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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..University  of B r i t i s h 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 COLUMBIA April 1977 (c)  Denis E r i c Boyd, 1977  In p r e s e n t i n g t h i s t h e s i s  in p a r t i a l  an advanced degree at the U n i v e r s i t y the L i b r a r y  s h a l l make i t f r e e l y  f u l f i l m e n t o f the requirements of B r i t i s h Columbia, I agree  available for  I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e  r e f e r e n c e and copying o f t h i s  It  i s understood that copying or  thesis  permission.  Department o The U n i v e r s i t y o f B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1WS  Date  -ftffUl  3tj  11  or  publication  o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d w i t h o u t my written  that  study.  f o r s c h o l a r l y purposes may be g r a n t e d by the Head of my Department by h i s r e p r e s e n t a t i v e s .  for  ABSTRACT EVALUATING THE PREPARATI ON TOR TEACHERS ,OF DYING AND DEATH  ;  The purpose of t h i s study was t o explore the s i g n i f i c a n c e of preparation (by measuring changes i n the fear of dying and death) f o r teachers interested i n teaching about dying and death.  The preparation was an e x p e r i e n t i a l and  d i d a c t i c workshop (see " D e f i n i t i o n 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 e x p e r i e n t i a l and d i d a c t i c workshop on dying and death. shop took place one evening a week over a three week period.  This work-  The C o l l e t t -  Lester Fear of Death Scale was administered at the beginning of the t r a i n i n g and again a t the end.  A second group of teachers (Control: males 11; females 22) was not given the workshop.  The C o l l e t t - L e s t e r Fear of Death Scale was administered twice,  with a three week period between t e s t i n g s .  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 e x p e r i e n t i a l / d i d a c t i c workshop would not lower  the anxiety of the r e l i g i o u s l y committed p a r t i c i p a n t s to any greater extent than the death anxiety of the n o n - r e l i g i o u s l y  committed p a r t i c i p a n t s .  Hypothesis  three d e a l t with sex and proposed that male p a r t i c i p a n t s ' scores would be decreased t o a greater extent than those of the female p a r t i c i p a n t s .  The r e s u l t s of t h i s i n v e s t i g a t i o n indicated that an e x p e r i e n t i a l / d i d a c t i c 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 C o l l e t t - L e s t e r Fear of Death Scale, i n d i c a t i n g a.decrease i n death f e a r s .  There was.no d i f f e r e n c e in.scores  between the male and female p a r t i c i p a n t s as t o lowering of death anxiety.  The  death anxiety scores of the r e l i g i o u s l y committed p a r t i c i p a n t s d i d not decrease more than those of the n o n - r e l i g i o u s l y committed.  In f a c t , on some of the  C o l l e t t - L e s t e r sub-scales, j u s t the opposite occurred.  The r e s u l t s of t h i s study point t o the value of preparation f o r teachers interested i n teaching about death.  A case i s made f o r the need of such pre-  paration and the value of an e x p e r i e n t i a l / d i d a c t i c workshop i s supported.  An-  other i m p l i c a t i o n of t h i s research i s the value of such t r a i n i n g t o any i n d i v i d u a l interested i n becoming more comfortable with h i s or her m o r t a l i t y .  iv.  TABLE OF CONTENTS  Abstract  .  .'. '.' . '.' . ". '.' . .  .  '.  .  '.' '.' . •  .  .  '.  .  .  .  .  .  .  .  L i s t of Tables  .  .  L i s t o f Figures  and I 1 l u s t r a t ions  C h a p t e r One:  Introduction .  C h a p t e r Two:  Review o f t h e L i t e r a t u r e .  A.  Culture  .  .  .  .  perspective  .  .  .  .: .: .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  • .  .  .  .  .  .  .  . .  .  . .  .  .  .  .  i i  v  v  i  i  -  iii«  .  1  .  .  .  .  .  k  .  .  .  .  .  ^  1.  Historical  2.  Religious perspectives  3.  A "Death System" : technology  't.  Signs  5.  Fear o f Death  ]k  a)  u n i v e r s a l nature  15  b)  the reality  o f death  16  c)  definitions  of fear  17  d)  management o f f e a r  6..  B.  : general  .  '.. . •  2.  .  .  .  .  .  - help or hindrance  .  o f Change  .  .  .  .  .  .  .  .  .  .  20. 26  enhancing forces  b)  negating  forces  c)  finitude  : t h e key t o meaning  The d y i n g  8 10  a)  : specific  5 6  Meaning o f L i f e  Culture 1.  overview  26: .  .  .  .  .  .  .  .  .  .  27  .  28 31  concerns  31  process perspective  the medical  b)  the patient's perspective  36  c)  growth p o t e n t i a l  kO  d)  at the point o f death  41  Bereavement  .  .  .  a)  "little  deaths"  b)  Influential  .  .  .  .  .  .  .  .  .  .  .  32  a)  .  . .  .  factors in grief  .  . .  . .  . .  . .  . .  kl  . .  k)  .  A3  V .  TABLE OF CONTENTS (cont'd)  3.  C.  D.  c)  grieving process  .  d)  g r i e f dramatized : .the :funeral  Children and Death  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  44  .  .  47  .  .  48  .  .  .  .  .  .  a)  developmental perspectives  .  .  .  .  .  b)  the need to teach  Death Education : a plan to meet the need 1.  Variety of approaches  2.  The Classroom  Conclusions  Chapter three :  .  .  .  .  .  .  .  43  .  .  .  kS  .  .  .  50 51  .  .  .  .  .  .  .  .  .  .  Method .  .  s  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  54  .  .  56  .  .  52  A.  Problem  56  B.  Hypotheses - Substantive  56  C.  Hypotheses - S t a t i s t i c a l  57  D. .  Definition of terms  58  E.  Sample  59  F.  Treatment  60  G.  Instrumentation  61  H.  Design and S t a t i s t i c a l Analysis  61  Chapter four :  Results  .  .  Chapter five :  Discussion 1 .  .  .  .  .  .  .  .•  ..J.  77  A.  Hypothesis one  B.  Hypothesis two  C.  Hypothesis three  .  .  D.  Shortcomings and Needed Improvements .  .  E.  Implications of the Study  .'  F.  Summary  . .  .  .  .  . . .  .  .  . . .  . . .  63  . .  . .  .  .  .  .  .  . .  . .  . .  . .  .  .'  . .  . .  .  .  77 78  .  .  .  .  81  .  .  .  .  81  .  .  .  .  84  .  84  VI,  TABLE OF CONTENTS  .  .  (cont'd)  Chapter S i x  :  References  Appendix A  :  Vancouver School Board l e t t e r t o c o n t r o l group members .  .  .  .  .  .  .  .  .  .  .  .  .'  86  .  .  93  .  .  96  .  .  -100  prospective .  .  Appendix B  :  An o u t l i n e of the treatment workshop .  Appendix C  :  Experimental group members workshop  Appendix D  :  evaluations . . .'• . . . . . Col 1 e t t - L e s t e r Fear of Death S c a l e and Manual . . . . . . . .  . .  . .  . .  .  . .  .  .  .  vii .  L I S T OF TABLES  I.  Table  1  Combined C e l l  Means  Experimental  ii.  Table  2  Observed  Cell  Table 3  Observed  Religious  table  k  Analysis of  V.  Table  5  Observed  Observed  Cell  Table 7  Observed  Cell  .  (Group/Religion)  (Combined)  .  and C o n t r o l  Standard Deviations  Experimental  •  (Group/Religion)  and C o n t r o l  C o m b i n e d Means  Analysis of  .  (Sex/Group)  M a l e s and Females  V I I I . ' Table 8  .  (Group/Religion)  Commitment  Means  Experimental  VII.  .  and C o n t r o l  Covariance  Experimental  Table 6  .  Commitment a n d  No R e l i g i o u s  IV.  .  and C o n t r o l  C o m b i n e d Means  Experimental  VI.  and C o n t r o l  Standard Deviations  Experimental  III.  (Group/Religion)  .  .  . . .  (Sex/Group)  (combined)  and C o n t r o l  Covariance  .  (Sex/Group)  .  .  (Sex/Group)  .  .  .  •  •  viii .  LIST OF F l GURES. AND ILLUSTRATI ONS  1.  Graph a .  Observed Cell Means Experimental  2.  Graph b.  (Group/Religion)  . . . . . . •.' . . .  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 : t h t f o d u c t 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 a v a i l a b l e on what t o teach, there has been no work done on the prepara t i o n of teachers t o administer the curriculum. A d e s c r i p t i o n of proposals for  preparing teachers w i l l f o l l o w information which acts as a foundation f o r  this 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 i n s u l a t e d from o l d age, dying and death.  H i s t o r i c a l l y t h i s was not the s i t u a t i o n (Hofmeier, 1972). I n  the middle ages there was a preoccupation w i t h m o r t a l i t y (Kastenbaum £ Aisenburg, 1972).  R e l i g i o n has moved from a p o s i t i o n of influence t o one of l e s s  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 ( M i t f o r d , 1963).  Urbanization and a growing technology have changed s o c i e t y con-  s i d e r a b l y (Kastenbaum £ Aisenburg, 1972).  One of the unfortunate changes has  been an over-emphasis on youth and l i f e t o the exclusion of o l d age and death.  Although the general p i c t u r e i s one of avoidance, there are some i n d i c a t i o n s of change. Some people have become aware of how harmful ignoring mortali t y can be and they are encouraging others t o 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 " u n i v e r s a l 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 a d d i t i o n t o a v a r i e t y of  d e f i n i t i o n s f o r the fear of death, there are suggestions f o r management of these concerns (Choron,1964).  There i s a d i r e c t l i n k between fear of death and the meaning of l i f e (Frankl,1973).  Although some see the q u a l i t y 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 soci a l setting.  The focus now changes t o three areas of s p e c i f i c concern.  Direc-  t l y a f f e c t i n g each of these t o p i c s i s the tone set by society with regard to a t t i t u d e s about m o r t a l i t y .  Avoidance of death has d i r e c t l y influenced the care of the t e r m i n a l l y ill.  Medical p r o f e s s i o n a l s 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 l o n e l y 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 s i t 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 a l s o d i r e c t l y influenced by how society manages death (Hendin, 1973).  By f a c i n g the.eventuality of death i t i s p o s s i b l e to be some-  what prepared f o r 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 ( M i t f o r d , 1963; Harmer, 1963).  Much.of the c r i t i c i s m has been d i r e c t e d at the  f u n e r a l i n d u s t r y . P a r t i c u l a r concern has been expressed about how the indust r y has evolved to support the growing stance of d e n i a l .  The modern f u n e r a l  has become a dramatization, i n t e n t on camouflaging the r e a l i t y of death ( M i t f o r d , 1963).  The t h i r d t o p i c i s death and c h i l d r e n . c h i l d r e n about most t h i n g s ^ i n c l u d i n g sex. sharing by adults (Yudkin, 1968).  There i s a tendency to t a l k with  Death i s u s u a l l y excluded i n any  This avoidance c o n f l i c t s with a c h i l d ' s  n a t u r a l tendency to l e a r n 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).  S o c i a l 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 w i t h . i t ?  makes sense to s t a r t with c h i l d r e n . . However someone has to teach the c h i l d r e n .  Ross and others have found.that to be comfortable with.the.subject of death an i n d i v i d u a l has to become aware of h i s or her own f e e l i n g s .  I f teach-  ers are to teach about death they should have an opportunity t o . d e a l with t h e i r own a t t i t u d e s and f e a r s .  The purpose of t h i s study i s twofold: and to evaluate i t s e f f e c t i v e n e s s .  to develop a t r a i n i n g  procedure  There i s no research a v a i l a b l e which docu-  ments the subject of teacher preparation in.the area of death and dying.  What f o l l o w s 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 o u t l i n e d i n t h i s i n t r o d u c t i o n .  4. CHAPTER TWO Rev Jew o f : t h e L t t e r a t u r e  A.  Culture V general  perspective  Death has indeed been a "taboo" subject i n North America ( F e i f e l , 1959). "Death has become unmanageable f o r our c u l t u r e and f o r us as i n d i v i d u a l s " ( L i f t o n , 1974, p.3).  I t has been relegated t o a very p r i v a t e or c r a s s l y com-  m e r c i a l a f f a i r (Hofmeier, 1974).  Only a hundred and twenty-five years ago t h i s was not the s i 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; f r i e n d s b u i l t a c o f f i n or picked one up from the f u r n i t u r e store; someone else dug a grave.  Everybody had a part t o play i n l i f e ' s ending.  Today, technology and urbanization have doubled l i f e expectancy and yet a l i e n a t e d people from t h e i r dying.  Customs and creeds have been developed t o  allow us a comfortable distance from the r e a l i t y of death.  "Secular and r e -  l i g i o u s t a c t i c s p e r t a i n i n g t o death share a common i n t e n t : t o placate an adversary" (Weisman, 1972, p.5).  Keleman i n L i v i n g Your Dying (1974, p.16) echoes and expands t h i s idea when he says that "The myths of a l l s o c i e t i e s t r y t o ensure that we don't d i e meaningless deaths.  They t r y t o give an avenue of approach t o the dying pro-  cess so that we are not swept away i n despair at meaninglessness."  Kastenbaum and Aisenburg have w r i t t e n an a u t h o r i t a t i v e 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 m i l i e u ' of yesterday and today, and w i l l be r e f e r r e d t o frequently  ;in t h i s section . of the paper.  Kas.tenb.aum . and Aisenburg believe: ''... we no  longer p a r t i c i p a t e i n a society that i s dominated by t r a d i t i o n , lineage, or We no longer have a c u l t u r a l buffer to help us  accepted dogma" (p.208).  under-  stand and adjust to our mortality.  Perhaps i t i s the loss of our dogmas and traditions.that has forced death to be hidden away. most out of sight.  Both physical death and symbolic portrayals are a l -  Kastenbaum and Aisenburg d i f f e r e n t i a t e between "natural"  and "unnatural death".  Natural death happens to old people which makes i t a  distant and remote menace.  Natural death i s becoming obsolete i n today's  youth oriented society and only happens to people who have become obsolete. Unnatural death i s primarily associated with youth and.accidental deaths i n car crashes and the l i k e .  If death constituted the overwhelming fact of l i f e to the man of the l a t e middle ages, then to many of us, death may seem a l l but i r r e l e v a n t . Perhaps more than any society the world has known, we have succeeded i n relegating death to a,small peripheral corner of our conscious mental l i f e . Death b e f a l l s the aged, who are semi-visible on our phenomenological screen anyhow; and death is the business of s p e c i a l i s t s whose work i s largely unseen by our eyes. (p.207) 1.  H i s t o r i c a l overview . In the past i t was d i f f e r e n t .  few people even reaching old age.  There was a more limited l i f e span with There was a high infant mortality rate and  no adolescence because children began to work early. sure to death i n people and animals.  There was common expo-  Man also had l i t t l e control over the  forces of nature. Toynbee i n Man's Concern with Death (1968) says that his parents grew up i n the "Ancient World". expectancy was so low.  For them death was an early r e a l i z a t i o n since l i f e ' s He compares his parents to his more immediate  who l i v e i n the "Modern World":  family  "Thus I and my s i s t e r s are modern i n 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 o f f e r an i n t e r e s t i n g contrast to our present times. "In Northern Europe f o r two hundred years - from the middle of the 14th to the middle of the 16th ( c e n t u r i e s ) ... the subject of death was c e n t r a l , perv a s i v e , v i v i d , intense - i n short the concern of 14th century man" & Aisenburg, 1972, p.198).  (Kastenbaum  Not only was l i f e expectancy normally short but  there were great catastrophes, p e s t i l e n c e s , witch manias, dancing manias, the crusades and the Black Death (which was 90% f a t a l ) . Readers are i n v i t e d by Kastenbaum and Aisenburg to imagine the most a p p a l l i n g s i t u a t i o n i n h o s p i t a l s , s h i p s , and prisons; the crudest sort of funerary p r a c t i c e s ; the most desperate combinations of disease, famine and ignorance.  Death was the f a v o u r i t e t o p i c of preachers and w r i t e r s as w e l l as one  of the most common subjects f o r popular a r t . Statues existed that were h a l f healthy man and h a l f decaying man. that mirrored the preoccupation.  Brueger's "Triumph of Death" i s a p a i n t i n g 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 t e c h n o l o g i c a l defense and there were i n e f f e c t u a l s o c i a l controls and adjustments.  However there was a major source  of comfort: t h e o l o g i c a l d o c t r i n e with f a i t h and t r u s t i n the " a l l - p o w e r f u l c r e a t o r " and a j o y f u l r e s u r r e c t i o n were of help t o many. The h e r e a f t e r a l s o however, became a source of t e r r o r f o r those unable to l i v e up t o the teachings of the church.  Death became God's punishment of man and needless t o say the  moment of death a dreaded occasion. This concept w i l l be explored f u r t h e r i n a l a t e r section on " f e a r " .  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 a t t i t u d e s towards death. i s f a s t disappearing"  (p.13).  "This influence  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 n a t i o n a l and r e l i g i o u s r i t u a l s f o r g r i e v i n g , the wakes, the anniversary masses, the regular prayers, the proper c l o t h i n g , post f u n e r a l feasts.  Cemeteries no longer hold much magnetism and holidays f o r honoring  the dead have l e s s meaning and p o p u l a r i t y each passing year."(p.7) Kavanaugh an e x - p r i e s t , goes a step f u r t h e r 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 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. act of b e l i e v i n g and not the b e l i e f that counts.  increased,  He says that i t i s the  "True b e l i e v e r s are  committed to any set of transcendent values who dare to l i v e them to the  men end."  (p.14) Kavanaugh's ideas are supported by others.  Hinton (1967) states that i t  i s unclear what e f f e c t 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 v a l i d a t e d 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 f o r l e a r n i n g 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. strength or q u a l i t y of the "held" b e l i e f i s s i g n i f i c a n t . Ross has s a i d more on t h i s subject.  She a l s o f e e l s that the More r e c e n t l y Dr.  At a conference i n S e a t t l e , Washington i n  March 1976 she stated t h a t , i n her opinion, C h r i s t i a n s 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 C h r i s t i a n f a i t h were l e a s t l i k e l y to " l i v e " t h e i r beliefs.  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 a t t i t u d e s and concerns about death.  8. For  Kavanaugh (1972), worldly.gods have taken over f o r t r a d i t i o n a l  r e l i g i o n : p h y s i c a l h e a l t h , youthful appearance, sexual a t t r a c t i v e n e s s , success and peace of mind.  The l a t t e r goal can be achieved i n death (Refer t o s e c t i o n  "meaning of l i f e " ) . Fulton (1963) t a l k s about a s e c u l a r l y 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 t o view death as an infringement upon the r i g h t t o l i f e and the  pursuit of happiness." (p.8)  Suffering i s t o be avoided at a l l costs. How-  ever the p u r s u i t of happiness can r e s u l t i n "loose l i v i n g " ( d r i n k i n g , smoking, sex) which can i n t u r n 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) a p t l y r e f e r s t o Arnold Toynbee's statement that death i s "un-american".  "He means that i n a c u l t u r e that places so much emph-  a s i s 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 d i g n i t y of age, death has no place. ing  In such a s o c i e t y , dy-  can be a t e r r i b l y l o n e l y and desperate experience as indeed i t often i s . "  3.  A "Death System" : Technology - h e l p o r  hihdranee?  Kastenbaum and Aisenburg (1972) claim that s o c i e t i e s have "death systems". They define a death system as "the words and actions concerning death" that allow people t o come t o terms with death i n both i t s personal and s o c i a l aspects.  Such an arrangement i s sanctioned by governing a u t h o r i t i e s and shared  by the community. I t would seem that our death system mainly encourages an a t t i t u d e of den i a l and avoidance.  The weakening of a u t h o r i t a t i v e customs and r e l i g i o u s tra4  d i t i o n s have l e d t o the s e c u l a r i z a t i o n already described. A s o c i a l system w i t h  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. led  Blauner (1966) points out that our present death system has expel-  the dead.  They are no longer important t o the s o c i a l . s t r u c t u r e .  i s a "diminished v i s i b i l i t y of death" (.p.238).  There  In the past, s p i r i t s had a  large part t o 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 daily routines. Kastenbaum and Aisenburg (1972) say our death system of avoidance can a l s o be seen i n our a t t i t u d e toward the p h y s i c a l environment. us t o believe that we are capable of c o n t r o l and mastery.  Science has l e d  "Science p o t e n t i a l -  l y can solve any problem i n which we care t o invest s u f f i c i e n t time and resources.  Money changes the world." (p.207) S c i e n t i f i c medicine seeks t o understand and use the laws of l i f e and  death (Hofmeier, 1974)<;thus man f i n d s himself with some new issues t o be dealt with: b i r t h c o n t r o l , abortion, prolongation of l i f e , and euthanasia. Hendin (1973) defines d i r e c t ( p o s i t i v e ) euthanasia as a d e l i b e r a t e a c t i o n which shortens a l i f e ( i . e . mercy k i l l i n g ) and i n d i r e c t 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 w r i t t e n a book .supporting  both types of euthanasia which even d e t a i l s a " L i v i n g W i l l " which w i l l permit a person t o place h i s euthansic concerns i n w r i t i n g while he i s s t i l l quite healthy.  