Death and Dying 3rd Test

Doctor-patient relations

A concept that was expounded upon in the movie Wit where Vivian feels objectified by the doctoral staff. She is portrayed and feels like a guinea pig undergoing experimentation and the process dehumanizes her. An example of this is her former student interrogating her with questions while performing a gyno inspection and talks as if she is not there to his nurse. The cold, denouncing relationship is what unfortunately many doctor-patients share.

"The real thing"

"What if my entire life, my entire conscious life, was not the real thing? It occurred to him that what had seemed utterly inconceivable before -- that he had not lived the kind of life he should have -- might in fact be true...His official duties, his manner of life, his family, the values adhered to by people in society and in his profession -- all these might not have been the real thing."xxviii But then what would make a life "real? This causes him great moral agony as he is worried he didn't live correctly and his entire life was not the "real thing". It seemed to him as he reflected on himself that everything in his life that he defended might not have been real.

issue of remorse

(Beauvoir) This comes about in Beauvoir's book as she felt very remorseful about the operation that her mother went through completely unaware. Her mom did not know what was going on throughout the whole thing, and there was a huge wall of deception between the two, as they could have talked about it but Beauvoir never decided to do so. She felt guilty and remorseful for the way that she handled this by not telling her what was happening.

Theodicy

(C.S Lewis) The theological question that tries to connect belief in God's nature as omnipotent, omnibenevolent, and omniscient with the reality that evil exists in the world as sometimes good people suffer unjustly and die. People question God and ask "How could he let this happen", and it can often cause people to be very angry at God. After the death of his wife, Lewis struggles with this same question as he sees no reason for how God could have allowed it to happen, and thus, changes his opinions of the nature of God as he views him as a cosmic sadist.

Guilt in bereavement

(C.S Lewis) often when the period of bereavement starts to lighten up, there is a sense of guilt. the guilt Lewis explains he felt was due to him feeling poorly that he is no longer as upset about his wife passing. he felt it was wrong to not be sad still. He felt guilty about moving on from it and getting better because he thinks he'll forget about her. Additionally, he felt guilty as during his process of bereavement he felt he was being self-absorbed and focusing on his suffering only, while his wife was the one that died.

initial denial

(From Kubler-Ross) Initial denial comes as the first part of the first stage of grief and is necessary. It is a universal response to death, and we pretend that it isn't there or that it didn't happen. Initial denial can be healthy, as it serves as a buffer to ease the shock of whatever the circumstance. However, it can lead to being unhealthy if it progresses into extended denial.

Depersonalization/objectification

(From Kubler-Ross) Relates to the lack of interpersonal connection between the staff and patients in modern health care, as the patients are treated as a number, object, or sickness instead of as people. They become an object of science or of experimentation.

extended denial

(Kubler-Ross) Coming after initial denial, extended denial is unhealthy because it denies one the care they really need. Also, by denying it, it doesn't allow a person to get all of their affairs in order. It also leads to all sorts of psychological issues and is not good for the rest of the family to go through either.

decathexis

(Kubler-Ross) Decathexis is the detachment and seperation from the people, objects, and world outside of you, and ones focus becomes more around themselves. It reverts one back to a state similar to the one we are in as newborn babies, all our sensations merge in this primary state of narcism.

reactive depression

(Kubler-Ross) One of the two kinds of depression, reactive depression, also called situational, people may suffer this as a result of things like hospital bills, scars or bodily alterations, loss of hair or teeth. One is depressed about things that they have already lost, for you cannot do what you used to love doing or things that you had that you miss.

Fear of Dying

(Kubler-Ross) People universally have always responded to death with feelings of fear. We are all naturally fearful and scared of it happening to us. Much of this comes from the fact that we don't know what happens after death so we cling to ourselves and desires and fear the day death comes for us.

issue of communication

(Kubler-Ross) Problems arise if everybody is silent and nobody talks, for then the staff or family don't know what the patient or dying person wants. Nobody knows when the right time to accept death is, and the silence caused from possibly feeling awkward can cause tension between the patient and visitors as discrepancies arise.

therapy of silence

(Kubler-Ross) Therapy of silence refers to dealing with a person coming close to death. You should still visit them and let them know that you are there for them, however, one should not speak on endlessly to the other person as verbal communication might make them more tired or sick. One should not force the person to talk to them if they do not feel like it.

anticipatory/preparatory depression

(Kubler-Ross) This type of depression is a depression about things to come in the future. Often people get depressed because they know they do not have long to live and they are going to die soon. This type of depression prepares one for acceptance. It can be negative because it may result in a person not making the most of their time.

