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Evaluating the preparation for teachers of dying and death Boyd, Dennis Eric 1977

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EVALUATING THE PREPARATION FOR TEACHERS OF DYING AND DEATH by DENIS ERIC BOYD B.A. .Univers i ty of Brit ish Columbia, 1972 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES THE FACULTY OF EDUCATION THE DEPARTMENT OF COUNSELLING PSYCHOLOGY We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH April 1977 (c) Denis Eric Boyd, COLUMBIA 1977 In p resent ing t h i s t h e s i s in p a r t i a l f u l f i l m e n t o f the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e fo r reference and study. I f u r t h e r agree tha t permiss ion fo r e x t e n s i v e copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the Head of my Department or by h i s r e p r e s e n t a t i v e s . It i s understood that copying or p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l ga in s h a l l not be a l lowed without my w r i t t e n p e r m i s s i o n . Department o The U n i v e r s i t y of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1WS Date -ftffUl 3tj 11 ABSTRACT EVALUATING THE PREPARATI ON TOR TEACHERS ,OF DYING AND DEATH ; The purpose of t h i s study was to explore the significance of preparation (by measuring changes i n the fear of dying and death) for teachers interested i n teaching about dying and death. The preparation was an experiential and didactic workshop (see "Definition of terms" on page 58). Subjects of t h i s study were secondary school teachers employed with the Vancouver School Board. A group of 32 teachers (Experimental: males 6; females 26) were given a three evening experiential and didactic workshop on dying and death. This work-shop took place one evening a week over a three week period. The C o l l e t t -Lester Fear of Death Scale was administered at the beginning of the tr a i n i n g and again at the end. A second group of teachers (Control: males 11; females 22) was not given the workshop. The Collett-Lester Fear of Death Scale was administered twice, with a three week period between testings. There are three hypotheses i n t h i s study. The f i r s t was that an exper-i e n t i a l / d i d a c t i c workshop would lower the death anxiety of those who p a r t i c i -pated. The second was that an experiential/didactic workshop would not lower the anxiety of the r e l i g i o u s l y committed participants to any greater extent than the death anxiety of the non-religiously committed participants. Hypothesis three dealt with sex and proposed that male participants' scores would be de-creased to a greater extent than those of the female participants. The results of t h i s investigation indicated that an experiential/ didactic workshop i s a means of lowering death anxiety. The teachers who were involved had s i g n i f i c a n t . score changes, on the Collett-Lester Fear of Death Scale, indicating a.decrease i n death fears. There was.no difference in.scores between the male and female participants as to lowering of death anxiety. The death anxiety scores of the r e l i g i o u s l y committed participants did not decrease more than those of the non-religiously committed. In f a c t , on some of the Collett-Lester sub-scales, just the opposite occurred. The results of t h i s study point to the value of preparation for teachers interested i n teaching about death. A case i s made for the need of such pre-paration and the value of an experiential/didactic workshop i s supported. An-other implication of t h i s research i s the value of such t r a i n i n g to any indi v -i d u a l interested i n becoming more comfortable with his or her mortality. TABLE OF CONTENTS A b s t r a c t . .'. '.' . '.' . '. . '.' '.' • • iv.  ' ' "  . '.. . . . . .: .: . . i i -L i s t o f T a b l e s . . . . . . '. . . . . . . . . . . . v i i -L i s t o f F i g u r e s and I 1 l u s t r a t ions . . . . . . . . . . . • . v i i i« C h a p t e r One: I n t r o d u c t i o n . . . . . . . . . . . . . . 1 Chapter Two: Review o f t h e L i t e r a t u r e . . . . . . . . . . k A. C u l t u r e : g e n e r a l p e r s p e c t i v e . . . . . . . . . ^ 1. H i s t o r i c a l o v e r v i e w . . . . . 5 2. R e l i g i o u s p e r s p e c t i v e s 6 3. A "Death System" : t e c h n o l o g y - h e l p o r h i n d r a n c e . 8 't. S i g n s o f Change 10 5. Fear o f Death ]k a) u n i v e r s a l n a t u r e 15 b) t h e r e a l i t y o f d e a t h 16 c) d e f i n i t i o n s o f f e a r 17 d) management o f f e a r . . . . . . . . . . 20. 6.. Meaning of L i f e 26 a) e n h a n c i n g f o r c e s 26: b) n e g a t i n g f o r c e s . . . . . . . . . . . 27 c) f i n i t u d e : t h e key t o meaning 28 B. C u l t u r e : s p e c i f i c c o n c e r n s 31 1. The d y i n g p r o c e s s 31 a) t h e m e d i c a l p e r s p e c t i v e . . . . . . . . 32 b) t h e p a t i e n t ' s p e r s p e c t i v e 36 c ) growth p o t e n t i a l kO d) a t t h e p o i n t o f d e a t h 41 2. Bereavement . . . . . . k) a) " l i t t l e d e a t h s " . . . . . . . . . . . kl b) I n f l u e n t i a l f a c t o r s i n g r i e f . . . . . . . A3 V . TABLE OF CONTENTS (cont'd) c) grieving process . . . . . . . . . . . s 43 d) grief dramatized : .the :funeral . . . . . . . 44 3. Children and Death . . . . . . . . . . . . 47 a) developmental perspectives . . . . . . . . 48 b) the need to teach . . . kS C. Death Education : a plan to meet the need . . . . . . 50 1. Variety of approaches 51 2. The Classroom . . . . . . . . . . . . . . 52 D. Conclusions . . . . . 54 Chapter three : Method . . . . . . . . . . . . . . . 56 A. Problem 56 B. Hypotheses - Substantive 56 C. Hypotheses - Stat ist ical 57 D. . Definition of terms 58 E. Sample 59 F. Treatment 60 G. Instrumentation 61 H. Design and Stat ist ical Analysis 61 Chapter four : Results . . . . . . • ..J . 63 Chapter five : Discussion 1 . . . . 77 A. Hypothesis one . . . . . . . . . 77 B. Hypothesis two . . . . . . . . . . . . . . . 78 C. Hypothesis three . . . . . . . . . . . . . . . 81 D. Shortcomings and Needed Improvements . . . . . . . . 81 E. Implications of the Study . . . . . ' . . ' . . . . 84 F. Summary . 84 V I , TABLE OF CONTENTS (cont 'd ) Chapter S i x : References . . . . . . . . . . . ' 86 Appendix A : Vancouver School Board l e t t e r to p r o s p e c t i v e c o n t r o l group members . . . . . . . . . . 93 Appendix B : An o u t l i n e of the treatment workshop . . . . . 96 Appendix C : Experimental group members workshop e v a l u a t i o n s . . .'• . . . . . . . . . . -100 Appendix D : Col 1 e t t - L e s t e r Fear of Death Sca le and Manual . . . . . . . . . . . . . v i i . L I S T OF TABLES I. T a b l e 1 Combined C e l l Means ( G r o u p / R e l i g i o n ) E x p e r i m e n t a l and C o n t r o l . . . . . . i i . T a b l e 2 O b s e r v e d C e l l S t a n d a r d D e v i a t i o n s ( G r o u p / R e l i g i o n ) E x p e r i m e n t a l and C o n t r o l III. T a b l e 3 O b s e r v e d Combined Means ( G r o u p / R e l i g i o n ) E x p e r i m e n t a l and C o n t r o l R e l i g i o u s Commitment and No R e l i g i o u s Commitment (Combined) • • • IV. t a b l e k A n a l y s i s o f C o v a r i a n c e ( G r o u p / R e l i g i o n ) . V. T a b l e 5 O b s e r v e d C e l l Means ( S e x / G r o u p ) E x p e r i m e n t a l and C o n t r o l VI. T a b l e 6 O b s e r v e d C e l l S t a n d a r d D e v i a t i o n s ( S e x / G r o u p ) E x p e r i m e n t a l and C o n t r o l . . . . . . VII. T a b l e 7 O b s e r v e d Combined Means ( S e x / G r o u p ) M a l e s and Females ( c o m b i n e d ) E x p e r i m e n t a l and C o n t r o l . . . . . VIII . ' Table 8 A n a l y s i s o f C o v a r i a n c e ( S e x / G r o u p ) v i i i . LIST OF F l GURES. AND ILLUSTRATI ONS 1. Graph a. Observed Cell Means (Group/Religion) Experimental . . . . . . •'. . . . 2. Graph b. Observed Cell Means (Group/Religon) Control 3. Graph c. Observed Cell Means (Sex/Group) Experimental . . k. Graph d. Observed Cell Means (Sex/Group) Control . . . . . . . . . . 1. CHAPTER ONE : th t foduct l;on This research project deals with the need to prepare educators who wish to teach about dying and death. The subject i s now being taught i n some.secon-dary schools i n Canada and the United States. Although there are curriculum guides available on what to teach, there has been no work done on the prepar-ation of teachers to administer the curriculum. A description of proposals for preparing teachers w i l l follow information which acts as a foundation for t h i s project. Death i s treated as a taboo i n our society ( F e i f e l , 1959). The s o c i a l system i s structured i n such a way that people are insulated from old age, dying and death. H i s t o r i c a l l y t h i s was not the situ a t i o n (Hofmeier, 1972). In the middle ages there was a preoccupation with mortality (Kastenbaum £ Aisen-burg, 1972). Religion has moved from a position of influence to one of less influence (Hofmeier, 1972; Kavanaugh, 1972). In r u r a l North America death was more a part of the l i f e process (Mit-ford, 1963). Urbanization and a growing technology have changed society con-siderably (Kastenbaum £ Aisenburg, 1972). One of the unfortunate changes has been an over-emphasis on youth and l i f e to the exclusion of old age and death. Although the general picture i s one of avoidance, there are some indica-tions of change. Some people have become aware of how harmful ignoring mortal-i t y can be and they are encouraging others to be more r e a l i s t i c (Kastenbaum £ Aisenburg, 1972). 2. At the core of avoidance or acceptance of death i s the fear which death evokes. Weisman (1972) and others consider t h i s fear a "universal negative". Jung (1959) on the other hand believes that man can not evade t h i s fear and should consider i t as part of l i f e ' s process. In addition to a variety of de f i n i t i o n s for the fear of death, there are suggestions for management of these concerns (Choron,1964). There i s a direct l i n k between fear of death and the meaning of l i f e (Frankl,1973). Although some see the quality of l i f e negated, many others make a strong case f o r enhancement (Curran, 1972; Kavanaugh, 1972; Keleman, 1974; and Langone, 1972). To t h i s point the perspective has been quite broad, dealing with the soc-i a l s e t t i n g . The focus now changes to three areas of s p e c i f i c concern. Direc-t l y affecting each of these topics i s the tone set by society with regard to attitudes about mortality. Avoidance of death has d i r e c t l y influenced the care of the terminally i l l . Medical professionals i n p a r t i c u l a r , have been taught to cure, to the point where a death i s interpreted as a personal f a i l u r e (Hendin, 1973; Strauss, 1969; Mount, 1973-4). For a patient the experience of dying can be a lonely one (Mount, 1973-4). When medical personnel, family and the i n d i v i -dual patient are w i l l i n g to acknowledge the r e a l i t y of death, the sit u a t i o n changes r a d i c a l l y . Dying can be a time of r e a l growth (Saunders, 1969; Curran, 1972; Kavanaugh, 1972; Imara, 1975; Ross, 1974). Bereavement i s also d i r e c t l y influenced by how society manages death (Hendin, 1973). By facing the.eventuality of death i t i s possible to be some-what prepared for the g r i e f experience when i t happens (Pincus, 1974). The.funeral has been c r i t i c a l l y examined oyer the l a s t 15 years (Mitford, 1963; Harmer, 1963). Much.of the c r i t i c i s m has been directed at the funeral industry. Particular concern has been expressed about how the indus-t r y has evolved to support the growing stance of denial. The modern funeral has become a dramatization, intent on camouflaging the r e a l i t y of death (Mitford, 1963). The t h i r d topic i s death and children. There i s a tendency to t a l k with children about most things^including sex. Death i s usually excluded i n any sharing by adults (Yudkin, 1968). This avoidance c o n f l i c t s with a child's natural tendency to learn about l i f e and can create confusion (Kastenbaum £ Aisenburg, 1972). There are many opportunities to share the r e a l i t y of death (Ginott, 1969; Pincus, 197.4; Ross, 1974). Social b e l i e f s and standards are often imparted to young people as they are educated. I f there i s to be a change in.the way death i s dealt with. ?it makes sense to sta r t with children. . However someone has to teach the children. Ross and others have found.that to be comfortable with.the.subject of death an ind i v i d u a l has to become aware of his or her own feelings. I f teach-ers are to teach about death they should have an opportunity to.deal with t h e i r own attitudes and fears. The purpose of t h i s study i s twofold: to develop a t r a i n i n g procedure and to evaluate i t s effectiveness. There i s no research available which docu-ments the subject of teacher preparation in.the area of death and dying. What follows i s the "review of the l i t e r a t u r e " which w i l l provide an indepth look at the foundation information outlined i n t h i s introduction. 4. CHAPTER TWO  Rev Jew o f : t h e L t t e r a t u r e A. C u l t u r e V general p e r s p e c t i v e Death has indeed been a "taboo" subject i n North America ( F e i f e l , 1959). "Death has become unmanageable for our culture and for us as individuals" ( L i f t o n , 1974, p.3). I t has been relegated to a very private or crassly com-mercial a f f a i r (Hofmeier, 1974). Only a hundred and twenty-five years ago t h i s was not the si t u a t i o n . Death was a more v i s i b l e and acknowledged part of l i f e i n r u r a l America. I t was more of a community r e s p o n s i b i l i t y ; the family prepared the body; friends b u i l t a c o f f i n or picked one up from the furniture store; someone else dug a grave. Everybody had a part to play i n l i f e ' s ending. Today, technology and urbanization have doubled l i f e expectancy and yet alienated people from t h e i r dying. Customs and creeds have been developed to allow us a comfortable distance from the r e a l i t y of death. "Secular and re-li g i o u s t a c t i c s pertaining to death share a common intent: to placate an adver-sary" (Weisman, 1972, p.5). Keleman in Living Your Dying (1974, p.16) echoes and expands t h i s idea when he says that "The myths of a l l societies t r y to ensure that we don't die meaningless deaths. They t r y to give an avenue of approach to the dying pro-cess so that we are not swept away i n despair at meaninglessness." Kastenbaum and Aisenburg have written an authoritative book e n t i t l e d The 'Psychology of 'Death (1972). They have examined at some length the ''cul-t u r a l milieu' of yesterday and today, and w i l l be referred to frequently ;in this section . of the paper. Kas.tenb.aum . and Aisenburg believe: ''... we no longer participate in a society that is dominated by tradition, lineage, or accepted dogma" (p.208). We no longer have a cultural buffer to help us under-stand and adjust to our mortality. Perhaps i t is the loss of our dogmas and traditions.that has forced death to be hidden away. Both physical death and symbolic portrayals are a l -most out of sight. Kastenbaum and Aisenburg differentiate between "natural" and "unnatural death". Natural death happens to old people which makes i t a distant and remote menace. Natural death is becoming obsolete in today's youth oriented society and only happens to people who have become obsolete. Unnatural death is primarily associated with youth and.accidental deaths in car crashes and the l i k e . If death constituted the overwhelming fact of l i f e to the man of the late middle ages, then to many of us, death may seem a l l but irrelevant. Perhaps more than any society the world has known, we have succeeded in relegating death to a,small peripheral cor-ner of our conscious mental l i f e . Death befalls the aged, who are semi-visible on our phenomenological screen anyhow; and death is the business of specialists whose work is largely unseen by our eyes. (p.207) 1. H i s t o r i c a l overv iew . In the past i t was different. There was a more limited l i f e span with few people even reaching old age. There was a high infant mortality rate and no adolescence because children began to work early. There was common expo-sure to death in people and animals. Man also had l i t t l e control over the forces of nature. Toynbee in Man's Concern with Death (1968) says that his parents grew up in the "Ancient World". For them death was an early realization since l i f e ' s expectancy was so low. He compares his parents to his more immediate family who live in the "Modern World": "Thus I and my sisters are modern in having b. no experience, i n childhood, of the death of anyone i n our immediate family c i r c l e " (p.259). The Middle Ages offer an interesting contrast to our present times. "In Northern Europe for two hundred years - from the middle of the 14th to the middle of the 16th (centuries) ... the subject of death was central, per-vasive, v i v i d , intense - i n short the concern of 14th century man" (Kastenbaum & Aisenburg, 1972, p.198). Not only was l i f e expectancy normally short but there were great catastrophes, pestilences, witch manias, dancing manias, the crusades and the Black Death (which was 90% f a t a l ) . Readers are inv i t e d by Kastenbaum and Aisenburg to imagine the most appalling s i t u a t i o n i n hospitals, ships, and prisons; the crudest sort of fun-erary practices; the most desperate combinations of disease, famine and ignor-ance. Death was the favourite topic of preachers and writers as well as one of the most common subjects for popular a r t . Statues existed that were half healthy man and half decaying man. Brueger's "Triumph of Death" i s a painting that mirrored the preoccupation. Death even predominated as a theme of c h i l d -rens' games. 2. Relig ious perspectives During the middle ages there was no technological defense and there were ineffe c t u a l s o c i a l controls and adjustments. However there was a major source of comfort: theological doctrine with f a i t h and t r u s t i n the "all-powerful creator" and a j o y f u l resurrection were of help to many. The hereafter also however, became a source of terror f o r those unable to l i v e up to the teachings of the church. Death became God's punishment of man and needless to say the moment of death a dreaded occasion. This concept w i l l be explored further i n a l a t e r section on "fear". 7. Hofmeier (;1974). states .that u n t i l the middle of the 19th.century r e l i g -ion was a major influence i n Western attitudes towards death. "This influence i s fast disappearing" (p.13). Kavanaugh i n "Facing Death" (1972) believes that the influence of r e l i g i o n i s not simply disappearing but indeed gone. "Gone are the national and r e l i g i o u s r i t u a l s for grieving, the wakes, the anniversary masses, the regular prayers, the proper clothing, post funeral-feasts. Cemeteries no longer hold much magnetism and holidays for honoring the dead have less meaning and popularity each passing year."(p.7) Kavanaugh an ex-priest, goes a step further to state that although some people seem to f i n d comfort i n t h e i r f a i t h while others' fears are increased, r e l i g i o u s f a i t h does l i t t l e to help man with death. He says that i t i s the act of believing and not the b e l i e f that counts. "True believers are men committed to any set of transcendent values who dare to l i v e them to the end." (p.14) Kavanaugh's ideas are supported by others. Hinton (1967) states that i t i s unclear what effect r e l i g i o u s b e l i e f s do have. O'Connell (1974) has an opin-ion that r i t u a l s validated by i n s t i t u t i o n a l r e l i g i o n "do not help the l i v i n g -dying develop the conditions for learning to l i v e . " Ross i n her c l a s s i c On Death and Dying (1967) mentions that she observed both r e l i g i o u s and non-religious persons die i n peace. She also feels that the strength or quality of the "held" b e l i e f i s s i g n i f i c a n t . More recently Dr. Ross has said more on t h i s subject. At a conference i n Seattle, Washington i n March 1976 she stated that, i n her opinion, Christians are best equipped to handle death and dying. Unfortunately however, of a l l the worlds r e l i g i o n s , she f e l t members of the Christian f a i t h were least l i k e l y to " l i v e " t h e i r b e l i e f s . I f they would l i v e t h e i r f a i t h they would experience i t s influence i n t h e i r attitudes and concerns about death. 8. For Kavanaugh (1972), worldly.gods have taken over for t r a d i t i o n a l r e l i g i o n : physical health, youthful appearance, sexual attractiveness, success and peace of mind. The l a t t e r goal can be achieved i n death (Refer to section "meaning of l i f e " ) . Fulton (1963) t a l k s about a secularly oriented society where death i s no longer the wages of s i n , but rather the wages of "loose l i v i n g " . "Modern America with i t s emphasis upon youth, health, sports cars, long vacations, and longevity has come to view death as an infringement upon the ri g h t to l i f e and the pursuit of happiness." (p.8) Suffering i s to be avoided at a l l costs. How-ever the pursuit of happiness can result i n "loose l i v i n g " (drinking, smoking, sex) which can i n turn r e s u l t i n i l l n e s s and death. When t h i s occurs the v i c -tims complain about t h e i r lack of luck i n being "caught". Lif-ton (1974, p. 19) aptly refers to Arnold Toynbee's statement that death i s "un-american". "He means that i n a culture that places so much emph-asis on progress, strength and the v i t a l i t y and beauty of youth, and so l i t t l e on the wisdom and dignity of age, death has no place. In such a society, dy-ing can be a t e r r i b l y lonely and desperate experience as indeed i t often i s . " 3. A "Death System" : Technology - he lp or hihdranee? Kastenbaum and Aisenburg (1972) claim that societies have "death systems". They define a death system as "the words and actions concerning death" that allow people to come to terms with death i n both i t s personal and s o c i a l asp-ects. Such an arrangement i s sanctioned by governing authorities and shared by the community. It would seem that our death system mainly encourages an attitude of de-n i a l and avoidance. The weakening of authoritative customs and re l i g i o u s tra4 ditions have led to the secularization already described. A s o c i a l system with such "worldly" p r i o r i t i e s ' h a s . t o camouflage or.completely.deny the existence of death. Blauner (1966) points out that our present death system has expel-led the dead. They are no longer important to the social.structure. There i s a "diminished v i s i b i l i t y of death" (.p.238). In the past, s p i r i t s had a large part to play i n the l i v e s of those l e f t behind. Today we generally do not f e e l that the dead exert much influence over us as we go about our da i l y routines. Kastenbaum and Aisenburg (1972) say our death system of avoidance can also be seen i n our attitude toward the physical environment. Science has led us to believe that we are capable of control and mastery. "Science po t e n t i a l -l y can solve any problem i n which we care to invest s u f f i c i e n t time and resour-ces. Money changes the world." (p.207) S c i e n t i f i c medicine seeks to understand and use the laws of l i f e and death (Hofmeier, 1974)<;thus man finds himself with some new issues to be dealt with: b i r t h control, abortion, prolongation of l i f e , and euthanasia. Hendin (1973) defines direct (positive) euthanasia as a deliberate action which shortens a l i f e ( i . e . mercy k i l l i n g ) and indirect euthanasia as a s i t -uation where death i s not induced but rather i s permitted. Apparently t h i s l a t t e r type i s much more common. Mannes (1975) has written a book .supporting both types of euthanasia which even d e t a i l s a "Living W i l l " which w i l l permit a person to place his euthansic concerns i n writing while he i s s t i l l quite healthy. Such a document has become legalized i n the State of C a l i f o r n i a during October, 1976. Science also offers the alternative of 'cyronics' or r e f r i g e r a t i o n after death (Hendin, 1973; Hofmeier, 1974). The hope i s that.the body could be thawed out and r e v i t a l i z e d at some point i n the future when the cure to the • JLU. disease which k i l l e d the person has been discovered. One of the reasons why science helps to perpetuate an attitude of avoid-ance may be due to the fact that i t tends to measure a l l experience within the bounds of space and time. Thus science does not furnish man with " a l l the necessary parameters for investigating and understanding death" ( F e i f e l , 1959). On the other hand, c l e a r l y science and technology are also helping man-kind to achieve greater enlightenment i n the area of death and dying. Scien-t i f i c progress has reduced many burdens on the ind i v i d u a l and made i t poss-i b l e for him to have an attitude to death which i s not dominated by fear. (Hofmeier, 1974). Today man does have the opportunity to develop an attitude which encompasses a r e a l i s t i c awareness of the l i m i t s of one's l i f e . Technological advances have c a l l e d into question the d e f i n i t i o n of death i t s e l f . Today there i s a challenge before medical, l e g a l and theolog-i c a l groups to redefine death (Langone, 1972; Hendin, 1973; Sneidman, 1973). In the past death has occurred with cessation of respiratory functions (heart and lungs). Today there i s strong support for a d e f i n i t i o n of death which i s based on the ceasing of mental or brain processes. 