Such a document has become l e g a l i z e d i n the State o f C a l i f o r n i a  during October, 1976. Science also o f f e r s the a l t e r n a t i v e of 'cyronics' or r e f r i g e r a t i o n a f t e r 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 t o the •  JLU.  disease which k i l l e d the person has been discovered. One o f the reasons why science helps t o perpetuate an a t t i t u d e o f avoidance may be due t o the f a c t that i t tends t o measure a l l experience w i t h i n the  bounds of space and time.  Thus science does not f u r n i s h man with " a l l  the  necessary parameters f o r i n v e s t i g a t i n g 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 a l s o helping mankind t o achieve greater enlightenment i n the area o f death and dying.  Scien-  t i f i c progress has reduced many burdens on the i n d i v i d u a l and made i t possi b l e f o r him t o have an a t t i t u d e t o death which i s not dominated by fear. (Hofmeier, 1974). Today man does have the opportunity t o develop an a t t i t u d e 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 i n t o question the d e f i n i t i o n o f 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 t o redefine death (Langone, 1972; Hendin, 1973; Sneidman, 1973). In the past death has occurred with cessation o f r e s p i r a t o r y functions (heart and lungs).  Today there i s strong support f o r a d e f i n i t i o n of death  which i s based on the ceasing of mental or b r a i n processes.  4.  S!gns of Change  There are reports of a renewed i n t e r e s t i n death and dying i n North America (Kastenbaum £ Aisenburg, 1972). ered f o r such a statement.  There are a v a r i e t y of reasons o f f -  One i s the "BOMB": a r e a l i t y which forces people  to examine the meaning t o 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, f a i t h , i n m a t e r i a l progress,. is. beginning t o ebb. ing  that technology does not n e c e s s a r i l y solve s o c i a l problems.  are  many new d i s c o v e r i e s which have undesirable aspects.  W.e are.learnIndeed there  "Unacceptable types  and l e v e l s of s u f f e r i n g 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 t o do so." (Kastenbaum and Aisenburg, 1972, p.235) T h i r d l y , some people have begun to suspect that our very way of l i f e may have l e t h a l components. pollution.  There i s i n c r e a s i n g evidence of a i r and water  Species of w i l d l i f e are disappearing from the face of the earth.  Highway deaths, alcoholism, drug a d d i c t i o n , violence with guns, and economica l l y i n s p i r e d wars are taking t h e i r t o l l . The f o u r t h reason deals with exposure to v i o l e n t death due to mass media. I f there is a war i n some remote part of the world i t i s reproduced n i g h t l y on t e l e v i s i o n newscasts.  F i r e s , automobile and a i r p l a n e crashes u s u a l l y receive  s i m i l a r treatment. Due to major media coverage, North Americans are " l i t e r a l l y obsessed w i t h the occurence of a c c i d e n t a l deaths" ( P r o j e c t o r , 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 a c t u a l f a c t only .5% of U.S. deaths are due to accidents  and the remaining 95% to n a t u r a l causes. There i s ahtehderiey to believe that accidents are much more prevalent than i n days gone by. tion.  Projector (1968) shows that t h i s i s an i n v a l i d assump-  In the days of horse and buggy, r a i l w a y , 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.  died i n a steamboat f i r e i n New York harbour i n 1904.  Another 1000 people  12.  Projector believes that t h e r e . i s a r e l a t i o n s h i p between modern man's i n f a t u a t i o n with a c c i d e n t a l death and h i s i n s u f f i c i e n t concern with normal death. Hofmeier (1974) says that increased violence does not help e n l i g h t e n 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 i o l e n c e .  Perhaps i t  i s t h i s condonement by society that prevents people from being shocked by the r e p o r t i n g of v i o l e n t events i n the media.  Although o b j e c t i v e l y v i o l e n t  death - presented i n the media "increases the frequency of d i r e c 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 . 2 0 ) .  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 e c t i o n of any r e l i e f offered by medical progress. Mount (1974) concurs: "The media have brought a sense of u n r e a l i t y to death.  The p i c t u r e of George Wallace l y i n g paralyzed on the pavement provok-  ed merely a ho-hum response". point.  He goes on to name movies which i l l u s t r a t e h i s  There are f i l m s l i k e "The Godfather", "Catch-22" and "Butch Cassidy  and the Sundance K i d " . More r e c e n t l y there has been the " E x o r c i s t " and "Jaws".  At the time of t h i s w r i t i n g there i s " S u r v i v e " .  This l a t e s t movie  concerns the s e n s a t i o n a l i z i n g of Read's A l i v e (1974) which t e l l s of the surv 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 w i t h very r e a l i s t i c . p o r t r a y a l s .of death.  The.  Vancouver F i l m 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 l m s f e l l  into  13.  three  c a t e g o r i e s - a r t works, s a t i r e s and  documentaries.  "Exterminating  A n g e l " (1962) d e a l s w i t h death i n a most s u r r e a l i s t i c manner. Venice"  (1971) i s a p o w e r f u l l y  National Health" f o r My  Father"  These f i l m s and  and  "The  i n t e l l e c t u a l production  Loved One"  "Death i n  from I t a l y .  (1965) are s a t i r e s and  (1970) a s e r i o u s drama about a f a t h e r and  "The  "I:N.ever Sang  son r e l a t i o n s h i p .  o t h e r s which have been produced t o c h a l l e n g e man's a t t i t u d e s  toward m o r t a l i t y have not been e n t h u s i a s t i c a l l y r e c e i v e d .  L i t e r a t u r e and o f d y i n g and  l i v e drama a l s o a c t as v e h i c l e s f o r r e a l i s t i c  death ( B l o c h i n g 1974;  N e l s o n , 1973).  i t t o f a c i n g the r e a l i t i e s of t h e i r l i v e s and r i g h t a f t e r another i n our t i m e . o f f t h e s e messages" (Nelson,  "The  portrayals  r e s i s t a n c e s men  deaths have provoked one  includes a lengthy  several  "j  p.118).  S h i b l e s (1974) has w r i t t e n a book which  s e c t i o n on v a r i o u s l i t e r a r y o f f e r i n g s p u b l i s h e d  death. over  years.  The  support  play-  Audiences have worked wonders i n f e n d i n g  would seem t o be the r e s u l t o f 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 He  exhib-  f i f t h and  f i n a l r e a s o n g i v e n by Kastenbaum and  t h e i r t h e s i s that there  have more "mental h e a l t h e r s " who p s y c h o l o g i s t s a r e now  A i s e n b u r g (1972) t o  i s a renewed i n t e r e s t i n death i s t h a t we have been "through the m i l l " .  g e t t i n g o l d e r and  a n a l y s i s ) do not meet the c h a l l e n g e s  "Old  learning that t h e i r theories  now  School" (psycho-  of m o r t a l i t y .  Mental h e a l t h s p e c i a l i s t s are encouraging members o f today's s o c i e t y t o change t h e i r i d e a s about death (Kastenbaum S A i s e n b u r g , 1972). most a c t i v e i n attempting Suicide Prevention and  t o prevent s u i c i d e .  The  They are  Center f o r S t u d i e s  (CSSP) has been e s t a b l i s h e d w i t h the aim  o f "encouraging  e v a l u a t i n g mental h e a l t h e f f o r t s p e r t a i n i n g d i r e c t l y or i n d i r e c t l y  suicide prevention"  (p.236').  of  The " P s y c h o l o g i c a l Autopsy"-' c r e a t e d  by  to  xv.  Kastenbaum and.others (Sneidman, '1973) i s an.attempt t o i n v e s t i g a t e a dead person's p s y c h o l o g i c a l make-up and h i s t o r y . can  I n so d o i n g , t h e i n v e s t i g a t o r s  t r y t o determine what might have l e d t h e i n d i v i d u a l t o k i l l  Psychologists  are a l s o involved  i n attempting t o i d e n t i f y  i c a l components i n o t h e r t y p e s o f d e a t h . l o t o f the. t e r m i n a l length  patient.  himself.  psycholog-  Work i s b e i n g done t o improve t h e  T h i s concern w i l l be examined a t some g r e a t e r  i n t h e s e c t i o n on ''care o f t h e d y i n g " .  Much energy i s b e i n g d i r e c t e d towards d e c o n t a m i n a t i n g t h e t o p i c o f death.  "There has developed t h e t r a d i t i o n o f i n v e s t i g a t i n g death a t t i t u d e s  i n order t o confront  t h e p u b l i c w i t h i t s own b i a s e s  and r e s i s t a n c e s . "  (Kastenbaum S A i s e n b u r g , 1972, p.237).  Decontamination o f d y i n g and death i n s o c i e t y w i l l i n v o l v e some i n d e p t h f o c u s upon " f e a r o f d e a t h " and t h e "meaning o f l i f e " .  I t i s the fears  keep people from l o o k i n g d i r e c t l y a t t h e i r m o r t a l i t y .  Once t h e f e a r s a r e  faced there  5.  that  i s a d i r e c t e f f e c t upon l i f e ' s meaning.  Fear o f  Death  In Overcoming t h e Fear o f Death (1970) Gordon w r i t e s  "Most o f us a r e  a f r a i d t o contemplate our own ending; and when a n y t h i n g reminds us t h a t we too  s h a l l d i e , we f l e e and t u r n our thoughts t o h a p p i e r m a t t e r s " (p.13). I f  and  when we do c o n s i d e r  t h e p o s s i b i l i t y t h a t we might a c t u a l l y d i e , we t h i n k  of i t a s an event i n t h e remote f u t u r e .  In so d o i n g we a r e a b l e t o r e p r e s s  our  forget i t .  fear of ultimate  doom or c o n s c i o u s l y  One's a t t i t u d e towards death i s u l t i m a t e l y r e l a t e d t o one's f e a r o f t h e subject. his fears.  A person w i t h an open and o b j e c t i v e a t t i t u d e i s somehow managing Another i n d i v i d u a l who p r e f e r s t o "avoid"' t h e whole  issue  XD.  i s dealing with h i s 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 s e c t i o n as w e l l as management of death anxieties. A fear of death i s dependent upon a number of v a r i a b l e s (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 c u l t u r e i s defined i n terms of m a t e r i a l  t r a i t s and a r t i f a c t s , much of what man does and b u i l d s i s motivated by h i s desire t o endure."  (Gordon, 1970, p.24) Gordon sees our c u l t u r e as a r e s -  ponse t o our fear of death.  Culture thus i n turn has a causal e f f e c t i n  nurturing the same f e a r . Ih a d d i t i o n t o c u l t u r e and r e l i g i o n , Langone c i t e s "our a t t i t u d e s toward l i f e and l i v i n g , and our- general emotional h e a l t h " (p.4), as playing a part i n fear of death. (The s e c t i o n on "meaning of l i f e " - w i l l delve i n t o the s i g n i f i c a n c e of these two issues i n some greater  a)  detail.  aj)i^e^ ubiveiisalanature  Weisman (1972) says t h a t , f o r p r a c t i c a l l y everyone, the meaning of death i s a '!.universal negative" own death. life.  (p.13) and that i t i s impossible t o imagine one's  Death repudiates  and n u l l i f i e s a l l the o b j e c t i v e s so sought i n  Weisman r e s t a t e s the Freudian idea that although man recognizes death  i s u n i v e r s a l , he i s unable t o face i t i n d i v i d u a l l y . the "primary paradox".  This i s described as  The penalty paid f o r avoidance i s that when a death  does occur i t catches us unprepared. In 1973 Becker wrote The Denial of Death j u s t before he himself of cancer i n Vancouver General H o s p i t a l .  died  Becker t a l k 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 w i t h i n 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 i e s the g i l l - m a r k s to prove i t . His body i s a m a t e r i a l f l e s h y casing that i s a l i e n to him i n many ways - the strangest and most repugnant way being that i t aches and bleeds and w i l l decay and d i e . 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 h i s own splendid uniqueness i n . t h a t he.sticks out of nature with a towering majesty, and yet he goes back i n t o the ground a few feet i n order b l i n d l y and dumbly to r o t 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 t o 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 s i t u a t i o n (p.55).  It  i s a means of l i v i n g securely and serenely with the f a c t of our creatureliness.  Repression  i s seen as required f o r normal l i f e .  Culture i s a  compromise with l i f e that makes l i f e p o s s i b l e (p.265). Choron has w r i t t e n 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 f e a r which w i l l receive  a good deal of a t t e n t i o n i n t h i s s e c t i o n .  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 f o r 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 m o r t a l i t y there are times when i t i s impossible to plead ignorance any.longer, F e i f e l (1959) states t h i s most a p t l y :  Jung i n a book by  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 f a c t s which remorsefully indicate-how f a r 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 w a l l of darkness which w i l l eventually engulf everything you love, possess, wish, s t r i v e , and hope f o r - then a l l our p r o f u n d i t i e s about l i f e s l i n k o f f to some undiscoverable h i d i n g place, and fear envelops the sleepless one l i k e a smothering blanket, (p.4) Choron admits that Pascal did a l s o 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 a c t u a l l y quite widespread as the f o l l o w i n g p h i l osophers had a l l experienced i t : Augustine, Montaigne, Descartes, P a s c a l , Comte, Schopenhauer, Renouvier and James (p.110).  As has been stated the  a l t e r n a t i v e to d e n i a l and avoidance i s to attempt to deal with the problem of m o r t a l i t y .  Before discussing a v a r i e t y 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 tii t i o n  of  fear  For F e i f e l (1959) fear of death i s p o s s i b l y the source of a l l anxiety. Any loss represents  total loss.  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 a l s o 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 a f t e r death; fear of ceasing to be; and fear of the "event" of dying (pp 74-79). suffering.  By fear of the event of dying Choron equates dying  " I t would seem therefore, that we have i n the l a t t e r  with  instance  fear of pain, and of the i n d i g n i t y of being weak, h e l p l e s s , 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 m i d l i f e phase.  I t 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 p s y c h o l o g i c a l task.  Such  a goal i s paradoxical f o r 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. matter.  One's own r e a l m o r t a l i t y becomes a personal  Greater l i f e expectancy has changed the fear of death t o a fear of  aging (Bloching, 1974). On the other hand a person who has l i v e d h i s l i f e the way he wanted i s not a f r a i d df the end. The fear of dying/aging i s t i e d t o the goals of who you believe you have t o be rather than who you are (Keleman, 1974, p. 102). :  1  There i s a tendency t o look at death as simply the end o f a process  (Jung, 1959). fulfillment.  I t does not occur t o us t o conceive of death as a goal and a A youth i s urged on t o a purposeful f u t u r e .  An o l d man, who  i s s t r u g g l i n g with h i s o l d age, causes us discomfort and we respond with s u p e r f i c i a l b a n a l i t i e s l i k e "everyone must d i e 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, d i r e c t e d 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 s t a t e of r e s t , r i s e s and then returns t o a state of repose." (p.5) Man i s urged to t r e a t the descent t o 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 i n d i v i d u a l i s a deepening of awareness, under-  19.  standing a n d . s e l f - r e a l i z a t i o n .  Genuine values can be c u l t i v a t e d (wisdom,  f o r t i t u d e , courage) as w e l l as a.deeper capacity f o r love and a f f e c t i o n , human i n s i g h t , hopefulness and enjoyment (Jacques, 1969, p.163). As long as i n d i v i d u a l s continue t o t r e a t dying as they do, o l d age w i l l be an unpopular and t r a g i c 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 r e s u l t s w i l l be as Jung (1959) so succintlyy describes: "an o l d man who does not know how t o l i s t e n t c the secrets of the brooks as they tumble down from the peaks t o the v a l l e y s 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 t o  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 f o r c e s people  to part "and morbid fears are l i k e l y t o a r i s e at the prospect of the imposed and unsought-for separation" (p.28).  Langone notes that fear of separation  from family and f r i e n d s was the most prominent aspect of F e i f e l ' s study of death f e a r s . Choron's second category has t o do with fear of what happens a f t e r death.  This fear has been the dominant form of death fear f o r almost "two  millenia".  R e l i g i o n 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 f e a r " i s a fear of the beyond. Choron's t h i r d category i s the fear of ceasing t o be or e x t i n c t i o n . 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 n a t u r a l aversion t o 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  and premature 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  Curran t a l k s about mares t o c h i l d r e n .  our l i v e s survival".  " a n n i h i l a t i o n f e a r " which brings  Adults  paralyzing  c a r r y w i t h them many u n r e s o l v e d  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 Keleman,  unnecessarily  night-  childhood  fears  (Curran, 1974;  1974).  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 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 k n o w e r  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 safeguard  h i m s e l f t h e knower  (1972)  o r l e a r n e r . To  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 from t h e l e a r n e r .  "This  p r o t e c t i v e dynamic, o n  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 either  t h e a d v i c e may d o s o when t h e o n e r e c e i v i n g - t h e a d v i c e  i n c a p a b l e o f making  A knower's  i t o p e r a t i o n a l o r a l r e a d y knows w h a t t o d o . " ( p . 9 2 )  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 . f i v e understanding  Gordon's  Curran's  irreversibility, losing and a b i l i t y  q u o t e s R e n o u v i e r who s a i d i t i s very d i f f i c u l t  support--  evolves.  (1970)' composite f e a r o f death f a l l s i n t o t h i s  l o s i n g our thoughts  d)  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  as t h e l e a r n i n g process  fear of time, decay,  life,  is  our pleasures  to think - losing the self  third  and  category:  sensations,  (p.20).  Choron  "When a man i s o l d , v e r y o l d a n d a c c u s t o m e d t o to d i e " .  management of fear  W i t h t h e f e a r s o f d y i n g a n d d e a t h a c k n o w l e d g e d - a n d e x a m i n e d 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 m a n a g i n g sions.  such  apprehen-  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 s o l u t i o n t o 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 f r e e from the penalty c f dying, of being k i l l e d . " (p.99)  This idea might p a r t i a l l y e x p l a i n the  existence of mercenaries, murderers and. even hunters of w i l d game.  Needless  to say t h i s i s not l i k e l y t o become a popular way of appeasing personal f e a r s . 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 c f time (p.34). ' "This i s the man who has completely forgotten b i s m o r t a l i t y , and. i n h i s headlong f l i g h t t o escape i t , i s r e a l l y rushing t o embrace i t . This i s the man who k i l l s hims e l f , f i n a l l y , a f t e r f i r s t k i l l i n g everything i n himself that i s human." (p.29) L i f t o n (1.974) proposes f i v e modes f o r achieving a sense of ( s y n t h e t i c ) immortality: b i o l o g i c a l , c r e a t i v e , t h e o l o g i c a l , n a t u r a l and e x p e r i e n t a l . He has come up with these ideas because he. thinks that " s e r e n i t y i n the face of death depends upon the sense t h a t , 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  i n the section on c u l t u r e 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 o f 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) i s n ' 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 r o l e 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 expendable 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 f e a r s 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 f o u r . Number two i s the c r e a t i v e option and involves: teaching, art-making, r e p a i r i n g , c o n s t r u c t i o n , w r i t i n g and healing,.etc.  Any a c t i v i t y that per-  mits a person t o enter i n t o a general human flow beyond, himself. agrees and says that "...  Becker  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 i n t o the confusion, make an o f f e r i n g of i t , so to speak, to the l i f e f o r c e . " (p.285) Death j a r s one i n t o a c r e a t i v e state (Curran).  I t forces one i n t o  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 i n t o the unknown. L i f t o n t a l k s 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 i n s i g h t s " .  The survivor i s a creator who has known d i s i n t e g r a t i o n , separation and s t a s i s and who world.  i s now s t r u g g l i n g to achieve a new formulation of s e l f i n the  An area where the survivor struggles i s that of work: "The  basic  theme i s the quest f o r s i g n i f i c a n t work experience that w i l l be immediately i n v o l v i n g and that w i l l contribute to the continuing human e n t e r p r i s e " (p.1.33). The t h i r d mode, theology, proposes l i f e a f t e r 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 e r a d i cates anxiety over death" (p.38). that a man  He says that the C h r i s t i a n doctrine teaches  i s a g u i l t y sinner and deserves punishment a f t e r death.  Berman  and Kays d i d a study which they c a l l e d "Relation Between Death Anxiety, B e l i e f i n A f t e r l i f e , and Locus of C o n t r o l " (1973).  In general the f i n d -  ings suggest that the r e l a t i o n s h i p 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 t o man, the t r e e s , mountains and seas endure.  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 r e t u r n i n g t o nature from  "whence we came": from dust you came and t o dust you s h a l l r e t u r n The f i n a l mode f o r synthetic :'£mmort-aQ5ity i s e x p e r i e n t i a l  (p.70).  