– Cognitive avoidance or denial – deny or
minimize the crisis.
Domains of Coping
• (2) Problem Focused Coping: what one
does about the problem.
– Seeking information and support.
– Taking problem solving action.
– Identifying alternative rewards.
• (3) Emotion focused coping
– Affective regulation – trying to maintain hope
and control emotions.
– Emotional discharge – venting, gallows humor.
– Resigned acceptance.
Factors that influence coping
• Dying trajectories
– How might the shape and duration of a person’s
death trajectory influence coping?
• Awareness contexts
– The interactions among those who are coping
with dying with an emphasis on the levels of
openness and honesty between them.
– 4 types of awareness (these are not stages)
Awareness Contexts
• Closed Awareness
– Dying person does not know. Is this fair? How
long can it be maintained?
• Suspected Awareness
– Ill person suspects that they haven’t received the full
story. Undermines trust.
• Mutual Pretense
– Both parties know, but do not discuss. Requires
constant vigilance and is very draining.
• Open Awareness
– Free and open communication.
Stage Based Approaches
• Elisabeth Kubler-Ross: Based her model on
interviews. Stages can occur out of order
and/or simultaneously.
– Denial – “It can’t be true!”
– Anger – resentment of the non-dying,
dehumanizing treatment.
– Bargaining – acknowledgement that death is
coming, but asks for more time.
– Depression – active mourning process.
– Acceptance – calm recognition and readiness.
Critiques of Kubler-Ross’ Model
• Although important, there is much debate
about her theory.
– No research support
– Line is blurred between description and
prescription
– Misused by public and medical community
– Complexity of environment is ignored
Corr’s Task Based Approach
• Corr’s model moves away from stages to an
investigation of the things that a dying person
“needs” to do.
– Physical Dimensions: to satisfy bodily needs and
minimize physical distress in ways that are consistent
with other values. Physical comfort and symptom relief.
Pain control.
– Psychological Dimensions: to maximize psychological
security, autonomy, and richness in living. Thus, person
is respected as a fully living person, maintains
independence and control, is helped to enjoy life.
Corr’s Task Based Approach
• Social Dimension: To sustain and enhance
those interpersonal attachments significant
to the person and to address the social
implications of dying.
– Patient is not abandoned or isolated
– There is private time to share with loved ones
– Connections with larger social groups
– Positive relationships with healthcare workers
– Resolve unfinished business
Corr’s Task Based Approach
• Spiritual Dimension: to identify, develop, or
reaffirm sources of spiritual energy and in
so doing foster hope.
– Religious needs
– Life review (e.g., Erikson’s idea of ego
integrity vs. despair)
– Provide opportunity for aesthetic involvement
Living with a life threatening
illness
• Doka provided a 5 phase model of facing a
potentially fatal illness.
– Prediagnostic phase: initial indicators of illness
and disease. What do I do?
– Acute phase: tasks that occur with a serious, but
treatable condition. Learning, changing
lifestyle, express feelings.
– Chronic phase: living with a life threatening
illness. Managing symptoms and side effects,
dealing with financial concerns, preserving self-
concept.
Doka’s 5 Phase Model
• Recovery Phase
– Deal with after effects, anxiety about
reoccurrence, reformulating of one’s lifestyle.
• Terminal Phase
– Trying to find meaning from experience
– Saying goodbye
– Deciding what kind of care to have
– Dealing with caretakers.