4. S!gns of Change There are reports of a renewed interest i n death and dying i n North America (Kastenbaum £ Aisenburg, 1972). There are a variety of reasons o f f -ered for such a statement. One i s the "BOMB": a r e a l i t y which forces people to examine the meaning to end a l l death, because i t would end a l l l i f e as we know i t ( L i f t o n , 1974). J--L. .Secondly, faith, i n material progress,. is. beginning to ebb. W.e are.learn-ing that technology does not necessarily solve s o c i a l problems. Indeed there are many new discoveries which have undesirable aspects. "Unacceptable types and levels of suffering and unnecessary premature deaths have not vanished and show l i t t l e i n c l i n a t i o n to do so." (Kastenbaum and Aisenburg, 1972, p.235) Thirdly, some people have begun to suspect that our very way of l i f e may have l e t h a l components. There i s increasing evidence of a i r and water p o l l u t i o n . Species of w i l d l i f e are disappearing from the face of the earth. Highway deaths, alcoholism, drug addiction, violence with guns, and economic-a l l y inspired wars are taking t h e i r t o l l . The fourth reason deals with exposure to violent death due to mass media. If there is a war i n some remote part of the world i t i s reproduced nightly on t e l e v i s i o n newscasts. F i r e s , automobile and airplane crashes usually receive similar treatment. Due to major media coverage, North Americans are " l i t e r a l l y obsessed with the occurence of accidental deaths" (Projector, 1968). They have come to believe that accident f a t a l i t i e s comprise a large proportion of the t o t a l mortality rate. In actual fact only .5% of U.S. deaths are due to accidents and the remaining 95% to natural causes. There i s ahtehderiey to believe that accidents are much more prevalent than i n days gone by. Projector (1968) shows that t h i s i s an i n v a l i d assump-t i o n . In the days of horse and buggy, railway, and steamboat t r a v e l there were frequent tragedies. To c i t e an example, the steamboat Sultana exploded on the M i s s i s s i p p i r i v e r i n 1865. Over 1500 people died. Another 1000 people died i n a steamboat f i r e i n New York harbour i n 1904. 12. Projector believes that there . i s a re la t ionship between modern man's infatuat ion with accidental death and his i n su f f i c i en t concern with normal death. Hofmeier (1974) says that increased violence does not help enlighten-ment but continues avoidance. On the one hand, there i s a society which i n some ways promotes a healthy open approach to dying and death, and on the other hand a society which condones and even promotes v io lence . Perhaps i t i s t h i s condonement by society that prevents people from being shocked by the report ing of v io len t events i n the media. Although object ively v io len t death - presented i n the media "increases the frequency of d i rec t contact with death . . . -in an amazingly large number of cases, ( i t ) f a i l s to produce profound experiences of shock" (p.20). Technological advancements encourage the consideration of the nature of a meaningful and responsible l i f e . The i l l u s o r y r e l i e f given by dramatized death works i n the opposite d i r ec t i on of any r e l i e f offered by medical progress. Mount (1974) concurs: "The media have brought a sense of unrea l i ty to death. The picture of George Wallace l y i n g paralyzed on the pavement provok-ed merely a ho-hum response". He goes on to name movies which i l l u s t r a t e his po in t . There are f i lms l i k e "The Godfather", "Catch-22" and "Butch Cassidy and the Sundance K i d " . More recent ly there has been the "Exorc is t" and "Jaws". At the time of t h i s wr i t i ng there i s "Survive". This l a t e s t movie concerns the sensat ional iz ing of Read's A l i v e (1974) which t e l l s of the sur-v i v a l v i a cannibalism of a group whose plane crashed i n the Andes mountains. What media c r i t i c s f a i l to mention i s that there have been a number of movies which have come.out with very r e a l i s t i c . p o r t r a y a l s .of death. The. Vancouver Fi lm Society featured several of these works i n a series e n t i t l e d " L i v i n g with Death" from January 20.thru March. 9, 1976. . The f i lms f e l l in to 13. three categories - art works, s a t i r e s and documentaries. "Exterminating Angel" (1962) deals with death i n a most s u r r e a l i s t i c manner. "Death i n Venice" (1971) i s a powerfully i n t e l l e c t u a l production from I t a l y . "The National Health" and "The Loved One" (1965) are s a t i r e s and "I:N.ever Sang fo r My Father" (1970) a serious drama about a father and son r e l a t i o n s h i p . These fi l m s and others which have been produced to challenge man's at t i t u d e s toward mortality have not been e n t h u s i a s t i c a l l y received. L i t e r a t u r e and l i v e drama also act as vehicles f o r r e a l i s t i c portrayals of dying and death (Bloching 1974; Nelson, 1973). "The resistances men exhib-i t to facing the r e a l i t i e s of t h e i r l i v e s and deaths have provoked one play-r i g h t a f t e r another i n our time. Audiences have worked wonders i n fending o f f these messages" (Nelson, p.118). Shibles (1974) has written a book which would seem to be the r e s u l t of o f f e r i n g an i n t e r d i s c i p l i n a r y course on death. He includes a lengthy section on various l i t e r a r y o f f e r i n g s published over several years. "j The f i f t h and f i n a l reason given by Kastenbaum and Aisenburg (1972) to support t h e i r t h e s i s that there i s a renewed i n t e r e s t i n death i s that we now have more "mental healthers" who have been "through the m i l l " . "Old School" psychologists are now getting older and learning that t h e i r theories (psycho-analysis) do not meet the challenges of m o r t a l i t y . Mental health s p e c i a l i s t s are encouraging members of today's society to change t h e i r ideas about death (Kastenbaum S Aisenburg, 1972). They are most active i n attempting to prevent s u i c i d e . The Center f o r Studies of Suicide Prevention (CSSP) has been established with the aim of "encouraging and evaluating mental health e f f o r t s pertaining d i r e c t l y or i n d i r e c t l y to suicide prevention" (p.236'). The "Psychological Autopsy"-' created by x v . Kastenbaum and.others (Sneidman, '1973) i s an.attempt to investigate a dead person's psychological make-up and h i s t o r y . In so doing, the inve s t i g a t o r s can t r y to determine what might have l e d the i n d i v i d u a l to k i l l himself. Psychologists are a l s o involved i n attempting to i d e n t i f y psycholog-i c a l components i n other types of death. Work i s being done to improve the l o t of the. terminal p a t i e n t . This concern w i l l be examined at some greater length i n the section on ''care of the dying". Much energy i s being dir e c t e d towards decontaminating the to p i c of death. "There has developed the t r a d i t i o n of i n v e s t i g a t i n g death at t i t u d e s i n order to confront the pu b l i c with i t s own biases and re s i s t a n c e s . " (Kastenbaum S Aisenburg, 1972, p.237). Decontamination of dying and death i n society w i l l involve some indepth focus upon "fear of death" and the "meaning of l i f e " . I t i s the fears that keep people from looking d i r e c t l y at t h e i r m o r t a l i t y . Once the fears are faced there i s a d i r e c t e f f e c t upon l i f e ' s meaning. 5. F e a r o f D e a t h In Overcoming the Fear of Death (1970) Gordon writes "Most of us are a f r a i d to contemplate our own ending; and when anything reminds us that we too s h a l l d i e , we f l e e and turn our thoughts to happier matters" (p.13). I f and when we do consider the p o s s i b i l i t y that we might a c t u a l l y d i e , we think of i t as an event i n the remote future. In so doing we are able to repress our fear of ultimate doom or consciously forget i t . One's a t t i t u d e towards death i s ultim a t e l y r e l a t e d to one's fear of the subject. A person with an open and objective a t t i t u d e i s somehow managing his f e a r s . Another i n d i v i d u a l who prefers to "avoid"' the whole issue X D . i s dealing with his fears i n the way.Gordon has mentioned. This avoidance of fear s h a l l be analysed i n t h i s section as well as management of death anxieties. A fear of death i s dependent upon a number of variables (Langone, 1972, p.4). Already discussed at some length has been the influence of c u l t u r a l and r e l i g i o u s b e l i e f s . "Insofar as culture i s defined i n terms of material t r a i t s and a r t i f a c t s , much of what man does and builds i s motivated by his desire to endure." (Gordon, 1970, p.24) Gordon sees our culture as a res-ponse to our fear of death. Culture thus i n turn has a causal effect i n nurturing the same fear. Ih addition to culture and r e l i g i o n , Langone c i t e s "our attitudes toward l i f e and l i v i n g , and our- general emotional health" (p.4), as play-ing a part i n fear of death. (The section on "meaning of l i f e " - w i l l delve into the significance of these two issues i n some greater d e t a i l . a) aj)i^e^ ubiveiisalanature Weisman (1972) says that, for p r a c t i c a l l y everyone, the meaning of death i s a '!.universal negative" (p.13) and that i t i s impossible to imagine one's own death. Death repudiates and n u l l i f i e s a l l the objectives so sought i n l i f e . Weisman restates the Freudian idea that although man recognizes death i s universal, he i s unable to face i t i n d i v i d u a l l y . This i s described as the "primary paradox". The penalty paid for avoidance i s that when a death does occur i t catches us unprepared. In 1973 Becker wrote The Denial of Death just before he himself died of cancer i n Vancouver General Hospital. Becker talk s about the " e x i s t e n t i a l paradox" of i n d i v i d u a l i t y within f i n i t u d e . This i s the paradox:.he.is out of nature and hopelessly i n i t , he i s dual, up i n the.stars and yet.housed i n a heart-pumping, breath grasping body that once belonged to a f i s h a n d . s t i l l c a r r ies the gill-marks to prove i t . His body i s a material fleshy casing that i s a l i e n to him i n many ways - the strang-est and most repugnant way being that i t aches and bleeds and w i l l decay and die. Man i s l i t e r a l l y s p l i t i n two: he has an . awareness of his own splendid uniqueness in.that he.sticks out of nature with a towering majesty, and yet he goes back into the ground a few feet i n order b l i n d l y and dumbly to rot and disappear forever. I t i s a t e r r i f y i n g dilemma to be i n and to have to l i v e with. (p.26) Becker goes to some length to show that a n a l i t y or concern with one's analness i s at the base of most of Freud's work. One's l i f e s t y l e i s a nec-essary and basic dishonesty about oneself and one's situ a t i o n (p.55). I t i s a means of l i v i n g securely and serenely with the fact of our creature-l i n e s s . Repression i s seen as required for normal l i f e . Culture i s a compromise with l i f e that makes l i f e possible (p.265). Choron has written a c l a s s i c on fear of death e n t i t l e d Death and Modern Man (1964). His book i s a c o l l e c t i o n of ideas on fear which w i l l receive a good deal of attention i n t h i s section. Choron quotes Pascal as saying that some people t r y to not think of death at a l l . He quotes 17th century poet Young as saying " A l l men think a l l men mortal but themselves" (p.107). Choron has observed a deep seated reluctance by people to v i s u a l i z e the end of the process of l i v i n g . He states that t h i s stance i s confirmed by the synonyms given for death such as "the grim reaper, the pale horseman, the destroying angel, the grim monster, and the arch foe" (p.107). 6) b)ic rthet r e a l i t y o ' f . d e a t h Try as one'might to avoid the r e a l i t y of mortality there are times when i t i s impossible to plead ignorance any.longer, Jung i n a book by F e i f e l (1959) states t h i s most aptly: 17* But when one i s alone and i t i s night and so dark and s t i l l that one hears nothing and sees nothing but the thoughts which add and subtract the years, and the long row,of disagreeable facts which remorsefully indicate-how far the hand of the clock has moved forward, and the' slow, i r r e s i s t i b l e approach of the wall of dark-ness which w i l l eventually engulf everything you love, possess, wish, s t r i v e , and hope for - then a l l our profundities about l i f e s l i n k off to some undiscoverable hiding place, and fear envelops the sleepless one l i k e a smothering blanket, (p.4) Choron admits that Pascal did also say that "average normal" people do think of death from time to time but i n a f e a r f u l sense. He acknowledged himself that death fear was actually quite widespread as the following p h i l -osophers had a l l experienced i t : Augustine, Montaigne, Descartes, Pascal, Comte, Schopenhauer, Renouvier and James (p.110). As has been stated the alternative to denial and avoidance i s to attempt to deal with the problem of mortality. Before discussing a variety of p o s s i b i l i t i e s I t .is appropriate tbasf 6'cus^ori ideat''If f ear i t s e l f . c) d e f i t i i t i o n o f f e a r For F e i f e l (1959) fear of death i s possibly the source of a l l anxiety. Any loss represents t o t a l l o s s . Cohen and Parker (1974) hypothesized that i f death i s viewed as an infringement upon one's l i f e , a f f i l i a t i o n with others and success, i t would be predicted that those high i n fear of f a i l -ure would also be high i n fear of death. Their hypothesis was supported i n t h e i r research with 47 male undergraduates. Choron (1964) has divided death fear into three sub-categories: fear of what happens after death; fear of ceasing to be; and fear of the "event" of dying (pp 74-79). By fear of the event of dying Choron equates dying with suffering. " I t would seem therefore, that we have i n the l a t t e r instance fear of pain, and of the indignity of being weak, helpless, and miserable rather than the fear of the termination of l i f e " , (p.77) . 18. The event .of dying i s the..crucial and .central feature of the mi d l i f e phase. It i s the feature of t h i s .stage of the l i f e process which makes i t , for many, a d i f f i c u l t time (Jacques, 1969). The achievement of mature and independent adulthood presents i t s e l f as our main psychological task. Such a goal i s paradoxical for as one enters the prime of l i f e , the stage of f u l f i l l m e n t , death l i e s beyond. One's own r e a l mortality becomes a personal matter. Greater l i f e expectancy has changed the fear of death to a fear of aging (Bloching, 1974). On the other hand a person who has l i v e d his l i f e the way he wanted i s not afraid df the end. The fear of dying/aging i s t i e d to the goals of who you believe you have to be rather than who you are (Keleman, 1974, p.:102). 1 There i s a tendency to look at death as simply the end of a process (Jung, 1959). I t does not occur to us to conceive of death as a goal and a f u l f i l l m e n t . A youth i s urged on to a purposeful future. An old man, who i s struggling with his old age, causes us discomfort and we respond with s u p e r f i c i a l banalities l i k e "everyone must die sometime" or "one doesn't l i v e forever". For Jung " l i f e i s an energy process. Like every energy process, i t i s i n p r i n c i p l e i r r e v e r s i b l e and therefore unequivocally, directed towards a goal. That goal i s a state of r e s t . " (p.4) " I t i s as i f l i f e i s l i k e a parabola of a p r o j e c t i l e which disturbed from i t s i n i t i a l state of r e s t , r i s e s and then returns to a state of repose." (p.5) Man i s urged to treat the descent to death from middle age with the same, i f not increased, respect that i s offered the ascent from youth. I f t h i s i s done, the gain for.the in d i v i d u a l i s a deepening of awareness, under-19. standing and.self-realization. Genuine values can be cultivated (wisdom, fo r t i t u d e , courage) as well as a.deeper capacity for love and af f e c t i o n , human insight, hopefulness and enjoyment (Jacques, 1969, p.163). As long as individuals continue to treat dying as they do, old age w i l l be an unpopular and tragic time f o r many people. They s h a l l continue to be discouraged i n t h e i r aging and the resu l t s w i l l be as Jung (1959) so succintlyy describes: "an old man who does not know how to l i s t e n t c the secrets of the brooks as they tumble down from the peaks to the valleys T: makes no sense; he i s a s p i r i t u a l mummy who i s nothing but a r i g i d r e l i c of the past. He stands apart from l i f e , mechanically repeating himself to the l a s t t r i v i a l i t y " (p.6) Hinton (1967) sees dying as a separation experience. I t forces people to part "and morbid fears are l i k e l y to arise at the prospect of the imposed and unsought-for separation" (p.28). Langone notes that fear of separation from family and friends was the most prominent aspect of F e i f e l ' s study of death fears. Choron's second category has to do with fear of what happens after death. This fear has been the dominant form of death fear for almost "two mi l l e n i a " . Religion has made a f t e r l i f e a r e a l i t y which must be earned. Curran i n an audio tape e n t i t l e d Death arid Dying says that the "core fear" i s a fear of the beyond. Choron's t h i r d category i s the fear of ceasing to be or extinction. What i s meant here i s that where there i s a love of l i f e there w i l l be a natural aversion to death. Hinton (1967) t e l l s us that "much of the anxiety that the prospect of death arouses i s normal and has a b i o l o g i c a l value"(p.21). 20 . He c l a i m s t h a t i f t h i s f e a r were a b s e n t . w e . w o u l d r i s k ou r l i v e s u n n e c e s s a r i l y and p r e m a t u r e d e a t h . w o u l d c o m e . " t o o o f t e n . f o r r a c i a l s u r v i v a l " . C u r r a n t a l k s about " a n n i h i l a t i o n f e a r " w h i c h b r i n g s p a r a l y z i n g n i g h t -mares t o c h i l d r e n . A d u l t s c a r r y w i t h them many u n r e s o l v e d c h i l d h o o d f e a r s and d e a t h b r i n g s , t h e t h r e a t o f a n n i h i l a t i o n t o t h e f o r e ( C u r r a n , 1974; K e l e m a n , 1 9 7 4 ) . I n C o u n s e l l i n g L e a r n i n g - a Whole P e r s o n M o d e l f o r E d u c a t i o n ( 1972 ) C u r r a n o f f e r s a good example o f a n n i h i l a t i o n f e a r s . The t e a c h e r o r knower f e a r s a n n i h i l a t i o n a s he s h a r e s h i s knowledge w i t h t h e s t u d e n t o r l e a r n e r . To s a f e g u a r d h i m s e l f t h e knower i n t e l l e c t u a l i z e s and f a c t u a l i z e s h i s m a t e r i a l t o keep a s a f e p e r s o n a l d i s t a n c e f r o m t h e l e a r n e r . " T h i s p r o t e c t i v e dynamic, on t h e p a r t o f t h e knower c a n be seen i n an a d v i c e - g i v i n g r e l a t i o n s h i p , i n w h i c h t h e one g i v i n g t h e a d v i c e may do so when t h e one r e c e i v i n g - t h e a d v i c e i s e i t h e r i n c a p a b l e o f mak i ng i t o p e r a t i o n a l o r a l r e a d y knows what t o d o . " ( p . 9 2 ) A k n o w e r ' s d e a t h f e a r s have t o do w i t h t h e d i m i n i s h m e n t o f h i s b e i n g , a s what he knows i s s h a r e d . C u r r a n ' s s o l u t i o n i s t o have t h e l e a r n e r p r o v i d e suppor t - -f i v e u n d e r s t a n d i n g a s t h e l e a r n i n g p r o c e s s e v o l v e s . G o r d o n ' s (1970) ' c o m p o s i t e f e a r o f d e a t h f a l l s i n t o t h i s t h i r d c a t e g o r y : f e a r o f t i m e , d e c a y , i r r e v e r s i b i l i t y , l o s i n g ou r p l e a s u r e s and s e n s a t i o n s , l o s i n g o u r t h o u g h t s and a b i l i t y t o t h i n k - l o s i n g t h e s e l f ( p . 2 0 ) . Cho ron q u o t e s R e n o u v i e r who s a i d "When a man i s o l d , v e r y o l d and accu s tomed t o l i f e , i t i s v e r y d i f f i c u l t t o d i e " . d) management of fear W i t h t h e f e a r s o f d y i n g and d e a t h acknowledged- and examined i t i s now a p p r o p r i a t e t o t a k e a l o o k a t some p r o p o s e d ways o f manag ing such a p p r e h e n -s i o n s . 