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Make Death an Acceptable Word


Published: March 30th, 2017

By Hui Wang, Student Reporter for NC. State University


North Carolina - If you think the two checklists are not enough to help you and your dying family
member to deal with the tough issue of death, you should check out this article, to see whether
you might need to find some psychotherapists or learn to behave like one.


Culkin (2002) shows readers the idea of providing psychotherapy to dying person. The idea of
psychotherapy comes from the discovery that dying persons have many obscure psychological
changes that have not been experienced either by themselves or by their family members. Such
sudden and constant changes make dying patients mysterious and hard to be understood in
many perspectives.

According to Culkin, modern psychotherapies are divided into four approaches: psychodynamic,
humanistic, behavioral, and family therapy. While, most patients and family members are not
concerned about what kind of psychotherapy they will have, as long as it works. So, the actual
effectiveness weighs a lot in this process. One key difference between psychotherapy for dying
patients and for normal people lies that the former has a very stressful limit on time. It
emphasizes short term mental and behavior changes, rather than long term changes in
personality. Whats more, the purpose of the psychotherapy is not helping the patients to
recover or get back to the normal status, but helping them to form an appropriate and positive
attitude and response toward death. To sum up, psychotherapy is to prepare death an accepted
word for both patients and family members.

Before we decide to receive psychotherapy, we should know the possible reasons that make such
therapy needed. A more simplified question can be put in this way: why does dying people
undergo dramatic psychological changes. My personal experience of taking care of Grandpa
proves that dying patient is easy to misunderstand others kindness, to become crusty and
cynical, and to get moody for no obvious causes. Such weird and sudden changes make family
members frustrated and desperate. Culkin reminds us that this is probably because the dying
person has sensed a loss of control of self, apart from the suffering of physical turmoil. His life is
experiencing a degrading from the level of fullness and meaning to the level of limitation and
nothingness. Whats more, he can do nothing to make a difference in this situation. Such a loss
of control makes him undergo several rounds of psychological development before the final stage
of death, from the ego integrity before the critical situation in health, to the fear of the
unforeseeable future, to later concern over self and family members, to defense system or
blaming toward the outsiders, to immature and dependable thought and behaviors toward
family members, then to despair, and to the final acceptance of death. We do not mean every
dying patient experiences the whole series of psychological changes or in the fixed order as
described above, but most of them will go through most of the stages. That is to say, we, as the
ones who dont want our loving family member feel helpless and suffering, should be clear of
these psychological changes and the proper ways to deal with or conquer them.

As for the four approaches of psychotherapy mentioned earlier, I would like to emphasize the
psychodynamic approach, based on the case of Grandpa. If you are interested to learn more of
the other approaches, you can read the article Psychotherapy with the Dying Person written by
Joseph Culkin (2002).

The psychodynamic approach is concerned with the dying patients psychological development
or changes. The development of ego integrity to ego despair or nothingness is something difficult
to accept for everyone. Therapist and family members should pay attention to the psychological
turmoil in the patients, which is more suffocating than physical turmoil. A lot of the psychological
status mentioned above have occurred to Grandpa during the process of his physical treatment.
At first, he was quite unwilling to receive treatment, as he believed he could conquer the illness
and recover soon by himself. His stubborn resistance was a headache for family members. From
the article, I know this is his insistence on keeping his control of self. Later, when he realized that
he could not recover by himself, he became quite cooperative in treatment, though he
sometimes suffered from mood swings. Generally speaking, he was quite considerate and
appreciating for what doctors and family members did for him. Later, when his illness got severe
and the treatment did not make much change or reduce much pain, he grew fearful and doubtful.
Anyones comment or unintentional words could cause his sudden depression or isolation. He
began to speak less about how he felt and what he wanted. He became less optimistic of
regaining his control of self. It seems this was a critical turning point for him. While, what we
family members did then was lying to him, saying he would get well soon, and even asked doctors
to conceal the factual situation from him. We had made a lot of fancy but empty dreams for him.
We thought this could help him to recover the confidence and will to live. After reading this
article, I discovered that we made the first mistake at that time. Instead of lying to him and
concealing the real situation, we should have had a good conversation with him about the
possible future he might have and discussed a plan to give him more control of self. Later, with
illness turning worse, he grew less care of whats going on around him, as he was passively
resistant to any medical suggestion from doctors. After that, he went through a stage of anxiety
and concern for whats going on after his death. One thing that is quite obvious is that he
constantly asked us to take good care of Grandma if he passed away one day. He talked about
such things in a very peaceful and calm manner, so my family members thought he was ready for
his death and had no living desire. Considering this, we always prevented him from talking about
this unlucky topic, and told him that he would not die, and we would not take care of Grandma
if he did not cooperate with his treatment. We did and said this to him, in order to encourage his
will to survive. But the article says family members should relieve the dying patients from their
anxiety and concern. Instead of avoiding these topics, they should assure the dying patient that
things will be settled well after the death. So, my family members made the second mistake and
worsened Grandpas psychological situation. Probably because of our ignorance and mistakes,
things turned worse when he began to curse things happening on him and people taking care of
him. He often complained about his family members by threatening to commit suicide. Family
members felt disappointed and saddened for his response to family members devotion and
sacrifice. He became more furious and unreasonable. We did not know what he really needed.
We thought all he needed was stronger medication and hope, but it should be security, affection,
support, dignity and self-expression. Such an ignorance made things worse when he became
completely dependent on others, as he lost many of his basic living abilities. That was a tough
time for both Grandpa and family members, as both sides saw nothing promising. It seems
everybody could do nothing but wait for his death. Although he was quite dependent, he was still
resistant to a lot of treatment and nursing. So, our family members made a lot of decisions for
him, against his resistance. As a matter of fact, he has undergone some painful surgeries to rescue
himself from several rounds of critical situation. I have seen him plugged with lots of pipes on his
body, suffering in pain but could do nothing in ICU. He looked so fragile and helpless in front of
those powerful machines. We family members thought being alive was the priority for him. The
article has taught me another lesson that it is the dying patients personal will that should
determine the treatment to receive. Family members should respect their decision, if they
choose to end his life in dignity and free from over-medicalization. Many patients do not want to
leave the last image of being treated like a breathing body supported by machines to family
members. After reading the article, I found this is the third mistake we have made. This stage
lasted for a couple of years, before he finally relieved himself from pain by taking a large dosage
of sleeping pills secretly one night. Some of my family members felt regretful for not giving him
enough attention. Some of us thought this was a hard and crucial way to end his life. Due to the
decision made secretly by Grandpa, we did not talk to him much, as he became sleepy all night
till his last breath in the next morning. After reading this article, I become realized that this is not
a healthy way to say Goodbye to each other, as both of us were not ready for such an eternal
farewell. Family members might still bear misunderstandings and grumble for Grandpa, while
Grandpa might not be assured that Grandma would be taken good care of. It is suggested in the
article that family members should give a chance to let the dying person have a life review if he
could speak, or let family members do a review for him. This is a chance to clear away all the
unhappy feelings for both sides, before time allows.

Generally speaking, the psychodynamic approach could help patients know and control their
psychological development during the physical treatment. If family members have known these
changes before they happen, they could have more understanding of some of the seemingly
weird and ridiculous actions and words, and adopt an appropriate way to deal with such
psychological turmoil. Whats more important, based on the understanding, they can think of
more effective method to make patients feel better about their current psychological situation.

Psychotherapy is far from a panacea for dying patients, as it cannot exert magic on physical
condition. Also is true that psychotherapy cannot make death desired, but it can make death
more accepted and less terrifying, by doing something practical and achievable.