transcendence.  L i f t o n describes t h i s as a psychological state which involves extraordinary psychological u n i t y ; an i n t e n s i t y of sensual awareness; and unexpressable i l l u m i n a t i o n and i n s i g h t . religion".  Becker (1973) describes psychology as the "new  I t s purpose i s t o discover the s t r a t e g i e s that a person uses  to avoid anxiety. s e l f knowledge.  Psychology attempts t o help people f i n d paradise through 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 c o n d i t i o n .  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 t o be a c r e a t i v e genius as a psychologist and t o use psy-  chology as the immortality v e h i c l e f o r oneself as Freud and subsequent psychoanalysts have done.  Another i s t o 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 t o take psychology and deepen i t with r e l i g i o u s  and metaphysical a s s o c i a t i o n s so that i t becomes a c t u a l l y 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 t h a t "man's b a s i c m o t i v a t i o n i s t o a t t a i n and r e p e a t t h e spontaneous peak e x p e r i e n c e i n which man i s u n i f i e d w i t h hims e l f , o t h e r s and t h e w o r l d , and i n which h i s thought ing  processes, h i s think-  and h i s d i s c u r s i v e i n t e l l e c t a r e momentarily s t i l l e d "  (p.89).  Man  becomes one with h i m s e l f , o t h e r s , and t h e world o f n a t u r e .  Gordon has developed  h i s i d e a s t o t h e p o i n t where he has come up w i t h  a t h e o r y which he c a l l s t h e " u n i f i c a t i o n e x p e r i e n c e " .  Gordon b e l i e v e s t h a t  s e x u a l orgasm i s t h e u n i f i c a t i o n e x p e r i e n c e p a r e x c e l l e n c e .  Death need not  be f e a r e d because i t i s t h e u l t i m a t e u n i f i c a t i o n e x p e r i e n c e , which may make death t h e u l t i m a t e orgasm. t h i s mode.  L i f t o n ' s s u r v i v o r i s . a b l e t o t r u l y evolve i n  He seeks a s u s t a i n e d e x p e r i e n c e o f e x q u i s i t e i n n e r harmony, o f  wholeness and u n i t y (p.135).  When t h e r e i s death t h e r e i s r e b i r t h and hope.  L i f t o n quotes Roethke " I n a dark time, t h e eye b e g i n s t o s e e " .  Gh6ron (1964) has f i v e s u g g e s t i o n s f o r " a l l e v i a t i n g t h e f e a r o f death". ply  The f i r s t  i s to ignore i t .  does not pay i t any heed.  sorbing  One does not r e p r e s s t h e f e a r , one sim-  Time i s spent s t u d y i n g o r i n some o t h e r ab-  activity.  The  second p o s s i b i l i t y i s t o s i m p l y f a c e t h e f e a r "head on". By  becoming f a m i l i a r w i t h i t one i s a b l e t o m i t i g a t e i t s t e r r o r s .  A t h i r d c h o i c e i s t o minimize  death.  "Death i s l e s s t o be f e a r e d  than n o t h i n g — — n e i t h e r can i t i n any way concern you, whether you a r e l i v ing  o r dead; l i v i n g by r e a s o n t h a t you a r e s t i l l  i n b e i n g , dead because you  a r e no more'', (p.114)»  The f o u r t h a l t e r n a t i v e : minimize in  the value o f l i f e .  t h i s e x i s t e n c e and a n 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 " .  Christians  suffer  One may l e a d an  a s c e t i c l i f e or dedicate oneself to helping others or t o 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 . i s the key.  Commitment to something  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 c l e a r that none (of these methods) can be u n i v e r s a l l y e f f e c t i v e because of the v a r i e t i e s of these (death and dying) f e a r s " (p.126). A means of dealing with the hard f a c t s of m o r t a l i t y not yet suggested by anyone quoted i s a healthy sense of humour.  (O'Connell, 1966).  "Humour  i n the Freudian sense was a p a r a d o x i c a l l y healthy r e p u d i a t i o n of the r e a l i t y of one's death.  The i n t e r p r e t a t i o n 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 p h y s i c a l d i s s o l u t i o n , although s t i l l , as with Freud, a sign of r a r e emotional maturity."  "Life  i s too important t o be taken s e r i o u s l y . " (O'Connell, 1974) It has been shown that fear of dying and death i s the issue at the centre of c u l t u r e ' s stance towards m o r t a l i t y .  Although death i s generally  a most uncomfortable f a c t of l i f e i n the present s o c i a l system there are i n d i c a t i o n s of change.  I t i s the fears associated with dying and death  and must be broached by anyone t a c k l i n g t h i s aspect of l i f e . As has been i n d i c a t e d there are d i r e c t b e n e f i t s to f a c i n g death fears.  There i s the obvious r e s u l t that death does not n e c e s s a r i l y loom  so t r a u m a t i c a l l y .  Perhaps of even greater s i g n i f i c a n c e i s the e f f e c t on  the q u a l i t y of l i f e .  6)  Meaning of  Life  Curran (1974) says that death i s the tax we pay for l i v i n g . frames l i f e or completes the picture of l i f e .  Death „?;.-  When a companion dies i t i s  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 t r u l y objective.  A part of l i f e i s closed o f f when people refuse to face death as i n dividuals and as a culture ( L i f t o n , 1974).  " U n t i l we accept the personal  r e a l i t y 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 i n the face of death have been discussed as a c h a r a c t e r i s t i c North American outlook.  However l i f e i s not "comprehended  t r u l y or l i v e d f u l l y unless the idea of death i s grappled with honestly". "This has implications not only f o r the individual but f o r society as well/. "\ ( F e i 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".  F e 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 o s t r i c h adjustment to neglect  one of the e s s e n t i a l r e a l i t i e s of l i f e , a kind of fraud perpetuated  on our-  selves? " ( F e i f e l , 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 "He's  i s characterized by the need to face the i n e v i t a b i l i t y of death.  the creature who  can die consciously." (p.24)  Hinton and Ross think  that many people are able to accept the r e a l i t y of death.  It takes a long  z/.  time t o a c c o m p l i s h and i n f a c t c o n t i n u e s t o o c c u r u n t i l death i t s e l f sonally arrives.  The r e s u l t o f t h i s p r o c e s s i s t h a t " l i f e becomes much  more meaningful and v a l u a b l e " (Ross, 1974, who  per-  s a i d : "Death d e s t r o y s a man;  p.21).  L i f t o n quotes  the i d e a o f Death saves him"  Forster  (p.21).  C o n f r o n t a t i o n o f one's m o r t a l i t y s i m p l i f i e s l i f e and makes i t more s a t i s fying  (Gordon,  1970).  A l t h o u g h everyone die,  how  has t h e c e r t a i n knowledge t h a t t h e y must and  many persons are t r u l y a b l e t o "know" i t ?  t i o n i n Death and t h e F a m i l y (1974). "We  She  shall  P i n c u s asks t h i s ques-  says t h a t i f we  c o u l d r e a l l y know,  might then be a b l e t o l i v e more f u l l y , l e s s burdened by f e a r s and  anxie-  t i e s , and thus improve the q u a l i t y o f our l i v e s and our d e a t h s " ( p . 9 ) . T h i s l i n k between q u a l i t y o f l i f e and q u a l i t y o f death i s supported by o t h e r s ( C u r r a n , 1974;  Kavanaugh, 1972;  Keleman, 1974;  ample o f what P i n c u s means she t a l k s about  Langone, 1972).  As an  ex-  her d y i n g husband:  He f e l t t h a t d u r i n g t h e s e l a s t months o f h i s l i f e , he had a c q u i r e d a new i n t e n s i t y o f p e r c e p t i o n , o f enjoyment, o f b e i n g i n t o u c h w i t h what was b e a u t i f u l , and I c o u l d share on our g e n t l e walks, h i s sheer d e l i g h t i n s m a l l c h i l d r e n , b i r d s , f l o w e r s , t r e e s , c l o u d s . We were p r o b a b l y c l o s e r dur i n g t h a t t i m e , more u n i t e d i n mutual t r u s t , than a t any o t h e r time i n our l o n g m a r r i a g e , (p.4) People,, a r e encouraged 1970).  t o l i v e each moment t o the f u l l e s t  (Gordon,  T h i s i s a worthy g o a l but one t h a t i s d i f f i c u l t t o a c h i e v e  (Toynbee, 1968).  To t h e extent one  i s able to l i v e  i n t h e p r e s e n t he/she  i s a b l e t o become one w i t h the moment, the person they are w i t h , the u a t i o n t h e y are c o n f r o n t i n g , the world and most i m p o r t a n t l y w i t h  b)  themselves.  riegati hg f o r c e s  There a r e many who, ing  sit-  a l t h o u g h t h e y agree t h a t death provokes  o f human e x i s t e n c e , ( t h e y ) d i s a g r e e about  the mean-  the answer t o the q u e s t i o n .  28.  Some choose to accept a negative response. Choron (1964-) quotes Krutch who says that "Living i s only a physiol o g i c a l process with only a physiological meaning".  Nagel i s also consul-  ted: "Human destiny i s but an episode between two o b l i v i o n s " (p.162). I f death i s the end then l i f e makes no sense.  "Death may be 'nothing' as  Epicurus and some modern 'tough minded' philosophers  claim, f o r 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 d i s a s t e r , a struggle that i s fated t o be lost. ,' (p. 163) 1  For Choron the main problem has very l i t t l e to do with mortality at all. less.  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 senseGordon c a l l s t h i s 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 i s an absence of meaning i n l i f e , death forces the painf u l question "What have I done with my l i f e ? " one has not t r u l y l i v e d .  One would think that where l i f e has no meaning  that death would be a release. same time.  and there i s a regret that  Choron says that both fears exist at the  One finds l i f e meaningless and yet fears i t s end.  c)  finitude : the key to meaning  Frankl (1973) i s a leading proponent of l i f e having meaning as a r e sult of " f i n i t u d e " .  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 ( F e i f e l , 1959; Gordon, 1970;  Ross, 1975).  "We are under the imperative  of u t i l i z i n g o u r ' l i f e -  times to the utmost, not l e t t i n g the singular opportunities - whose ' f i n i t e '  sum c o n s t i t u t e s the whole of l i f e - pass by unused." ( F r a n k l , 1973, p.64-) F i n a l i t y i s e s s e n t i a l 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 f i n i t e n e s s 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 r e j e c t those e x t r i n s i c r o l e s and expectations and to devote each day of our l i v e s - however long they may be - to resources, t o 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 i n t o some i l l - f i t t i n g stereotyped r o l e . I t i s the d e n i a l of death that i s p a r t i a l l y responsible f o r people l i v i n g empty, purposeless l i v e s ; f o r 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 c o n t r a s t , 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, t o 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 h i s own sphere of destiny every man man  i s irreplaceable".  exclusive  ( F r a n k l , 1973, p.74)  has a unique destiny u n l i k e any other i n the cosmos.  The  Each  opportunities  that come h i s way f o r the a c t u a l i z a t i o n of c r e a t i v e or e x p e r i e n t i a l values and the t r i a l s and t r i b u l a t i o n s which a l s o come h i s way are a l l h i s very own.  The t r i b u l a t i o n s cannot be a l t e r e d and therefore must be endured and  i n the enduring of them a d d i t i o n a l values are a c t u a l i z e d ( F r a n k l , 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 i n d i v i d u a l s 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 f o r i t s meaning. The a l t e r n a t i v e to involvement i n a community i s membership i n a "mass" I n d i v i d u a l i t y i s d i s r u p t i n g 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 l i m i t e d f o r the sake of e q u a l i t y .  Frater-  n i t y i s replaced by the herd i n s t i n c t ( F r a n k l , 1973, p.71). "Good uniqueness" i s d i r e c t e d toward a community f o r 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 t o h i s r e s p o n s i b i l i t y .  One l i v e s with an a c t i v e s o c i a l i n t e r e s t  (O'Connell, 1976): "to. escape i n t o the mass i s to disburden oneself of i n d i v i d u a l r e s p o n s i b i l i t y " ( F r a n k l , 1973, p.73). the  "True community i s i n essence  community of responsible persons; mere mass i s the sum of depersonalized  entities." For  F r a n k l , being human means being a responsible choice maker.  sees t h i s as man's e s s e n t i a l freedom.  He  Man has no c o n t r o l over what happens  to him but he does have some c o n t r o l over how he w i l l choose t o react to what happens. ."During no moment of h i s 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 t o act 'as i f he had no choice and  no freedom of d e c i s i o n .  This 'acting as i f c o n s t i t u t e s a part of the human  tragicomedy." (p.76). To be human means not only to be d i f f e r e n t but t o be able to become d i f f e r e n t , to change and grow.  Those who admit to an unknown  f e a r 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 t o look at h i s a t t i t u d e 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 l e s s fear of death and a more p o s i t i v e and accepting a t t i t u d e toward i t . Durlak (1972)  31.  had e a r l i e r found s i m i l a r r e s u l t s i n a study of his own. Man has the freedom to decide how he w i l l react to any s i t u a t i o n he encounters.  His mortality urges t h i s r e s p o n s i b i l i t y upon him and  him to l i v e l i f e to the f u l l e s t on a d a i l y basis.  encourages  "What i s demanded of man  i s not as some e x i s t e n t i a l philosophers teach, to endure the meaninglessness of l i f e , but rather to bear his incapacity to grasp i t s unconditional meaningfulness i n r a t i o n a l terms." (Frankl, B)  1963)  Culture: s p e c i f i c concerns Up to t h i s point the perspective has been quite broad.  itudes past and present have been examined.  Cultural att-  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 f o r a closer look at some s p e c i f i c mortality issues. It i s i n the care of the dying, bereavement and sharing death with children that there are opportunities to experience f i r s t hand the f r u i t s of one's attitudes towards mortality.  Each of these areas w i l l be approa-  ched more comfortably and e f f e c t i v e l y i f one has begun to grasp one's own discomfort with dying and death.  1)  The dy irig process F i r s t of . a l l the various professional r o l e s surrounding a terminal  person s h a l l be examined.  A discussion of the family position w i l l then  lead to the patient; his needs, his r i g h t to information about his disease and his growth i n 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 i n helping to a l l e v i a t e phys 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, g r i e f 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 i s not infrequent that the patient as a psychologic, sociologic  and i n d i v i d u a l i s t i c organism i s overlooked" (Langone, 1972, p.37). care has become highly specialized and divided into many branches  Health (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 i n a  c o n f l i c t which engenders feelings of i n s e c u r i t y .  Doctors and nurses react  to these feelings by maintaining a safe professional distance which prevents them from t r u l y supporting the emotional needs of t h e i r patients. Mount (1973-4) asked his medical colleagues just why i s i t that t e r minal care i s not more generally recognized as a problem area.  He notes  three points i n response: medical people see themselves as sensitive people and they do not recognize t h e i r i n s e n s i t i v i t y to those around them; there i s more of a tendency to recognize d e f i c i e n c i e s i n those colleagues around one; and there i s a tendency to think that colleagues avoid questions regarding dying more than they themselves.  "The biased perspective of physicians and  nurses, acquired while working i n close contact with the problem year a f t e r year and the tendency f o r the patient to respond to those, caring f o r him  with a p a t r o n i z i n g comment rather than a c r i t i c a l assessment of t h e i r def i c i e n c i e s were seen as two f u r t h e r f a c t o r s which tend t o cloud our awareness o f our d e f i c i t s i n dealing with the dying." (p.6) The p h y s i c i a n i s being urged from many sources t o attend t o the psyc h o l o g i c a l as w e l l as p h y s i c a l 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 p o s i t i o n i n our s o c i e t y ' s  "death system" and i s able t o exert much influence over the s p e c i f i c functioning of! .others i n the system i n c l u d i n g the p a t i e n t and h i s f a m i l y . "While there i s l i t t l e a doctor can do t o help a person to d i e , there i s much he can do t o help a person l i v e u n t i l the time of death." (Langone, 1972,  p.33). To be e f f e c t i v e with the dying the doctor must become aware of h i s  own f e e l i n g s about death (Mount, 1973-4; Kastenbaum £ Aisenburg, 1972). Hendin (1973) b e l i e v e s that physicians must d i s t i n g u i s h between t r e a t i n g t h e i r own a n x i e t i e s and deciding what i s best f o r the p a t i e n t (p.68). When i t i s f e l t that a p a t i e n t ' 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 l i f e - s u p p o r t systems become more and more appealing f o r use i n medical care. Tremendous advances i n technology have made'"heroics" a common place occurence.  This i s a s i t u a t i o n where a person i s kept a l i v e p h y s i c a l l y on  a machine when h i s b r a i n has ceased t o f u n c t i o n . Euthanasia, a c t i v e and passive, i s becoming an i n c r e a s i n g l y popular, issue i n which doctors are going t o be c e n t r a l f i g u r e s . F e i f e l conducted a study and learned t h a t physicians and medical s t u dents tend t o have an above average f e a r 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. ently future p s y c h i a t r i s t s exhibited the most apprehension.  Appar-  The implication  of t h i s research i s that many physicians enter t h e i r profession and secure"prominent mastery over disease, to help control personal concerns about death" (Kastenbaum £ Aisenburg, 1972, p.215). There i s a status system i n a h o s p i t a l which allows the doctor t o make most of the decisions.  "The nurse i s obligated to enforce and implement  these decisions regardless of her own opinions and preferences*" (Kastenbaum 6 Aisenburg, 1972, p.220)  Such decisions may get i n the way of the  nurse honestly and s e n s i t i v e l y meeting the patient's emotional needs.  An  example would be where the doctor has decided to share no f a c t u a l informa-t i o n with a patient about h i s prognosis. The nurse i s the member of the care team who i s l i k e l y to have most of the direct contact with a dying person.  Kastenbaum asked 200 attendants  and licensed p r a c t i c a l 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 all".  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 f e e l comfortable  "discussing" with the i n d i v i d u a l his/her concerns.  Another member of the care team i s the mental health s p e c i a l i s t . the past he has been conspicuous by h i s absence.  In  There are a variety of  reasons f o r t h i s absence, however of greater importance i s the f a c t that more of these people are becoming active i n work with the dying.  Areas of  interest and involvement by mental health professions were dealt with i n the section on "culture".  35.  The other major professional who works with dying people i s the clergyman or chaplain.  " I t i s a f a m i l i a r contention that the roots of a l l r e l i -  gions are to be found i n 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 r e l a t i o n s h i p 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 f o r c i n g  him to examine his perspective and purpose. is hazy (Kastenbaum 6 Aisenburg, 1972). big  At the present time his r o l e  Euthanasia and b i r t h control are  issues f o r any chaplain l e t alone those working within a hospital set-  ting. Many pastors are as uncomfortable with dying and death as any one else. This i s made p a r t i c u l a r l y d i f f i c u l t f o r them when others expect them to be "in-the-know" with God and have a l l the r i g h t answers.  Kastenbaum arid  Aisenburg note that a chaplain can have a variety of defensive s t y l e s : a set  apartness, r i t u a l i z e d action, special language, s p e c i a l a t t i r e or a  business approach i n which one must always be o f f to the.next appointment.  Like any one else, "to be useful i n the death s i t u a t i o n (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 p o t e n t i a l i n  work with the dying f o r he does not have a s p e c i f i c medical function.  He  can simply "be with" a patient as he has the time\:to s i t f o r awhile.  A clergyman's presence can improve a patient's interpersonal l i f e by demonstrating t o s t a f f and v i s i t o r s 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 i n d i v i d u a l t o come to better terms w i t h h i s own s i t u a t i o n thereby making him more appealing t o the h o s p i t a l 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 H o s p i t a l .  This p o s i t i o n was held f o r 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 i n t e r e s t i n g but they are accurate.  There was the experience of f i r s t hand r e l a t i o n s h i p s with p a t i e n t s  which d i d confirm t h e i r personal s i g n i f i c a n c e .  The chaplain-patient r e l a -  t i o n s h i p a l s o was h e l p f u l t o these dying people i n t h e i r continuing adjustment t o various h o s p i t a l conditions i n c l u d i n g s t a f f . Hendin (1973) suggests that the best thing f o r medical people would be more education i n the area of death.  Later there w i l l be b r i e f mention of  courses now a v a i l a b l e f o r nurses and t h e i r a t t i t u d e s t o these programmes.  b)  the patient's perspective  Ross i n On Death and Dying (1969) mentions stages which she has'observed dying p a t i e n t s t o pass through.  