Health Psychology and Human
Diversity
Dying, death and bereavement
Dr. Vian Sadiq Muhsin
MSc. Child Psychiatry, MSc. Medical Physiology
Department of Psychiatry
College of Medicine Duhok university

Learning Objectives
This lecture points to:
*Discuss bereavement; recognize the varied responses of
individuals.
*The 5 stage Grief model
*Clinical symptoms to bereavements
*Consider the reactions of health professionals to working with
dying patient.
* Good Death

Death , grief, bereavement
• Death: is - a permanent cessation of all vital
functions : the end of life. Is the permanent
cessation of all biological functions that
sustain a living organism.
• Grief : sadness. Is the response to loss.
• Bereavement: Is a big catastrophe like death,
loss.. Is being deprived of a relative, loved one
or friend, esp. by death.

Diversity in death: 1- Gender
Gender:
– Women on average live longer
– UK life expectancy at birth (2009-2011)
• Men 78.7
• Women 82.6

Diversity in death: 2- Age
• Death rates highest in older age groups
• 2010: 67 per cent of deaths were people age 75+
• But people can die at any age
• Death of child / young person can be particularly difficult to cope with

Diversity in death: 3- socioeconomic
differences
• Socioeconomic status:
– Less wealthy on average experience poorer health and die
sooner

Diversity in dying
1. Gradual death with a slow
decline in ability and health
2. Catastrophic death through
sudden and unexpected
events
3. Premature death in children
and young adults through
accidents or illness

Initial reactions to news of terminal
illness
• Most people experience shock, numbness,
disbelief and confusion.

Coping with a terminal illness
1. Shock
2. fear
3. anger
4. resentment (feeling of disagreement or non acceptance)
5. denial
6. helplessness
7. sadness
8. frustration
9. relief
10.acceptance

Adjusting to the idea of dying:
The 5 stage Grief model (Kübler-Ross 1969)
1• Denial
2• Anger
3• Bargaining
4• Depression
5• Acceptance

The 5 stage Grief model
1. Denial: blocking external events from awareness.
e.g.
• refusal to discuss illness
• it’s not true
• it can’t be happening to me.
• Can be a coping mechanism.
• – “it’s not true” “it can’t be happening to me”

The 5 stage Grief model
2. Anger:
– “why me?”
– Who is to blame? “the doctors don’t know what they are
doing”
– Search for alternatives?
3. Bargaining: Bargaining: ways to avoid having the bad thing
happen. Bargaining is vain expression of hope that the bad
news is reversible. e.g.
I’ll go to mosque every day if I can just live to see my
grandchild”?

The 5 stage Grief model
4. Depression: – “what’s the point?” “I can’t fight any longer”
(low or depress mood, loss of energy, loss of interest,
disturbance of sleep and appetite).
5. Acceptance: where the person is ready and actively
involved in moving on to the next phase of their lives, no
matter how short
(– “It will be OK” “I’m ready to make funeral arrangements”)

The grieving process
• Each person experiences stages differently
– BUT reassuring for people to know that grief passes through
various stages and for most people grief will lessen and end

Bereavement
Clinical symptoms:
• Physical e.g. shortness of breath & palpitations; fatigue;
digestive symptoms; reduced immune function.
• Behavioral: e.g. insomnia, irritability, crying, social
withdrawal
• Emotional: e.g. depression, anxiety, anger, guilt,
loneliness
• Cognitive: e.g. lack of concentration, memory loss,
hopelessness, disturbance of identity, visual and
auditory hallucinations

Bereavement & grief Prognosis
• Within 2 years
– 85% adjusted to bereavement & experiencing minimal grief
– 15% experiencing chronic grief: anxiety, depression, PTSD
• *“there is no way around grief, only a way through” Collick (1986)

Risk factors for chronic grief
1. Prior bereavements,
2. Psychiatric illnesses .
3. Type of loss (young person, nature of death).
4. Lack of social support.
5. Presence of stress from other crises.
Factors that lead to complications in grief process
1. Expression of grief discouraged
2. Ending of grief discouraged

Palliative care to terminal illness
• Improve quality of life
• Manage emotional and physical symptoms
• Support patients to live productively
• Good death

GOOD DEATH
.

Death of a patient
• Death should never be ‘routine’ but more likely to seriously
impact on health of professional when the patient is well
known or likes us or likes someone we are close to
• Feelings?
• Failure, sadness, guilt, anger,
• Reminder of mortality or own personal loss
• Is it right to express emotions when you are the doctor?
• Coping
• need to protect yourself, but important not to lose empathy

Summary
• There is a great deal of diversity in death
• Individuals have different patterns of adjusting to the idea of dying
• Grief in response to bereavement has common patterns, but there
are large individual differences in experience
• Doctors play an important role in helping patients to have a ‘good
death’
• Doctors need to reflect on their own reactions to dying and death