21. Becker (-1973) .mentions .that Rank believed that k i l l i n g another l i v i n g creature or being was a symbolic solution to one's b i o l o g i c a l l i m i t a t i o n . "The death fear of the ego i s lessened by the k i l l i n g , the s a c r i f i c e , of the other; through the death of the.other, one buys oneself free from the penalty cf dying, of being k i l l e d . " (p.99) This idea might p a r t i a l l y explain the existence of mercenaries, murderers and. even hunters of wild game. Needless to say t h i s i s not l i k e l y to become a popular way of appeasing personal fears. Secondly Gordon suggests a popular antidote: work and the making of money. Work which has as i t s r e s u l t the earning of money has been considered by many as the most s o c i a l l y approved use cf time (p.34). ' "This i s the man who has completely forgotten bis mortality, and. i n his headlong f l i g h t to escape i t , i s r e a l l y rushing to embrace i t . This i s the man who k i l l s him-s e l f , f i n a l l y , after f i r s t k i l l i n g everything i n himself that i s human." (p.29) Li f t o n (1.974) proposes f i v e modes for achieving a sense of (synthetic) immortality: b i o l o g i c a l , creative, theological, natural and experiental. He has come up with these ideas because he. thinks that "serenity i n the face of death depends upon the sense that, i n some symbolic way, one's l i f e w i l l endure" (p.49). There i s a concurrence here with Kavanaugh's statement made in the section on culture that a b e l i e f i n something i s s i g n i f i c a n t i n the face of death. L i f t o n does, however place emphasis on the type of b e l i e f held. Mode one i s the b i o l o g i c a l and necessitates l i v i n g on i n one's progeny. Becker (1973) isn't impressed, with t h i s plan,for i f sex i s f u l f i l l m e n t of man's role i t i s also an ongoing reminder that "he i s nothing himself but a l i n k i n the .chain of being, exchangeable with any other, completely expend-able i n himself" (p.113). Frankl (1973).asks about.childless people . • How are they to f i n d an answer to t h e i r fears i n t h i s approach? L i f t o n would no doubt suggest that they check out one of the other four. Number two i s the creative option and involves: teaching, art-making, repairing, construction, writing and healing,.etc. Any a c t i v i t y that per-mits a person to enter into a general human flow beyond, himself. Becker agrees and says that "... some kind of objective c r e a t i v i t y i s the only an-swer man has to the problem of l i f e " (p.183). "The most that any one of us can seem to do i s to fashion something' - an object or ourselves - and drop i t into the confusion, make an offering of i t , so to speak, to the l i f e force." (p.285) Death jars one into a creative state (Curran). I t forces one into the world of f a i t h and hope which are. preambles to love. C r e a t i v i t y involves leaping into the unknown. L i f t o n talks about the nuclear age, Hiroshima and Vietnam. People have come, close to death i n Hiroshima and Vietnam i n p a r t i c u l a r , and many have survived. These survivors are able to a t t a i n "profound insights". The survivor i s a creator who has known disintegration, separation and sta-s i s and who i s now struggling to achieve a new formulation of s e l f i n the world. An area where the survivor struggles i s that of work: "The basic theme i s the quest for s i g n i f i c a n t work experience that w i l l be immediately involving and that w i l l contribute to the continuing human enterprise" (p.1.33). The t h i r d mode, theology, proposes l i f e after death. Hinton (1967) c l e a r l y disagrees: "A convinced b e l i e f i n a future l i f e by no means eradi-cates anxiety over death" (p.38). He says that the Christian doctrine teaches that a man i s a g u i l t y sinner and deserves punishment after death. Berman and Kays did a study which they called "Relation Between Death Anxiety, B e l i e f i n A f t e r l i f e , and Locus of Control" (1973). In general the f i n d -ings suggest that the relationship between death fear and a f t e r l i f e b e l i e f s i s weak. Nature i s the theme of mode four and supplies man with ample evidence that regardless of what happens to man, the trees, mountains and seas en-dure. In a c t u a l i t y mountains do disappear, r i v e r s dry up and oceans change locations. Some gather solace from the image of returning to nature from "whence we came": from dust you came and to dust you s h a l l return (p.70). The f i n a l mode for synthetic :'£mmort-aQ5ity i s experiential transcendence. L i f t o n describes t h i s as a psychological state which involves extraordinary psychological unity; an int e n s i t y of sensual awareness; and unexpressable illumination and insight. Becker (1973) describes psychology as the "new r e l i g i o n " . Its purpose i s to discover the strategies that a person uses to avoid anxiety. Psychology attempts to help people f i n d paradise through s e l f knowledge. Becker thinks that t h i s i s f o l l y because there i s no way to transcend the l i m i t s of the human condition. Becker does say, however, that there are three ways that psychology can become an adequate b e l i e f system. One i s to be a creative genius as a psychologist and to use psy-chology as the immortality vehicle for oneself as Freud and subsequent psy-choanalysts have done. Another i s to use the language and concepts of psychotherapy i n much of one's waking l i f e so that i t becomes a l u c i d b e l i e f system. The t h i r d method i s to take psychology and deepen i t with r e l i g i o u s and metaphysical associations so that i t becomes actually a r e l i g i o u s b e l i e f system with some breadth and depth; the psycho-therapist becomes the guru. Gordon C1970) f e e l s that "man's basic motivation i s to a t t a i n and repeat the spontaneous peak experience i n which man i s u n i f i e d with him-s e l f , others and the world, and i n which h i s thought processes, his think-ing and his discurs i v e i n t e l l e c t are momentarily s t i l l e d " (p.89). Man becomes one with himself, others, and the world of nature. Gordon has developed h i s ideas to the point where he has come up with a theory which he c a l l s the " u n i f i c a t i o n experience". Gordon believes that sexual orgasm i s the u n i f i c a t i o n experience par excellence. Death need not be feared because i t i s the ultimate u n i f i c a t i o n experience, which may make death the ultimate orgasm. L i f t o n ' s survivor i s . a b l e to t r u l y evolve i n t h i s mode. He seeks a sustained experience of exquisite inner harmony, of wholeness and unity (p.135). When there i s death there i s r e b i r t h and hope. L i f t o n quotes Roethke "In a dark time, the eye begins to see". Gh6ron (1964) has f i v e suggestions f o r " a l l e v i a t i n g the fear of death". The f i r s t i s to ignore i t . One does not repress the fear, one sim-ply does not pay i t any heed. Time i s spent studying or i n some other ab-sorbing a c t i v i t y . The second p o s s i b i l i t y i s to simply face the fear "head on". By becoming f a m i l i a r with i t one i s able to mitigate i t s t e r r o r s . A t h i r d choice i s to minimize death. "Death i s less to be feared than nothing — — neither can i t i n any way concern you, whether you are l i v -ing or dead; l i v i n g by reason that you are s t i l l i n being, dead because you are no more'', (p.114)» The fourth a l t e r n a t i v e : minimize the value of l i f e . C h r i s t i a n s s u f f e r i n t h i s existence and an t i c i p a t e a " b l i s s f u l a f t e r l i f e " . One may lead an ascetic l i f e or dedicate oneself to helping others or to some cause, s c i e n t i f i c or a r t i s t i c i n nature. Choice f i v e i s to l i v e a r i c h and f u l l l i f e . Commitment to something i s the key. This stance was p a r t i c u l a r l y t r i e d and supported by Goethe. Unfortunately he s t i l l feared death. Choron says that "... i t has become clear that none (of these methods) can be universally effective because of the v a r i e t i e s of these (death and dying) fears" (p.126). A means of dealing with the hard facts of mortality not yet suggested by anyone quoted i s a healthy sense of humour. (O'Connell, 1966). "Humour i n the Freudian sense was a paradoxically healthy repudiation of the r e a l i t y of one's death. The interpretation of t h i s phenomenon i n e x i s t e n t i a l terms would be more the r e a l i z a t i o n and acceptance of one's physical d i s s o l u t i o n , although s t i l l , as with Freud, a sign of rare emotional maturity." " L i f e i s too important to be taken seriously." (O'Connell, 1974) It has been shown that fear of dying and death i s the issue at the centre of culture's stance towards mortality. Although death i s generally a most uncomfortable fact of l i f e i n the present s o c i a l system there are indications of change. It i s the fears associated with dying and death and must be broached by anyone tackling t h i s aspect of l i f e . As has been indicated there are direct benefits to facing death fears. There i s the obvious res u l t that death does not necessarily loom so traumatically. Perhaps of even greater significance i s the effect on the quality of l i f e . 6) Meaning of L i f e Curran (1974) says that death is the tax we pay for l i v i n g . Death „?;.-frames l i f e or completes the picture of l i f e . When a companion dies i t is the f i n a l brush stroke of l i f e which allows us to round out our awareness of the other. The peace of death allows us to be truly objective. A part of l i f e is closed off when people refuse to face death as i n -dividuals and as a culture (Lifton, 1974). "Until we accept the personal reality of death as a common legacy of mankind, of mine as well as yours, pertaining to me as well as to that other person, we w i l l remain caught in a dense web of a r t i f i c e and denial". (Weisman, 1972, p.18) Denial and avoidance in the face of death have been discussed as a characteristic North American outlook. However l i f e i s not "comprehended truly or lived f u l l y unless the idea of death is grappled with honestly". "This has implications not only for the individual but for society as well/. "\ (Fei f e l , 1959) The 17th century French writer and moralist, La Roche-foucauld said that "one can no more look steadily at death than at the sun". Fe i f e l points out that much has been learned about our planet and mankind from observing the sun. "Is i t not a form of ostrich adjustment to neglect one of the essential r e a l i t i e s of l i f e , a kind of fraud perpetuated on our-selves? " (Feifel, p.XIII). a) enhahci hg f o r c e s Bloching (1974) says that there i s general agreement about the fact that man i s characterized by the need to face the in e v i t a b i l i t y of death. "He's the creature who can die consciously." (p.24) Hinton and Ross think that many people are able to accept the rea l i t y of death. It takes a long z / . time to accomplish and i n f a c t continues to occur u n t i l death i t s e l f per-sonally a r r i v e s . The r e s u l t of t h i s process i s that " l i f e becomes much more meaningful and valuable" (Ross, 1974, p.21). L i f t o n quotes Forster who said: "Death destroys a man; the idea of Death saves him" (p.21). Confrontation of one's mortality s i m p l i f i e s l i f e and makes i t more s a t i s -f y i n g (Gordon, 1970). Although everyone has the c e r t a i n knowledge that they must and s h a l l d i e , how many persons are t r u l y able to "know" i t ? Pincus asks t h i s ques-t i o n i n Death and the Family (1974). She says that i f we could r e a l l y know, "We might then be able to l i v e more f u l l y , l e s s burdened by fears and anxie-t i e s , and thus improve the q u a l i t y of our l i v e s and our deaths" (p.9). This l i n k between q u a l i t y of l i f e and q u a l i t y of death i s supported by others (Curran, 1974; Kavanaugh, 1972; Keleman, 1974; Langone, 1972). As an ex-ample of what Pincus means she t a l k s about her dying husband: He f e l t that during these l a s t months of h i s l i f e , he had acquired a new i n t e n s i t y of perception, of enjoyment, of being i n touch with what was b e a u t i f u l , and I could share on our gentle walks, h i s sheer delight i n small c h i l d r e n , b i r d s , flowers, t r e e s , clouds. We were probably closer du-r i n g that time, more united i n mutual t r u s t , than at any other time i n our long marriage, (p.4) People,, are encouraged to l i v e each moment to the f u l l e s t (Gordon, 1970). This i s a worthy goal but one that i s d i f f i c u l t to achieve (Toynbee, 1968). To the extent one i s able to l i v e i n the present he/she i s able to become one with the moment, the person they are with, the s i t -uation they are confronting, the world and most importantly with themselves. b) riegati hg f o r c e s There are many who, although they agree that death provokes the mean-ing of human existence, (they) disagree about the answer to the question. 28. Some choose to accept a negative response. Choron (1964-) quotes Krutch who says that "Living is only a physio-logical process with only a physiological meaning". Nagel is also consul-ted: "Human destiny i s but an episode between two oblivions" (p.162). If death is the end then l i f e makes no sense. "Death may be 'nothing' as Epicurus and some modern 'tough minded' philosophers claim, for i t i s 'only' a natural end to l i f e ; but i t , nevertheless, turns l i f e into 'nothing' by making i t appear pointless and absurd. A journey whose f i n a l destination i s disaster, a struggle that i s fated to be lost.1,' (p. 163) For Choron the main problem has very l i t t l e to do with mortality at a l l . The primary d i f f i c u l t y i s that l i f e ' s process makes l i f e seem sense-less. Gordon calls this the fear of l i f e . Much of l i f e i s "consumed by mental anguish and suffering and dark despair and unhappiness" (p.63). Where there is an absence of meaning in l i f e , death forces the pain-f u l question "What have I done with my l i f e ? " and there i s a regret that one has not truly lived. One would think that where l i f e has no meaning that death would be a release. Choron says that both fears exist at the same time. One finds l i f e meaningless and yet fears i t s end. c) finitude : the key to meaning Frankl (1973) is a leading proponent of l i f e having meaning as a re-sult of "finitude". He refutes the various arguments that death relegates l i f e meaningless by pointing out that death ends procrastination. If man were immortal he could postpone every action forever (Fe i f e l , 1959; Gordon, 1970; Ross, 1975). "We are under the imperative of u t i l i z i n g our'life-times to the utmost, not letting the singular opportunities - whose 'fi n i t e ' sum constitutes the whole of l i f e - pass by unused." (Frankl, 1973, p.64-) F i n a l i t y i s essential to the meaningfulness of l i f e . This quotation from Ross' Death the F i n a l Stage of Growth says i t c l e a r l y : Death i s the key to the door of l i f e . I t i s through accepting the finiteness of our i n d i v i d u a l existences that we are enabled to f i n d the strength and courage to reject those e x t r i n s i c roles and expectations and to devote each day of our l i v e s - however long they may be - to resources, to define ourselves i n terms of the feedback we receive from our own i n t e r n a l valuing system rather than t r y i n g to f i t ourselves into some i l l - f i t t i n g stereo-typed r o l e . I t i s the denial of death that i s p a r t i a l l y responsible for people l i v i n g empty, purposeless l i v e s ; for when you l i f e as i f y o u ' l l l i v e forever, i t becomes too easy to postpone the things you know you must do. You l i v e your l i f e i n preparation for tomorrow or i n remembrance of yesterday, and meanwhile, each today i s l o s t . In contrast, when you f u l l y understand that each day you awaken could be the l a s t you have, you take time that day to grow, to become more of who you r e a l l y are, to reach out to other human beings, (p.164) Uniqueness and s i n g u l a r i t y lead to r e s p o n s i b i l i t y . Man's existence i s a r e s p o n s i b i l i t y springing from f i n i t e n e s s . "Within his own exclusive sphere of destiny every man i s irreplaceable". (Frankl, 1973, p.74) Each man has a unique destiny unlike any other i n the cosmos. The opportunities that come his way for the actualization of creative or experiential values and the t r i a l s and t r i b u l a t i o n s which also come his way are a l l his very own. The t r i b u l a t i o n s cannot be altered and therefore must be endured and i n the enduring of them additional values are actualized (Frankl, 1973). The true meaning of i n d i v i d u a l i t y comes to f u l f i l l m e n t i n the community The individuals receive value from the group and the group i n turn depends upon the i n d i v i d u a l i t y of i t s members for i t s meaning. The alternative to involvement i n a community i s membership i n a "mass" Indi v i d u a l i t y i s disrupting to any mass so such uniqueness must be submerged. •30. In a mass a person's l i b e r t y i s limited for the sake of equality. Frater-n i t y i s replaced by the herd i n s t i n c t (Frankl, 1973, p.71). "Good uniqueness" i s directed toward a community for which a person has a s i g n i f i c a n t value. A person shoulders the task set him by society and adds to his r e s p o n s i b i l i t y . One l i v e s with an active s o c i a l interest (O'Connell, 1976): "to. escape into the mass i s to disburden oneself of i n d i -vidual r e s p o n s i b i l i t y " (Frankl, 1973, p.73). "True community i s i n essence the community of responsible persons; mere mass i s the sum of depersonalized e n t i t i e s . " For Frankl, being human means being a responsible choice maker. He sees t h i s as man's essential freedom. Man has no control over what happens to him but he does have some control over how he w i l l choose to react to what happens. ."During no moment of his l i f e does man escape the mandate to choose among p o s s i b i l i t i e s . Yet he can pretend to act 'as i f he had no choice and no freedom of decision. This 'acting as i f constitutes a part of the human tragicomedy." (p.76). To be human means not only to be different but to be able to become d i f f e r e n t , to change and grow. Those who admit to an unknown fear i n death undoubtedly l i v e i n d a i l y fear of the unknown i n a l l novelty and change (Kavanaugh, 1972, p.16). Blazer (1975) suggests that a good way to estimate a person's meaning or purpose i n l i f e would be to look at his attitude toward dying and death. This idea comes from a study he conducted which discovered that people who reported a.high purpose and meaning i n t h e i r l i f e tended to have less fear of death and a more positive and accepting attitude toward i t . Durlak (1972) 31. had earlier found similar results in a study of his own. Man has the freedom to decide how he w i l l react to any situation he encounters. His mortality urges this responsibility upon him and encourages him to li v e l i f e to the fullest on a daily basis. "What is demanded of man is not as some existential philosophers teach, to endure the meaningless-ness of l i f e , but rather to bear his incapacity to grasp i t s unconditional meaningfulness in rational terms." (Frankl, 1963) B) Culture: specif ic concerns Up to this point the perspective has been quite broad. Cultural att-itudes past and present have been examined. The topic of fear has been dealt with and i t s significance to l i f e ' s meaning expressed. This overview has prepared the way for a closer look at some specific mortality issues. It is in the care of the dying, bereavement and sharing death with children that there are opportunities to experience f i r s t hand the fr u i t s of one's attitudes towards mortality. Each of these areas w i l l be approa-ched more comfortably and effectively i f one has begun to grasp one's own discomfort with dying and death. 1) The dy irig process First of .all the various professional roles surrounding a terminal person shall be examined. A discussion of the family position w i l l then lead to the patient; his needs, his right to information about his disease and his growth in dying. This section w i l l end with some information about attitudes observed near death and death-like experiences. a) the medical perspective Modern medicine has made great progress in helping to alleviate phy-s i c a l pain. It has, however, done precious l i t t l e to ease the f i n a l burden of loneliness, emotional pain, grief and indignity which a dying person encounters (Hendin, 1973). Medical people are l i t t l e prepared to deal with death (Strauss, 1969). In medical care there seems to be an emphasis on technological care: 11 ... i t is not infrequent that the patient as a psychologic, sociologic and individualistic organism i s overlooked" (Langone, 1972, p.37). Health care has become highly specialized and divided into many branches (Hofmeier, 1974). Hofmeier sees medical professionals as those who provide the necessary services which maintain l i f e . Each dying person places these helpers in a conflict which engenders feelings of insecurity. Doctors and nurses react to these feelings by maintaining a safe professional distance which prevents them from truly supporting the emotional needs of their patients. Mount (1973-4) asked his medical colleagues just why i s i t that ter-minal care is not more generally recognized as a problem area. He notes three points in response: medical people see themselves as sensitive people and they do not recognize their insensitivity to those around them; there i s more of a tendency to recognize deficiencies in those colleagues around one; and there is a tendency to think that colleagues avoid questions regarding dying more than they themselves. "The biased perspective of physicians and nurses, acquired while working in close contact with the problem year after year and the tendency for the patient to respond to those, caring for him with a patronizing comment rather than a c r i t i c a l assessment of t h e i r de-f i c i e n c i e s were seen as two further factors which tend to cloud our aware-ness of our d e f i c i t s i n dealing with the dying." (p.6) The physician i s being urged from many sources to attend to the psy-chological as well as physical needs of people i n t h e i r charge (Kastenbaum £ Aisenburg, 1972). The doctor i s i n a p i v o t a l position i n our society's "death system" and i s able to exert much influence over the s p e c i f i c functioning of! .others i n the system including the patient and his family. "While there i s l i t t l e a doctor can do to help a person to die, there i s much he can do to help a person l i v e u n t i l the time of death." (Langone, 1972, p.33). To be effective with the dying the doctor must become aware of his own feelings about death (Mount, 1973-4; Kastenbaum £ Aisenburg, 1972). Hendin (1973) believes that physicians must distinguish between treating t h e i r own anxieties and deciding what i s best for the patient (p.68). When i t i s f e l t that a patient's death i s a personal f a i l u r e as a "healer", a r t i f i c i a l life-support systems become more and more appealing for use i n medical care. Tremendous advances i n technology have made'"heroics" a common place occurence. This i s a si t u a t i o n where a person i s kept a l i v e physically on a machine when his brain has ceased to function. Euthanasia, active and passive, i s becoming an increasingly popular, issue i n which doctors are going to be central figures. F e i f e l conducted a study and learned that physicians and medical stu-dents tend to have an above average fear of death (Kastenbaum £ Aisenburg, 1972). Another study by O'Connell (1966) reported that medical students ';, 34. have more concern over death than do comparable college age groups. Appar-ently future psychiatrists exhibited the most apprehension. The implication of this research is that many physicians enter their profession and secure-"prominent mastery over disease, to help control personal concerns about death" (Kastenbaum £ Aisenburg, 1972, p.215). There is a status system in a hospital which allows the doctor to make most of the decisions. "The nurse is obligated to enforce and implement these decisions regardless of her own opinions and preferences*" (Kasten-baum 6 Aisenburg, 1972, p.220) Such decisions may get in the way of the nurse honestly and sensitively meeting the patient's emotional needs. An example would be where the doctor has decided to share no factual informa--tion with a patient about his prognosis. The nurse is the member of the care team who is li k e l y to have most of the direct contact with a dying person. Kastenbaum asked 200 attendants and licensed practical nurses how they would respond to possible patient statements: "I think I'm going to die soon" or "I wish I could just end i t a l l " . Most of the respondents said they would either reassure the patient, deny the seriousness of the concern, change the subject or respond with a f a t a l i s t i c platitude. Only a few nurses said they would feel comfortable "discussing" with the individual his/her concerns. Another member of the care team i s the mental health specialist. In the past he has been conspicuous by his absence. There are a variety of reasons for this absence, however of greater importance is the fact that more of these people are becoming active in work with the dying. Areas of interest and involvement by mental health professions were dealt with in the section on "culture". 