These stages number f i v e and, i n  order, are as f o l l o w s : shock and d e n i a l , 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 h i s resources to help the medical people i n t h e i r continuing work to save h i s 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 t o good r e l a t i o n s h i p s .  0/  .  Ross spoke at a Conference on Dying Person Care i n Seattle on March 5, 1976.  At that time she urged her l i s t e n e r s to relax on the stages and  concentrate on honest non-judgemental  sharing of f e e l i n g s .  wholeheartedly (Kavanaugh, 1972; Leshan, 1969).  Others agree  "The encounter needs  empathy, not sympathy, and the empathy must go both ways.  One must be i n  f u l l contact with the patient before the patient can accept being i n contact with himself and with l i f e - . " (Leshan, 1969)  I t i s not necessary to  move a person through the stages but rather to accept him where he i s at and t r y to understand what i s happening.  Sneidman (1973) t a l k s 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 i n t h i s whole issue i s the one who has the terminal illness.  Sudnow (1967) wrote about dying i n Passing On - The Social Organ-  i z a t i o n of Dying.  He found a f t e r observing the routine of two large hos-  p i t a l s , that the dying person was shunned and alienated by the treatment professionals. l i t t l e changed.  Mount (1973-4) writes more recently and the s i t u a t i o n seems "Instead of sympathetic understanding and expertise i n  meeting his medical and emotional needs, the Canadian dying i n an i n s t i t u t i o n today (and more than 70% of us die i n i n s t i t u t i o n s ) i s l i k e l y to encounter i s o l a t i o n , loneliness and depersonalization! " 1  (p.4)  To ignore the person who i s dying i s thought by Weisman (1972) to be a mutilation and desecration of the d i g n i t y i n death.  Kavanaugh (1972) states  that a dying human "deserves .more than e f f i c i e n t 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 i s solitude".  Leshan (1969) has found  38.  t h a t t h e r e i s evidence t o support t h e b e l i e f t h a t deep p s y c h o l o g i c a l iso.-, l a t i o n decreases one's w i l l t o l i v e .  The p a t i e n t should be t h e " c e n t r e o f a t t e n t i o n " (Saunders,  1969).  There should be a f o c u s upon b o t h t h e p h y s i c a l and emotional needs o f t h e s i c k one.  H i s r e q u e s t s must be a t t e n d e d t o r a t h e r than i n s i s t i n g he submit  t o t h e a r b i t r a r y w i l l o f t h o s e i n attendance  .(Hendin,  1973; Ross, 1974).  D u r i n g t h e March c o n f e r e n c e , Ross s a i d t h a t we have o n l y t o ask a p a t i e n t how we might h e l p and we w i l l be t o l d .  We must be a v a i l a b l e a t a v a r i e t y  o f times so as t o p r o v i d e h e l p when h e l p i s needed.  S p e c i a l treatment dying.  f f a e i l i t i e s s a r e e v o l v i n g t o meet t h e needs o f t h e  The most famous f a c i l i t y o f t h i s k i n d i s S t . C h r i s t o p h e r ' s Hospice  i n London.  A t t h e t i m e o f t h i s w r i t i n g t h e r e i s one such programme i n  Canada and i t i s l o c a t e d i n R o y a l V i c t o r i a H o s p i t a l i n M o n t r e a l . who i s quoted  a t v a r i o u s p l a c e s throughout  r e c t o r o f t h e Montreal "hospice". u l a r l y s e n s i t i v e and f l e x i b l e .  Dr. Mount,  t h i s chapter i s the medical d i -  These u n i t s p r o v i d e s t a f f who a r e p a r t i c -  In a hospice the patient""remains a c t i v e i n  d e c i s i o n s about h i m s e l f as l o n g as p o s s i b l e " (Hendin,  1973, p.96).  Mount (1973-4) quotes a d y i n g nurse: " I know you f e e l i n s e c u r e , don't know what t o say, don't you c a n ' t go wrong. search" (p.5).  know what t o do.  But p l e a s e b e l i e v e me, i f you c a r e ,  J u s t admit t h a t you c a r e ; t h a t i s r e a l l y f o r what we  What i s needed i s a s p e c i a l "someone" who can be a c o n t i n u e d  empathic p r e s e n c e , a s p e c i a l f r i e n d who can walk t o the edge w i t h t h e d y i n g person  (Kavanaugh).  " I f t o g e t h e r w i t h adequate p h y s i c a l c a r e , t h e d y i n g  person had . s u f f i c i e n t human companionship, most o f h i s anguish would be prevented"" '(Hinton, 3  1967, p. 120)  "We can h e l p t h e p a t i e n t f i n d and a c c e p t  his  own being and path; to sing his own i n d i v i d u a l song, to play i n l i f e  the s p e c i a l 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 s i t u a t i o n e x i s t s .  Hendin believes that i t i s the  patient's r i g h t to know what i s 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 t a l k about death to people who are dying, the feelings of i s o l a t i o n are enhanced (Langone, 1972).  The problem of awareness i s c r u c i a l not only to the patient but f o r  those who care for him (Glaser and Strauss, 1965). Glaser and Strauss have written a book on t h i s aspect of terminal pat i e n t treatment c a l l e d , 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 s t a f f support the patients. Patients could even r a i s e the flagging s p i r i t s of the s t a f f I From t h e i r death beds, they could thank the ; physicians f o r t h e i r unstinting e f f o r t s and wish them l u c k i i n solving t h e i r research problems to save other patients. They could close t h e i r l i v e s with proper r i t u a l s , such as l e t t e r writing and praying. They could review t h e i r l i v e s and plan r e a l i s t i c a l l y for t h e i r families future. (Strauss, p.128) Weisman thinks a family may have very good reasons not to be open with a sick member of t h e i r group.  He says that g u i l t may a r i s e from a sincere  regret that they have not been able to avoid the calamity which has occurred. "For t h i s reason, families and friends may want to avoid the i m p l i c i t r e proach that mere confrontation with the v i c t i m might e l i c i t . " (p.17)  This  sounds l i k e the patient's needs are secondary to those of the "family".  40.  While on the subject of families and t h e i r part i n the dying of one of t h e i r number, i t i s appropriate to mention some other opinions. Relatives are often discouraged from playing active and supportive roles by the hosp i t a l (Hofmeier, 1974).  "The consistently casual treatment of family  members i n almost a l l hospitals proves that medicine does not yet consider the family an important factor i n patient care." (Kavanaugh,  1972)  It i s suggested that families be encouraged to be as a c t i v e l y involved as possible f o r as long as possible (Hinton, 1967).  The r e s u l t i s that  these family groups report being brought closer together through the process.  There are new resource books being published which can be of s p e c i a l  help to a family with a dying member (Davidson, 1975; Jury 6 Jury, 1976). Tolstoy's story of Ivan Ilych (1960 ed) i s a functional account of what can occur i n a setting where there i s "closed awareness". to  No one t a l k s  Ilych about his i l l n e s s even when he has become aware of the true nature  of his predicament.  His i s o l a t i o n greatly magnifies the turmoil of h i s dy-  ing. c)  growth potential  Dying can be a time'of tremendous personal growth (Saunders, Curran, 1974;  Kavanaugh, 1972;  Imara, 1975; Ross, 1974).  to and appreciation of l i f e i s greatly enhanced.  1969;  One's s e n s i t i v i t y  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. approach w i l l not work with the dying (Curran, 1974). to dying.  Unfortunately t h i s There i s no answer  What i s needed i s a creative flow between patient and helper.  Due to the i n t e n s i t y of the dying person's experience even short encounters can be powerful.  If one respects and doesn't p i t y , the dying person w i l l  teach one how to l i v e (Saunders, 1969).  " I t i s 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 i n our young age, we would l i v e a much more meaningful l i f e , appreciate small things and have d i f f e r e n t values." (Ross, 1974,  d)  p.33)  at the poi lit of death  What i s death r e a l l y l i k e when the time comes?  Choron (1964) notes  "numerous reports" of people facing execution i n a peaceful state of mind. "Recent studies show that the state of mind of those facing death i n accidents or natural catastrophes i s characterized by a sentiment of b e a t i tude, an unusual r a p i d i t y of thought and imagination, anesthesia to touch, absence of f e e l i n g 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 i n those who have been i n alpine climbing accidents and near drownings. The head of a large sanitarium i n Norway has been quoted as saying that his observations have led him to believe that death i s 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 c h a r a c t e r i s t i c s as  commonly experienced by a l l those she has seen:  separation from the body;  a f e e l i n g 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 i s no longer a fear of death.  2.  Bereavement The terminally i l l person i s the centre of attention during the dying  process but t h i s changes once death occurs. 1  Those l e f t behind have to t r y  and go on l i v i n g with the loss of t h e i r loved one. "There are two parties to the suffering that death i n f l i c t s ; and i n the apportionment of t h i s  42. suffering, the survivor takes the brunt." (Toynbee, 1968, p.271) Avoidance of the r e a l i t y of death must c e r t a i n l y have some e f f e c t on the  g r i e f process.  (Hendin, 1973).  There i s a tendency to urge the repression of g r i e f  A major problem of g r i e f seems to be a lack of s o c i a l  involvement by the bereaved. through t h e i r l o s s .  Often they are l e f t on t h e i r own to work  Loneliness i s the greatest curse of widowhood (Pincus,  1974). Since bereavement cannot be prevented the most useful thing that can be done i s to acknowledge i t hot as a "horrible threat looming over us, but  as an important part of our l i v e s f o r which we can prepare ourselves"  (Pincus, 1974, p.250). I t i s 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 g r i e f experience. Mourning  the death of another provides us with an excellent opportunity to  rehearse our own dying (Keleman, 1974). " I t i s a r i t u a l f o r 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 i n the womb, loss of the breast, l o s s , r e a l , 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 ( C a t t e l l , 1969).  Keleman,  1974) refers to these occurences as " l i t t l e deaths". People who l i v e i n i n s t i t u t i o n s - state or p r o v i n c i a l hospitals and nursing homes, are l i v i n g p a r t i a l deaths (Ross, 1974).  S p i r i t u a l death  p r i o r to physical death i s where a person loses his mind to insanity or s e n i l i t y , (Toynbee, 1968).  M-CS .  b)  i n f l u e n t i a l factors in g r i e f  There are a variety of factors which influence our response to bereavement: mode of death; timeliness; previous warning and preparation. The key factor would seem to be the quality of the r e l a t i o n s h i p .  The i n t e r -  actions that existed between the surviving and the dead (Pincus, 1974). The subtleties of the relationship play an important r o l e ( C a t t e l l , 1969). Fore-knowledge of an impending death can lessen the i n t e n s i t y of a bereavement when i t comes (Herter £ Knight, 1969). been described as "anticipatory g r i e f " .  This preknowledge has  When a wife i s l e f t alone while  her husband goes o f f to war she experiences separation anxiety. xiety w i l l soften any news of sudden death.  Such an-  S i m i l a r l y 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 g r i e f 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 i n place of post death g r i e f .  Also i t i s necessary  to assume g r i e f - l i k e behavior i n s o c i a l 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 g r i e f process.  Since that time many others have had something to say about the nu-  merous stages of g r i e f (Jackson, 1957; C a t t e l l , 1969;  Imara, 1975; Kavanaugh,  1972; Pincus, 1974; Hendin, 1975;Langone, 1972; R o s e l l , 1969; Kutscher, 1969). There i s general agreement that the stages of g r i e f include the following  44.  sorts of reactions; i n i t i a l shock and d i s b e l i e f or denial; disorganization; release of v o l a t i l e emotions; g u i l t ; loneliness; feelings of r e l i e f ; event u a l re-establishment. The basic task of grieving i s to give up old relationships and est a b l i s h new t i e s .  The key to doing t h i s i s to express the whole gamut of  experienced emotions "which may include yearning, anger, fear, depression, panic, helplessness, L'angone, 1972;  hopelessness or emptiness" (Hendin, 1975, p.14-5;  R o s e l l , 1964; Pincus, 1974).  Knowledge of the many d i f f e r e n t  phases of g r i e f can allow one t o relax somewhat when the noted feelings are f e l t .  Abnormal g r i e f 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 f o r grieving i s not necessary (Pincus, 1974). Bereavement i s normal.  Special attention to t h i s time of adjustment by  mental health professionals may make i t seem otherwise. There are resources which a mourner may consult. written about the C h r i s t i a n perspective a short and readable book.  Hunt (1971) has  on death and resurrection.  It i s  Perhaps one of the best books available i s  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 i s the common assertion that a funeral or some sort of " r i t e ' of passage" should exist to aid i n the mourning process (Hendin, 1975; Pincus, 1974; Ross, 1974; Langone, 1972).  "The primary purpose of many of  the t r a d i t i o n a l funeral r i t e s - from ancient times to present - has  45.  consistently been to o f f e r 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 l o t of scrutiny and c r i t icism over the l a s t 15 years (Morgan 1975; Mitford 1963; Harmer, 1963; C o r i o l i s j n 1967).  [Perhaps the e a r l i e s t c r i t i c i s m o f the funeral industry  was Waugh's The Loved One (1948)3  It i s f e l t that the modern funeral i s a  manifestation of s o c i e t i e s ' avoidance of death. since the American C i v i l War. r u r a l l y populated.  This has only been the case  Before t h i s event North America was mainly  Death used to be. a family involvement from beginning to  end (Mitford, 1963). "The Forest Lawn Memorial Park cemetry in Southern C a l i f o r n i a epitomizes our attempt to 'bury death'.  There a t the world's largest  death i t s e l f i s a d i r t y word." ( L i f t o n , 1974, p.18)  cemetery,  During the month of  July 1976 the author had the opportunity to v i s i t two of the four Forest Lawn cemeteries i n Los Angeles.. They are huge rambling parks with numerous churches, statues, paintings, mosaics and museums.  A l l these attrac-  tions are a front f o r the actual purpose of these f a c i l i t i e s : to.bury the  dead.  One of the few v i s i b l e clues as to the true money making nature  of the cemeteries i s 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 i s being sold f o r b u r i a l s .  One of the major c r i t i c i s m s of the funeral director i s that i n making the  corpse look " l i f e l i k e " he i s 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 e n t i t l e d "The Time My Father Died" poigniantly.state the concern (Mount, 1973-4):  4b.  I d i d 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 l a t t e r years he had wonderfully chiseled wrinkles. I had helped t o put them there. His cheeks were deeply sunken; h i s l i p s pale. He was an old man. There i s a kind of glory i n the face of an old. man. Not so with the stranger l y i n g there. They had my Papa looking l i k e he was 53. Cotton stuffed i n his cheeks had erased the best wrinkles. Make-up powder and rouge plastered h i s 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 f o o t l i g h t s of the matinee performance. I f i e r c e l y wanted to pluck out the cotton but was a f r a i d . At least the make-up could come o f f . I c a l l e d f o r alcohol and. l i n e n s . A very reluctant mortician brought them to me. I began the restorat i o n as the.powder, the rouge, the l i p s t i c k disappeared, the stranger grew older. He never recovered the look of his 9-2 years, but i n the end the man i n the c o f f i n 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 d i d see i s d i f f i c u l t to believe. . I mean the green s t u f f . Someone had come before us and covered that good, wonderful raw d i r t , every clod of i t , with green s t u f f . 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 h i s t o r y , against Papa, against us, against God. I. wanted to scream, I wanted to cry out to the whole world: "Something i s going on here, something great, something s i g n i f i c a n t l y human. Look! Everybody, look! Here i s my father's death. It_ i s going on here! (p.4) Many funeral industry c r i t i c s blame the industry f o r society's avoidance of death.  I t i s however a somewhat unfair c r i t i c i s m as "our culture's  death system has neither been created by the funeral d i r e c t o r , 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-  istic.  There i s a desire f o r 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 l e v e l of  i n t e l l e c t u a l interest and output. described as " b r i t t l e " .  Their attitudes towards death"were  "In general there was no evidence to indicate  that career- choice had been based upon a p a r t i c u l a r commitment to the problems  of bereavement, or an exploration and resolution of the mean-  ing of death i n t h e i r own lives'. (p.212) 11  Today there are memorial and funeral planning s o c i e t i e s which allow a person to plan i n writing i n advance of death f o r d i s p o s i t i o n of his body.  B a s i c a l l y these organizations promote simple, d i g n i f i e d and low  cost f i n a l arrangements  (Morgan, 1965).  The largest such group i n the  world i s located here i n B r i t i s h Columbia: The Memorial Society of B.C. There are also books evolving to help the consumer be better prepared 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 t h e i r mortality.  3.  Chi ldreri arid Death Although information about b i r t h i s shared with children, death i s  s t i l l generally avoided (Yudkin, 1968).  I f dying and death are d i f f i c u l t  for adults then i t i s going to be increasingly so f o r 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 i n e a r l i e r times death was more of a fact of l i f e .  This was c e r t a i n l y so f o r children.  Brothers, s i s -  t e r s , friends and grown-ups would d i e . Many youngsters never even l i v e d  48.  to maturity. Death was observable by children  a)  f i r s t hand" (Yudkin, 1968).  developmental perspectives  Although research i s sparse i n t h i s area some information i s a v a i l able about a c h i l d ^ s perspective of death.  Most developmental psycholo-  g i s t s state that the very young c h i l d ( b i r t h 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 t h i s appraisal: "Be-  tween the extremes of 'no understanding' and e x p l i c i t , integrated abstract thought, there are many ways by which the young mind can enter into a r e lationship with death" (p.9). Kastenbaum and Aisenburg have suggested three developmental stages. The f i r s t i s from b i r t h u n t i l f i v e years. not recognized as being f i n a l . gement.  During t h i s period, death i s  I t i s seen as sleep or a temporary arran-  The aspect of separation i s the most d i s t r e s s i n g .  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 c h i l d when his parents say that everything i s a l r i g h t , yet act very upset i n front of him. Or when a c h i l d nonchalantly t a l k s about a dead person and i s met with embarassment and concern i n response (Yudkin, 1968).  Today adult secrecy and protectiveness  feed into a child's fantasies (Yudkin, 1968).  "Ambiguities i n adult l a n -  guage and thought are apt to confuse the young c h i l d as he attempts to make sense out of death." (Kastenbaum £ Aisenburg, 1972, p.15)  In the second phase (5 years t o 9.year's) the c h i l d tends to personi f y death.  There i s a f i n a l i t y i n 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 p e r s i s t i n g fantasies (Yudkin, 1968). It i s i n the t h i r d phase (9 years, 10 years and thereafter) that death i s seen as f i n a l and i n e v i t a b l e .  Everyone i n the world w i l l d i e .  This sort of r e a l i z a t i o n can take place and proceed no further.  It i s a  s u p e r f i c i a l "common sense" acknowledgement which n i c e l y compliments the average a d u l t s stance of avoidance. 1  Kavanaugh (1972) believes that teenagers have f a i r l y liberated ideas about death.  They t a l k of i t g l i b l y , romanticize i t i n song and even "pon-  t i f i c a t e on the irrelevance and waste i n funeral customs".  In a p o l l , how-  ever, Kavanaugh learned that 78% of h i s sample had yet to see a dead person and 92% had yet to witness a death.  I t i s easy to be romantic and  i n t e l l e c t u a l about an emotional issue, of which one knows very l i t t l e . The true feelings are n i c e l y hidden u n t i l such time as the r e a l i t y of death arrives on the scene. b)  the need to teach  A c h i l d should and must be taught about death ( L i f t o n , 1974). " I f ideas about death are not developed gradually i n t h i s way and talked about at appropriate moments, the death of a c h i l d ' s f r i e n d , brother, s i s t e r 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 l a t e r date ( C a t t e l l , 1969). children have a tought time when a death occurs. :  Psychologically insecure The secure ones suffer as  well but "they w i l l be able to express t h e i r sufferings i n some form and obj e c t i f y them" (Pincus, p.243).  50.  If a c h i l d i s taught about the r e a 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 becomes terminally i l l (Ross, 1974).  Guiding children i n looking at and  accepting death can r e s u l t i n adults who are more directed i n l i f e ,  who  have more purpose and meaning i n t h e i r l i v e s , and who can be mature and responsible c i t i z e n s (Blazer, 1973).  Another purpose i n openly discussing  death with children i s that i t enables them to l i v e more freely.