Bereavement

(Lewis) Bereavement comes from the being deprived of a loved one usually as a result of death. Lewis describes it as a universal and natural consequence of any marriage, however, it still causes people extreme grief. It is the mourning process after that person has died.

Introjection

(Lewis) Introjection refers to when two lovers carry an idealized image of eachother in their heads, but as long as they are both alive the idealized image is balanced out by the actual person. But, when one person dies, all that the living person is left with is the idealized image of the deceased, which is not the real person because it neglects to recognize their faults. Lewis struggled with this as he felt guilty and was afraid of forgetting who she really was.

Ivan's dream and its meaning

(Tolstoy) Ivan had this recurring nightmare where he was getting pushed into a black sack, he gets stuck in it and he wants to get through the sack completely in one sense but in another sense he also fears it. This dream comes towards the end of his life and thus, the sack may represent his confrontation with death. The dream is also in a sense brought about by his moral agony as he realizes that he may not have lived his life correctly.

Ivan's moral agony

(Tolstoy) The moral agony for Ivan was his realization that he may not have lived his life correctly, and that his work, living conditions, family, and his interests might not have all been "right". The only time he can remember being truly happy was in his childhood, and as a result of this moral agony he suffers from his recurring nightmare. He also as a result of all of this suffered some physical pain as well in his stomach.

death as social, and as individual

(kubler-ross) This explains how death can be both experienced socially and individually. Although usually its only the one person dying, those closest around them also suffer too, and the five stages of grief can absolutely occur within the minds of the living as well as the person who is dying. But also, death is merely an individual thing, it is only the one person dying of cancer, for example, not the whole family at the same time (usually).

Preparation for Dying

Coming to terms with

aloneness of the bereaved

Having a void in their life, the bereaved is forced to go through life without the presence of their significant other/person and this results in a feeling of aloneness. Not only from not having exposure to that person but no one being able to truly relate to what it is like to not have them around anymore.

"The Lie"

In addition to his function as spiritual midwife, Gerasim also represents truthfulness. Gerasim's willingness to admit and accept the fact that Ivan is dying is in contrast to the hypocritical attitude of Ivan's family and friends. By acknowledging that it is death and not illness, Gerasim explodes "the lie" and is able to connect with Ivan on a sympathetic and human level. By the end of the chapter, it is the moral pain caused by "the lie" that torments Ivan most of all. And it is clear that "the lie" carried on by his friends and family is symptomatic of a larger problem plaguing Ivan's society as a whole: the inability to acknowledge the unpleasant aspects of life. For nobody else recognizes the possibility of their own death. People are lying and not recognizing the fact that death is normal, universal, and inevitable and everyone's refusal to recognize this enrages Ivan.

meaning of "forgive" also in Suzy's story

Initially misspoken as forgo by Ivan in Tolstoy's tale it is Ivan's attempt to ask for the forgiveness of his family as he wanted to show them he recognized his shortcomings. The last word Ivan tried to mutter was "forgive", and relates to death as often times when people are very close to death they try to resolve past grudges, forgive people, or in Ivan's case they hope to be forgiven in order to die completely at peace. We notice it in Suzy's story too as she attempted to get closure with her friends from her life before she dies.

Ivan's relationship to other people (coworkers, doctors, family)

Ivan throughout the piece had a rather austere relationship and was solely focused on his social appearance. His only concern was the way people perceived him and this lead him to live a rather superficial where societal pressure crafted him into the person he was.

Five stages of dying

Kubler-Ross' well known description of the stages one goes through when suffering grief or dying. They are 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance Reaching the 5th stage leaves one in the best state to die in. Not every stage is noticeable in every case of grief, but you can always expect to see atleast one. The model postulates a progression of emotional states experienced by terminally ill patients after diagnosis.

Unconscious refusal of death

Our mind's refusal to recognize death as an inevitability and a reality. Naturally, we expect to continue living but the thought of our departure is unnatural in the sense that we can not picture the world without our presence and the notion itself is inconceivable.

Existential aloneness of dying

The idea that no one can empathize with you dying because they are not experiencing it and therefore cannot be cognizant of what you are truly going through. With no one to console you with wisdom about it because those who have this wisdom are dead, you feel existentially alone and this unrelatability with everyone causes sadness.

therapeutic communication

Therapy of Communication primarily deals with discussing what is on the mind of the person confronting death. Therapeutic communication is defined as the face-to-face process of interacting that focuses on advancing the physical and emotional well-being of a patient. Nurses use therapeutic communication techniques to provide support and information to patients.

"It"

the "it" Ivan constantly references is death. throughout the book he mentions how he cannot understand or accept "it" and that it is soon to happen to him