35. The other major professional who works with dying people is the clergy-man or chaplain. "It i s a familiar contention that the roots of a l l r e l i -gions are to be found in man's encounter with death, his need to adorn and interpret the bare fact of mortality." (Kastenbaum S Aisenburg, 1972, p.225) The clergy has had a long term relationship with the dying. The chaplain does not have the pressures to update his methods as do others on the care team. His very presence on that team however i s forcing him to examine his perspective and purpose. At the present time his role is hazy (Kastenbaum 6 Aisenburg, 1972). Euthanasia and birth control are big issues for any chaplain let alone those working within a hospital set-ting. Many pastors are as uncomfortable with dying and death as any one else. This is made particularly d i f f i c u l t for them when others expect them to be "in-the-know" with God and have a l l the right answers. Kastenbaum arid Aisenburg note that a chaplain can have a variety of defensive styles: a set apartness, ritualized action, special language, special attire or a business approach in which one must always be off to the.next appointment. Like any one else, "to be useful in the death situation (a chaplain) must function as a mature and sensitive person as well as a l i v i n g symbol of God and Church" (p.226). The chaplain has a tremendous potential in work with the dying for he does not have a specific medical function. He can simply "be with" a patient as he has the time\:to s i t for awhile. A clergyman's presence can improve a patient's interpersonal l i f e by demonstrating to staff and visitors that somebody s t i l l considers the patient to be a person deserving of f u l l attention. Such a presence enables the indi v i d u a l to come to better terms with his own situa t i o n thereby making him more appealing to the hospital s t a f f (p.228). A year ago the author had the opportunity to work f i r s t hand as a chaplain i n Vancouver General Hospital. This position was held for about four hours a day, f i v e days a week over three months. The-points made by Kastenbaum and Aisenburg (1972) are not only interesting but they are accurate. There was the experience of f i r s t hand relationships with patients which did confirm t h e i r personal significance. The chaplain-patient r e l a -tionship also was helpful to these dying people i n t h e i r continuing adjust-ment to various hospital conditions including s t a f f . Hendin (1973) suggests that the best thing for medical people would be more education i n the area of death. Later there w i l l be br i e f mention of courses now available for nurses and t h e i r attitudes to these programmes. b) the patient's perspective Ross i n On Death and Dying (1969) mentions stages which she has'ob-served dying patients to pass through. These stages number f i v e and, i n order, are as follows: shock and denial, anger, depression, bargaining and acceptance. Hope i s maintained throughout a l l the stages. Ross notes that acceptance i s a worthy goal i n the dying process as i t allows the patient to marshal his resources to help the medical people i n t h e i r continuing work to save his l i f e . Since t h i s information has come out medical people have been using i t i n a very i n t e l l e c t u a l fashion (O'Connell, 1974). The author knows from personal experience that t h i s approach by a helper i s d e f i n i t e l y a hindrance to good relationships. 0 / . Ross spoke at a Conference on Dying Person Care in Seattle on March 5, 1976. At that time she urged her listeners to relax on the stages and concentrate on honest non-judgemental sharing of feelings. Others agree wholeheartedly (Kavanaugh, 1972; Leshan, 1969). "The encounter needs empathy, not sympathy, and the empathy must go both ways. One must be in f u l l contact with the patient before the patient can accept being in con-tact with himself and with life-." (Leshan, 1969) It i s not necessary to move a person through the stages but rather to accept him where he is at and try to understand what i s happening. Sneidman (1973) talks about "appropriate death" where a man who has been angry a l l his l i f e remains so throughout his dying. The key person in this whole issue i s the one who has the terminal ill n e s s . Sudnow (1967) wrote about dying in Passing On - The Social Organ- ization of Dying. He found after observing the routine of two large hos-pita l s , that the dying person was shunned and alienated by the treatment professionals. Mount (1973-4) writes more recently and the situation seems l i t t l e changed. "Instead of sympathetic understanding and expertise in meeting his medical and emotional needs, the Canadian dying in an institution today (and more than 70% of us die in institutions) i s l i k e l y to encounter isolation, loneliness and depersonalization! 1" (p.4) To ignore the person who is dying is thought by Weisman (1972) to be a mutilation and desecration of the dignity in death. Kavanaugh (1972) states that a dying human "deserves .more than efficient care from strangers, more than machines and septic hands, more than a mouth f u l l of p i l l s , arms f u l l of tubes and a rump f u l l of needles" (p.6) Hendin (1973) quotes theologian Ramsey who says "the sting of death is solitude". Leshan (1969) has found 38. that there i s evidence to support the b e l i e f that deep psychological iso.-, l a t i o n decreases one's w i l l to l i v e . The patient should be the "centre of at t e n t i o n " (Saunders, 1969). There should be a focus upon both the p h y s i c a l and emotional needs of the sick one. His requests must be attended to rather than i n s i s t i n g he submit to the a r b i t r a r y w i l l of those i n attendance .(Hendin, 1973; Ross, 1974). During the March conference, Ross sa i d that we have only to ask a patient how we might help and we w i l l be t o l d . We must be a v a i l a b l e at a v a r i e t y of times so as to provide help when help i s needed. Special treatment f f a e i l i t i e s s are evolving to meet the needs of the dying. The most famous f a c i l i t y of t h i s kind i s St. Christopher's Hospice i n London. At the time of t h i s w r i t i n g there i s one such programme i n Canada and i t i s located i n Royal V i c t o r i a Hospital i n Montreal. Dr. Mount, who i s quoted at various places throughout t h i s chapter i s the medical d i -re c t o r of the Montreal "hospice". These units provide s t a f f who are p a r t i c -u l a r l y s e n s i t i v e and f l e x i b l e . In a hospice the patient""remains active i n decisions about himself as long as p o s s i b l e " (Hendin, 1973, p.96). Mount (1973-4) quotes a dying nurse: "I know you f e e l insecure, don't know what to say, don't know what to do. But please believe me, i f you care, you can't go wrong. Just admit that you care; that i s r e a l l y f o r what we search" (p.5). What i s needed i s a s p e c i a l "someone" who can be a continued empathic presence, a s p e c i a l f r i e n d who can walk to the edge with the dying person (Kavanaugh). " I f together with adequate p h y s i c a l care, the dying person had . s u f f i c i e n t human companionship, most of h i s anguish would be prevented"" 3'(Hinton, 1967, p. 120) "We can help the patient f i n d and accept his own being and path; to sing his own individual song, to play in l i f e the special music of his unique personality." (Leshan, 1969, p.31) There are some medical people who w i l l not even acknowledge to a patient that a terminal situation exists. Hendin believes that i t i s the patient's right to know what is going on. Recognition of such a stage i s not defeatism rather i t displays respect of the individual's dignity (Saunders, 1969). When medical personnel, family and friends refuse to talk about death to people who are dying, the feelings of isolation are enhanced (Langone, 1972). The problem of awareness is crucial not only to the patient but for those who care for him (Glaser and Strauss, 1965). Glaser and Strauss have written a book on this aspect of terminal pa-tient treatment called, Awareness of Dying (1965). They outline several degrees of awareness and come out strongly supporting "open awareness". Patients could give each other support; and the staff support the patients. Patients could even raise the flagging sp i r i t s of the staff I From their death beds, they could thank the ; physicians for their unstinting efforts and wish them luckiin solving their research problems to save other patients. They could close their lives with proper r i t u a l s , such as letter writing and praying. They could review their lives and plan r e a l i s t i c a l l y for their families future. (Strauss, p.128) Weisman thinks a family may have very good reasons not to be open with a sick member of their group. He says that guilt may arise from a sincere regret that they have not been able to avoid the calamity which has occurred. "For this reason, families and friends may want to avoid the implicit re-proach that mere confrontation with the victim might e l i c i t . " (p.17) This sounds like the patient's needs are secondary to those of the "family". 4 0 . While on the subject of families and their part in the dying of one of their number, i t is appropriate to mention some other opinions. Relatives are often discouraged from playing active and supportive roles by the hos-p i t a l (Hofmeier, 1974). "The consistently casual treatment of family members in almost a l l hospitals proves that medicine does not yet consider the family an important factor in patient care." (Kavanaugh, 1972) It is suggested that families be encouraged to be as actively involved as possible for as long as possible (Hinton, 1967). The result i s that these family groups report being brought closer together through the pro-cess. There are new resource books being published which can be of special help to a family with a dying member (Davidson, 1975; Jury 6 Jury, 1976). Tolstoy's story of Ivan Ilych (1960 ed) is a functional account of what can occur in a setting where there is "closed awareness". No one talks to Ilych about his illness even when he has become aware of the true nature of his predicament. His isolation greatly magnifies the turmoil of his dy-ing. c) growth potential Dying can be a time'of tremendous personal growth (Saunders, 1969; Curran, 1974; Kavanaugh, 1972; Imara, 1975; Ross, 1974). One's sensitivity to and appreciation of l i f e i s greatly enhanced. The separation experience can be " l i f e affirming or l i f e denying" (Imara, 1975). Helpers tend to be task oriented problem solvers. Unfortunately this approach w i l l not work with the dying (Curran, 1974). There is no answer to dying. What is needed is a creative flow between patient and helper. Due to the intensity of the dying person's experience even short encounters can be powerful. If one respects and doesn't pity, the dying person w i l l teach one how to live (Saunders, 1969). "It is from our dying patients that we learn the true values of l i f e , and i f we could reach the stage of acceptance in our young age, we would live a much more meaningful l i f e , appreciate small things and have different values." (Ross, 1974, p.33) d) at the poi lit of death What is death really like when the time comes? Choron (1964) notes "numerous reports" of people facing execution in a peaceful state of mind. "Recent studies show that the state of mind of those facing death in accidents or natural catastrophes is characterized by a sentiment of beati-tude, an unusual rapidity of thought and imagination, anesthesia to touch, absence of feeling of sadness and f i n a l l y a 'review' of past l i f e . " (p.86) Keleman (1974) talks of similar responses in those who have been in alpine climbing accidents and near drownings. The head of a large sanitarium in Norway has been quoted as saying that his observations have led him to believe that death is a "pleasant experience". Ross (1976) has talked to many individuals who have "died"' and then come back to l i f e . She mentions the following characteristics as commonly experienced by a l l those she has seen: separation from the body; a feeling of undescribable peace; a sense of wholeness - even when the physical body was not whole; being met by someone who has died previously; and there is no longer a fear of death. 2. Bereavement The terminally i l l person is the centre of attention during the dying process but this changes once death occurs. Those l e f t behind have to try 1 and go on living with the loss of their loved one. "There are two parties to the suffering that death i n f l i c t s ; and in the apportionment of this 42. suffering, the survivor takes the brunt." (Toynbee, 1968, p.271) Avoidance of the reality of death must certainly have some effect on the grief process. There is a tendency to urge the repression of grief (Hendin, 1973). A major problem of grief seems to be a lack of social involvement by the bereaved. Often they are l e f t on their own to work through their loss. Loneliness is the greatest curse of widowhood (Pincus, 1974). Since bereavement cannot be prevented the most useful thing that can be done is to acknowledge i t hot as a "horrible threat looming over us, but as an important part of our lives for which we can prepare ourselves" (Pincus, 1974, p.250). It is often the mourner who has never been able to face his own death who has d i f f i c u l t y surviving a grief experience. Mourn-ing the death of another provides us with an excellent opportunity to rehearse our own dying (Keleman, 1974). "It is a r i t u a l for the expression of some of the deepest and most intimate feelings of our existence." (p.45) a) " 1 i t t l e deaths'1 "From the moment l i f e begins through a l l phases of child- development, human growth depends on accepting and mastering loss - loss of the safety in the womb, loss of the breast, loss, real, fantasied or threatened." (Pincus, 1974, p.127) There are a l l kinds of losses; physical to the body image and socio-professional or status losses (Cattell, 1969). Keleman, 1974) refers to these occurences as " l i t t l e deaths". People who live in institutions - state or provincial hospitals and nursing homes, are living partial deaths (Ross, 1974). Spiritual death prior to physical death is where a person loses his mind to insanity or senility, (Toynbee, 1968). M-CS . b) influential factors in grief There are a variety of factors which influence our response to be-reavement: mode of death; timeliness; previous warning and preparation. The key factor would seem to be the quality of the relationship. The inter-actions that existed between the surviving and the dead (Pincus, 1974). The subtleties of the relationship play an important role (Cattell, 1969). Fore-knowledge of an impending death can lessen the intensity of a bereavement when i t comes (Herter £ Knight, 1969). This preknowledge has been described as "anticipatory grief". When a wife is l e f t alone while her husband goes off to war she experiences separation anxiety. Such an-xiety w i l l soften any news of sudden death. Similarly a family which has a member dying over an extended, period of time, may only experience r e l i e f when death actually occurs. The problem with anticipatory grief i s that a sense of r e l i e f at the time of death may be accompanied by feelings of confusion and g u i l t . This can occur when the bereaved do not understand that a great deal of grieving ' has already occurred in place of post death grief. Also i t is necessary to assume grief-like behavior in social settings as "any overt expression of r e l i e f i s unappropriate" (Herter £ Kn'ight., 1969). "Hence honest emotions are sublimated to a degree and a charade played out." (p.200) c) grieving process Lindeman (1944) wrote the f i r s t a r t i c l e that dealt with the grief pro-cess. Since that time many others have had something to say about the nu-merous stages of grief (Jackson, 1957; Cattell, 1969; Imara, 1975; Kavanaugh, 1972; Pincus, 1974; Hendin, 1975;Langone, 1972; Rosell, 1969; Kutscher, 1969). There is general agreement that the stages of grief include the following 4 4 . sorts of reactions; i n i t i a l shock and disbelief or denial; disorganization; release of volatile emotions; guilt; loneliness; feelings of r e l i e f ; even-tual re-establishment. The basic task of grieving is to give up old relationships and es-tablish new ti e s . The key to doing this i s to express the whole gamut of experienced emotions "which may include yearning, anger, fear, depression, panic, helplessness, hopelessness or emptiness" (Hendin, 1975, p.14-5; L'angone, 1972; Rosell, 1964; Pincus, 1974). Knowledge of the many different phases of grief can allow one to relax somewhat when the noted feelings are f e l t . Abnormal grief reactions are most often diagnosed on the basis of repressed emotions. These feelings w i l l express themselves somehow, often as physical and/or mental symptoms. Therapeutic intervention for grieving i s not necessary (Pincus, 1974). Bereavement is normal. Special attention to this time of adjustment by mental health professionals may make i t seem otherwise. There are resources which a mourner may consult. Hunt (1971) has written about the Christian perspective on death and resurrection. It is a short and readable book. Perhaps one of the best books available is Lewis' A Grief Observed (1961). Lewis wrote of his bereavement when his wife died, as the process unfolded. d) g r i e f d r a m a t i z e d : the f u n e r a l There is the common assertion that a funeral or some sort of "rite' of passage" should exist to aid in the mourning process (Hendin, 1975; Pincus, 1974; Ross, 1974; Langone, 1972). "The primary purpose of many of the traditional funeral r i t e s - from ancient times to present - has 4 5 . consistently been to offer solace and a.period.of healing to the survivors." (Hendin, 1975,.p.140) The funeral also disposes of the body and acts as a public acknowledgement of death (Kavanaugh, 1972). The North American funeral has come under a lot of scrutiny and c r i t -icism over the last 15 years (Morgan 1975; Mitford 1963; Harmer, 1963; C o r i o l i s j n 1967). [Perhaps the earliest criticism of the funeral industry was Waugh's The Loved One (1948)3 It is f e l t that the modern funeral i s a manifestation of societies' avoidance of death. This has only been the case since the American C i v i l War. Before this event North America was mainly rurally populated. Death used to be. a family involvement from beginning to end (Mitford, 1963). "The Forest Lawn Memorial Park cemetry in Southern California epitom-izes our attempt to 'bury death'. There at the world's largest cemetery, death i t s e l f is a dirty word." (Lifton, 1974, p.18) During the month of July 1976 the author had the opportunity to v i s i t two of the four Forest Lawn cemeteries in Los Angeles.. They are huge rambling parks with numer-ous churches, statues, paintings, mosaics and museums. A l l these attrac-tions are a front for the actual purpose of these f a c i l i t i e s : to.bury the dead. One of the few visible clues as to the true money making nature of the cemeteries is the close proximity of the graves to each other. The writer was amazed at the closeness of individual graves with only a few inches separating them. Every available space is being sold for burials. One of the major criticisms of the funeral director i s that in making the corpse look " l i f e l i k e " he is masking death's r e a l i t y . The following words by John Matthews from an a r t i c l e entitled "The Time My Father Died" poigniantly.state the concern (Mount, 1973-4): 4 b . I did not.want to see my father u n t i l I could have some time with him alone. Several hours before the funeral I went to where he waited. I can scarcely describe what I saw and-felt. My father, I say, was 92, In his latter years he had wonderfully chiseled wrinkles. I had helped to put them there. His cheeks were deeply sunken; his l i p s pale. He was an old man. There i s a kind of glory in the face of an old. man. Not so with the stranger lying there. They had my Papa looking lik e he was 53. Cotton stuffed in his cheeks had erased the best wrinkles. Make-up powder and rouge plastered his face way up into his hair and around his',neck and ears. His l i p s were painted. He looked ready to step before the footlights of the matinee performance. I fiercely wanted to pluck out the cotton but was afraid. At least the make-up could come off. I called for alcohol and. linens. A very reluctant mortician brought them to me. I began the restora-tion as the.powder, the rouge, the li p s t i c k disappeared, the stranger grew older. He never recovered the look of his 9-2 years, but in the end the man in the coffin became my Papa." (p.3) At the graveside Matthews continues: I say I smelled the fresh earth. There was none to be seen. What I did see is d i f f i c u l t to believe. . I mean the green stuff. Some-one had come before us and covered that good, wonderful raw d i r t , every clod of i t , with green stuff. Everything, every scar of the grave, was concealed under simulated grass: Just as i f nothing had been disturbed, here: Just as i f nothing were going on here: Just as i f nothing were happening. , What an offense against nature, against history, against Papa, against us, against God. I. wanted to scream, I wanted to cry out to the whole world: "Some-thing i s going on here, something great, something significantly human. Look! Everybody, look! Here i s my father's death. It_ is going on here! (p.4) Many funeral industry c r i t i c s blame the industry for society's avoid-ance of death. It is however a somewhat unfair criticism as "our culture's death system has neither been created by the funeral director, nor passively received by him. The system operates through him" (Kastenbaum 6 Aisenburg, 1972, p.24). Social expectations of the funeral man may also be a l i t t l e unreal-i s t i c . There i s a desire for a physical administrative function as well as emotional comfort. Goldberg and Kastenbaum did a study of students preparing to be undertakers. They learned that these people exhibited a low level of intellectual interest and output. Their attitudes towards death"were described as " b r i t t l e " . "In general there was no evidence to indicate that career- choice had been based upon a particular commitment to the problems of bereavement, or an exploration and resolution of the mean-ing of death in their own lives'. 1 1 (p.212) Today there are memorial and funeral planning societies which allow a person to plan in writing in advance of death for disposition of his body. Basically these organizations promote simple, dignified and low cost f i n a l arrangements (Morgan, 1965). The largest such group in the world i s located here in British Columbia: The Memorial Society of B.C. There are also books evolving to help the consumer be better pre-pared to manage death. Watt has written Canadian Guide to Death and Dy- ing (1974.)and Wong The Layman's Guide to Drafting Wills (1974). Such books are a response to an increasing desire for people to face "head on" the implications of their mortality. 3. Chi ldreri arid Death Although information about birth i s shared with children, death is s t i l l generally avoided (Yudkin, 1968). If dying and death are d i f f i c u l t for adults then i t is going to be increasingly so for children (Hendin, 1973). Children are very well protected from the r e a l i t i e s of death. They are barred from many hospitals where some contact with dying people could take place (Ross, 1976; Kastenbaum £ Aisenburg, 1972). It has already been discussed how in earlier times death was more of a fact of l i f e . This was certainly so for children. Brothers, s i s -ters, friends and grown-ups would die. Many youngsters never even lived 48. to maturity. Death was observable by children f i r s t hand" (Yudkin, 1968). a) developmental perspectives Although research i s sparse in this area some information is avai l -able about a child^s perspective of death. Most developmental psycholo-gists state that the very young child (birth to about 2 years) has no understanding of death (Kastenbaum £ Aisenburg, 1972). The general con-tention i s that young children lack the a b i l i t y to grasp any abstract conception. Kastenbaum and Aisenburg do not share this appraisal: "Be-tween the extremes of 'no understanding' and explicit, integrated abstract thought, there are many ways by which the young mind can enter into a re-lationship with death" (p.9). Kastenbaum and Aisenburg have suggested three developmental stages. The f i r s t is from birth u n t i l five years. During this period, death i s not recognized as being f i n a l . It i s seen as sleep or a temporary arran-gement. The aspect of separation is the most distressing. Curiosity, an-xiety and fear are aroused as fantasies intermingle with actual experiences. Usually the experiences are rare due to the shielding from parents. Con-fusion must no doubt occur within a young child when his parents say that everything i s alright, yet act very upset i n front of him. Or when a child nonchalantly talks about a dead person and is met with embarassment and concern in response (Yudkin, 1968). Today adult secrecy and protectiveness feed into a child's fantasies (Yudkin, 1968). "Ambiguities in adult lan-guage and thought are apt to confuse the young child as he attempts to make sense out of death." (Kastenbaum £ Aisenburg, 1972, p.15) In the second phase (5 years to 9.year's) the child tends to person-i f y death. There i s a f i n a l i t y in dying, and death,although i t can be "run away from". Violent games are played which may be a way of dealing with anxieties generated by persisting fantasies (Yudkin, 1968). It i s in the third phase (9 years, 10 years and thereafter) that death is seen as f i n a l and inevitable. Everyone in the world w i l l die. This sort of realization can take place and proceed no further. It i s a superficial "common sense" acknowledgement which nicely compliments the average adult 1s stance of avoidance. Kavanaugh (1972) believes that teenagers have f a i r l y liberated ideas about death. They talk of i t gli b l y , romanticize i t in song and even "pon-t i f i c a t e on the irrelevance and waste in funeral customs". In a p o l l , how-ever, Kavanaugh learned that 78% of his sample had yet to see a dead per-son and 92% had yet to witness a death. It i s easy to be romantic and intellectual about an emotional issue, of which one knows very l i t t l e . The true feelings are nicely hidden u n t i l such time as the reality of death arrives on the scene. b) the need to teach A child should and must be taught about death (Lifton, 1974). "If ideas about death are not developed gradually in this way and talked about at appropriate moments, the death of a child's friend, brother, sister or parent can be a trauma from which there never w i l l be f u l l recovery." (p.35) The healthier a child's emotional development the better able he w i l l be to deal with loss at a later date (Cattell, 1969). Psychologically insecure children have a tought :time when a death occurs. The secure ones suffer as well but "they w i l l be able to express their sufferings i n some form and ob-jectify them" (Pincus, p.243). 