(Kavanaugh, 1972). "Death education can e a s i l y be a simple extension of a c h i l d ' s r e a l world''.." (Kavanaugh, 1972, p. 131)  The key would seem to be to l e t the c h i l d  1  speak f r e e l y of his/her concerns. and respond candidly and honestly.  The adult should scrap the euphemisms Ginott i n Between Parent and Child (1969)  has a short and straight-forward section on t h i s subject.  He offers j u s t -  i f i c a t i o n as well as suggestions for parents sharing with t h e i r children the facts of death. C.  Death E d u c a t i o n : a p l a n t o meet the need A parent who i s hopeful of being open with h i s children must f i r s t of  a l l examine h i s own attitudes.  The easiest way to manage t h i s 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 i n touch with our v i s c e r a l f e e l i n g s " (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 t i o n s " (Kavanaugh, 1972).  I t 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 i s to come to terms with the fact  that we do have feelings about t h i s basic truth of l i f e (Leshan, 1969).  51.  1.  Variety of approaches There are a number of methods i n which to achieve the goal of better  understanding oneself.  Keleman (1974) t a l k s of " s e l f dialogue"; where the  "neural and the v i s c e r a l " are consulted and considered.  Ross (1975) t a l k s  of " i d e n t i f i c a t i o n " with those who are suffering as a means of grasping personal reactions.  Psychodrama i s Langone's suggestion. "By playing r o l e s  i n dramas involving death, by experiencing i t , so to speak, they take a c l o ser look at i t , even though i t i s not r e a l , and hangups about the usually unmentionable  subject may be softened." (p.49)  O'Connell (1975,6) i s a strong supporter of the "death l a b " or experi 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 i s appropriate here: "... members developed almost instant rapport and closeness within t h e i r groups when coping with death together.  C h a r a c t e r i s t i c a l l y they noted that they  had never talked about t h e i r 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 creaturel i n e s s acted as a powerful catalyst f o r both group coh'esion and goal a c t u a l ization.  He goes on to speculate that confrontation of:one's mortality may  be an important part of obtaining "natural highs" and a c t u a l i z a t i o n of one's own happiness.  We have already explored t h i s connection between death and  l i f e ' s meaning at some length.  2.  The classroom Formal education i s seen as an excellent opportunity f o r children to  learn about death (Pincus, 1974). bereavement t o occur.  The teacher should not simply wait f o r  Rather he should take many opportunities to deal with  mortality "and thus counteract the taboo which leads to a b u i l t - i n repression of c u r i o s i t y and a l l sorts of i r r a t i o n a l fears and nightmares"  (p.244).  The educator of older children who i s interested i n the teaching of death has a growing l i s t of resources available f o r students to read (Craven, 1967; Gunther, 1949; Klein, 1974; L e v i t , 1974; Lund, 1974; Morgan, 1975). Many of the books are s t o r i e s of dying people and act as good starters f o r i n - c l a s s discussions. The idea of teaching about death i s r e l a t i v e l y new.  There i s a small  number of a r t i c l e s 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 D i s t r i c t , 1975). of death education.  A l l of these a r t i c l e s support the concept  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 i s a teaching unit compiled and published by the Memorial Society of Edmonton and D i s t r i c t  (1975).  An awareness of psychological dynamics and community readiness can be c r u c i a l to preparing the teacher to teach about death (Sommerville, 1974). Concern i s expressed that teachers may not be able to handle death education. Zazzaro (1973) quotes educator Leviton as she outlines f i v e c r i t e r i a f o r 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 i n the dynamics of his t o t a l personality functioning.  2.  Know.the appropriate.subject matter.he.is to teach.  3. Be able t o use.the language of death e a s i l y and'-naturally,.' e s p e c i a l l y with the young. 4. Be f a m i l i a r with the sequence of psychothantological developmental events throughout l i f e and have a sympathetic understanding of common problems associated with them. 5. Possess an acute awareness of enormous s o c i a l changes curr e n t l y i n progress and of t h e i r implications f o r changes i n accepted patterns of death attitudes, practices, laws and i n s t i t u t i o n s . Teachers need the support of superiors i f they are to teach about death (Pincus, 1974).  "No administrator should be surprised t o f i n d that  his s t a f f i s a f r a i d o f handling t h i s t o p i c , when he considers that research studies reveal similar fears among medical p r a c t i t i o n e r s and even prospective funeral d i r e c t o r s . " (McLure, 1974) Hawener (1974) i n a d i s s e r t a t i o n e n t i t l e d "Teaching about Death : An exploration study of teacher candidates attitudes toward death and behavior situations involving death" supports McLure. to "explore possible relationships  The purpose of her study was  between kindergarten teacher candidates'  anxiety towards death and perceived behavior i n classroom situations i n v o l ving death". The r e s u l t s of t h i s investigation indicated that personal death anxiety was not s i g n i f i c a n t l y related t o 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 i n the classroom. They expressed personal discomfort and lack of knowledge about what to do i n classroom s i t u a t i o n s . In general these kindergarten teacher candidates expressed b e l i e f s and attitudes about death quite l i k e those reported i n other studies of American views of death, (avoidance and d e n i a l ) . The candidates, nevertheless d i d indicate they believed teachers should have some special t r a i n i n g to handle classroom s i t u a t i o n s .  54.  There i s nothing contained i n .-the l i t e r a t u r e examined about any sort of "special t r a i n i n g " program ..to prepare teachers to deal with death education.  There are, however, some studies of nursing t r a i n i n g programs  and t h e i r effectiveness (Snyder, Gertler, S Ferneau, 1973; Murray, 1974; Lester, Getty £ Kneisl, 1974; Yeaworth,Knapp £ Winget, 1974).  Generally  the r e s u l t s of these studies indicate that some sort of t r a i n i n g to deal with death and dying decreases the nurse's anxiety of death.  "Experien-  t i a l factors i n the nursing student's t r a i n i n g , have brought considerable o v e r a l l changes i n attitudes towards death and dying." (Snyder et a l ) D.  Conclus i on Although there i s 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 a f f e c t s the q u a l i t y of l i f e  in general, and s p e c i f i c aspects of l i f e i n p a r t i c u l a r . ing,  Care of the dy-  the bereavement process and the way children are educated about l i f e ,  have been shown i n t h i s review of the l i t e r a t u r e to be adversely affected by a denial of m o r t a l i t y . In addition to the work of mental health professionals, death educat i o n for medical people and others i s becoming increasingly popular. Such education i s proving to be p a r t i c u l a r l y h e l p f u l to doctors, nurses and chaplains who work with dying persons. Ross (1974) and others point to the importance of becoming more comfortable with one's own fears about death. i d e n t i f i c a t i o n with those who  suffer.  She recommends experiential  O'Connell (1975) has found that the  experiential death labs are powerful experiences f o r those who Several papers on nurses' education  participate.  outline the effectiveness of an  55. experiential emphasis. It has been said that death education i n schools i s desirable. There are such courses now available i n numerous secondary schools i n the Vancouver area.  Teachers are using curriculum materials available or i n most  cases are developing t h e i r own.  I t 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 t h e i r ideas home and challenge t h e i r f a m i l i e s .  The r e s u l t can be the i n i t i a t i o n of open discussion  about death. The assumption  i s made that i f death education i s to be t r u l y e f f e c t -  ive i t should have a strong experiential component.  The teacher would be  the instigator of whatever tasks are used i n a course.  The writer believes  that a teacher w i l l only be e f f e c t i v e i n 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, f o r such learning to take place (Mitford, 1963). I t i s hoped that death education w i l l be of value t o those who p a r t i cipate i n such programs.  The writer believes that death educators require  some preparation before they can be e f f e c t i v e .  Nurses have been shown to  have decreased anxiety towards death a f t e r such t r a i n i n g .  This study w i l l  provide teachers with an opportunity f o r t h i s sort of experience to occur.  Chapter three provides very pspecific:ibfbrma'tion.about t h i s project. It begins with a statement of the problem and hypotheses.  CHAPTER THREE  Method  The This  remainder  chapter  statistical  begins (null)  sub-sections: mentation,  The It  is  be  A.  in  with  a  fourth  the  statement  of  are  a detailed presentation of  the  next.  terms,  is  the  problem.  Also  The  included  sample,  a presentation  a d i s c u s s i o n of  A l l  is  the  of  the  study.  substantive  are  the  treatment,  and  following instru-  analysis.  chapter  by  paper  hypotheses  and d a t a  five.  found  this  definition  followed  chapter  of  the  sixth  references  the  of  results  the  results  and g e n e r a l  mentioned throughout  of  the  project.  conclusions  this  paper  are  in to  chapter.  PProbfrem: Will  on t h e  an e x p e r i e n t i a l  subject  of  dying  and d i d a c t i c  and d e a t h ,  training  affect  the  program f o r  attitudes  of  teachers  those  parti-  cipating?  B.  Hypotheses-SubstantIve: A three  1. workshop death  on dying  anxiety  of  others;  by  the  and death  (change  dying  of  one's  self;  Collett-Lester  Fear  for  attitudes  dying of  on dying  and death f o r  committed p a r t i c i p a n t s  of  will  toward  others-;  Death  2. workshop  teachers  evening  lower death:  general  the  didactic  participant's  death death  and  of  self;  fear)  as  death  measured  Scale.  A three teachers  death anxiety  experiential  to  evening will  experiential  not  a greater  lower extent  the  and  didactic  religiously  than  the  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 f o r 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 1.  (null): A three evening experiential and didactic  workshop on dying and death f o r 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 s i g n i f i c a n t at the  .01 l e v e l , i n one's attitudes toward death of s e l f , death of others, dying of s e l f , dying of others, and death i n general) as measured by the Collett-Lester Fear of Death Scale. 2.  A three evening experiential and didactic  workshop on dying and death f o r teachers w i l l not lower the r e l i g i o u s l y committed participants' death anxiety t o a greater extent than, the r e l i g iously non-committed participants'death anxiety (no change, i . e . not stat i s t i c a l l y s i g n i f i c a n t at the .01 l e v e l , i n one's attitudes toward death of s e l f , death of others, dying of s e l f , dying of others and death i n general) as measured by the Collett-Lester Fear of Death Scale.  3.  A three evening experiential and didactic  workshop on dying and death f o r 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 s i g n i f i c a n t at the .01 l e v e l , i n one's attitudes toward death of s e l f , death of others, dy-, ing of s e l f , dying of others, and death i n general) to a greater extent  58.  than.the female participants''death anxiety, as.measured by the C o l l e t t Lester Fear of Death Scale. Chapter two provides ample rationale f o r these hypotheses, especia l l y the f i r s t .  Additional comments are i n order f o r the second and t h i r d  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 s i g n i f i c a n t l y greater fear of death of s e l f , death of others, and dying of s e l f .  There was no difference with males i n the fear of dy-  ing of others and general fear of death.  Durlak (1973) used a d i f f e r e n t  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 r e s u l t s .  The t h i r d hypothesis i s an attempt to c l a r i f y t h i s  issue. The second hypothesis supports the contention of several authors that r e l i g i o u s commitment does not a f f e c t 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 a)  terms: e x p e r i e n t i a l and d i d a c t i c workshop:  i n t h i s research  project a program which involves short presentations (approx. 15 min. each), films (1 f o r 20 min. 1 f o r 50 min.), and small group discussions (from 60 to 90 min. per session).  The experiential nature of the program requires  that participants become a c t i v e l y involved i n the discussion groups which deal with the presented material or assigned tasks.  59.  b)  r e l i g i o u s cbmitii trhent:  a decision made by participants  i n the research project about whether or not they believed i n God and were or were not active i n some church or r e l i g i o u s denomination.  Affirmative  responses i n both cases were considered as indicative of r e l i g i o u s commitment . c)  no r e l i g i o u s commitment:  a decision made by p a r t i c i -  pants i n t-heestudyvabgutfwhether or not they believed i n God and were or were not active i n some church or r e l i g i o u s denomination.  Negative res-  ponses t o either one or both points were considered as indicative of "no r e l i g i o u s commitment".  d)  death a n x i e t y :  concern about death of s e l f , death of  others, dying of s e l f , dying of others and death i n general as measured by the  Collett-Lester Fear of Death Scale.  E.  Sample: The subjects were obtained by advertising f o r volunteers with-  i n the Vancouver School D i s t r i c t . ments:  The promotion was limited to two depart-  Counselling and Home Economics.  I t i s i n these two departments  ( i n addition t o English) that teachers teach family l i f e courses within which death may be included. There were 32 persons i n the experimental group. 26 were female and 6 male. of the workshop.  Of t h i s group  A t o t a l of 41 persons attended the f i r s t night  Six persons d i d not attend the f i n a l session.  Some of  these did not return a f t e r one night and some a f t e r night two. Two i n d i v i ^ duals came the f i r s t and t h i r d nights but missed the second.  Another two  people came f o r the second and t h i r d 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  c o r r e c t l y and . her'. r e s u l t s . 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 t h e i r second form i n c o r r e c t l y . 22 females and  F.  The f i n a l t a l l y for the control group was  33:  11 males.  Treatment : The treatment was a workshop held over a three week period.  There were three weekly two and one h a l f hour sessions.  The l a s t session  was held on two consecutive evenings as about half of the  experimental  group could not attend on the night o r i g i n a l l y 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 i s to be found i n Appendix B.  What follows i s a b r i e f overview of the program. The f i r s t night was  introductory i n nature.  The measurement  scale was administered and t h i s was followed by a presentation. was  "care of the dying".  followed.  The'night  The. theme  A f i l m was viewed and small group discussions  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 f i l m on the same subject.  This was followed by a small group discussion of personal.,,  experiences with death.  The f i n a l task f o r the evening involved each  61.  participant  imagining that  he o r s h e h a d a . t e r m i n a l i l l n e s s .  c a t i o n s o f t h i s dilemma were d i s c u s s e d  The r a m i f i -  i n small groups.  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 small groups.  The t a s k was t o w r i t e a n d 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 . f o l l o w e d by a p r e s e n t a t i o n on c u r r i c u l u m suggestions experienced Family L i f e teacher. stration of  the m e a s u r e m e n t  uation  (Appendix C ) .  G.  Instrumentat i o n : The s c a l e  Death S c a l e . cited This  scale,  T h i s was  and r e s o u r c e s  by an  F o l l o w i n g d i s c u s s i o n and t h e r e a d m i n i each p a r t i c i p a n t f i l l e d  out an e v a l -  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  T h i s measure c o u l d be r e a c t i v e  and t h e r e  is l i t t l e  evidence  i n t h e manual o f r e l i a b i l i t y , v a l i d i t y and s o c i a l d e s i r a b i l i t y . scale  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 .  one o f t w o s c a l e s  reported i n a variety  of studies  (the other being Templers Death A n x i e t y S c a l e ) . a u t h o r s o f b o t h measures  It  is  i n the l i t e r a t u r e  A request  and o n l y D r . L e s t e r r e p l i e d .  was made t o t h e  This instrument  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  Design *  * Note  Yb Ya X -X  Yb Yb  Analysis:  X ^X  Ya Ya  - pre-test - post-test - treatment - no t r e a t m e n t  T h e r e was a 2 x 2 a n a l y s i s sis  involves tables  experimental control  of.covariance  performed..  a n d 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 .  The a n a l y Ths s i g n -  62.  i f i c a n c e l e v e l i s .01.  This conservative l e v e l was chosen because of the  following f a c t o r s : the p a r t i c i p a n t s i n the study were volunteers; i t was not possible to randomly assign participants to the experimental and cont r o l groups; the sample size was not representative;of the general teacher population but a group of secondary school teachers s p e c i a l i z i n g mainly i n either Home Economics or Counselling. The covariate i n the analysis of co-variance was the pret e s t scores.  The analysis of covariance was performed to  statistically  equalize the experimental and control groups,on t h e i r . i n i t i a l l e v e l s of death anxiety.  The analysis was a two t a i l e d test because i t was pos-  s i b l e the t r a i n i n g could have caused either an increase or decrease i n death anxiety according to previous studies reported i n the l i t e r a t u r e 0  (see Review of the Literature and Method).  63.  CHAPTER FOUR  This chapter i s a presentation of the r e s u l t s 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) d i s play the r e s u l t s related to hypotheses one and  two.  Hypothesis one stated that a workshop would lower the participants death anxiety.  There was a drop i n scores f o r 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 s i g n i f i c a n t differences: "dying of s e l f " ( P = .0006); "dying of others" (P = .0001); and "death general" (P = .0001). The r e s u l t s r e l a t e d to the second hypothesis are displayed i n tables one through four and graphs a and b.  This hypothesis stated that a  workshop on dying and death would not lower the r e l i g i o u s l y committed p a r t i cipants''death anxiety to a greater extent than the r e l i g i o u s l y non-committed participants' death anxiety. 1  The tables and graphs show that the r e l i g i o u s l y  committed had an increase i n anxiety on three scales and a decrease i n anxi e t y on two scales. mitted group.  Two  A l l f i v e scales decreased f o r the non-religiously com-  of these changes were s t a t i s t i c a l l y s i g n i f i c a n t : "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 Commitment (N=24)  Pr Po  2.25 -4.38  4.75 2.42  1.71 -1.96  -9.00 -20.00  - 0.29 -23.92  1. Religious Commitment (N=7)  Pr Po  -4.29 -5.86  2.43 0.00  1.14 0.86  -16.57 -14.14  -17.29 -19.14  2. No Religious Commitment (N=26)  Pr Po  -2.31 0.08  0.92 0.85  0.19 1.88  -11.15 -12.31  -12.35 - 9.12  Control  Note:  Pr  Pretest  Po  Posttest  In the experimental group,the r e l i g i o u s l y 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 r e l i g i o u s l y 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 r e l i g i o u s l y 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 Self  Death of Others  Dying of Self .  Dying of Others  Death General  Experimental 1. Religious Commitment (N=8)  Pr 11.41 Po 9.73  3.70 5.40  6.50 4.70  6.53 5.30  21.15 15.63  2. No Religious Commitment (N=24)  Pr 14.05. Po 11.53  7.96 7.74  4.83 5.47  7.93 8.17  24.12 24.84  1. Religious Commitment (N=7)  Pr 13.29 Po 12.25  10.20 7.90  4.26 6.69  6.40 10.53  26.3932.77  2. No Religious Commitment (N=26)  Pr 8.10 Po 10.36  7.42 7.35  6.65 6.92  9.71 10.29  23.21 27.17  Control  Note:  Pr - Pretest Po - Posttest  III. Table 3 Observed Combined Means (GROUP/RELIGION)  Subjects  -  Experimental and C o n t r o l  -  R e l i g i o u s C o m m i t m e n t and No R e l i g i o u s : Commitment (Combined")  Test  S C A L E Death of Self  Experimental (N=32) (males 6 females) Control (N=33) (males £ females)  PrPr 0.38 PoPo -2.81  Pr°" -2.73 -Pol'o -1.18  Combined Religious Commitment (N=15)  Pr Po  -4.80 -1.73  Combined No Religious Commitment (N=50)  Pr Po  -0.12 -2.06  Note:  Pr - Pretest Po - Posttest  Death of Others  Dying of Others  Death General  - 9.53 -17.97  - 3.25 • -18.31-  0.39 1.67  -12.30 -12.70  -13.39 -11.24  1.67 2.87  2.27 12.07  -13.67 -12.93  -14.53 - 9.73  2.76 1.60  0.92 0.40  -10.12 ^-16.00  - 6.56 -16.22  3.81 3.16  •  -  1.24 0.67  Dying of Self 2.09 -0.69-  * Combined = subjects (male £ female) from both experimental and control groups.  In the experimental group.there are.decreases on a l l scales between pre and post t e s t i n g . 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 C o v a r i a n c e (GROUP/RELIGION)  • F.  P.  s.s  .d.f.  Death of Self Group Religion Interaction Within C e l l s  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  Death of Others Group Religion Interaction Within C e l l s  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 Group Religion Interaction Within C e l l s  219.94 14.94 91.21 982.79  1 1 1 60  13.4278 • 219.94 0.9124 14.94 91.21 5.5687 16.38 •  .0006" .3434 .0216  858.10 421.45 . 