50. If a child i s taught about the rea l i t y of mortality he w i l l not have to go through a l l the stages i f and when.he or someone close to him be-comes terminally i l l (Ross, 1974). Guiding children in looking at and accepting death can result in adults who are more directed in l i f e , who have more purpose and meaning in their l i v e s , and who can be mature and responsible citizens (Blazer, 1973). Another purpose in openly discussing death with children is that i t enables them to live more freely.(Kavanaugh, 1972). "Death education can easily be a simple extension of a child's real world'1'.." (Kavanaugh, 1972, p. 131) The key would seem to be to l e t the child speak freely of his/her concerns. The adult should scrap the euphemisms and respond candidly and honestly. Ginott in Between Parent and Child (1969) has a short and straight-forward section on this subject. He offers just-i f i c a t i o n as well as suggestions for parents sharing with their children the facts of death. C. Death Educat ion : a p lan to meet the need A parent who i s hopeful of being open with his children must f i r s t of a l l examine his own attitudes. The easiest way to manage this i s to take a look at his own feelings about dying and death: "... an honest and humane approach to death can begin only when we allow ourselves to get in touch with our visceral feelings" (Kavanaugh, 1972, p.23). Honest recognition of our mortality feelings allows us to make some choices. When we know what our feelings are we can better respect "our unique reac-r tions" (Kavanaugh, 1972). It w i l l no longer be necessary to force our emo-tions behind a r t i f i c i a l defenses. The key is to come to terms with the fact that we do have feelings about this basic truth of l i f e (Leshan, 1969). 51. 1. Variety of approaches There are a number of methods in which to achieve the goal of better understanding oneself. Keleman (1974) talks of "self dialogue"; where the "neural and the visceral" are consulted and considered. Ross (1975) talks of "identification" with those who are suffering as a means of grasping personal reactions. Psychodrama i s Langone's suggestion. "By playing roles in dramas involving death, by experiencing i t , so to speak, they take a clo-ser look at i t , even though i t is not real, and hangups about the usually unmentionable subject may be softened." (p.49) O'Connell (1975,6) is a strong supporter of the "death lab" or exper-i e n t i a l workshop. The author attended the American Society of Adlerian Psychology convention and encouragement workshop held May 28 through June 1, 1976 at U.B.C. Dr. O'Connell attended and talked of his workshops. He was most impressed with the group reactions when such experiences take place. The following quotation from a recent a r t i c l e is appropriate here: "... mem-bers developed almost instant rapport and closeness within their groups when coping with death together. Characteristically they noted that they had never talked about their own death to others. Consequently the accep-tance by others through sharing was often overwhelming" (p.4). It was found by O'Connell (1975) that consideration of one's creature-liness acted as a powerful catalyst for both group coh'esion and goal actual-ization. He goes on to speculate that confrontation of:one's mortality may be an important part of obtaining "natural highs" and actualization of one's own happiness. We have already explored this connection between death and l i f e ' s meaning at some length. 2 . The classroom Formal education is seen as an excellent opportunity for children to learn about death (Pincus, 1974). The teacher should not simply wait for bereavement to occur. Rather he should take many opportunities to deal with mortality "and thus counteract the taboo which leads to a bu i l t - i n repres-sion of curiosity and a l l sorts of irrational fears and nightmares" (p.244). The educator of older children who is interested in the teaching of death has a growing l i s t of resources available for students to read (Craven, 1967; Gunther, 1949; Klein, 1974; Levit, 1974; Lund, 1974; Morgan, 1975). Many of the books are stories of dying people and act as good starters for in-class discussions. The idea of teaching about death i s relatively new. There i s a small number of articles which have been published on the topic (Leviton, 1969; Schrank, 1971; Berg and Daugherty, 1973; Harnett, 1973; Zazzaro, 1973; Fontenot, 1974; Sommerville, 1974; McLure, 1974; and the Memorial Society of Edmonton and Di s t r i c t , 1975). A l l of these articles support the concept of death education. Most of them describe curriculum guides on the subject. The majority of these "guides" have been prepared by professionals working for the funeral industry. The one exception is a teaching unit compiled and published by the Memorial Society of Edmonton and District (1975). An awareness of psychological dynamics and community readiness can be crucial to preparing the teacher to teach about death (Sommerville, 1974). Concern is expressed that teachers may not be able to handle death education. Zazzaro (1973) quotes educator Leviton as she outlines five c r i t e r i a for a death educator. He must: 1. Come to terms with his own death feelings and admit not only to death's existence but to i t s f u l l status in the dynamics of his total personality functioning. 2 . Know.the appropriate.subject matter.he.is to teach. 3. Be able to use.the language of death easily and'-naturally,.' especially with the young. 4. Be familiar with the sequence of psychothantological develop-mental events throughout l i f e and have a sympathetic understanding of common problems associated with them. 5. Possess an acute awareness of enormous social changes cur-rently in progress and of their implications for changes in accepted patterns of death attitudes, practices, laws and institutions. Teachers need the support of superiors i f they are to teach about death (Pincus, 1974). "No administrator should be surprised to find that his staff i s afraid of handling this topic, when he considers that resea-rch studies reveal similar fears among medical practitioners and even pro-spective funeral directors." (McLure, 1974) Hawener (1974) in a dissertation entitled "Teaching about Death : An exploration study of teacher candidates attitudes toward death and behavior situations involving death" supports McLure. The purpose of her study was to "explore possible relationships between kindergarten teacher candidates' anxiety towards death and perceived behavior in classroom situations invol-ving death". The results of this investigation indicated that personal death an-xiety was not significantly related to perceived classroom teaching behavior. Subjects by and large indicated that they would be neutral; would not i n i t i a t e dialogue about death situations in the classroom. They expressed personal discomfort and lack of knowledge about what to do in classroom situations. In general these kindergarten teacher candidates expressed beliefs and attitudes about death quite l i k e those reported i n other studies of American views of death, (avoidance and denial). The candidates, nevertheless did indicate they believed teachers should have some special training to handle classroom situations. 54. There is nothing contained in .-the literature examined about any sort of "special training" program ..to prepare teachers to deal with death education. There are, however, some studies of nursing training programs and their effectiveness (Snyder, Gertler, S Ferneau, 1973; Murray, 1974; Lester, Getty £ Kneisl, 1974; Yeaworth,Knapp £ Winget, 1974). Generally the results of these studies indicate that some sort of training to deal with death and dying decreases the nurse's anxiety of death. "Experien-t i a l factors in the nursing student's training, have brought considerable overall changes in attitudes towards death and dying." (Snyder et al) D. Conclus i on Although there is a growing trend towards honest openness, society s t i l l very much encourages an attitude of denial and avoidance with the subjects of dying and death. Such a stance affects the quality of l i f e in general, and specific aspects of l i f e in particular. Care of the dy-ing, the bereavement process and the way children are educated about l i f e , have been shown in this review of the literature to be adversely affected by a denial of mortality. In addition to the work of mental health professionals, death educa-tion for medical people and others is becoming increasingly popular. Such education is proving to be particularly helpful to doctors, nurses and chaplains who work with dying persons. Ross (1974) and others point to the importance of becoming more com-fortable with one's own fears about death. She recommends experiential identification with those who suffer. O'Connell (1975) has found that the experiential death labs are powerful experiences for those who participate. Several papers on nurses' education outline the effectiveness of an 55. experiential emphasis. It has been said that death education in schools i s desirable. There are such courses now available in numerous secondary schools in the Van-couver area. Teachers are using curriculum materials available or in most cases are developing their own. It i s f e l t that these courses w i l l do much to change society's position towards mortality. Not only are young people grappling with the subject, but they take their ideas home and chal-lenge their families. The result can be the in i t i a t i o n of open discussion about death. The assumption is made that i f death education is to be truly effect-ive i t should have a strong experiential component. The teacher would be the instigator of whatever tasks are used in a course. The writer believes that a teacher w i l l only be effective in a death course to the degree that he or she has begun to manage his or her own feelings about mortality. In the present culture i t i s unlikely that many opportunities beyond the death of family or friends, would have arisen, for such learning to take place (Mitford, 1963). It i s hoped that death education w i l l be of value to those who pa r t i -cipate in such programs. The writer believes that death educators require some preparation before they can be effective. Nurses have been shown to have decreased anxiety towards death after such training. This study w i l l provide teachers with an opportunity for this sort of experience to occur. Chapter three provides very pspecific:ibfbrma'tion.about this project. It begins with a statement of the problem and hypotheses. CHAPTER THREE Method T h e r e m a i n d e r o f t h i s p a p e r i s a d e t a i l e d p r e s e n t a t i o n o f t h e s t u d y . T h i s c h a p t e r b e g i n s w i t h a s t a t e m e n t o f t h e p r o b l e m . T h e s u b s t a n t i v e a n d s t a t i s t i c a l ( n u l l ) h y p o t h e s e s a r e n e x t . A l s o i n c l u d e d a r e t h e f o l l o w i n g s u b - s e c t i o n s : d e f i n i t i o n o f t e r m s , t h e s a m p l e , t h e t r e a t m e n t , i n s t r u -m e n t a t i o n , a n d d a t a a n a l y s i s . T h e f o u r t h c h a p t e r i s a p r e s e n t a t i o n o f t h e r e s u l t s o f t h e p r o j e c t . I t i s f o l l o w e d b y a d i s c u s s i o n o f t h e r e s u l t s a n d g e n e r a l c o n c l u s i o n s i n c h a p t e r f i v e . A l l t h e r e f e r e n c e s m e n t i o n e d t h r o u g h o u t t h i s p a p e r a r e t o b e f o u n d i n t h e s i x t h c h a p t e r . A . PProbfrem: W i l l a n e x p e r i e n t i a l a n d d i d a c t i c t r a i n i n g p r o g r a m f o r t e a c h e r s o n t h e s u b j e c t o f d y i n g a n d d e a t h , a f f e c t t h e a t t i t u d e s o f t h o s e p a r t i -c i p a t i n g ? B. Hypotheses-SubstantIve: 1. A t h r e e e v e n i n g e x p e r i e n t i a l a n d d i d a c t i c w o r k s h o p o n d y i n g a n d d e a t h f o r t e a c h e r s w i l l l o w e r t h e p a r t i c i p a n t ' s d e a t h a n x i e t y ( c h a n g e o n e ' s a t t i t u d e s t o w a r d d e a t h : d e a t h o f s e l f ; d e a t h o f o t h e r s ; d y i n g o f s e l f ; d y i n g o f o t h e r s - ; g e n e r a l d e a t h f e a r ) a s m e a s u r e d b y t h e C o l l e t t - L e s t e r F e a r o f D e a t h S c a l e . 2. A t h r e e e v e n i n g e x p e r i e n t i a l a n d d i d a c t i c w o r k s h o p o n d y i n g a n d d e a t h f o r t e a c h e r s w i l l n o t l o w e r t h e r e l i g i o u s l y c o m m i t t e d p a r t i c i p a n t s d e a t h a n x i e t y t o a g r e a t e r e x t e n t t h a n t h e r e l i g -iously non-committed participants death anxiety as measured by the Collett-Lester Fear of Death.Scale. 3. A three evening experiential and didactic workshop on dying and.death for teachers w i l l lower the male participants' death anxiety to a greater extent than: the female participants'death anxiety, as measured by the Collett-Lester Fear of Death Scale. C. Hypotheses-Statistical (null): 1. A three evening experiential and didactic workshop on dying and death for teachers w i l l not lower the death anxiety of the participants (no change, i.e. not s t a t i s t i c a l l y significant at the .01 level, in one's attitudes toward death of self, death of others, dy-ing of self, dying of others, and death in general) as measured by the Collett-Lester Fear of Death Scale. 2. A three evening experiential and didactic workshop on dying and death for teachers w i l l not lower the religiously committed participants' death anxiety to a greater extent than, the r e l i g -iously non-committed participants'death anxiety (no change, i.e. not sta-t i s t i c a l l y significant at the .01 level, in one's attitudes toward death of self, death of others, dying of self, dying of others and death in general) as measured by the Collett-Lester Fear of Death Scale. 3. A three evening experiential and didactic workshop on dying and death for teachers w i l l not lower the male p a r t i c i -pants' death anxiety (no change, i.e. not s t a t i s t i c a l l y significant at the .01 level, in one's attitudes toward death of self, death of others, dy-, ing of self, dying of others, and death in general) to a greater extent 58. than.the female participants''death anxiety, as.measured by the Collett-Lester Fear of Death Scale. Chapter two provides ample rationale for these hypotheses, especi-a l l y the f i r s t . Additional comments are in order for the second and third hypotheses. Lester (1972) noted that i t had been shown that males have less fear of death than females on general measures of the fear of death. Fe-males had significantly greater fear of death of self, death of others, and dying of self. There was no difference with males in the fear of dy-ing of others and general fear of death. Durlak (1973) used a different scale and found that females scored higher. In another study, Durlak (1972) used the Collett-Lester scale and found that males and females had similar results. The third hypothesis is an attempt to c l a r i f y this issue. The second hypothesis supports the contention of several authors that religious commitment does not affect one's fear of death (Berman 6 Hays, 1973; Hinton, 1967; Hofmeier, 1974; Kavanaugh, 1972; O'Connell, 1974). D. D e f i n i t i o n of terms: a) e x p e r i e n t i a l and d i d a c t i c workshop: in this research project a program which involves short presentations (approx. 15 min. each), films (1 for 20 min. 1 for 50 min.), and small group discussions (from 60 to 90 min. per session). The experiential nature of the program requires that participants become actively involved in the discussion groups which deal with the presented material or assigned tasks. 5 9 . b) r e l i g ious cbmitii trhent: a decision made by participants in the research project about whether or not they believed in God and were or were not active in some church or religious denomination. Affirmative responses in both cases were considered as indicative of religious commit-ment . c) no r e l i g i o u s commitment: a decision made by p a r t i c i -pants in t-heestudyvabgutfwhether or not they believed in God and were or were not active in some church or religious denomination. Negative res-ponses to either one or both points were considered as indicative of "no religious commitment". d) death a n x i e t y : concern about death of self, death of others, dying of self, dying of others and death in general as measured by the Collett-Lester Fear of Death Scale. E. Sample: The subjects were obtained by advertising for volunteers with-in the Vancouver School D i s t r i c t . The promotion was limited to two depart-ments: Counselling and Home Economics. It i s i n these two departments (in addition to English) that teachers teach family l i f e courses within which death may be included. There were 32 persons in the experimental group. Of this group 26 were female and 6 male. A total of 41 persons attended the f i r s t night of the workshop. Six persons did not attend the f i n a l session. Some of these did not return after one night and some after night two. Two in d i v i ^ duals came the f i r s t and third nights but missed the second. Another two people came for the second and third sessions but missed the f i r s t . One 60. woman who attended a l l three evenings did not f i l l out her questionnaire correctly and . her'. results . could . not be . used. The control group began with 4-2 people. Seven chose not to complete the attitude scale a second time; two others completed their second form incorrectly. The f i n a l t a l l y for the control group was 33: 22 females and 11 males. F. Treatment: The treatment was a workshop held over a three week period. There were three weekly two and one half hour sessions. The last session was held on two consecutive evenings as about half of the experimental group could not attend on the night originally scheduled. A l l three eve-nings were spent at the Vancouver School Board "Teacher Centre", 123 E. 6th Avenue, Vancouver. A detailed description of the workshop is to be found in Appendix B. What follows is a brief overview of the program. The f i r s t night was introductory in nature. The measurement scale was administered and this was followed by a presentation. The. theme was "care of the dying". A film was viewed and small group discussions followed. The'night ended with the t o t a l group sharing ideas generated i n the smaller groups. The second night's theme was the "commercial side of death". There was a short presentation on the funeral industry and a film on the same subject. This was followed by a small group discussion of personal.,, experiences with death. The f i n a l task for the evening involved each 6 1 . p a r t i c i p a n t i m a g i n i n g t h a t he o r she had a . t e r m i n a l i l l n e s s . The r a m i f i -c a t i o n s o f t h i s d i l e m m a were d i s c u s s e d i n s m a l l g r o u p s . The t h i r d n i g h t b e g a n w i t h e v e r y o n e i n t h e i r s m a l l g r o u p s . The t a s k was t o w r i t e and s h a r e a n d d i s c u s s a p e r s o n a l e u l o g y . T h i s was f o l l o w e d b y a p r e s e n t a t i o n o n c u r r i c u l u m s u g g e s t i o n s a n d r e s o u r c e s by a n e x p e r i e n c e d F a m i l y L i f e t e a c h e r . F o l l o w i n g d i s c u s s i o n a n d t h e r e a d m i n i -s t r a t i o n o f the measurement s c a l e , e a c h p a r t i c i p a n t f i l l e d o u t a n e v a l -u a t i o n ( A p p e n d i x C ) . G. Instrumentat i o n : The s c a l e u s e d i n t h i s s t u d y was t h e C o l l e t t - L e s t e r F e a r o f D e a t h S c a l e . T h i s m e a s u r e c o u l d be r e a c t i v e a n d t h e r e i s l i t t l e e v i d e n c e c i t e d i n t h e m a n u a l o f r e l i a b i l i t y , v a l i d i t y a n d s o c i a l d e s i r a b i l i t y . T h i s s c a l e was t h e o n l y i n s t r u m e n t a v a i l a b l e t o t h e e x p e r i m e n t e r . I t i s one o f t w o s c a l e s r e p o r t e d i n a v a r i e t y o f s t u d i e s i n t h e l i t e r a t u r e ( t h e o t h e r b e i n g T e m p l e r s D e a t h A n x i e t y S c a l e ) . A r e q u e s t was made t o t h e a u t h o r s o f b o t h m e a s u r e s a n d o n l y D r . L e s t e r r e p l i e d . T h i s i n s t r u m e n t a n d i t s m a n u a l c a n be f o u n d i n A p p e n d i x D . H. Design and S t a t i s t i c a l A n a l y s i s : D e s i g n * Yb X Y a e x p e r i m e n t a l Yb ^X Ya c o n t r o l * N o t e Yb - p r e - t e s t Y a - p o s t - t e s t X - t r e a t m e n t - X - no t r e a t m e n t T h e r e was a 2x2 a n a l y s i s o f . c o v a r i a n c e p e r f o r m e d . . The a n a l y -s i s i n v o l v e s t a b l e s and g r a p h s o f means a n d . s t a n d a r d d e v i a t i o n s . Ths s i g n -6 2 . ificance level i s .01. This conservative level was chosen because of the following factors: the participants in the study were volunteers; i t was not possible to randomly assign participants to the experimental and con-t r o l groups; the sample size was not representative;of the general teacher population but a group of secondary school teachers specializing mainly in either Home Economics or Counselling. The covariate in the analysis of co-variance was the pre-test scores. The analysis of covariance was performed to s t a t i s t i c a l l y equalize the experimental and control groups,on t h e i r . i n i t i a l levels of death anxiety. The analysis was a two tailed test because i t was pos-sible the training could have caused either an increase or decrease in death anxiety 0according to previous studies reported in the literature (see Review of the Literature and Method). 63. CHAPTER FOUR This chapter is a presentation of the results of the study. There are eight tables and two graphs. The f i r s t four tables (1 through H) and two graphs (a and b) dis-play the results related to hypotheses one and two. Hypothesis one stated that a workshop would lower the participants death anxiety. There was a drop in scores for the experimental group mem-bers on a l l scales between the pre and post testing (Tables 3 and H). Three scales had s t a t i s t i c a l l y significant differences: "dying of self"(P = .0006); "dying of others" (P = .0001); and "death general" (P = .0001). The results related to the second hypothesis are displayed in tab-les one through four and graphs a and b. This hypothesis stated that a workshop on dying and death would not lower the religiously committed part i -cipants''death anxiety to a greater extent than the religiously non-committed participants' 1 death anxiety. The tables and graphs show that the religiously committed had an increase in anxiety on three scales and a decrease in anx-iety on two scales. A l l five scales decreased for the non-religiously com-mitted group. Two of these changes were s t a t i s t i c a l l y significant: "dying of other" (P = .0026) and "death general" (P = .0004). 64. I. Table 1 Observed Cell Means. (GROUP/RELIGION) Experimental and Control Subjects Test S C A L E Death of Self Death of Others Dying of Self Dying of Others Death General Experimental 1. Religious Commitment (N=8) Pr Po -5.25 1.88 1.00 5.38 3.25 3.13 -11.13 -11.88 -12.13 -. 1.50 2. No Religious Pr 2.25 4.75 Commitment Po -4.38 2.42 (N=24) 1.71 -1.96 -9.00 -20.00 - 0.29 -23.92 Control 1. Religious Pr -4.29 2.43 Commitment Po -5.86 0.00 (N=7) 1.14 0.86 -16.57 -14.14 -17.29 -19.14 2. No Religious Pr -2.31 0.92 Commitment Po 0.08 0.85 (N=26) 0.19 1.88 -11.15 -12.31 -12.35 - 9.12 Note: Pr Po Pretest Posttest In the experimental group,the religiously committed have increases on three scales (D. of S, D. of 0., and Dy- of 0.) and decreases on two scales (By.'.of'S, and D general). . .The.non religiously committed have decreases' on a l l . scales but In the control group the religiously.committed have decreases on a l l scales.but "Dying of Others". The.non religiously committed have decreases on two scales (D of 0, and Dy of 0) and increases on three (D of S, Dy of S and D gen.). t>5. .II. Table 2 . Obseryed Cell Standard Deyiations (GROUP/RELIGION) Experimental and Control Subjects Test S C A L E Death of Death of Dying of Dying of Death Self Others Self . Others General Experimental 1. Religious Pr 11.41 3.70 6.50 6.53 21.15 Commitment Po 9.73 5.40 4.70 5.30 15.63 (N=8) 2. No Religious Pr 14.05. 7.96 4.83 7.93 24.12 Commitment Po 11.53 7.74 5.47 8.17 24.84 (N=24) Control 1. Religious Pr 13.29 10.20 4.26 6.40 26.39-Commitment Po 12.25 7.90 6.69 10.53 32.77 (N=7) 2. No Religious Pr 8.10 7.42 6.65 9.71 23.21 Commitment Po 10.36 7.35 6.92 10.29 27.17 (N=26) Note: Pr - Pretest Po - Posttest III. Table 3 Observed Combined Means (GROUP/RELIGION) - Experimental and Contro l - Re l ig iousCommitment and No Re l ig ious : Commitment (Combined") Subjects Test S C A L E Death of Death of Dying of Dying of Death Self Others Self Others General Experimental PrPr 0.38 3.81 2.09 - 9.53 - 3.25 • (N=32) PoPo -2.81 3.16 -0.69- -17.97 -18.31-(males 6 females) Control Pr°" -2.73 • 1.24 - 0.39 -12.30 -13.39 (N=33) -Pol'o -1.18 0.67 1.67 -12.70 -11.24 (males £ females) Combined Re-ligious Pr -4.80 1.67 2.27 -13.67 -14.53 Commitment Po -1.73 2.87 12.07 -12.93 - 9.73 (N=15) Combined No Religious Pr -0.12 - 2.76 0.92 -10.12 - 6.56 Commitment Po -2.06 1.60 0.40 -^16.00 -16.22 (N=50) Note: Pr - Pretest * Combined = subjects (male £ female) from both experimental and control groups. Po - Posttest In the experimental group.there are.decreases on a l l scales between pre and post testing. In.the control group.there are increases on three scales (D of S, Dy-of S and D gen.) and decreases on two scales (D of 0 and Dy,of 0). IV . Table 4 A n a l y s i s of Covar iance (GROUP/RELIGION) . Scale . Factor s.s .d.f. .m.s. • F. P. Death of Self Group Religion Interaction Within Cells 241.46 174.19 746.99 2.,973.27 1 1 1 60 241.46 174.19 746.99 49.55 4.8726 3.5152 15.0742 .0312 .0657 .003* Death of Others Group Religion Interaction Within Cells 3.75 50.36 175.33 1,148.88 1 1 1 60 3.75 50.36 175.33 19.14 0.1959 2.6299 9.1559 .6597 .1101 .0037* Dying of Self Death Group 219.94 1 • 219.94 13.4278 .0006" Religion 14.94 1 14.94 0.9124 .3434 Interaction 91.21 1 91.21 5.5687 .0216 Within Cells 982.79 60 16.38 • Others Group 858.10 1 858.10 20.1845 .0001* Religion 421.45 . 1 421.45 9.9136 .0026* Interaction 159.05 1 159.05 3.7413 .0579 Within Cells 2,550.78 60 42.51 General Group 4,288.66 1 4,288.66 24.7764 .0001* Religion 2,504.18 1 2,504.18 14.4672 .0004* Interaction 4,341.86 1 4,341.86 25.0838 . 001* Within Cells 10,385.67 60 173.09 Note' s.s. = sum of squares F = Frequency d.f. = degrees of freedom P = Significance Level m.s. mean score significant: (.01) -Three- scales are ..statistically significant (Dy of S; Dy of 0, and D GenO under "Group".. Two .scales are . s t a t i s t i c a l l y significant (Dy.o'f 0 and D Gen.) under "Religion" and there is a s t a t i s t i c a l l y significant "Interaction" on two scales (D of 0 and D Gen.). D O , I ' I L:i±lviG:raph;^;_z::;i^Li:r Observed : Cel1 Means (Group/Rel ig ion) i i J - L rr TT Pretest RC.. — Religious Commitment rj. m Post test ;.^ NRC_ .No, Religious ..Commitment ~ 1 i l l ! i , i T L _i_ _ 1 i 1 r i l l ! i I | 4 _ U I I ! r i r i 1 i i i ! ._Lj.-i._ i 4 • :T •4— • ! 1 i " r i T -1 - j . ! _.!.„U. t i ! | ±J i _ 1 ! r T i T i i 1 j ! f i i~ 1 1 _ l _ m i 1 ! 1 j. i 1 i j J ! 1 _ i i ! i 'i : I i - 1 1 1 j 1 ! 1 I • i i t u \ i -A— ; i i i 1 1 1 1 1 -+• i m i ILL'- ! 1 ! ! i i i 1 i ~ ' — - ... ........ 1. _ i 1 ! 1 J ' LI 1 1 , ! . , _!_ , i i f i i i 1 7 n i i I I I r i 1 i I 1 i 1 _ ; 1 n 1 1 1 ! . . . . — r c i p i r u • •'-)" ! 1 1 i J_. 1 1 i L i ! i 1 i ... Observed C e l I Means r n u n / n . f t l tn i n n ) _ _ T ; _ i _ - f l_J _ ! 1 1 — C o n t r o l _ i U ! _ ._!— I 1 • _ I I i . > 1 _ _ [ . . . . 1 •"1 • I 1 ' I ! 1 1 < i ! 1 ; 1 ; 1 ~ i ~ 1 ! I I . - i l l _rri__i i LLL 1 ! i ! r 1 M-" " i — ' i : i : \ ; r i I L • ! 1 ! ! i ! i 1. 1 1 1 ! ' [ r n ' i \ ! f — ! i „1_1._ i - i - ' i 1 _ 1 , ! U 1 1 i 1"! I ; j i I ! 1 1 r — . . . . . , ; -1 ' — II • n • ].J ; j . I i i . _ * • j* - I T : f i~ !_]_ JJ_i L. ! i 1 1 i f 1 1 _ 1 I i - l -i _l _'_ I_ - t ; 1 I 4...: 1 1 ! 1 ... "~r _J j .1 J L \— !_ !_ j L 1—i 1 1 i > : ! I j . t 1 i i 1 [_ j_ !_ i l .1 _ RC . Religious Commitment -Posttest NRC -—| No-Religious- Commitment. . The second four t a b l e s (.5. t h rough 8). and .second two g raphs . (c . £ d) d i s p l a y the r e s u l t s r e l a t e d . t o hypo thes i s . . t h r ee . . T h i s hypothes i s s t a t e d tha t a workshop on dy ing and death.would decrease the male p a r t i c i p a n t s death a n x i e t y . t o . a g rea te r extent than . the females death a n x i e t y . As i t tu rned out both sexes had decreased scores between pre and post t e s t -i n g . V. Table 5 Observed C e l l Means•(SEX/GROUP) Experimental and Contro l .Subjects Test . . S. C. A. L. E. Death of Death of Dying of Dying of Death Self Others Self Others General Experimental 1. Males Pr • -2.67 0.67 0.33 -10.00 -11.67 (N=6) Po -4.33 0.00 -0.50 -15.83 -20.67 2. Females Pr 1.08 4.54 . 2.50 . - 9.42 - 1.31 (N=26) Po -2.46 3.88 -0.73 -18.46 -17.77 Control 1. Males Pr -2.18 -3.36 . 0.36 -10.55 -15.73 (N=ll) Po -3.18 -2.82 1.36 • -11.36 -16.00 2. Females Pr -3.00 3.55 0.41 -13.18 -12.23 N=22) Po -0.18 • 2.41 1.82 -13.36 - 8.86 Note: Pr - Pretest Po - Posttest In the experimental group there is decrease on a l l scales for men and women between pre and post testing. VI. Table 6 Obseryed Cell Standard Deviations; (SEX/GROUP) Experimental and Control Subjects Test S C A L E Death of Self Death of Others Dying of Self Dying of Others Death General Experimental 1. Males (N=6) Pr Po 17.75 13.65 8.19 4.34 6.22 5.39 9.38 11.75 21.93 25.74 Females (N=26) Pr Po 12.88 10.96 7.02 7.66 5.02 5.83 7.29 7.50 24.02 24.95 Control 1. Males •:• ( N = I I ) Pr 8.64 Po 6.01 5.32 4.96 5.99 6.62 8.95 9.69 20.02 17.96 2. Females Pr 9.69 (N=22) Po 12.63 8.10 7.81 6.40 7.00 9.55 10.61 25.53 32.26 Note: Pr - Pretest Po - Posttest 73. Y U . Table 7 Observed Combined Weans; (.SEX/GROUP) - Males and Females (combined*) - Experimental and Control Subjects Test S C A L E Death of Death of Dying of Dying of Death Self Others Self Others General Combined Pr -2.35 -1.94 0.35 -10.35 -14.29 Males Po -3.59 -1.82 0.70 -12.94 -17.65 (N=17) Combined Pr -0.79 44: <08 1.54 -11.15 - 6.31 Females Po -1.42 33'.'21 0.44 -16.12 -13.69 (N=48) Experimental Pr 0.38 3.81 2.09 - 9.53 - 3.25 (males and Po -2.81 3.16 -0.69 • -17.97 . -18.31 females) Control Pr -2.73 1.24 0.39 -12.30 -13.39 (males and Po -1.18 0.67 1.67 . -12.70 -11.24 females) Note: Pr - Pretest Po - Posttest " Combined - subjects (male and female) from experimental and control groups. VIII. Table 8 Analys i s of Covari ance (SEX/GROUP) Scale Factor s ,s, d.f. m.s. .F, Death of Self Sex Group Interaction Within Cells 15.55 249.05 . 51.65 3,786.81 1 1 1 60 15.55 249.05 51.65 63.11 0.2464 3.9460 0.8184 0.6215 0-.0516 0.3693 Death of Others Sex 4.42 1 4.42 0.1939 • 0.6614 Group 4.47 1 4.47 0.1960 0.6596 Interaction 2.22 1 2.22 • 0.0975 0.7560 Within Cells 1,367.30 60 22.79 Dying of Self Sex 19.50 1 19.50 l v0958 0.2994 Group 209.85 • 1 209.85 11.7917 0.0011 Interaction 17.32 1 17.32 • 0.9735 0.3278 Within Cells 1,067.79 60 17.80 Dying of Others Sex Group Interaction Within Cells 85.74 766.16 24.98 3,094.43 1 1 1 60 85.74 766.16 24.98 51.57 1.6625 14.8555 0.4844. 0V2022 0.0003 0.4892 Death General Sex Group Interaction Within Cells 118.73 3,913.95 310.32 16,857.63 1 1 1 60 118.73 3,913.95 310.32 280.96 0.4226 13.9306 1.1045 0.5182 0.0005 0.2975 Note: s.s. = sum.of squares d.f. = degrees of freedom m.s. = mean score Fi = Frequency P = Significance Level None of the scales are s t a t i s t i c a l l y significant under "Sex". CHAPTER 5 Discussion . A three evening exper ien t ia l and d idac t ic workshop on dying and death for teachers d id lower (on 3 of 5 scales) the death anxiety of the p a r t i c i -pants as measured by the Co l l e t t -Les t e r Fear of Death Scale . The f i r s t n u l l hypothesis i s re jected. A three evening exper ien t ia l and d idac t ic workshop on dying and death for teachers did not lower the r e l i g i o u s l y committed par t ic ipants death anxiety to a greater extent than the r e l i g i o u s l y non-committed p a r t i c i -pants death anxiety as measured by the Co l l e t t -Les te r Fear of Death Scale . The t h i r d n u l l hypothesis i s supported. A three evening exper ien t ia l and d idac t ic workshop on dying and death for teachers d id not lower the male par t ic ipants death anxiety more than the females death anxiety as measured by the Co l l e t t -Les te r Fear of Death Scale . The second n u l l hypothesis i s supported. The Co l l e t t -Les t e r Fear of Death Scale has four sub scales and a gen-e ra l anxiety score: death of s e l f ; death of others; dying of s e l f ; dying of others; and death fear i n general. A. Hypothesis one: The intent ion was to test"the effectiveness of an exper ien t i a l and d idac t ic workshop. There was a drop i n scores ( ind ica t ing a lowering of anxiety) on a l l the scales between pre and post tes t ing of the exper i -mental group when taken as a whole (table 3). Only some of these changes p roved - s t a t i s t i c a l l y s ign i f i can t i n an analysis of covariance (table 4) with a.chosen.level of significance being 0.1. The two . scales'. which had . s t a t i s t i c a l l y insignificant . score changes were "death.of self" (P = .0312) and "death of other" (P = .6597). The other three had significant differences: "dying of self" (P = .0006); "dying of others" (P = .0001); and "death general" (P = .0001). In-- In the control group there was a slight drop in scores between pre and post testing on two scales: "death of others" and "dying of others". The other three scales had increased.scores or a rise in death anxiety. The rise may have been generated by the test i t s e l f . These people would proba-bly not think or discuss dying or death very frequently and so the Collett-Lester scale would catch them unprepared. These results concur with the recommendations of Ross, O'Connell and others, that experiential training helps to decrease dying and death anxieties. These results also concur with the results obtained in three nursing studies (Snyder, Gertler and Ferneau, 1973; Lester, Gerry and Kneisl, 1974; Yeaworth,Knapp and Winget, 1974). B. H y p o t h e s i s t w o : The intention was to observe the effect of an experiential and didactic workshop on both religiously committed and non religiously com-mited participants. Within the experimental group at post workshop test-ing, those with a religious commitment when taken as a group, showed an increase in anxiety on three.scales and a decrease in anxiety on two scales (table I and Graph a). Four scales decreased for the non religious commit-ment group. The. analysis of . covariance .  (chosen.. leyel of significance . being .01) indicated s t a t i s t i c a l l y insignificant differences for: "death of self'-' (P = .0657); "death of other" (P = .1101); and "dying of s e l f ( P = .3434). There were s t a t i s t i c a l l y significant changes for."dying of.other" (P = .0026) and "death general" (P = .0004). The significant changes reflect the drop in anxiety of the non religiously committed (table 4). Three of the five scales had s t a t i s t i c a l l y significant inter-action effects: "death of self" (P = .0003); "death of other" (P - .0037); and "death general" (P = .001)} . The other two were s t a t i s t i c a l l y insign-ificant: "dying of self" (P = .0216) and "dying of other" (P = .0579). The interaction effect was a result of a reversal of direction between experimental and control groups. In the experimental the r e l i g i -ously committed participants'scores' rose and in the control they dropped. In the experimental the non religiously committed participants' scores dropped and in the control they rose. Of most significance is the interaction effect within the experi-mental group i t s e l f . The two groups (religiously committed and non r e l i g i -ously committed) moved in opposite directions. The religiously committed participants' scores rose and the non religiously committed participants' scores dropped (Graph a). In the experimental group.,it would seem that those with religious commitment benefited less from the workshop than those without such an in-volvement. The Christian faith teaches of l i f e after death. Ross and other are c r i t i c a l of Christians generally for not li v i n g their beliefs. There can.be a superficial acknowledgement of l i f e after.death. This w i l l be of 8 0 . l i t t l e help.to the individual.should a life.threatening experience.overv. take him. Only.those who'daily live.their beliefs w i l l find peace with, the issue of mortality (Ross•)'. This.. workshop provided . the participants with an opportunity to confront.their mortality. Perhaps.the increased anxieties t e l l something of the quality .of.commitments for. those acknow-ledging such bonds. It must be restated.that in this study.the definition of religious commitment i s : a decision made by participants in the . study about whether or not they believed in God and were or were not active in some church or religious denomination. Affirmative responses in both cases were considered as indicative of religious commitment. The research on religious beliefs and death fears has shown that there is usually l i t t l e difference between.religiously committed and non religiously committed. Several authors have noted that religious com-r mitment does not affect an individual's death.fears (Berman and Hays, 1973; Hinton, 1967; Hofmeier, 1974; Kavanaugh, 1972; O'Gonnell, 1974). This pro-ject found that non religiously committed participants' anxiety levels dropped substantially more than religiously.committed participants (table I; table 4, graph a.). When people are asked to confront their mortality, i t can be a d i f f i c u l t experience. The fears evoked are not easily managed, primarily due to their unfamiliarity. Perhaps some:of those who claimed a religious belief were alarmed that they f e l t anxious when supposedly "knowing" that there is l i f e after death. Such alarm may have prevented them from bene-f i t i n g from the confrontation experience to the extent of non believers who had no reason to be overly alarmed at.their .anxieties'.-' '•': . The. control group was a different situation altogether. The .religiously committed.showed a . decrease.in.scores and anxiety on all.scales but one: "dying of others" (table I, .graph b). The non religiously commit-ted showed an increase of scores and anxiety on three scales: "death of self"; "dying of self"; and "death general".. The.other two scales ("death of others" and "dying of others") decreased on the post test. In the control group the religiously committed dealt with death in a superficial fashion (i.e. by simply f i l l i n g out the questionnaire) as there was no indepth involvement as with the experimental group. It would be easy for the religiously committed to treat the scales as per the dict-ates of their f a i t h . The non religiously committed, again not having a doctrinal framework to guide them tended to have an increase in anxiety. The questionnaire would have unexpectedly come to them, quite suddenly forcing them to think of their own deaths and evoking some anxiety in.the process. C. Hypothes i s t h r e e : The intention was to observe the effect of an experiential and didactic workshop on both male and female participants. Both groups had decreased scores between pre and post testing (indicating a lowering of anxiety) on a l l the scales (table 5 and graph c). None of these changes proved s t a t i s t i c a l l y significant in an analysis of covariance with a chosen level of significance being .01 (table 8). D. Short-comi ngs and Needed Improvements: . The Vancouver School.Board gave.its approval for this study but wished that publicity about i t be minimized. When the time came to hold the workshop, i t became apparent.that only about 20 persons were interested 8 2 . The "low key" publicity was stepped up and a.decision made.to treat a l l volunteers as '-participants in . the', experimental group. . . Other . teachers would be randomly approached to form a control:group. Delays with the school board required adjustments which, weak-ened the research design of this study. It would be interesting.to repeat the study along the lines originally planned. It was hoped that there could be two control groups along with the experimental. Recruited tea-chers interested in a workshop would be randomly divided into experimental and control groups. The control people would have also been offered a workshop after the study was completed...The second control group would have been composed of a randomly selected group of teachers and would have received a pretest only. There would have been an opportunity to compare control one with the general teacher population. In addition to exper-ienced teachers i t was hoped to involve student teachers and include an hypothesis about "years of experience". It i s f e l t by the writer that the results of hypothesis two can not be taken too seriously for two reasons: . there were only 15 people with religious commitment compared to 50 who were not so committed; to be in the religiously committed group a person had to believe in God, have an a f f i l i -ation and attend i t regularly. Some participants believed in God but had no a f f i l i a t i o n or believed in God and had an a f f i l i a t i o n which was inactive. These persons were classified as non religiously committed in this study. The workshop i t s e l f could.be improved. At the.beginning the writer did not have a good technique for breaking people into small groups. The method used.works well when there are even numbers and unfortunately there.were not even numbers::attthe workshop. I t . i s important to insist (which was not. done)'.that people join a group with, people they know, least well. feedback.was received from participants that they f e l t inhibited in groups with their friends.. The depth of.the friendship tended to set the tone for the group. There is a problem when the friends are only work-ing acquaintances. It would be valuable to have group leaders with each group. This would encourage participants to . address the task at hand. Two of the six groups in the workshop never got below the surface with the tasks. Some of the participants were pleased with the experience so perhaps they went as "deep" as they were able. A disadvantage to placing group leaders within groups would be the possibility of distracting power struggles. Another way of encouraging the groups to do the assigned tasks would be to circulate between groups as the course leader. Although such vi s i t i n g might distract group process i t would be a good way to observe group interaction and a means of keeping people "on course". The workshop as i t presently exists packs too much material into too short a period of time. The second night offers a good example. Many people never did get around to discussing what they imagined a terminal i l -ness to be. Another unforeseen problem which arose during the workshop weak-ened the process which had been established. A large group of teachers were attending from one particular school. They were a l l unable to attend the scheduled third night of the workshop.due to a school open house the same evening. Thus the third session was held on two consecutive nights. Unfor-tunately some of the groups were broken up and the continuity lost. 8 4 . E. Impl i.cat ions of the Study; Although the Interaction of.religious belief and treatment, and sex and treatment i s interesting, i t i s of only indirect releyance to this project. It i s the result of testing hypothesis one.that has the greatest practical significance. It would seem'that an experiential and didactic workshop on dy-ing and death does lower the participants^ death anxiety. Such a program might be a valuable a'dditibn to teacher training programs. Although i t would be valuable for any teacher, i t would be most significant for any planning to teach of dying or death in their classrooms. An experiential and didactic workshop on dying and death could be developed for anyone interested in learning about mortality. A step in this direction has been taken by the writer by developing a six week (one evening per week) course on dying and death to be offered through a T community college. F. Summa ry: In this.study i t was hypothesized that participants in an exper-ie n t i a l and didactic workshop on dying and death would have a decrease in death anxiety following such an experience. The experimental group was com-pared to another group of teachers who received no workshop experience. Those who were involved in the workshop had a greater decrease in scores than those who did not. Within the experimental group i t was predicted that males would have greater score decreases than females. The results showed no s i g n i f i -cant .differences in scores between the male and.female participants. Also within the experimental group i t was predicted that r e l i g i -ously committed participants scores;.would.not be lowered to any greater extent than.scores for the non religiously.committed participants. This hypothesis was confirmed and in fact.the opposite occurred. The scores of the non religiously committed dropped significantly more than the r e l i g i -ously committed participants'scores on some of the Collett-Lester sub scales There are a number of possible improvements for noted short-comings in this study. The major implication of this research is that an experiential and didactic workshop is of value for teachers interested in teaching about dying and death. Indeed such a workshop i s li k e l y to be of value to anyone interested in becoming more comfortable with his or her own mortality. CHAPTER SIX References Becker, E. The Denial of Death. New York: The Free Press, 1973. Berg, D., £ Daugherty, S. Teaching About Death. Today's Education, 1973, 102, 46-47. Berman, A.L. £ Hays, J . E * Relation Between Death Anxiety, B e l i e f i n A f t e r l i f e , and Locus of Control. Journal of Consulting and C l i n i c a l  Psychology, 1973, 41 (2), 318. Blauner, R. Death and Social Structure. Psychiatry, 1966, 29_, 378-394. Blazer, J.A. The Relationship Between Meaning i n L i f e and Fear of Death, Psychology, May 1973, 10 (2), 33-34. Blocbing, K. The Reflection of Death i n Contemporary Literature. In N. Greinacher £ A. Muller (Eds.), The Experience of Dying. New York: Herder £ Herder, 1974. C a t t e l l , J. Psychiatric Implications i n Bereavement. In A.H. Kutscher (Eds.),. Death and Bereavement. Chicago: CC. Thomas Publisher, 1969. Choron, J . Death and Modern Man. New York: C o l l i e r Books, 1964. Cohen, R.J. £ Parker, C. Fear of Failure and Death. Psychological  Reports, 1974, 34, 54. C o r i o l i s . Death Here i s thy Sting. Toronto: McClelland and Stewart, 1967. Curran, C.A. Counseling - Learning, A Whole-Person Model for Education. New York: Grune £ Stratton,•1972. Curran, C.A. Death and Dying. Chicago: Loyola University, 1974. (audio tape) 8 7 . Craven, M. I Heard the Owl Call My Name.. Vancouver: Clarke, Irwin £• Co. Ltd., 1967. Davidson, - G.W. (-ed.), . Living with Dying• Minneapolis: Augsburg Publi-shing Hse, 1975. Durlak, J.A. Relationship Between Individual Attitudes.Toward•• Life--and Death. Journal of Consulting and Cl i n i c a l Psychology, 1972, 38 (3), 463. Durlak, J.A. Measurement of the Fear of Death: An Examination-of Some Existing Scales. Journal of C l i n i c a l Psychology, October 1972, 28 (4), 545-547. Feif e l , H.