159.05 2,550.78  1 1 1 60  858.10 421.45 159.05 42.51  20.1845 9.9136 3.7413  .0001* .0026* .0579  1 1 1 60  4,288.66 2,504.18 4,341.86 173.09  24.7764 14.4672 25.0838  .0001* .0004* . 001*  . Scale  . Factor  Others Group Religion Interaction Within C e l l s Death  .m.s.  .0312 .0657 .003*  General Group Religion Interaction Within C e l l s  4,288.66 2,504.18 4,341.86 10,385.67  Note'  s.s. = sum of squares  F = Frequency  d.f. = degrees of freedom  P = Significance Level  mean score m.s. significant: (.01)  -Three- scales are ..statistically s i g n i f i c a n t (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 s i g n i f i c a n t (Dy.o'f 0 and D Gen.) under "Religion" and there i s a s t a t i s t i c a l l y s i g n i f i c a n t "Interaction" on two scales (D of 0 and D Gen.).  DO ,  I  J-L '  L:i±lviG:raph;^;_z::;i^Li:r O b s e r v e d C e l 1 Means :  Pretest rj. m  (Group/Religion)  RC.. — Religious Commitment  Post test ;.^NRC_  rr  I  .No, Religious ..Commitment ~  ii  TT  i l l ! i l l !  1  1  r i  i  i i  i~ I  i  1! 1 1  i  i  i i i 1 7 n  i  i  1  1 1 , ! . ,  i  1  r  _  •iit m  i  _!_ _  1  ... _ i _ _  1  1  _  _  [ r n ' 1 i 1"! I 1 1  1  1  !  1 1  ...  ! 1  ._!— ~i~ "i  I  'i \  i  ; jiI ;  !  _ 1  !  _.!.„U.  T i ! 1 i 'i : I i -  r  i  ! 1  -  L  _i_ _  •4— t  i i i 1  1  ; i i _  1 i  ! i  1 !  ,  I; 1r  c i p i r  u  •  Means  !  •'-)"  i  n  1  1  r  —Control  j.  Iii.  :i :  \  ; r  —  i—  • I  . - i l l •"1 IL ..... 1  _J  RC  .  •  i-i-' i , ; -1 '  I  * • j* i-l-  IT  -  j  .1  1  f i~ i _l _'_ j.  Religious Commitment  NRC -—| No-Religious- Commitment.  _  !  1  1  _  Li  _  J i' LI  i _i  1  t  , !U  1  J  J J -_ i L . t ;!_  L 1 i i 1  \—  U  I I  ! 1 i 1!  II  —  I_  i  !  i ' I !<1 1 !  !_]_  -+•  1  1  i  1  1  f  i  I  i  1  !  1  ±J  f  !  Jj  _rri__i i1 L L L ! 1 ! ! i ! i 1.  :  I  j  -f  _  ! i „1_1._  _  "~r  1  r n u n / . f t l tn i n n )  ....  f  1  i  n  [  II  i  1  |  1 j 1 1 i 1  1 !  i  1 1  i 1 !  • !  i  j. i  -A— ... ........ 1.  _  !  -Posttest  i r  4 • :T i  ILL'—  r  1  II  •  1 1  i>: !  —  1  1  1 ! —  ~'  i  -1 - j .  m i i ! u \  _l_  CelI  Observed  ,I Ii!T  4_U ._Lj.-i._  T  ....  1 !  J_.  i  |  !  T  "ri  _  i  iI  [_  ; 1r  1  !  1  !_  i  . >  1  M-' "  1 !  1  • n  i  !  i  ;  1  1  T l_J ;  • .J 1if ]  1  j I L4. 1—.i:  j_ !_i l .1 _  . The second f o u r t a b l e s (.5. t h r o u g h 8). and .second two g r a p h s . ( 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 h y p o t h e s i s . . t h r e e . .  This hypothesis  stated  t h a t a workshop on d y i n g and d e a t h . w o u l d d e c r e a s e the male 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 females d e a t h a n x i e t y . i t t u r n e d out b o t h sexes had d e c r e a s e d s c o r e s between p r e and p o s t ing.  As test-  V.  Table 5  Observed C e l l Means•(SEX/GROUP) Experimental and C o n t r o l  .Subjects  Test . . Death of Self  S. C. A. L. E. Death of Others  Dying of Self  Dying of Others  Death General  Experimental 1. Males (N=6)  Pr • -2.67 Po -4.33  0.67 0.00  0.33 -0.50  -10.00 -15.83  -11.67 -20.67  2. Females (N=26)  Pr Po  1.08 -2.46  4.54 .. 3.88  2.50 . -0.73  - 9.42 -18.46  - 1.31 -17.77  1. Males (N=ll)  Pr Po  -2.18 -3.18  -3.36 . -2.82  0.36 1.36 •  -10.55 -11.36  -15.73 -16.00  2. Females N=22)  Pr Po  -3.00 -0.18 •  0.41 1.82  -13.18 -13.36  -12.23 - 8.86  Note:  Pr - Pretest  Control  3.55 2.41  Po - Posttest In the experimental group there i s decrease on a l l scales for men and women between pre and post t e s t i n g .  VI.  Table 6  Obseryed Cell Standard Deviations; (SEX/GROUP) Experimental and Control  Subjects  S C A L E  Test  Dying of Others  Death of Self  Death of Others  Dying of Self  Death General  Pr Po  17.75 13.65  8.19 4.34  6.22 5.39  9.38 11.75  21.93 25.74  Pr Po  12.88 10.96  7.02 7.66  5.02 5.83  7.29 7.50  24.02 24.95  Pr Po  8.64 6.01  5.32 4.96  5.99 6.62  8.95 9.69  20.02 17.96  Pr 9.69 Po 12.63  8.10 7.81  6.40 7.00  9.55 10.61  25.53 32.26  Experimental 1. Males (N=6) Females (N=26)  Control 1. Males •:•  (N=II)  2. Females (N=22)  Note:  Pr - Pretest Po - Posttest  73. Y U . Table 7 Observed Combined Weans; (.SEX/GROUP) - Males and Females -  Subjects  (combined*)  Experimental and Control  Test  S C A L E Death of Self  Death of Others  Dying of Self  Dying of Others  Death General  Combined Males (N=17)  Pr Po  -2.35 -3.59  -1.94 -1.82  0.35 0.70  -10.35 -12.94  -14.29 -17.65  Combined Females (N=48)  Pr Po  -0.79 -1.42  44:<08 33'.'21  1.54 0.44  -11.15 -16.12  - 6.31 -13.69  Experimental (males and females)  Pr Po  0.38 -2.81  3.81 3.16  2.09 -0.69 •  - 9.53 -17.97 .  - 3.25 -18.31  Control (males and females)  Pr Po  -2.73 -1.18  1.24 0.67  0.39 1.67 .  -12.30 -12.70  -13.39 -11.24  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)  .F,  s ,s,  d.f.  Death of Self Sex Group Interaction Within C e l l s  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 Group Interaction Within C e l l s  4.42 4.47 2.22 1,367.30  1 1 1 60  4.42 4.47 2.22 22.79  0.1939 0.1960 • 0.0975  • 0.6614 0.6596 0.7560  Dying of S e l f Sex Group Interaction Within C e l l s  19.50 209.85 • 17.32 1,067.79  1 1 1 60  19.50 209.85 17.32 17.80  l 0958 11.7917 • 0.9735  0.2994 0.0011 0.3278  Dying of Others Sex Group Interaction Within C e l l s  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.  0 2022 0.0003 0.4892  General Sex Group Interaction Within C e l l s  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  Fi = Frequency  d.f. = degrees of freedom  P = Significance Level  Scale  Death  Factor  m.s. = mean score  m.s.  v  V  None of the scales are s t a t i s t i c a l l y s i g n i f i c a n t under "Sex".  CHAPTER 5 Discussion .  A three evening e x p e r i e n t i a l and d i d a c t i c workshop on dying and death f o r teachers d i d lower (on 3 of 5 s c a l e s ) the death anxiety of the p a r t i c i pants as measured by the C o l l e t t - L e s t e r Fear of Death S c a l e . n u l l hypothesis i s  The f i r s t  rejected.  A three evening e x p e r i e n t i a l and d i d a c t i c workshop on dying and death for teachers d i d not lower the r e l i g i o u s l y committed p a r t i c i p a n t s 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 C o l l e t t - L e s t e r Fear of Death S c a l e . The t h i r d n u l l hypothesis i s supported. A three evening e x p e r i e n t i a l and d i d a c t i c workshop on dying and death for teachers d i d not lower the male p a r t i c i p a n t s death anxiety more than the females death anxiety as measured by the C o l l e t t - L e s t e r Fear of Death Scale.  The second n u l l hypothesis i s  supported.  The C o l l e t t - L e s t e r Fear of Death Scale has four sub scales and a gene r a 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.  H y p o t h e s i s one:  The i n t e n t i o n was to test"the effectiveness and d i d a c t i c workshop.  of an e x p e r i e n t i a l  There was a drop i n scores ( i n d i c a t i n g a lowering  of anxiety) on a l l the scales between pre and post t e s t i n g of the e x p e r i mental group when taken as a whole (table 3 ) .  Only some of these changes  p r o v e d - s t a t i s t i c a l l y s i g n i f i c a n t i n an a n a l y s i s 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 i n s i g n i f i c a n t . score changes were "death.of s e l f " (P = .0312) and "death of other" (P = .6597). The other three had s i g n i f i c a n t differences: "dying of s e l f " (P = .0006); "dying of others" (P = .0001); and "death general" (P = .0001). In--  In the control group there was a s l i g h t drop i n scores between  pre and post t e s t i n g on two scales: "death of others" and "dying of others". The other three scales had increased.scores or a r i s e i n death anxiety. The r i s e 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 C o l l e t t Lester scale would catch them unprepared. These r e s u l t s concur with the recommendations of Ross, O'Connell and others, that experiential t r a i n i n g helps to decrease dying and anxieties.  These r e s u l t s also concur with the r e s u l t s obtained i n three  nursing studies (Snyder, Gertler and Ferneau, 1973; Kneisl, 1974;  B.  death  Lester, Gerry and  Yeaworth,Knapp and Winget, 1974).  Hypothesis  two:  The intention was to observe the effect of an experiential and didactic workshop on both r e l i g i o u s l y committed and non r e l i g i o u s l y mited p a r t i c i p a n t s .  com-  Within the experimental group at post workshop t e s t -  ing, those with a r e l i g i o u s commitment when taken as a group, showed an increase i n anxiety on three.scales and a decrease i n anxiety on two scales (table I and Graph a ) . ment group.  Four scales decreased f o r the non r e l i g i o u s commit-  The. analysis of . covariance .. (chosen.. l e y e l of significance . being .01)  indicated s t a t i s t i c a l l y i n s i g n i f i c a n t differences f o r : "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 s i g n i f i c a n t changes for."dying .0026) and  "death general" (P = .0004).  The  of.other" (P =  s i g n i f i c a n t changes r e f l e c t  the drop i n anxiety of the non r e l i g i o u s l y committed (table 4).  Three of the f i v e scales had  statistically significant inter-  action e f f e c t s : "death of s e l f " (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-  i f i c a n t : "dying of s e l f " (P = .0216) and The  interaction effect was  "dying of other" (P = .0579).  a r e s u l t of a reversal of d i r e c t i o n  between experimental and control groups.  In the experimental the  ously committed participants'scores' rose and  religi-  i n the control they dropped.  In the experimental the non r e l i g i o u s l y committed p a r t i c i p a n t s ' scores dropped and i n the control they rose.  Of most significance i s the interaction effect within the mental group i t s e l f .  The two  groups ( r e l i g i o u s l y committed and non  ously committed) moved i n opposite d i r e c t i o n s .  experireligi-  The r e l i g i o u s l y committed  participants' scores rose and the non r e l i g i o u s l y committed participants' scores dropped (Graph a).  In the experimental group.,it would seem that those with r e l i g i o u s commitment benefited volvement.  less from the workshop than those without such an i n -  The Christian f a i t h teaches of l i f e after death.  Ross and  are c r i t i c a l of Christians generally f o r not l i v i n g t h e i r b e l i e f s . can.be a s u p e r f i c i a l acknowledgement of l i f e after.death.  other  There  This w i l l be of  80.  l i t t l e help.to the individual.should a l i f e . t h r e a t e n i n g experience.overv. take him.  Only.those who'daily l i v e . t h e i r b e l i e f s w i l l f i n d peace with,  the issue of mortality (Ross•)'. with an opportunity  This.. workshop provided . the participants  to confront.their m o r t a l i t y .  Perhaps.the increased  anxieties t e l l something of the quality .of.commitments f o r . those acknowledging such bonds.  It must be restated.that i n t h i s study.the d e f i n i t i o n  of r e l i g i o u s commitment i s : a decision made by participants i n the . study about whether or not they believed i n God and were or were not active i n some church or r e l i g i o u s denomination. were considered  Affirmative responses i n both cases  as i n d i c a t i v e of r e l i g i o u s commitment.  The research on r e l i g i o u s b e l i e f s and death fears has shown that there i s usually l i t t l e difference between.religiously non r e l i g i o u s l y committed.  committed and  Several authors have noted that r e l i g i o u s com-r  mitment does not a f f e c t an individual's death.fears (Berman and Hays, Hinton, 1967;  Hofmeier, 1974;  Kavanaugh, 1972;  O'Gonnell, 1974).  1973;  This pro-  j e c t found that non r e l i g i o u s l y committed p a r t i c i p a n t s ' anxiety l e v e l s dropped substantially more than religiously.committed  participants (table I;  table 4, graph a.).  When people are asked to confront t h e i r mortality, i t can be a d i f f i c u l t experience.  The fears evoked are not e a s i l y managed, primarily  due to t h e i r u n f a m i l i a r i t y .  Perhaps some:of those who  claimed a r e l i g i o u s  b e l i e f were alarmed that they f e l t anxious when supposedly "knowing" that there i s l i f e a f t e r 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 had no reason to be overly alarmed a t . t h e i r .anxieties'.-  ' ''•'': . The. control group was  a d i f f e r e n t s i t u a t i o n altogether.  The  who  .religiously committed.showed a . decrease.in.scores and anxiety on a l l . s c a l e s but one: "dying of others" (table I, .graph b).  The non r e l i g i o u s l y commit-  ted showed an increase of scores and anxiety on three scales: "death of s e l f " ; "dying of s e l f " ; and "death general".. The.other two scales ("death of others" and "dying of others") decreased on the post t e s t . In the control group the r e l i g i o u s l y committed dealt with death in a s u p e r f i c i a l 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 f o r the r e l i g i o u s l y committed to treat the scales as per the d i c t ates of t h e i r f a i t h .  The non r e l i g i o u s l y committed, again not having a  d o c t r i n a l framework to guide them tended to have an increase i n anxiety. The questionnaire would have unexpectedly come to them, quite suddenly forcing them to think of t h e i r own deaths and evoking some anxiety in.the process.  C.  Hypothes i s  three:  The intention was to observe the effect of an experiential and d i d a c t i c workshop on both male and female p a r t i c i p a n t s .  Both groups had  decreased scores between pre and post testing ( i n d i c a t i n g 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 s i g n i f i c a n t i n an analysis of covariance with a chosen l e v e l of significance being .01 (table 8).  D.  S h o r t - c o m i ngs a n d Needed  Improvements:  . The Vancouver School.Board  gave.its approval f o r t h i s study but  wished that p u b l i c i t y about i t be minimized.  When the time came to hold  the workshop, i t became apparent.that only about 20 persons were interested  82.  The "low key" p u b l i c i t y was stepped up and a.decision made.to treat a l l volunteers as '-participants i n . the', experimental group. . . Other . teachers would be randomly approached to form a control:group. Delays with the school board required adjustments which, weakened the research design of t h i s study.  I t would be interesting.to repeat  the study along the l i n e s o r i g i n a l l y planned.  I t was hoped that there  could be two control groups along with the experimental.  Recruited tea-  chers interested i n 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 r e s u l t s of hypothesis two can not be taken too seriously for two reasons: . there were only 15 people with r e l i g i o u s commitment compared to 50 who were not so committed; to be i n the r e l i g i o u s l y committed group a person had to believe i n God, have an a f f i l i ation and attend i t r e g u l a r l y .  Some participants believed i n God but had  no a f f i l i a t i o n or believed i n God and had an a f f i l i a t i o n which was i n a c t i v e . These persons were c l a s s i f i e d as non r e l i g i o u s l y committed i n t h i s study. The workshop i t s e l f could.be improved.  At the.beginning the  writer did not have a good technique f o r breaking people i n t o 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 i n s i s t  (which was not. done)'.that people j o i n a group with, people they know, least well.  feedback.was received from p a r t i c i p a n t s that they f e l t  inhibited  i n groups with t h e i r friends.. The depth of.the friendship tended to set the tone f o r the group.  There i s 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 s i x groups i n 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 p o s s i b i l i t y of d i s t r a c t i n g power struggles. Another way of encouraging the groups to do the assigned tasks would be to c i r c u l a t e between groups as the course leader.  Although such  v i s i t i n g might d i s t r a c t 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  il-  ness to be. Another unforeseen problem which arose during the workshop weakened the process which had been established. attending from one p a r t i c u l a r school.  A large group of teachers were  They were a l l unable to attend the  scheduled t h i r d night of the workshop.due to a school open house the same evening.  Thus the t h i r d session was held on two consecutive nights.  tunately some of the groups were broken up and the continuity l o s t .  Unfor-  8 4 .  E.  Impl i.cat ions of the S t u d y ; Although the Interaction o f . r e l i g i o u s b e l i e f and treatment, and  sex and treatment i s i n t e r e s t i n g , i t i s of only i n d i r e c t releyance to t h i s project.  I t i s the result of testing hypothesis one.that has the greatest  p r a c t i c a l significance. It would seem'that an experiential and didactic workshop on dying and death does lower the participants^ death anxiety.  Such a program  might be a valuable a'dditibn to teacher t r a i n i n g programs.  Although i t  would be valuable f o r any teacher, i t would be most s i g n i f i c a n t f o r any planning to teach of dying or death i n t h e i r classrooms. An experiential and didactic workshop on dying and death could be developed f o r anyone interested i n learning about mortality.  A step  i n t h i s d i r e c t i o n has been taken by the writer by developing a s i x 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 i n an exper-  i e n t i a l and didactic workshop on dying and death would have a decrease i n 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 i n the workshop had a greater decrease i n 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 i n scores between the male and.female p a r t i c i p a n t s .  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 f o r the non religiously.committed  participants.  hypothesis was confirmed and i n fact.the opposite occurred.  This  The scores of  the non r e l i g i o u s l y committed dropped s i g n i f i c a n t l y more than the r e l i g i ously committed participants'scores on some of the C o l l e t t - L e s t e r sub scales There are a number of possible improvements f o r noted shortcomings i n t h i s study.  The major implication of t h i s research i s that an  experiential and d i d a c t i c workshop i s of value f o r teachers interested i n teaching about dying and death.  Indeed such a workshop i s l i k e l y to be  of value to anyone interested i n becoming more comfortable with h i s 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 * R e l a t i o n 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 S o c i a l Structure.  P s y c h i a t r y, 1966, 29_, 378-394.  B l a z e r , 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 R e f l e c t i o n of Death i n Contemporary L i t e r a t u r e . In N. Greinacher £ A. Muller (Eds.), The Experience of Dying. New York: Herder £ Herder, 1974. C a t t e l l , J . P s y c h i a t r i c Implications i n Bereavement. In A.H. Kutscher (Eds.),. Death and Bereavement. Chicago: C C . Thomas P u b l i s h e r , 1969. Choron, J . Death and Modern Man. Cohen, R.J. £ Parker, C. Reports, 1974, 34, 54. Coriolis. 1967.  New York: C o l l i e r Books, 1964.  Fear of F a i l u r e and Death.  Death Here i s thy S t i n g .  Psychological  Toronto: McClelland and Stewart,  Curran, C.A. Counseling - Learning, A Whole-Person Model f o r Education. New York: Grune £ Stratton,•1972. Curran, C.A. Death and Dying. Chicago: Loyola U n i v e r s i t y , 1974. (audio tape)  87.  Craven, M. I Heard the Owl C a l l My Name.. Vancouver: Clarke, Irwin £• Co. Ltd., 1967. Davidson, - G.W. (-ed.), . Living with Dying• shing Hse, 1975.  Minneapolis: Augsburg Publi-  Durlak, J.A. Relationship Between Individual Attitudes.Toward•• Life--and Death. Journal of Consulting and C l 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. F e i f e l , H.(Ed.),. The Meaning of Death. Inc., 1959. Fontenot, C.  Toronto: McGraw-Hill Book Co.  The Subject Nobody Teaches.  English Journal, 1974, 62-63.  Frankl, V.E. Man's Search f o r 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: B u f f i n Press, 1963. Ginott, H.G.  Between Parent and Child.  Glaser, B. £ Strauss, A. Co., 1965. Gordon, D. 1970.  New York: Avon Books, 1969.  Awareness of Dying.  Overcoming the Fear of Death,  Baltimore: Penguin Books Inc.,  Gunther, J . Death Be Not Proud - A Memoir. l i s h e r s , 1949. Harmer, R. Co., 1963.  The High Cost of Dying.  Harnett, A.L. How we do i t . (8), 526-527.  Chicago: Aldine Publishing  New York: Harper £ Row Pub-  New York: Crowell-Collier Publishing  The Journal of School Health, 1973, XLIII  88.  llawener, R.M.- An exploratory.study of teacher candidates'.attitudes toward .Death,-and Behavior . in situations.: involving Death (Doctoral d i s s e r t a t i o n , '1974).. Dissertation Abstracts.International, 1974, 167-A. Hendin, D.  Death as a Fact of L i f e .  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, i n N. Greinacher £ A. Muller (Eds.), The Experience of Dying. New York: Herder £ Herder, 1974. Hunt, G. Don't be Afraid to Die. l i s h i n g Hse., 1971.  Ann Arbor, Michigan: Zondervan Pub-  Imara, M. Dying as the Last Stage of Growth. In E. Kubler-Ross, Death the F i n a l 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: D e l l Publishing Co., 1969. Jung, C. The Soul and Death. In-H. F e i f e l (Ed.), Toronto: McGraw-Hill Book Co.Inc., 1959. Jury, D., £ Jury M.  Gramp.  The Meaning of Death.  New York: Grossman Publishers, 1976.  Kastenbaum, R., £ Aisenburg, R. The Psychology of Death. Springer Publishing Co.Inc., 1972. Kavanaugh, R. Keleman, S. Klein, N.  Facing Death.  Baltimore, Maryland:  New York:  Penguin Books, 1972.  'Living Your Dying.. Toronto: Random House, 1974. Sunshine.  New York:  Avon Books,  1974.  Langone,. J . :Death.is a Noun - A yiew:pf.the.End of L i f e . Publishing.Co.:Inc., 1972. -  New York; D e l l '  LeiShan, L. Psychotherapy and.the Dying Patient. In L. Pearson (Ed.), Death £ Dying: Current Issues i n the Treatment cf the Dying:Person. Cleveland: The Press of Case Western Reserve University, 1969.  Lester, D. Studies i n Death Attitudes: Part Two. 1972, 30, 440.  Psychological Reports,  Lester, D., 5 Getty, C , £ Kneisl, C. Attitudes of Nursing Students and Nursing Faculty toward Death. Nursing Research, 1974, 23 ( 1 ) . Lester, D. Inconsistency i n the Fear of Death of Individuals. Psychological Reports, 1967, 20, 1084. L e v i t , R. E l l e n - A Short L i f e Long Remembered. , San Francisco: Bantam Books, 1974. Leviton, D. Education f o r Death. Journal of Health, Physical Education and Recreation, 1969, 46-47, 50-51~ Lewis, C S .  A Grief Observed.  L i f t o n , R. £ Olson, E. 1974.  London: Faber £ Faber, 1961.  Living and Dying.  New York: Praeger Publisher,  Lindeman, E. Symptomatology and Management of Acute G r i e f . Journal of Psychiatry, Sept. 1944.  Lund, D.  Eric.  New York: J.B. Lippencott Co.,  Mannes, M. Last Rights. Canada Ltd., 1975. McLure, J .  Scarborough, Ont.:  Death Education.  American  1974.  New American Library of  Phi Delta Kappan, 1974, 483-485.  Mitford, J . The American Way of Death. Publications Inc., 1963.  Greenwich, Conn.: Fawcett  Morgan, E. A Manual of Death Education and Simple B u r i a l . B u r n s v i l l e , N.C.: Celo Press, 1965.  Mount, B. Death a Part-, of Life?. In P.W.. 1973-4, VII(3), 3-7. •  Murray,:P. of Nurses.  Gooch (Ed.),  Crux. . Toronto:  Death Education and i t s Effect on the Death Anxiety Level Psychological Reports, 1974, 35, 1250.  Nelson, B. The Games of L i f e 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 f o r Natural Highs. Manus c r i p t submitted f o r publication, 1975. O'Connell, W.E. Religion, Love and Our Deaths. Counseling, 1974-5, 9(2), 66. O'Connell, W.E.  Journal of Pastoral  The Humor of the Gallows. Omega, 1966; _1, 31-32.  O'Connell, W.E. £ Covert C. Death Attitudes and Humor Appreciation among Medical Students. E x i s t e n t i a l Psychiatry, 1967, 6(24), 433-442. Pincus, L. Death and the Family - The Importance of Mourning. York: Vintage Books - Random House, 1974. Read, P. Alive. - The Story of the Andes Survivors: Lippencott Co., 1.974.  New  Philadelphia: J.B.  Robinson, Mrs. J . , I f Disaster, How Would You See Death? Churchman,  Texas.  Rossell, A. Lindemann's Pioneer Studies of Reactions to G r i e f . 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. MacMillan Co., 1974. Ross, E. Death the Final-:Stage of Growth. Jersey: Prentice-Hall Inc., 1975.  New York:  Englewood C l i f f s ,  The  New  91. Ross, E.  Death £ Dying Seminar,.Seattle, Washington, March.5, 1976.  Ruitenbeck, -H., (Ed.), l i s h i n g Co., 1969.  Death: Interpretations.  New York: D e l l Pub-  Saunders, C. -The moment of truth: Care of the Dying Person. In.L. Pearson (Ed.),. Death and Dying: Current Issues i n the Treatment of the Dying PersonT Cleveland: The Press of Case Western Reserve University, 1969. Shibles, W. Death. - An I n t e r d i s c i p l i n a r y Analysis. Language Press, 1974. Schrank, J . Death, 1971, 64, 32.-35":  Sneidman, E.S.  Wisconsin: The  Media, and Methods - Exploration i n Education. :  Death of Man.  New York: New York Times Book Co.,  Somerville, R. Perspective on Death: A Th'ematic TeachinggUnit Co-ordinator, 1974, 421. "' ;  3  v  Sudnow, D. Passing On - The S o c i a l Organization of Dying. C l i f f s , New Jersey: Prentice-Hall Inc., 1967. Tolstoy, L. The Death of Ivan Ilych and Other Stories. Ont.: The New American Library of Canada, 1960.  Toynbee, A.  Family " '~  Englewood  Scarborough,  Man's Concern with Death - London: Hodder £ Stoughton, 1968.  Watt, J . Canadian Guide to Death £ Dying. Self-Counsel Press Ltd., 1974. Waugh, E.  1973.  The Loved One.  North Vancouver: International  Harmondsworth, Middlesex:. Penguin Books, 1951.  Weisman, A. On Dying and Denying - A Psychiatric Study of Terminality. New York: Behavioral Publications Inc., 1972. Wong, S.G. The Layman's Guide to Drafting Wills/Probate Procedure f o r • British'Columbia. North Vancouver.International.Self-Counsel Press.Ltd., 1974.  Wyschogrod,: E. . .'(Ed.), . The Phenomenon of Death - paces of M o r t a l i t y . New.York: Harper.Colophon Books T. Harper £ Row Publishers, 1975.  Yeaworth, R.C., £ Knapp', F.T., £-Winget, C. Attitudes of-Nursing Students Toward the Dying Patient. Nursing Research, 1974, 23(1), 20-24. Yudkin, S. Death and the Young. In:A. Toynbee, Man's.Concern with Death. London: Hodder £ Stoughton, 1968. Zazzaro, J . 39-42.  Death Be Not Distorted.  Nations Schools.  1973, 102,  a p p e n d i x  A .  93.  OFFICE O F T H E DEPUTY  1595  W E S T 10TH AVENUE V A N C O U V E R B.C V 6 J 1ZB TELEPHONE 731 1131  SUPERINTENDENT  E v a l u a t i o n and Research BOARD OF SCHOOL TRUSTEES OF SCHOOL DISTRICT NO 39 (VANCOUVER*  May  11th, 1976  TO:  Department Heads, C o u n s e l l o r s and Teachers  RE:  Research Study and Workshop on Death and Dying Conducted by Mr. Denis Boyd, a graduate student i n C o u n s e l l i n g Psychology at the U n i v e r s i t y o f B r i t i s h Columbia  Recently Mr. Boyd conducted at the Teacher Centre a t h r e e - s e s s i o n workshop on Death and Dying. As p a r t o f h i s r e s e a r c h study f o r a Master's t h e s i s Mr. Boyd asked a l l workshop p a r t i c i p a n t s t o complete an a t t i t u d i n a l q u e s t i o n n a i r e on death and dying d u r i n g p r e - and p o s t - t e s t s e s s i o n s to determine what changes i n a t t i t u d e o c c u r r e d d u r i n g the i n - s e r v i c e program. For comparative purposes Mr. Boyd would l i k e approximately 4 0 - 5 0 teachers who have not attended h i s workshop s e s s i o n s to complete the a t t a c h e d a t t i t u d i n a l scale. Each p a r t i c i p a n t i s asked to w r i t e h i s / h e r name and s c h o o l address a t the bottom o f the l a s t page of the q u e s t i o n n a i r e and m a i l i t i n the r e t u r n envelope to Mr. Boyd. A f t e r an i n t e r v a l o f three weeks another copy o f the same instrument w i l l be sent t o each p a r t i c i p a n t as a p o s t - t e s t a t t i t u d i n a l measure. On the p o s t - t e s t instrument the name o f the p a r t i c i p a n t and h i s / h e r s c h o o l w i l l be requested a g a i n as the r e s u l t s w i l l be compared t o the p r e - t e s t . P l e a s e be assured that the i d e n t i t i e s of a l l p a r t i c i p a n t s 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 f i n d i n g s w i l l be r e p o r t e d on an anonymous b a s i s by Mr. Boyd i n h i s r e s e a r c h study. Thank you f o r your k i n d c o n s i d e r a t i o n of t h i s r e s e a r c h request. i s genuinely a p p r e c i a t e d .  Yours  sincerely,  ALLAN G. MOODIE C o o r d i n a t o r o f Research S t u d i e s and T e s t i n g AGM/meg  Your  cooperation  94,  QUESTIONNAIRE ON DEATH and DYING Here i s a s e r i e s o f g e n e r a l statements, Px'ease I n d i c a t e how much you agree o r d i s a g r e e w i t h them.., Record your o p i n i o n i n t h e blank space i n f r o n t o f each i t e m a c c o r d i n g t o the f o l l o w i n g s c a l e s +1 s l i g h t agreement •$•2 moderate agreement +3 s t r o n g agreement  -1  s l i g h t disagreement  -3  s t r o n g disagreement'  - 2 moderate, disagreement  Read each i t e m and d e c i d e cjioicklv how you f e e l about i t j t h e n r e c o r d the extent o f your agreement?-or aisagreement• Put down your f i r s t i m p r e s s i o n . P l e a s e answer evary^ i t e m , 1,  I would a v o i d death a t a l l  2.  I would .experience a g r e a t l o s s i f someone c l o s e t o me died.  3.  I would not f e e l anxious i n the presence o f someone I knew was d y i n g .  4  The t o t a l i s o l a t i o n o f death f r i g h t e n s  0  costs„  me  0  5.,  I am d i s t u r b e d by the p h y s i c a l d e g e n e r a t i o n i n v o l v e d i n a slow d e a t h .  6«.  I would not mind d y i n g young „  7.  I accept the death o f o t h e r s as the end o f t h e i r on e a r t h  3.  1 would not mind v i s i t i n g a s e n i l e  9  I would e a s i l y a d j u s t a f t e r the death o f someone c l a s e to me.  e  life  friend,  10.  I f I had a choice as t o whether o r not a f r i e n d s h o u l d be informed he/she i s d y i n g , I would t e l l him/her.  11.  I would a v o i d 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  13.  I would l i k e t o be a b l e to communicate w i t h the s p i r i t of a f r i e n d who has d i e d  experience.  B  14.  I view death as a r e l e a s e from e a r t h l y  15.  The p a i n i n v o l v e d i n d y i n g f r i g h t e n s  16.  I would want t o know i f a f r i e n d were d y i n g .  17c  I am d i s t u r b e d by the s h o r t n e s s c f l i f e .  1&  I would not mind h a v i n g t o i d e n t i f y the corpse o f somebody I knew.  19.  I would never get over the death o f someone c l o s e t o  20,  The f e e l i n g t h a t I might be m i s s i n g out on so much a f t e r I d i e bothers me*  0  suffering.  me.  me  0  Q u e s t i o n n a i r e on Death and Dyinfi (Cont'd) 21.  I do not t h i n k o f dead people as h a v i n g an e x i s t e n c e o f some k i n d .  22.  I would f e e l uneasy i f someone t a l k e d t o me about t h e a p p r o a c h i n g death, o f a common f r i e n d .  23.  Not knowing what i t f e e l s l i k e , t o be dead does not b o t h e r me.  21+.  I f I had a f a t a l d i s e a s e I would l i k e t o be t o l d .  25.  I would v i s i t  26.  The i d e a o f never t h i n k i n g o r e x p e r i e n c i n g a g a i n I d i e does not bother me.  27.  I f someone c l o s e t o me d i e d , I would miss him/^ier v e r y much.  25.  I am not d i s t u r b e d by death b e i n g the end o f l i f e as I know i t .  29«  I would f e e l anxious i f someone who was d y i n g t a l k e d t o me about i t .  30.  The i n t e l l e c t u a l d e g e n e r a t i o n o f o l d age d i s t u r b s  310  I f a f r i e n d were d y i n g I would not want t o be t o l d .  32,  I c o u l d not accept t h e . f i n a l i t y o f t h e death o f a friend.  33*  I t would upset me t o have t o see someone who was dead.  34.  I f I knew a f r i e n d was d y i n g , I would not know what t e say t o him/her.  35.  I would not l i k e t o see t h e p h y s i c a l d e g e n e r a t i o n o f a f r i e n d who was d y i n g ,  36.  I am d i s t u r b e d by t h e thought t h a t my a b i l i t i e s be l i m i t e d w h i l e I'm d y i n g .  a f r i e n d on h i s / h  e r  deathbed. after  me  will  0  nppenaix  a.  96.  What follows i s a description of the.experiential/didactic workshop 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 t h e i r  name, address, phone number and school on a l i s t .  While they did t h i s  I made them a name tag. The evening began with myself being introduced by Mr. A l l a n 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 r e s u l t s would be kept c o n f i d e n t i a l by myself and would be used i n my research.  I d i d say  that I would be prepared to send them t h e i r results and those of the see cond questionnaire to be completed l a t e r . Once the scales were completed I continued with my introductory comments and outline.  When t h i s 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 f e e l about teaching death and dying i n the classroom?  Do you have any experiences teaching about death?  After a break the .subjects returned to one large group f o r a short presentation by myself on Dr. Elisabeth Kubler-Ross's work with.the dying.  This was followed by a f i l m on Dr. Ross e n t i t l e d , " U n t i l I Die"  which ran 20 minutes.  97.  Once the f i l m was finished the participants returned.to t h e i r small groups to share feelings, and ideas about the f i l m . . ..Someone i n each group acted as a recorder to note group consensus about the f i l m and.terminal care generally.  This f i r s t - n i g h t ended, with everyone returning , to the large group -  and hearing the recorders report the reactions to " U n t i l I.Die" and. t e r 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. b r i e f 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 f i l m e n t i t l e d "The Great American Funeral" which- ran 50 minutes.  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 t h e i r e a r l i e s t , most recent and most traumatic experience with dying or death.  In addition  to r e c a l l i n g the "memories they were to describe the feelings that were associated with them.  Later a second i n s t r u c t i o n . sheet was circulated which t o l d each group member that he or she had been diagnosed with a terminal sickness. They were to write down t h e i r 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 i n a large group.  I made  a short presentation to explain.the r a t i o n a l e for.the tasks done during the night.  This centered'on  f a m i l i a r i t y with them.  the importance of personal feelings and  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. tten i t was shared i n the...group.  Once t h i s was wri-  A break followed.  With everyone back i n a large group there was a sharing of group reactions to the task. life.  I then talked about death and the meaning of  My/' focus was primarily the ideas of Victor Frankl from The Doctor  and the Soul. (1955) and Man's Search f o r Meaning - an Introduction to Logotherapy (1963)  After some discussion I introduced Mrs. Anne Gardiner, a Home. Economics and Family L i f e teacher from Templeton Secondary i n Vancouver. Mrs. Gardiner and I had worked out a teaching unit on death and dying and had presented i t to some of her c l a s s .  We had also spoken with teachers and  student teachers i n workshops on teaching about death.  Mrs. Gardiner spoke f o r a.. short, time about the teaching unit, she had. been using with grade elevens and twelves.  .She also d i s t r i b u t e d several  handouts which included a r t i c l e s and a.reading l i s t . was followed by.some discussion.  This presentation  The. Collett-Lester Scale was .readrai.niste.red . and . an evaluation of the, workshop filled'.: out.  I thanked'.. the'.. sub j ects . f o r . t h e i r : involvement  and the evening (and workshop) ended.  Appendix  C.  Death and Dying Workshop "EVALUATION"  P l e a s e share your i m p r e s s i o n s of the workshop.  It would be u s e f u l t o 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 c o u l d have been done more e f f e c t ively.  Feel f r e e t o mention any p a r t s of the workshop you found t o be p a r t i c u l -  arly  worthwhile.  |..| ,  My gut reactions over the years have been one of panic and fear.  I have  been involved i n two death situations over the past 6 years which completely "FREAKED ME  OUT".  In o u t l i n i n g 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  t r i e d i t myself, mainly because I got a l o t of strength from you, other people in my group and the resources presented-;* Your continuing ease with the subject r e a l l y got to me and has made me more comfortable with facing death. Ann's resource material and ideas have c e r t a i n l y 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  d i f f e r e n t l y i n the classroom next time. *  F i r s t night I f e l t threatened and a l i t t l e down; but your reaction gave  a l o t of comfort.  Excellent f i l m .  Second night - Consumer f i l m good eye opener but made me f e e l uncomfortable.  Workshop talks - brought me back f e e l i n g OK. Third night - Excellent;; especially your summary and curriculum o u t l i n e . Thanks again, you have r e a l l y helped me.  101.  I f e l t that every part of the workshop was important, or i n a sense c r i t i c a l f o r the desired r e s u l t .  I also f e e l 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 i n being able to approach the subject with other people who are unwilling to discuss t h i s t o p i c . As you know Dennis, I attended your workshop i n the f a l l .  In a way I  f e e l 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 r e s u l t s would be, i f time  allowed, to have the workshop on three consecutive days, when people could r e a l l y get involved - not run out of time - and not have too much time inbet* ween each session. Thank you, Dennis, I r e a l l y 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 l o t of thoughts and mixed emotions within myself concerning the subject.  I t 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 a f t e r the 1st night that spending time with the same group of people brought back a l o t of the same old s t o r i e s .  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 f i n d  that p a r t i c u l a r l y useful.  • 102. P a r t I d i s l i k e d t h e most - t h e E u l o g y .  I fully realized  i t s purpose t o  the workshop, b u t c h a l l e n g e t h e vogueness o f E u l o g i e s i n t o d a y ' s  services.  W i l l a p p r e c i a t e r e c e i v i n g t h e r e s u l t s o f t h e q u e s t i o n n a i r e - but I found i t d i f f i c u l t t o answer a t t i m e s , w i t h wording o f statements do i t " q u i c k l y " .  I'm n o t sure t h a t what I responded  and t h a t we were t o  t o a r e my gut f e e l i n g s i f  I l a b o u r e d on i t .  In g e n e r a l , i t gave me p e r s o n a l i n s i g h t i n t o t h e f a c t t h a t o f t e n I f e e l I'm w a s t i n g my days and perhaps I s h o u l d be d o i n g more.  The i d e a o f p r o c r a s t -  i n a t i n g your y e a r s r e a l l y s t r u c k home.  Thank you f o r t h e e x p e r i e n c e .  The most worthwhile t h o s e around me. through  p a r t was t h i n k i n g about death and how i t would a f f e c t  A l s o how my h a n d l i n g o f t h e d y i n g p r o c e s s would p r o g r e s s  i t s v a r i o u s s t a g e s - knowing t h e s e stages w i l l a l s o h e l p me h e l p my  f a m i l y and f r i e n d s .  I t was good t a l k i n g t o o t h e r people about a t o p i c which i s c o n s i d e r e d "taboo"  i n our s o c i e t y .  I t was hard t o l e t go o f a l l your t r u e f e e l i n g s i n a group where you d i d not know a l l t h e members - T h i s became e a s i e r as t h e s e s s i o n s p r o g r e s s e d .  The  f i l m was o l d - but c e r t a i n l y made a p o i n t .  I wish I c o u l d make some s u g g e s t i o n s but I found thoughts  I got many  worthwhile  and e x p e r i e n c e s from each s e s s i o n - Thank you v e r y much f o r h e l p i n g  me w i t h Death and w i t h  Life.  103. Really enjoyed the tasks and staying with the same group.  Got to f e e l  that I know them and l i k e 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 t h i s subject before, has opened doors to ideas that I didn't know I had r e i n s on. Questionnaire technique was r e a l l y poor.  Questions were OK though.  Perhaps though, there needs to be a d i s t i n c t i o n between the pain aspect o f 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 p a r t i c i p a t i o n 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 c e r t a i n l y sign up f o r 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 t h i s area t o study i t objectively and then use t h i s knowledge f o r the good of h i s fellow men. d i f f i c u l t f o r me and so I have avoided i t .  Death i s an area that has been I appreciated being able to t a l k  about my baby',s death and have someone say i t i s 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 i n the way I reacted to my father's death but am beginning to see that i t was a r e j e c t i o n of the whole thing.  I l i k e d the way you outlined what we would do and i n order to protect the plan, i n s i s t e d 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 r e e l of the funeral f i l m would have been  enough - leaving more time f o r discussion.  Your organization was superb!  I r e a l l y appreciated also Anne's detailed outline of how to do i t with kids - excellent i n service t r a i n i n g . Many thanks.  I found i t very useful and i n t e r e s t i n g .  I know t h i s 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 t h i s topic i n t e r esting f o r students. P a r t i c u l a r l y valuable - both you and Anne Gardner seemed l i k e very warm people who were r e a l l y interested and concerned i n helping us as i n d i v i d u a l s . 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 t a l k s .  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. to do.  I found i t d i f f i c u l t at times to do what we were asked  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 f i n d 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 f e e l i n g that we couldn't r e l a t e on a similar l e v e l as my experiences were so touchy f o r me to handle.  I got the impression that my  deeper feelings were not "acceptable" to my group. my surface approach.  This seemed to perpetuate  However t h i s may give me some insight i n l a t e r 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 l o t of my fears and  although I s t i l l f e e l I have them I am beginning to understand the why's behind them.  Thank you f o r expressing that an "appreciation of l i f e " often i s  the cause of anxiety over DSD.  I t was an "unconscious" f e e l i n g .  wouldnjt verbally express i t as i t seems very s e l f i s h .  Or I  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 i n terms of me - for many years. I l i k e d the kinds of group experiences we d i d , e.g. the terminal case, the eulogy etc., however, I f e e l i t i s sometimes u n r e a l i s t i c to expect people who perhaps do not know each other very w e l l , i f at a l l , to " t e l l a l l " and be t e r r i b l y personal, bang, a l l at once.  I f e e l people need to have a kind of  "rapport" with each other before they can begin "divulging" and expressing personal "gut" f e e l i n g s .  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 f e e l i n g of having some degree of "confidence" to be able to teach the unit i n the classroom.  The workshop enabled me to r e a l i z e again the importance of l i 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 i s so precious to me as i t i s to  others. However a positive event - my husband and I discussed our deaths and have made plans to j o i n the "memorial society" to insure our desires are carried out and t o r e l i e v e our family of having to make decisions that could be d i f f i c u l t f o r them.  Anne's report on her classroom procedure was  excellent.  I found the workshop a worthwhile experience i n 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 a f t e r the f i r s t session.  However, perhaps none of us was w i l l i n g to  share. I appreciated your f r i e n d l y , 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 i l l n e s s  107.  w  e  of  r  e  very d i f f i c u l t to do.but probably made me think more about the meaning  life.  The workshop format was excellent and I have no comments to make  on improvements.  I could not possibly teach a section on DSD.  