(Ed.),. The Meaning of Death. Toronto: McGraw-Hill Book Co. Inc., 1959. Fontenot, C. The Subject Nobody Teaches. English Journal, 1974, 62-63. Frankl, V.E. Man's Search for Meaning - An Introduction to Logotherapy. New York: Washington Square Press, Inc., 1963. Frankl, V.E. The Doctor and the Soul. New York: Vintage Books, 1973. Fulton, R.L. The Sacred and the Secular Attitudes of the American Public Toward Death. Milwaukee: Buffin Press, 1963. Ginott, H.G. Between Parent and Child. New York: Avon Books, 1969. Glaser, B. £ Strauss, A. Awareness of Dying. Chicago: Aldine Publishing Co., 1965. Gordon, D. Overcoming the Fear of Death, Baltimore: Penguin Books Inc., 1970. Gunther, J. Death Be Not Proud - A Memoir. New York: Harper £ Row Pub-lishers, 1949. Harmer, R. The High Cost of Dying. New York: Crowell-Collier Publishing Co., 1963. Harnett, A.L. How we do i t . The Journal of School Health, 1973, XLIII (8), 526-527. 88. llawener, R.M.- An exploratory.study of teacher candidates'.attitudes toward .Death,-and Behavior . in situations.: involving Death (Doctoral dissertation, '1974).. Dissertation Abstracts.International, 1974, 167-A. Hendin, D. Death as a Fact of Life. New York: Warner Books Inc., 1973. Herter, F. £ Knight, J. Anticipatory Grief. In A.H. Kutscher (Ed.), Death and Bereavement. Chicago: C.C. Thomas Publisher, 1969. Hinton, J. Dying. Middlesex, England: Penguin Books, 1967. Hofmeier, J. The Present Day Experience of Death, in N. Greinacher £ A. Muller (Eds.), The Experience of Dying. New York: Herder £ Herder, 1974. Hunt, G. Don't be Afraid to Die. Ann Arbor, Michigan: Zondervan Pub-lishing Hse., 1971. Imara, M. Dying as the Last Stage of Growth. In E. Kubler-Ross, Death the Final Stage of Growth. Englewood C l i f f s , New Jersey: Prentice-Hall Inc., 1975. Jackson, E. Understanding Grief - It's Roots, Dynamics and Treatment. New York: Abingdon Press, 1957. Jacques, E. Death and the Mid-Life C r i s i s . In H. Ruitenbeck (Ed.), Death: Interpretations. New York: Dell Publishing Co., 1969. Jung, C. The Soul and Death. In-H. F e i f e l (Ed.), The Meaning of Death. Toronto: McGraw-Hill Book Co.Inc., 1959. Jury, D., £ Jury M. Gramp. New York: Grossman Publishers, 1976. Kastenbaum, R., £ Aisenburg, R. The Psychology of Death. New York: Springer Publishing Co.Inc., 1972. Kavanaugh, R. Facing Death. Baltimore, Maryland: Penguin Books, 1972. Keleman, S. 'Living Your Dying.. Toronto: Random House, 1974. Klein, N. Sunshine. New York: Avon Books, 1974. Langone,. J. :Death.is a Noun - A yiew:pf.the.End of Life. 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Lund, D. Eric. New York: J.B. Lippencott Co., 1974. Mannes, M. Last Rights. Scarborough, Ont.: New American Library of Canada Ltd., 1975. McLure, J. Death Education. Phi Delta Kappan, 1974, 483-485. Mitford, J. The American Way of Death. Greenwich, Conn.: Fawcett Publications Inc., 1963. Morgan, E. A Manual of Death Education and Simple Burial. Burnsville, N.C.: Celo Press, 1965. Mount, B. Death a Part-, of Life?. In P.W.. Gooch (Ed.), Crux. . Toronto: 1973-4, VII(3), 3-7. • Murray,:P. Death Education and i t s Effect on the Death Anxiety Level of Nurses. Psychological Reports, 1974, 35, 1250. Nelson, B. The Games of Life and the Dances of Death. In E. Wyschogrod (Ed.), The Phenomenon of Death - Faces of Mortality. New York: Harper Colophon Books - Harper £ Row Publishers, 1973. O'Connell, W.E.- The Death Lab as a Catalyst for Natural Highs. Manu-script submitted for publication, 1975. O'Connell, W.E. Religion, Love and Our Deaths. Journal of Pastoral Counseling, 1974-5, 9(2), 66. O'Connell, W.E. The Humor of the Gallows. Omega, 1966; _1, 31-32. O'Connell, W.E. £ Covert C. Death Attitudes and Humor Appreciation among Medical Students. Existential Psychiatry, 1967, 6(24), 433-442. Pincus, L. Death and the Family - The Importance of Mourning. New York: Vintage Books - Random House, 1974. Read, P. Alive. - The Story of the Andes Survivors: Philadelphia: J.B. Lippencott Co., 1.974. Robinson, Mrs. J., If Disaster, How Would You See Death? Texas. Churchman, Rossell, A. Lindemann's Pioneer Studies of Reactions to Grief. In A.H. Kutscher (Ed.), Death and Bereavement. Chicago: C.C. Thomas Publisher, 1969. Ross, E. On Death and Dying. New York: The MacMillan Co., 1969.. Ross, E. Questions and Answers on Death and Dying. New York: The MacMillan Co., 1974. Ross, E. Death the Final-:Stage of Growth. Englewood C l i f f s , New Jersey: Prentice-Hall Inc., 1975. 91. Ross, E. Death £ Dying Seminar,.Seattle, Washington, March.5, 1976. 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OFF ICE O F T H E D E P U T Y S U P E R I N T E N D E N T Evaluation and Research 1 5 9 5 W E S T 10TH AVENUE V A N C O U V E R B.C V 6 J 1ZB T E L E P H O N E 731 1131 BOARD OF SCHOOL TRUSTEES OF SCHOOL DISTRICT NO 39 (VANCOUVER* May 11th, 1976 TO: Department Heads, Counsellors and Teachers RE: Research Study and Workshop on Death and Dying Conducted by Mr. Denis Boyd, a graduate student i n Counselling Psychology at the University of B r i t i s h Columbia Recently Mr. Boyd conducted at the Teacher Centre a three-session workshop on Death and Dying. As part of his research study for a Master's thesis Mr. Boyd asked a l l workshop part i c i p a n t s to complete an a t t i t u d i n a l questionnaire on death and dying during pre- and post-test sessions to determine what changes in attitude occurred during the in-service program. For comparative purposes Mr. Boyd would l i k e approximately 4 0 - 5 0 teachers who have not attended his workshop sessions to complete the attached a t t i t u d i n a l scale. Each par t i c i p a n t i s asked to write his/her name and school address at the bottom of the la s t page of the questionnaire and mail i t i n the return envelope to Mr. Boyd. After an i n t e r v a l of three weeks another copy of the same instrument w i l l be sent to each p a r t i c i p a n t as a post-test a t t i t u d i n a l measure. On the post-test instrument the name of the pa r t i c i p a n t and his/her school w i l l be requested again as the res u l t s w i l l be compared to the pre-test. Please be assured that the i d e n t i t i e s of a l l participants w i l l be kept c o n f i d e n t i a l and that the a t t i t u d i n a l findings w i l l be reported on an anonymous basis by Mr. Boyd in his research study. Thank you for your kind consideration of this research request. Your cooperation is genuinely appreciated. Yours si n c e r e l y , AGM/meg ALLAN G. MOODIE -Coordinator of Research Studies and Testing 9 4 , QUESTIONNAIRE ON DEATH and DYING Here i s a s e r i e s of general statements, Px'ease Indicate how much you agree or disagree with them.., Record your opinion i n the blank space i n front of each item according to the following scales +1 s l i g h t agreement - 1 s l i g h t disagreement •$•2 moderate agreement -2 moderate, disagreement +3 strong agreement - 3 strong disagreement' Read each item and decide cjioicklv how you f e e l about i t j then record the extent of your agreement?-or aisagreement• Put down your f i r s t impression. Please answer evary^ item, 1 , I would avoid death at a l l costs„ 2. I would .experience a great loss i f someone close to me died. 3. I would not f e e l anxious i n the presence of someone I knew was dying. 4 0 The t o t a l i s o l a t i o n of death frightens me0 5., I am disturbed by the phy s i c a l degeneration involved i n a slow death. 6«. I would not mind dying young „ 7. I accept the death of others as the end of t h e i r l i f e on earth 3. 1 would not mind v i s i t i n g a s e n i l e f r i e n d , 9 e I would e a s i l y adjust a f t e r the death of someone clase to me. 10. I f I had a choice as to whether or not a f r i e n d should be informed he/she i s dying, I would t e l l him/her. 1 1 . I would avoid a f r i e n d who was dying„ 12o Dying might be an i n t e r e s t i n g experience. 1 3 . I would l i k e to be able to communicate with the s p i r i t of a f r i e n d who has d i e d B 14. I view death as a release from earthly s u f f e r i n g . 1 5 . The pain involved i n dying frightens me. 1 6 . I would want to know i f a f r i e n d were dying. 17c I am disturbed by the shortness cf l i f e . 1&0 I would not mind having to i d e n t i f y the corpse of somebody I knew. 19. I would never get over the death of someone close to me0 20, The f e e l i n g that I might be missing out on so much a f t e r I die bothers me* Questionnaire on Death and Dyinfi (Cont'd) 21. I do not think of dead people as having an existence of some kind. 22. I would f e e l uneasy i f someone talked to me about the approaching death, of a common f r i e n d . 23. Not knowing what i t f e e l s l i k e , to be dead does not bother me. 21+. I f I had a f a t a l disease I would l i k e to be t o l d . 25. I would v i s i t a f r i e n d on h i s / h e r deathbed. 26. The idea of never thinking or experiencing again a f t e r I die does not bother me. 27. I f someone close to me died, I would miss him/^ier very much. 25. I am not disturbed by death being the end of l i f e as I know i t . 29« I would f e e l anxious i f someone who was dying talked to me about i t . 30. The i n t e l l e c t u a l degeneration of old age disturbs me0 31 0 I f a f r i e n d were dying I would not want to be t o l d . 32, I could not accept the . f i n a l i t y of the death of a f r i e n d . 33* I t would upset me to have to see someone who was dead. 34. I f I knew a f r i e n d was dying, I would not know what te say to him/her. 35. I would not l i k e to see the phy s i c a l degeneration of a f r i e n d who was dying, 36. I am disturbed by the thought that my a b i l i t i e s w i l l be l i m i t e d while I'm dying. nppenaix a. 9 6 . What follows is a description of the.experiential/didactic work-shop given to.the experimental group.. There were.three.evenings which began at approximately 7:30 and.were completed by 10:00. Night one: As the subjects arrived I asked them to write their name, address, phone number and school on a l i s t . While they did this I made them a name tag. The evening began with myself being introduced by Mr. Allan Moodie of the Evaluation and Research section of the Vancouver School Board. I started with a personal introduction and an.outline of the program. At the beginning of the introduction I administered the Collett-Lester Fear of Death Scale. The scale was given on the understanding that the results would be kept confidential by myself and would be used in my research. I did say that I would be prepared to send them their results and those of the see cond questionnaire to be completed later. Once the scales were completed I continued with my introductory comments and outline. When this was finished the large group divided themselves into seven small discussion groups. They were instructed to introduce themselves and t e l l why they had come. Next they were to res-pond to the two questions: How do you feel about teaching death and dy-ing in the classroom? Do you have any experiences teaching about death? After a break the .subjects returned to one large group for a short presentation by myself on Dr. Elisabeth Kubler-Ross's work with.the dy-ing. This was followed by a film on Dr. Ross entitled, "Until I Die" which ran 20 minutes. 9 7 . Once the film was finished the participants returned.to their small groups to share feelings, and ideas about the film.. ..Someone in each group acted as a recorder to note group consensus about the film and.terminal care generally. This first-night ended, with everyone returning-, to the large group and hearing the recorders report the reactions to "Until I.Die" and. ter-minal patient care. General concerns or questions were also dealt with as they arose. Night two: This session opened with everyone together. Unfinished, business from the previous week was cleared away f i r s t of a l l and followed by a. brief overview of the evening ahead. There, was a short presentation by myself on the history of North American funeral customs including the memorial society concept. We then saw a film entitled "The Great American Funeral" which- ran 50 min-utes. Questions and answers followed and then came a break. After the break the group divided, into the seven smaller groups for a discussion of personal "death" experiences. Instructions were circulated which requested that the subjects r e c a l l their earliest, most recent and most traumatic experience with dying or death. In addition to recalling the "memories they were to describe the feelings that were associated with them. Later a second instruction. sheet was circulated which told each group member that he or she had been diagnosed with a terminal sickness. They were to write down their feelings and actual plans u n t i l death. Once 98. these were recorded.they were.shared. The.evening ended with a wrap-up . session in a large group. I made a short presentation to explain.the rationale for.the tasks done during the night. This centered'on the importance of personal feelings and familiarity with them. Following a short discussion we ended the ses-sion. Night three: We again began by dealing with any unfinished business from the week before. The small groups reconvened and each participant was given the task of writing his or her own eulogy. Once this was wri-tten i t was shared in the...group. A break followed. With everyone back in a large group there was a sharing of group reactions to the task. I then talked about death and the meaning of l i f e . My/' focus was primarily the ideas of Victor Frankl from The Doctor  and the Soul. (1955) and Man's Search for Meaning - an Introduction to  Logotherapy (1963) After some discussion I introduced Mrs. Anne Gardiner, a Home. Econ-omics and Family Life teacher from Templeton Secondary in Vancouver. Mrs. Gardiner and I had worked out a teaching unit on death and dying and had presented i t to some of her class. We had also spoken with teachers and student teachers in workshops on teaching about death. Mrs. Gardiner spoke for a.. short, time about the teaching unit, she had. been using with grade elevens and twelves. .She also distributed several handouts which included articles and a.reading l i s t . This presentation was followed by.some discussion. The. Collett-Lester Scale was .readrai.niste.red . and . an evaluation of the, workshop filled'.: out. I thanked'.. the'.. sub j ects . for . their : involvement and the evening (and workshop) ended. Appendix C. Death and Dying Workshop "EVALUATION" P lease share your impressions of the workshop. It would be use fu l to know what you d i d not f i n d p a r t i c u l a r l y v a l u a b l e or what could have been done more e f f e c t -i v e l y . Feel f r e e to mention any par ts of the workshop you found to be p a r t i c u l -a r l y w o r t h w h i l e . |.| , My gut reactions over the years have been one of panic and fear. I have been involved in two death situations over the past 6 years which completely "FREAKED ME OUT". In outlining my family l i f e course (Sept. 75) I decided i t was important I share The Aged Death £ Dying with my kids - I didn't quite know how I was going to tackle i t ! - I had hoped to get a speaker! After your f i r s t night I tried i t myself, mainly because I got a lot of strength from you, other people in my group and the resources presented-;* Your continuing ease with the subject really got to me and has made me more comfortable with facing death. Ann's resource material and ideas have certainly given me a new dimension to the family l i f e program I teach. And I w i l l tackle death a l i t t l e more differently in the classroom next time. * First night I f e l t threatened and a l i t t l e down; but your reaction gave a lot of comfort. Excellent film. Second night - Consumer film good eye opener but made me feel uncomfort-able. Workshop talks - brought me back feeling OK. Third night - Excellent;; especially your summary and curriculum outline. Thanks again, you have really helped me. 101. I f e l t that every part of the workshop was important, or in a sense c r i t i c a l for the desired result. I also feel that i t was very useful not only i n being able to accept the f i n a l i t y of death but in being able to approach the subject with other people who are unwilling to discuss this topic. As you know Dennis, I attended your workshop in the f a l l . In a way I feel i t may have had a sharper effect on people because i t was not carried on over such a long period of time. I think the best results would be, i f time allowed, to have the workshop on three consecutive days, when people could really get involved - not run out of time - and not have too much time inbet* ween each session. Thank you, Dennis, I really enjoyed your' workshop, and learned, again, a tremendous amount. The workshop was generally very worthwhile. It has given me greater insight into death as a whole and has created a lot of thoughts and mixed emotions within myself concerning the subject. It was about time that thought was stimulated to the point where I began to take a look at my own personal opinions or-attitudes toward death. I gained more from your information on Kubler-Ross theories, consumer aspects, etc., than I did from small group discussion on the 2nd night. I found that after the 1st night that spending time with the same group of people brought back a lot of the same old stories. Workshop - Excellent, exciting, carried with you:- long after you l e f t the building. Really enjoyed the curriculum side of i t with Anne - w i l l find that particularly useful. • 102. Part I d i s l i k e d the most - the Eulogy. I f u l l y r e a l i z e d i t s purpose to the workshop, but challenge the vogueness of Eulogies i n today's s e r v i c e s . W i l l appreciate r e c e i v i n g the r e s u l t s of the questionnaire - but I found i t d i f f i c u l t to answer at times, with wording of statements and that we were to do i t "quickly". I'm not sure that what I responded to are my gut f e e l i n g s i f I laboured on i t . In general, i t gave me personal i n s i g h t into the f a c t that often I f e e l I'm wasting my days and perhaps I should be doing more. The idea of procrast-i n a t i n g your years r e a l l y struck home. Thank you f o r the experience. The most worthwhile part was thinking about death and how i t would a f f e c t those around me. Also how my handling of the dying process would progress through i t s various stages - knowing these stages w i l l also help me help my family and f r i e n d s . It was good t a l k i n g to other people about a to p i c which i s considered "taboo" i n our soci e t y . It was hard to l e t go of a l l your true f e e l i n g s i n a group where you did not know a l l the members - This became easier as the sessions progressed. The f i l m was old - but c e r t a i n l y made a point. I wish I could make some suggestions but I found I got many worthwhile thoughts and experiences from each session - Thank you very much f o r helping me with Death and with L i f e . 103. Really enjoyed the tasks and staying with the same group. Got to feel that I know them and like them, and w i l l miss not having to come next Tues. night. The films excellent. Well organized, always f e l t that you knew where (and how) you were "leading" or guiding us. Had never even thought of this subject before, has opened doors to ideas that I didn't know I had reins on. Questionnaire technique was really poor. Questions were OK though. Perhaps though, there needs to be a distinction between the pain aspect of dying and the f i n a l act of death, so we know i f our fears are of the pain, or of the f i n a l or isolated aspect of death. As to the participation of the group - the credit goes to your organized soft s e l l approach - very open to feedback on a sincere basis. Really enjoyed i t and would certainly sign up for any other workshops, lectures, etc., that you may present. I found i t valuable to me to get to know a young person l i k e yourself concerned enough with this area to study i t objectively and then use this knowledge for the good of his fellow men. Death i s an area that has been d i f f i c u l t for me and so I have avoided i t . I appreciated being able to talk about my baby',s death and have someone say i t is OK that I have not come to terms with i t . Perhaps I w i l l some time. I have often f e l t that I was a very cold 13 year daughter in the way I reacted to my father's death but am beginning to see that i t was a rejection of the whole thing. I liked the way you outlined what we would do and in order to protect the plan, insisted that people follow the format. The mixing of people who didn't 104. work together the f i r s t night made.it easier to get into the swing of i t without reservations. I thought one reel of the funeral film would have been enough - leaving more time for discussion. Your organization was superb! I really appreciated also Anne's detailed outline of how to do i t with kids - excellent in service training. Many thanks. I found i t very useful and interesting. I know this to be true since i t was one of the many worshops I've attended that I actually looked forward to and didn't regret spending my time there. Very worthwhile - bibliography, hints, etc., to make this topic inter-esting for students. Particularly valuable - both you and Anne Gardner seemed like very warm people who were really interested and concerned in helping us as individuals. Perhaps i f we a l l jotted down a few thoughts on a piece of paper every time hefore we got into a group to discuss things I may have gotten a l i t t l e more out of the talks. Also i f there was some way to put us into a more serious mood (perhaps a solomn record? - I don't know) before doing the above i t may have helped. I found i t d i f f i c u l t at times to do what we were asked to do. Perhaps I'm asking for you to force me to think seriously. (Because I now know I would have gotten more out of the workshop i f I were more serious). I found the workshop extremely rewarding. I find death and dying very emotional and much of the time I was skimming the surface. One problem I had 105. was my grouping and a feeling that we couldn't relate on a similar level as my experiences were so touchy for me to handle. I got the impression that my deeper feelings were not "acceptable" to my group. This seemed to perpetuate my surface approach. However this may give me some insight in later dealing with my students ( i f I ever do). Because my group relationship was surface (week #1 S #2) does not mean the whole experience was the same. I f e e l I have faced a lot of my fears and although I s t i l l feel I have them I am beginning to understand the why's behind them. Thank you for expressing that an "appreciation of l i f e " often is the cause of anxiety over DSD. It was an "unconscious" feeling. Or I wouldnjt verbally express i t as i t seems very selfish. It i s good to hear someone else say i t . Thanks very much. Thought-provoking, stimulating, interesting - gave me an opportunity to think, and deal with a subject I've not done a great deal of thinking about -in terms of me - for many years. I liked the kinds of group experiences we did, e.g. the terminal case, the eulogy etc., however, I feel i t is sometimes unrealistic to expect people who perhaps do not know each other very well, i f at a l l , to " t e l l a l l " and be terribly personal, bang, a l l at once. I feel people need to have a kind of "rapport" with each other before they can begin "divulging" and expressing personal "gut" feelings. The kinds of exercises presented, however, are very valuable discovering and learning, awareness experiences. Perhaps the workshop might have been extended - more hours - with time to do reading, with follow-up discussion. Have l e f t with very positive 106. feelings about the subject and with a feeling of having some degree of "confidence" to be able to teach the unit in the classroom. The workshop enabled me to realize again the importance of li v i n g a l i f e of meaning to me and my family. To be more aware of the passing of time and beauty that surrounds us. The second evening l e f t me very low, as I am not able to cope yet with the event of my own death. I guess l i f e is so precious to me as i t is to others. However a positive event - my husband and I discussed our deaths and have made plans to join the "memorial society" to insure our desires are carried out and to relieve our family of having to make decisions that could be d i f f i c u l t for them. Anne's report on her classroom procedure was excellent. I found the workshop a worthwhile experience in that i t c l a r i f i e d some of my thoughts and feelings about death. The group with which I worked seemed to suffer from the absence of a leader after the f i r s t session. However, perhaps none of us was willing to share. I appreciated your friendly, warm approach. The workshop on death and dying gave me a f u l l e r appreciation of l i f e . The topic on the obituary (pardon me the eulogy) and the terminal illness 107. w e r e very d i f f i c u l t to do.but probably made me think more about the meaning of l i f e . The workshop format was excellent and I have no comments to make on improvements. I could not possibly teach a section on DSD. I find i t much too d i f f i c u l t to let myself become completely involved in an emotional experience such as this. For this reason I know I did not benefit as I might have from these sessions. It has, however, reinforced my awareness of liv i n g each day to the f u l l ; to appreciate my family and friends, and to do my job as best I can. I really liked starting and ending on time. The questionnaire on DSD I found a bit d i f f i c u l t because there were a lot of r'I would not... then I had to figure out whether I agreed/disagreed with the negative situation, and then f i n a l l y to what degree. I f e l t concerned because I was to do i t quickly and I couldn»t because there were a lot of "words" to think thru. I enjoyed the systematic approach, i.e. this is what we are going to do tonight and then at the end of the;i night we would be presented with what we would discuss next. Gave me time to gather my thoughts. I valued getting together with people who want to talk about death and . realize that I am not alone. It was good to go thru the experiences to broaden my thinking. 