I f i n d i t much too  d i f f i c u l t to l e t myself become completely involved i n an emotional experience such as t h i s .  For t h i s reason I know I d i d not benefit as I might have from  these sessions. It has, however, reinforced my awareness of l i v 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 r e a l l y l i k e d s t a r t i n g and ending on time. The questionnaire on DSD I found a b i t d i f f i c u l t because there were a l o t of 'I would not... then I had to figure out whether I agreed/disagreed with r  the negative s i t u a t i o n , and then f i n a l l y to what degree.  I felt  concerned  because I was to do i t quickly and I couldn»t because there were a l o t of "words" to think thru. I enjoyed the systematic approach, i . e . t h i s i s 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 t o gather my thoughts.  I valued getting together with people who want to t a l k about death and r e a l i z e 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 i n any of my thinking but the  seminars  helped me confirm my own ideas and attitudes and a r t i c u l a t e them i n a group. To a r t i c u l a t e these ideas and r e a l i z e that people were open to these thoughts strengthened me.  I r e a l i z e now that I should l i v e each day as i t i s my  last.  I l i k e d .everything about the course although parts were heavy, i . e . terminal i l l n e s s and eulogy but to me they were " r e a l " and where i t i s "at". Therefore I did grow!  Questionnaire confusing and d i f f i c u l t to respond t o . Found group discussion interesting as 2 members had experienced death of a mate.  Seemed each was i n d i f f e r e n t stage of adjustment.  Certainly an eye-  opener to process. Personal perspective exercise most revealing.  C l a r i f i e d my fears  greatly, i . e . think can handle fear of "sudden death" better. F e l t eulogy useful as s e l f - d i s c l o s u r e device,^i.e. attutude towards oneself.  Might be interesting i n classroom setting to have a f r i e n d 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.  ent approach me with the fact her father dying of cancer. s i t u a t i o n better as a r e s u l t of t h i s workshop.  Had a stud-  Feel I handled  Thank you.  .Possibly the best part of the workshop was the accepting attitude (very d i s t i n c t l y communicated to the group) of death as a part of the l i f e process.  109.  T h i s was  communicated not n e c e s s a r i l y through the v a r i o u s " d e v i c e s " , but  simply i n Denis r e l a t i n g h i s p e r s o n a l e x p e r i e n c e s the "stages" of  and  i n t h e d i s c u s s i o n s on  death.  Found i t o v e r a l l worthwhile. L i k e d f i n a l evening it  o f one main t o p i c b e s t because on f i r s t  seemed would j u s t g e t g o i n g and  Am  l o o k i n g forward  i t was  time t o  nights  quit.  t o r e a d i n g some o f the r e s o u r c e m a t e r i a l and  f u l l y g a i n some f u r t h e r i n s i g h t i n t o t h e t o p i c o f death and  Thank  two  hope-  dying.  you.  I l i k e d having i l l n e s s and how  t o be put i n t o t h e r e a l i t y o f t h i n k i n g I had  I would d e a l w i t h  i t . In f a c t I r e a l l y found  a terminal  a l l o f the  w r i t t e n assignments u s e f u l .  It  sure made me  appreciate l i f e  The  q u e s t i o n n a i r e was  r e a l l y c o n f u s i n g w i t h the double n e g a t i v e s , e t c .  The  gr^oup work might have worked out b e t t e r i f people  know each o t h e r q u i t e so w e l l . it  again.  One  o r two  i n my  group d i d n ' t  people d i d n ' t f e e l l i k e g e t t i n g i n  (and I r e s p e c t t h a t ) but i t sure made i t hard f o r the r e s t o f us t o get  into.  It  scarestme t o t h i n k t h a t people w i t h t h i s b r i e f exposure and  t h i n k i n g w i l l i n f a c t t r y t o t e a c h the  It  was  topic.  good t o hear about a programme someone e l s e has  tried.  minimal  110. It  I  w o u l d h a v e l i k e d t o h e a r a n d know a g r e a t d e a l more a b o u t  Ross.  I  w i s h t h a t I had r e a d a l l h e r books  one a f t e r t h e 1st l e c t u r e . is  one i n  I  also wish I  before I  session.  group perhaps  had r e a d h e r b i o g r a p h y  I  f e e l t h a t t h e f i l m was t o o l o n g .  i t w o u l d h a v e b e e n OK t o s e e j u s t h a l f .  Many o f u s h a v e b e e n e x p o s e d t o much o f w h a t i t  Perhaps  - if  of there  h a v e f o r m e d one g r o u p  i n a series  It  For  our p a r t i c u l a r  was a n o l d  film.  said.  i t would have been a good i d e a t o g i v e  1 s t t i m e we a t t e n d e d p e r h a p s  e v e r y o n e a number  o f 6 a n d a l l t h e number, l ' s  the could  a n d t h e n f r i e n d s who came t o g e t h e r w o u l d h a v e b e e n  l i k e l y t o end up i n t h e same  less  group.  would 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 .  I  attended instead  existence.  The 2nd  I  Kubler-  The w o r k y o u a r e d o i n g i s  d i d not attend t h i s  series  the approach t o t e a c h i n g .  I  terrific,  because  of i n f o r m a t i o n I would r e c e i v e  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  on  approa-  ches a t e r m i n a l l y i l l person.  A most v a l u a b l e w o r k s h o p ! t o r e a l i z e m o r t a l i t y though happiest about i s  I'm  I r e a l l y f e e l I've  b y no means a l l t h e way t h e r e .  t h a t t h e next t i m e I'm  c o m p l e t e l y f r e a k out as  I  begun t o l e a r n about  personally  have i n t h e p a s t .  I  think I w i l l  b u t n o 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 ) .  little  more h e l p t o t h e p e o p l e I  As t e a c h e r , I  The a s p e c t  involved w i t h death I  e m o t i o n s a n d 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 loss  I'm won't  u n d e r s t a n d my  f e e l i n g - mourning  Hopefully, I  can be o f  c a r e a b o u t when t h e y a r e i n t h i s  plan to attempt t o share  death,  some o f t h i s w i t h my  the a  experience.  kids.  111. Yes - i t ' s important. Best though rough!  -  discussions i n group terminal i l l n e s s experience eulogy thing (MOST hard!)  Best not rough  your summaries, Anne too  Not so best  films - so dated! though).  (I r e a l i z e your problem  1st one the best,  maybe some other approach to consumer thing panel of people r e l a t i n g experiences? Super workshop. (PS  Excellent organization, etc.  Best spring I've had i n terms of f e e l i n g i t - sun, fiLowers and  all.  Didn't r e a l i z e connection between a l l t h i s thinking t i l l you mentioned i t ) Thanks.  Most worthwhile - the eulogy - the i c i n g on the cake f o r me - r e a l l y made me aware of my l i f e and how I can make me a happier person. I wonder i f t h i s 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 r e a c t i o n s . Another advantage would be the closeness that would develop within the group which did i n the f i n a l evening, but I wished i t had done so e a r l i e r . A suggestion f o r the terminal i l l n e s s exercise - i f people are finding i t d i f f i c u l t , use the exercise that someone close i s dying and how would they r e a c t .  Then move on to t h e i r own death.  I used that exercise myself  to get into the question. Classroom session with Ann very i n t e r e s t i n g .  I f e l t the student  112. evaluations a b i t long - we are already members of the converted so we believed her.  She set out excellent directions f o r classroom presentations.  I r e a l l y found i t to be three worthwhile evenings.  Denis, thanks f o r  your time.  Denis you so kindly thanked us f o r attending the workshop on DSD, I would l i k e to thank you f o r giving us such a worthwhile I am a very emotional person.  project.  I am married with two c h i l d r e n .  I really  love my children and husband (every normal person does that I) and the thought of death used t o 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 r e a l l y good job. and very organized.  The workshop was well planned  I r e a l l y 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 l i k e d .  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 r e a l l y do f e e l that t h i s has helped me to begin to deal with death. topic that I've wanted to avoid. h e l p f u l f o r me.  This has always been a scary  This t h i r d session has been  I t has helped t i e a l o t o f things together.  particularly Thanks.  113. I f e e l that t h i s workshop i s excellent for me. ience i n a l l aspects of death.  I have gained exper-  My experiencexin death, whether i t i s regard-  ing emotions or consumerism i s t o t a l l y 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 i n my own  situation.  Good, good, good!  IJm r e a l l y glad I attended.  However, I f e e l that there  was not enough - i e more time needed, a l i t t l e , t o o s u p e r f i c i a l . l i k e every time I (and others) was  I t seems  "getting into i t " - i t was over.  I think  the simulation exercises (terminal i l l n e s s , eulogy) were p a r t i c u l a r l y worthwhile.  They covered feelings and ideas with which I was already f a m i l i a r  but Itwas forced to deal with them more i n depth.  I can't r e a l l y say much  more - what I already knew or suspected was confirmed.  I would l i k e to get  more involved i n trying to explore and understand  The f i l m on funerals  DSD.  was revealing, the resources ( l a s t session) very h e l p f u l . Oh yeah - the +1, -1 etc. was rather confusing. How,  I don't know!  Thank you.  Try and make i t simpler.  Good luck.  I could use more time to b u i l d r e l a t i o n s h i p s i n the group i n order to get below the surface. enough.  Seeing one h a l f the f i l m on funerals would have been  Does your questionnaire have to be double negatives?  more time on the topic with a group of strangers.  I would spend  Ann's s i t u a t i o n i s  d i f f e r e n t , because she has her students over a longer period of time.  114. I found i t a l l valuable, as I have never r e a l l y discussed t h i s topic before.  I enjoyed both films and a l l discussions.  I t was nice to know that  others share my concerns or look at the idea of dying more p h i l o s o p h i c a l l y or r e l i g i o u s l y than I do.  I found i t useful to discuss t h i s topic and f e e l  my feelings because, although I don't often think about DSD, I do have strong feelings about i t , esp. with regard t o my own death.  I hope I can learn to  l i v e the better l i f e I have resolved to l i v e tonight f o r a long time to come, and not s l i p e a s i l y back into a state of taking days,' weeks, months, years, etc.,  f o r granted.  Have gained much from t h i s workshop - e s p e c i a l l y have confirmed within myself the fact that I have been avoiding the r e a l i t y 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 f o r sharing your ideas!  You've made me do a l o t of  thinking.  very good feelings about 1st session, f i l m "Great American Funeral"wwas too long found Anne's sharing of what she did i n the classroom very u s e f u l .  The whole experience  has been most worthwhile.  As a r e s u l t of f i r s t  l i s t e n i n g to Anne, doing some reading and also attending the workshop, I have started to think and talk about death. been denying and avoiding i t .  I think that up to now I had  I have discussed t h i s with my father, my  115. husband.  I f e e l that I have made.it easier f o r students and friends to  share t h e i r experiences and feelings with me ( I t amazed me how anxious some people are to t a l k about t h i s - and only need to know that you f e e l comfortable i n sharing with them). Although I teach Family Dynamics, I probably won't teach t h i s topic t h i s 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 i n my group - l!m s t i l l t r y i n g to sort out why I not f e e l trusted?  - i s i t me?  Did  At least I have been able to t a l k to others - so t h i s  has not been a problem.  I t ' s hard to i s o l a t e any p a r t i c u l a r part that was  worthwhile - i t has been a t o t a l experience f o r me - with each meeting, reading, discussion with family, f r i e n d s , etc., b u i l d i n g on what has come before.  Thank you very much f o r sharing with us - i t has been a r e a l  'growing' experience f o r 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 b e a u t i f u l experience. Keep up the good work - everybody needs more of t h i s sharing. Good luck i n your work.  I f e l t the workshop was most worthwhile but I'm not r e a l l y sure that my death acceptance i s "gut" or "head".  I have no fear of my own death but I  know I w i l l miss my r e l a t i v e s and friends should they d i e .  116. t  Problems that have arisen during the workshop period are not due to the workshop but due to a f r i e n d who experienced a seance and had contact with a "dead s p i r i t " .  This has bothered me most.  l i f e after death seems wierd.  I believe this person and  No matter what - " l i f e " goes on u n t i l death.  Sorry f o r the rambling - I r e a l l y l i k e to think and t h i s has helped r a i s e new questions. My problem i s your term "heavy". were not "heavy" f o r me. You make" them too ominous.(sp)„ Death r e a l l y e x i s t s . Thanks.  These questions and topics are or  Appendix  117.  D.  THE COLLETT-LESTER FEAR OF DEATH SCALE A MANUAL  DAVID LESTER R i c h a r d Stockton. S t a t e C o l l e g e .  THE SCALE Here i s a series of general statements. You are to indicate how much you agree or disagree with them. Record your opinion i n the blank space in front of each item according to the following scale: +1 s l i g h t agreement +2 moderate agreement +3 strong agreement  -1 s l i g h t disagreement -2 moderate disagreement -3 strong disagreement  Read each item and decide quickly how you f e e l 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 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26  I would avoid death at a l l costs. I would experience a great loss i f someone close to me died. I would not f e e l anxious i n the presence of someone I knew was dying. The t o t a l i s o l a t i o n of death frightens me. I am disturbed by the physical degeneration involved i n a slow death. I would not mind dying young. I accept the death of others as the end of t h e i r l i f e on earth. Ilwould not mind v i s i t i n g a senile f r i e n d . I would e a s i l y adjust a f t e r the death of someone close to me. 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. I would avoid a friend who was dying. Dying might be an interesting experience. 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 died. I view death as a release from earthly s u f f e r i n g . The pain involved i n dying frightens me. I would want to know i f a f r i e n d were dying. I am disturbed by the shortness of l i f e . I would not mind having to i d e n t i f y the corpse of someone I knew. I would never get over the death of someone close to me. 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. I do not think of dead people as having an existence of some kind. 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 . Not knowing what i t feels l i k e to be dead does not bother me. I f I had a f a t a l disease, I would l i k e to be t o l d . I would v i s i t a f r i e n d on his/her deathbed. The idea of never thinking or experiencing again a f t e r I die does not bother me.  118.  27 28 29 30 31 32 33 34 35 36  I f someone close to me died I would miss him/her very much. I am not disturbed by death being the end of l i f e as I know i t . I would f e e l anxious i f someone who was dying talked to me about i t . The i n t e l l e c t u a l degeneration of old age disturbes me. I f a friend were dying I would not want to be t o l d . I could not accept the f i n a l i t y of the death of a f r i e n d . It would upset me to have to see someone who was dead. I f I knew a f r i e n d were dying, I would not know what to say to him/her. I would not l i k e to see the p h y s i c a l degeneration of a f r i e n d who was dying. 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 i s designed to assess four separate fears of death: fear fear fear fear  of of of of  death death dying dying  of of of of  oneself others oneself others.  Each subscale contains items keyed p o s i t i v e l y and items keyed negatively. Thus, although the scale i s scored as any conventional Likert-type scale, care i s needed i n distinguishing the items of each scale and i n distinguishing the p o s i t i v e l y keyed and the negatively keyed items. The d i s t r i b u t i o n of items i s as follows: positive  negative  death of s e l f  1, 4, 17, 20  6, 14, 23, 26, 28  death of others  2, 13, 19, 27, 32,  7, 9, 18, 21  33 dying of s e l f  5, 15, 30, 36  12, 24  dying of others  11, 22, 29, 31, 34, 35  3, 8, 10, 16, 25  NOTE:  The f i n a l score you get f o r any subject for each scale has no meaning by i t s e l f . I t has meaning only i n r e l a t i o n 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 i s l o g i c a l l y possible with t h i s scale i s 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 f o r a variety of subject populations.  BIBLIOGRAPHY of my studies using the scale C o l l e t t , 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" i n adults. Psychol. Rep., 1970, 27, 806. Lester, G., £ Lester, D. The fear of death, the fear of dying, and threshold differences f o r death words-'.and neutral words. Omega, 1970, 1, 175-179. Lester, D. Relation of fear of death i n subjects to fear of death i n t h e i r parents. Psychol. Rec., 1970, 20, 541-543. Lester, D. Religious behavior and the fear of death. Omega, 1970 1970, 1, 181-188. Lester, D., £ C o l l e t t , L.J. Fear of death and s e l f - i d e a l discrepancy. Arch. Found. Thanatol., 1970, 2, 130. Lester, D. Attitudes toward death i n a non-disturbed population. Psychol. Rep., 1971, 29, 386. Lester, D. Attitudes toward death held by s t a f f of a suicide prevention center. Psychol. Rep., 1971, 28, 650. Ford, R.E., Alexander, M., £ Lester, D. Fear of death i n a high stress occupation. Psychol. Rep., 1971, 29, 502. Alexander, M., £ Lester D., Fear of death i n parachute jumpers. Percept, Mot. S k i l l s , 1972, 34, 338. Lester,, D. Studies i n death attitudes: Part Two. Psychol. Rep., 1972, 30, 440. Lester, D. , Getty, C , £ K n e i s l , C. Attitudes of nursing students and nursing f a c u l t y toward death. Nurs. Res., 1974, 23, 50-53. CITATIONS o f the scale (obtained from Science C i t a t i o n Index) Dickstein, L. Psychol. Rep. , 1972, 30, 563. Sarason, I.G. Ann. Rev. Psychol., 1971, 22, 393. Durlak, J.A. J . C l i n . Psychol. , 1972,28,545. Hersen, M. Psychol. B u l l . , 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 a s s i s t users. Correlations Between Subscales s  a  m  p  l  e  nurses soph, jun. sen. 1st yr. grads2nd y r ggrad. faculty Intro Psych Ss Abnorm Psych Ss Psych course for nonmajors  n  32 40 55 33 32 62 40 28 33  DS DO  DS DyS  DS DyO  DO DyS  DO DyO  DyS DyO  21 20 56 36 57 . 26 26 28 22  49 19 60 60 54 38 52 29 . 31  . 24 32 47. 38 -09 35 . 31 •30 02  26 -06 40 19 54 13 14 09 . 27  50 49 33 -17 44 40 57 19 -16 01 41 42 . 37 33 35 39 45 .' 37  ( A l l correlations are product-moment correlations.) Correlations Between Scales and Other Fear of Death Scales Product-moment correlations between the Lester (1967) fear of death scale and n nurses soph. jun. sen. 1st yr grad. 2nd yr grad. faculty Intro Psych Ss Abnorm Psych Ss Psych course for nonmajors  32  32, 40 55 33 32 62 40 24 33  DS  DO  DyS  DyC  • 16 53 60 58 62 56 61 34 38  -27. 01 37 -17 28 10 -04 -25 -10  25' 18 25 53 18 09 36 09 34  10 17 31 39 -13 17 17 04 02  Other scales have been correlated with the C o l l e t t - L e s t e r scale - see Durlak (1972). Lester, D. Fear-of death of s u i c i d a l persons. 20, -1077-1078.  Psychol. Rep., 1967  Durlak-,- J.A. Measurement of the fear .of death."J. C l i n . Psychol., 1972, 28, 545-547.  121.  Factor Analysis  r  Although the basis of the iscales, presented here i s i n terms of t h e i r face v a l i d i t y , . i t i s of i n t e r e s t . t o explore.inter-item c o r r e l a t i o n s . . Accordingly, the data from 241 female:subjects who completed the scale f o r the study reported by Lester,.et a l . (.1974) were subjected to a f a c t o r - a n a l y s i s 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 f a c t o r s were extracted. FACTOR Item  1  2  3  DS+ D0+ DyODS+ DyS+ DSD0DyOD0DyODyO+ DySD0+ DSDyS+ DyODS+ D0DOt DS+ D0DyO+ DSDySDyODSD0+ DSDyOt DyS+ Dy0+ DOt DOt DyO+ Dy0+ DySt  29 14 -16 52 05 -55 -08 -15 -22 -10 08 -25 18 -11 27 -07 65 -20 11 72 12 06 -57 -11 01 -76 01 -75 12 08 04 17 28 17 02 25  29 05 -06 • -03 04 07 03 04 01 -76 03 -23 09 -12 -03 -12 21 06 -01 11 -14 15 -10 -82 -19 02 14 -09 03 07 46 02 21 02 -07 -10  23 05 -35 27 12 -02 -12 -07 -11 -04 14 -24 06 07 35 -07 03 -49 03 12 08 72 -32 -09 -14 -13 09 -15 75 11 17 19 51 57 59 38  % total variance  18%  6%  1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36  6%.  4  5  -06 . 20 01 80 -04 -05 09 02 -09 -02 -25 -39 02 -06 -03 02 14 -50 -01 -16 -05 07 -05 -59 -57 -11 -51 -04 04 05 09 • 02 02 17 10 -34 02 10 03 03 63 -17 04 02 -08 24 -01 -03 -14 31 -01 01 04 77 -12 -14 03 -01 -06 11 04 -15 -05 -03 01 09 11 09 -03 04 02 11 . .5% . .5%  6  7  8  -13 -01 01 21 07 -08 -08 16 -30 12 -02 -07 -07 02 16 -10 14 09 8.0 07 -19 07 -02 -10 -13 -05 05 -11 01 -02 11 78 20 10 06 06  -16 06 18 -28 -25 15 -71 -25 -10 02 05 06 14 -28 -27 -05 11 20 01 07 02 18 10 -04 01 04 01 -16 -16 18 -11 06 -01 14 16 -31  31 03 66 -16 -05 -05 -03 12 37 16 06 -06 01 41 38 03 05 18 01 14 01 -04 08 -08 03 08 -01 18 -07 -01 -01 -01 -11 -08 27 04  .4%.  4%  . .3%  9 -12 03 05 -06 01 02 04 34 -04 09 -73 16 32 -06 -11 07 01 28 -06 09 30 01 .10 03 67 06 . 07 06 -07 03 -10 -01 -05 -16 -01 24 3%  10  11  -24 10 -09 26 70 07 04 -47 19 01 -01 16 16 -16 32 12 21 06 03 18 -01 01 11 -06 02 -02 08 01 10 70 07 02 -01 18 36 48  -07 -01 -05 -08 02 -07 -01 -33 06 -07 23 09 17 -09 08 -80 07 -06 11 14 18 05 23 -12 09 -05 -16 -01 06 -22 55 03 -01 02 06 06  3%  3%  It can be seen from t h i s that the f a c t o r i a l structure of the.scale i s quite complex. Factor 1 appears to embody fear of death of s e l f , and f a c t o r 3 fear of dying of others. The other f a c t o r s are mixed. However, s i g n i f i c a n t correl a t i o n s between the d i f f e r e n t fears are t o be expected and the devising of mathematically unrelated scales may be impossible.  

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