108. I am not sure that I changed in any of my thinking but the seminars helped me confirm my own ideas and attitudes and articulate them in a group. To articulate these ideas and realize that people were open to these thoughts strengthened me. I realize now that I should li v e each day as i t is my last. I liked .everything about the course although parts were heavy, i.e. terminal illness and eulogy but to me they were "real" and where i t is "at". Therefore I did grow! Questionnaire confusing and d i f f i c u l t to respond to. Found group discussion interesting as 2 members had experienced death of a mate. Seemed each was i n different stage of adjustment. Certainly an eye-opener to process. Personal perspective exercise most revealing. Clarified my fears greatly, i.e. think can handle fear of "sudden death" better. Felt eulogy useful as self-disclosure device,^i.e. attutude towards one-self. Might be interesting in classroom setting to have a friend of student write the other's eulogy and compare, (i.e. to focus on positive aspect of onefls l i f e . Film most informative (funerals). Generally very well done. Certainly has helped me already. Had a stud-ent approach me with the fact her father dying of cancer. Feel I handled situation better as a result of this workshop. Thank you. .Possibly the best part of the workshop was the accepting attitude (very distinctly communicated to the group) of death as a part of the l i f e process. 109. This was communicated not ne c e s s a r i l y through the various "devices", but simply i n Denis r e l a t i n g h i s personal experiences and i n the discussions on the "stages" of death. Found i t o v e r a l l worthwhile. Liked f i n a l evening of one main t o p i c best because on f i r s t two nights i t seemed would j u s t get going and i t was time to q u i t . Am looking forward to reading some of the resource material and hope-f u l l y gain some further in s i g h t i n t o the t o p i c of death and dying. Thank you. I l i k e d having to be put i n t o the r e a l i t y of thinking I had a terminal i l l n e s s and how I would deal with i t . In f a c t I r e a l l y found a l l of the written assignments u s e f u l . I t sure made me appreciate l i f e again. The questionnaire was r e a l l y confusing with the double negatives, etc. The gr^oup work might have worked out better i f people i n my group didn't know each other quite so w e l l . One or two people didn't f e e l l i k e g e t t i n g i n i t (and I respect that) but i t sure made i t hard f o r the r e s t of us to get i n t o . It scarestme to think that people with t h i s b r i e f exposure and minimal thinking w i l l i n f a c t t r y to teach the t o p i c . I t was good to hear about a programme someone else has t r i e d . 110. It I wou ld have l i k e d t o h e a r and know a g r e a t d e a l more about K u b l e r -R o s s . I w i s h t h a t I had r e a d a l l h e r books b e f o r e I a t t e n d e d i n s t e a d o f one a f t e r t h e 1st l e c t u r e . I a l s o w i s h I had r e a d h e r b i o g r a p h y - i f t h e r e i s one i n e x i s t e n c e . The 2nd s e s s i o n . I f e e l t h a t t h e f i l m was t o o l o n g . F o r ou r p a r t i c u l a r g roup pe rhap s i t wou ld have been OK t o see j u s t h a l f . I t was an o l d f i l m . Many o f us have been expo sed t o much o f what i t s a i d . P e r h a p s i t wou l d have been a good i d e a t o g i v e e v e r y o n e a number t h e 1st t i m e we a t t e n d e d p e r h a p s i n a s e r i e s o f 6 and a l l t h e number, l ' s c o u l d have f o rmed one g roup and t h e n f r i e n d s who came t o g e t h e r wou l d have been l e s s l i k e l y t o end up i n t h e same g r o u p . I wou ld l i k e t o t h a n k b o t h you and Anne f o r t h e o p p o r t u n i t y t o a t t e n d and good l u c k . The work you a r e d o i n g i s t e r r i f i c , I d i d n o t a t t e n d t h i s s e r i e s be cau se o f i n f o r m a t i o n I wou l d r e c e i v e on t h e a p p r o a c h t o t e a c h i n g . I am more i n t e r e s t e d i n t h e a c t u a l way one a p p r o a -che s a t e r m i n a l l y i l l p e r s o n . A most v a l u a b l e w o r k s h o p ! I r e a l l y f e e l I ' v e begun t o l e a r n about d e a t h , t o r e a l i z e m o r t a l i t y t hough I 'm by no means a l l t h e way t h e r e . The a s p e c t I 'm h a p p i e s t a b o u t i s t h a t t h e n e x t t i m e I 'm p e r s o n a l l y i n v o l v e d w i t h d e a t h I w o n ' t c o m p l e t e l y f r e a k o u t a s I have i n t h e p a s t . I t h i n k I w i l l u n d e r s t a n d my e m o t i o n s and t h o s e o f o t h e r s a r o u n d me b e t t e r ( h o n e s t l y f e e l i n g - mou rn i n g t h e l o s s b u t no t b e i n g so f r i g h t e n e d o f t h e e m o t i o n ) . H o p e f u l l y , I c an be o f a l i t t l e more h e l p t o t h e p e o p l e I c a r e abou t when t h e y a r e i n t h i s e x p e r i e n c e . As t e a c h e r , I p l a n t o a t t e m p t t o s h a r e some o f t h i s w i t h my k i d s . 111. Best not rough Not so best Yes - i t ' s important. Best though rough! - discussions in group terminal illness experience eulogy thing (MOST hard!) your summaries, Anne too films - so dated! (I realize your problem though). 1st one the best, maybe some other approach to consumer thing panel of people relating experiences? Super workshop. Excellent organization, etc. (PS Best spring I've had in terms of feeling i t - sun, fiLowers and a l l . Didn't realize connection between a l l this thinking t i l l you mentioned i t ) Thanks. Most worthwhile - the eulogy - the icing on the cake for me - really made me aware of my l i f e and how I can make me a happier person. I wonder i f this sort of experience wouldnjt be better as an a l l day workshop. I f e l t each evening as i f I was spending 15-30 minutes just getting into the mood - moving the barricades and getting to the gut reactions. Another advantage would be the closeness that would develop within the group -which did in the f i n a l evening, but I wished i t had done so earlier. A suggestion for the terminal illness exercise - i f people are finding i t d i f f i c u l t , use the exercise that someone close is dying and how would they react. Then move on to their own death. I used that exercise myself to get into the question. Classroom session with Ann very interesting. I f e l t the student 112. evaluations a bit long - we are already members of the converted so we believed her. She set out excellent directions for classroom presentations. I really found i t to be three worthwhile evenings. Denis, thanks for your time. Denis you so kindly thanked us for attending the workshop on DSD, I would like to thank you for giving us such a worthwhile project. I am a very emotional person. I am married with two children. I really love my children and husband (every normal person does that I) and the thought of death used to leave me cold! After attending the workshop I am beginning to come to terms with human mortality. Thank you. Denis, I think you did a really good job. The workshop was well planned and very organized. I really can't think of any way to improve i t . I feel after two years of counselling workshops and groups that I'm a l i t t l e saturated (for the time being) with group experiences and therefore, maybe couldn't get into the exercises as much as I would have liked. However, I intend to think about them on my own and read the material and books suggested. As a counsellor but also more importantly as a person I really do feel that this has helped me to begin to deal with death. This has always been a scary topic that I've wanted to avoid. This third session has been particularly helpful for me. It has helped t i e a lot of things together. Thanks. 113. I feel that this workshop is excellent for me. I have gained exper-ience in a l l aspects of death. My experiencexin death, whether i t is regard-ing emotions or consumerism is totally nothing. I have gained through discussion within the groups others opinions and feelings regarding death and dying. I have become more aware of i t and can now think about i t more seriously in my own situation. Good, good, good! IJm really glad I attended. However, I feel that there was not enough - ie more time needed, a l i t t l e , t o o superficial. It seems like every time I (and others) was "getting into i t " - i t was over. I think the simulation exercises (terminal il l n e s s , eulogy) were particularly worth-while. They covered feelings and ideas with which I was already familiar but Itwas forced to deal with them more in depth. I can't really say much more - what I already knew or suspected was confirmed. I would l i k e to get more involved in trying to explore and understand DSD. The film on funerals was revealing, the resources (last session) very helpful. Thank you. Oh yeah - the +1, -1 etc. was rather confusing. Try and make i t simpler. How, I don't know! Good luck. I could use more time to build relationships in the group in order to get below the surface. Seeing one half the film on funerals would have been enough. Does your questionnaire have to be double negatives? I would spend more time on the topic with a group of strangers. Ann's situation is different, because she has her students over a longer period of time. 114. I found i t a l l valuable, as I have never really discussed this topic before. I enjoyed both films and a l l discussions. It was nice to know that others share my concerns or look at the idea of dying more philosophically or religiously than I do. I found i t useful to discuss this topic and feel my feelings because, although I don't often think about DSD, I do have strong feelings about i t , esp. with regard to my own death. I hope I can learn to li v e the better l i f e I have resolved to l i v e tonight for a long time to come, and not s l i p easily back into a state of taking days,' weeks, months, years, etc., for granted. Have gained much from this workshop - especially have confirmed within myself the fact that I have been avoiding the reality of death. It has made me more accepting of death as a whole - and I hope I can face i t more r e a l i s t i c a l l y . Thanks so much for sharing your ideas! You've made me do a lot of thinking. very good feelings about 1st session, film "Great American Funeral"wwas too long found Anne's sharing of what she did in the classroom very useful. The whole experience has been most worthwhile. As a result of f i r s t listening to Anne, doing some reading and also attending the workshop, I have started to think and talk about death. I think that up to now I had been denying and avoiding i t . I have discussed this with my father, my 115. husband. I feel that I have made.it easier for students and friends to share their experiences and feelings with me (It amazed me how anxious some people are to talk about this - and only need to know that you f e e l comfortable in sharing with them). Although I teach Family Dynamics, I probably won't teach this topic this year - I don't think l|m completely ready - and the timing just wouldn't be as good as I would want i t . The discussion groups were a good idea - unfortunately I didn't f e e l comfortable in my group - l!m s t i l l trying to sort out why - is i t me? Did I not feel trusted? At least I have been able to talk to others - so this has not been a problem. It's hard to isolate any particular part that was worthwhile - i t has been a total experience for me - with each meeting, reading, discussion with family, friends, etc., building on what has come before. Thank you very much for sharing with us - i t has been a real 'growing' experience for me - and one which I know i s s t i l l only at the beginning. Two comments on the other sheet. The whole workshop was excellent - a most beautiful experience. Keep up the good work - everybody needs more of this sharing. Good luck in your work. I f e l t the workshop was most worthwhile but I'm not really sure that my death acceptance is "gut" or "head". I have no fear of my own death but I know I w i l l miss my relatives and friends should they die. 116. t Problems that have arisen during the workshop period are not due to the workshop but due to a friend who experienced a seance and had contact with a "dead s p i r i t " . This has bothered me most. I believe this person and l i f e after death seems wierd. No matter what - " l i f e " goes on u n t i l death. Sorry for the rambling - I r e a l l y l i k e to think and this has helped raise new questions. My problem is your term "heavy". These questions and topics are or were not "heavy" for me. You make" them too ominous.(sp)„ Death really exists. Thanks. Appendix D. 117. THE COLLETT-LESTER FEAR OF DEATH SCALE A MANUAL DAVID LESTER Richard Stockton. S t a t e Co l lege . THE SCALE Here is a series of general statements. You are to indicate how much you agree or disagree with them. Record your opinion in the blank space in front of each item according to the following scale: +1 slight agreement -1 slight disagreement +2 moderate agreement -2 moderate disagreement +3 strong agreement -3 strong disagreement Read each item and decide quickly how you feel about i t , then record the extent of your agreement or disagreement. Put down your f i r s t impressions. Please answer every time. 1 I would avoid death at a l l costs. 2 I would experience a great loss i f someone close to me died. 3 I would not feel anxious in the presence of someone I knew was dying. 4 The total isolation of death frightens me. 5 I am disturbed by the physical degeneration involved in a slow death. 6 I would not mind dying young. 7 I accept the death of others as the end of their l i f e on earth. 8 Ilwould not mind v i s i t i n g a senile friend. 9 I would easily adjust after the death of someone close to me. 10 If I had a choice as to whether or not a friend should be informed he/she is dying, I would t e l l him/her. 11 I would avoid a friend who was dying. 12 Dying might be an interesting experience. 13 I would like to be able to communicate with the s p i r i t of a friend who has died. 14 I view death as a release from earthly suffering. 15 The pain involved in dying frightens me. 16 I would want to know i f a friend were dying. 17 I am disturbed by the shortness of l i f e . 18 I would not mind having to identify the corpse of someone I knew. 19 I would never get over the death of someone close to me. 20 The feeling that I might be missing out on so much after I die bothers me. 21 I do not think of dead people as having an existence of some kind. 22 I would feel uneasy i f someone talked to me about the approaching death of a common friend. 23 Not knowing what i t feels like to be dead does not bother me. 24 If I had a fat a l disease, I would like to be told. 25 I would v i s i t a friend on his/her deathbed. 26 The idea of never thinking or experiencing again after I die does not bother me. 118. 27 If someone close to me died I would miss him/her very much. 28 I am not disturbed by death being the end of l i f e as I know i t . 29 I would feel anxious i f someone who was dying talked to me about i t . 30 The intellectual degeneration of old age disturbes me. 31 If a friend were dying I would not want to be told. 32 I could not accept the f i n a l i t y of the death of a friend. 33 It would upset me to have to see someone who was dead. 34 If I knew a friend were dying, I would not know what to say to him/her. 35 I would not lik e to see the physical degeneration of a friend who was dying. 36 I am disturbed by the thought that my a b i l i t i e s w i l l be limited while I l i e dying. SCORING This scale is designed to assess four separate fears of death: fear of death of oneself fear of death of others fear of dying of oneself fear of dying of others. Each subscale contains items keyed positively and items keyed negatively. Thus, although the scale is scored as any conventional Likert-type scale, care is needed in distinguishing the items of each scale and in distinguish-ing the positively keyed and the negatively keyed items. The distribution of items is as follows: positive negative death of self 1, 4, 17, 20 6, 14, 23, 26, 28 death of others 2, 13, 19, 27, 32, 7, 9, 18, 21 33 dying of self 5, 15, 30, 36 12, 24 dying of others 11, 22, 29, 31, 3, 8, 10, 16, 25 34, 35 NOTE: The f i n a l score you get for any subject for each scale has no meaning by i t s e l f . It has meaning only in relation to the scores of other subjects. The items have not been constructed so that a score of, say, +A means that the subject has a fear of death while a score of -A means that the subject has no fear of death. The only kind of statement that is logically possible with this scale is that subject X has a higher (or lower) score than subject Y. THERE ARE NO adequate norms for these scales. Several of the studies that have been published, however, do report mean scores on each of the subscales for a variety of subject populations. BIBLIOGRAPHY of my studies using the scale Collett, L.J. , £ Lester, D. The fear of death and the fear of dying. J. Psychol., 1969, 72, 179-181. Lester, D. Fear of death and nightmare experiences. Psychol. Rep•, 1969, 25, 437-438. Lester, D. Correlates of "animism" in adults. Psychol. Rep., 1970, 27, 806. Lester, G., £ Lester, D. The fear of death, the fear of dying, and threshold differences for death words-'.and neutral words. Omega, 1970, 1, 175-179. Lester, D. Relation of fear of death in subjects to fear of death in their parents. Psychol. Rec., 1970, 20, 541-543. Lester, D. Religious behavior and the fear of death. Omega, 1970 1970, 1, 181-188. Lester, D., £ Collett, L.J. Fear of death and self-ideal discrepancy. Arch. Found. Thanatol., 1970, 2, 130. Lester, D. Attitudes toward death in a non-disturbed population. Psychol. Rep., 1971, 29, 386. Lester, D. Attitudes toward death held by staff of a suicide prevention center. Psychol. Rep., 1971, 28, 650. Ford, R.E., Alexander, M., £ Lester, D. Fear of death in a high stress occupation. Psychol. Rep., 1971, 29, 502. Alexander, M., £ Lester D., Fear of death in parachute jumpers. Percept, Mot. S k i l l s , 1972, 34, 338. Lester,, D. Studies in death attitudes: Part Two. Psychol. Rep., 1972, 30, 440. Lester, D. , Getty, C , £ Kneisl, C. Attitudes of nursing students and nursing faculty toward death. Nurs. Res., 1974, 23, 50-53. CITATIONS of the scale (obtained from Science Citation Index) Dickstein, L. Psychol. Rep. , 1972, 30, 563. Sarason, I.G. Ann. Rev. Psychol., 1971, 22, 393. Durlak, J.A. J. Clin. Psychol. , 1972,28,545. Hersen, M. Psychol. Bull., 1972, 78, 37. Edward, A.L. Ann. Rev. Psychol., 1973, 24, 241. 120. APPENDIX The following are some data'on the .scale, hitherto unpublished, which may assist users. Correlations Between Subscales DS DS DS DO DO DyS s a m p l e n DO DyS DyO DyS DyO DyO nurses soph, jun. sen. 1st yr. grads-2nd yr ggrad. faculty Intro Psych Ss Abnorm Psych Ss Psych course for nonmajors ( A l l correlations are product-moment correlations.) 32 21 49 . 24 26 49 50 40 20 19 32 -06 -17 33 55 56 60 47. 40 40 44 33 36 60 38 19 19 57 32 57 54 -09 54 01 -16 62 . 26 38 35 13 41 42 40 26 52 . 31 14 33 . 37 28 28 29 •30 09 35 39 33 22 . 31 02 . 27 .' 37 45 Correlations Between Scales and Other Fear of Death Scales Product-moment correlations between the Lester (1967) fear of death scale and n DS DO DyS DyC 32, • 16 -27. 25' 10 40 53 01 18 17 55 60 37 25 31 33 58 -17 53 39 32 62 28 18 -13 62 56 10 09 17 40 61 -04 36 17 24 34 -25 09 04 33 38 -10 34 02 nurses soph. 32 jun. sen. 1st yr grad. 2nd yr grad. faculty Intro Psych Ss Abnorm Psych Ss Psych course for nonmajors Other scales have been correlated with the Collett-Lester scale Durlak (1972). - see Lester, D. Fear-of death of suicidal persons. 20, -1077-1078. Psychol. Rep., 1967 Durlak-,- J.A. Measurement of the fear .of death."J. Clin. Psychol., 1972, 28, 545-547. 121. Factor Analysis r Although the basis of the iscales, presented here i s in terms of their face v a l i d i t y , . i t i s of interest.to explore.inter-item correlations. . Acc-ordingly, the data from 241 female:subjects who completed the scale for the study reported by Lester,.et a l . (.1974) were subjected to a factor-analysis using the UCLA Biomed S t a t i s t i c a l Programs BMD03M.. Eleven eigen values were greater than unity and eleven factors were extracted. FACTOR Item 1 2 3 4 5 6 7 8 9 10 11 1 DS+ 29 29 23 . 20 -06 -13 -16 31 -12 -24 -07 2 D0+ 14 05 05 80 01 -01 06 03 03 10 -01 3 DyO- -16 -06 • -35 -05 -04 01 18 66 05 -09 -05 4 DS+ 52 -03 27 02 09 21 -28 -16 -06 26 -08 5 DyS+ 05 04 12 -02 -09 07 -25 -05 01 70 02 6 DS- -55 07 -02 -39 -25 -08 15 -05 02 07 -07 7 D0- -08 03 -12 -06 02 -08 -71 -03 04 04 -01 8 DyO- -15 04 -07 02 -03 16 -25 12 34 -47 -33 9 D0- -22 01 -11 -50 14 -30 -10 37 -04 19 06 10 DyO- -10 -76 -04 -16 -01 12 02 16 09 01 -07 11 DyO+ 08 03 14 07 -05 -02 05 06 -73 -01 23 12 DyS- -25 -23 -24 -05 -59 -07 06 -06 16 16 09 13 D0+ 18 09 06 -11 -57 -07 14 01 32 16 17 14 DS- -11 -12 07 -04 -51 02 -28 41 -06 -16 -09 15 DyS+ 27 -03 35 05 04 16 -27 38 -11 32 08 16 DyO- -07 -12 -07 09 • 02 -10 -05 03 07 12 -80 17 DS+ 65 21 03 17 02 14 11 05 01 21 07 18 D0- -20 06 -49 -34 10 09 20 18 28 06 -06 19 DOt 11 -01 03 10 02 8.0 01 01 -06 03 11 20 DS+ 72 11 12 03 03 07 07 14 09 18 14 21 D0- 12 -14 08 -17 63 -19 02 01 30 -01 18 22 DyO+ 06 15 72 02 04 07 18 -04 01 01 05 23 DS- -57 -10 -32 24 -08 -02 10 08 .10 11 23 24 DyS- -11 -82 -09 -03 -01 -10 -04 -08 03 -06 -12 25 DyO- 01 -19 -14 31 -14 -13 01 03 67 02 09 26 DS- -76 02 -13 01 -01 -05 04 08 06 -02 -05 27 D0+ 01 14 09 77 04 05 01 -01 . 07 08 -16 28 DS- -75 -09 -15 -14 -12 -11 -16 18 06 01 -01 29 DyOt 12 03 75 -01 03 01 -16 -07 -07 10 06 30 DyS+ 08 07 11 11 -06 -02 18 -01 03 70 -22 31 Dy0+ 04 46 17 -15 04 11 -11 -01 -10 07 55 32 DOt 17 02 19 -03 -05 78 06 -01 -01 02 03 33 DOt 28 21 51 09 01 20 -01 -11 -05 -01 -01 34 DyO+ 17 02 57 09 11 10 14 -08 -16 18 02 35 Dy0+ 02 -07 59 04 -03 06 16 27 -01 36 06 36 DySt 25 -10 38 11 02 06 -31 04 24 48 06 % total 18% 6% 6%. . .5% . .5% .4%. 4% . .3% 3% 3% 3% variance It can be seen from this that the f a c t o r i a l structure of the.scale is quite complex. Factor 1 appears to embody fear of death of self, and factor 3 fear of dying of others. The other factors are mixed. However, significant corre-lations between the different fears are to be expected and the devising of mathematically unrelated scales may be impossible. 

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