Talking about death and dying: Findings from deliberative discussion groups with members of the public.

Talking about death and dying is promoted in UK health policy and practice, from a perception that to do so encourages people to plan for their end of life and so increase their likelihood of experiencing a good death. This encouragement occurs alongside a belief that members of the public are reluctant to talk about death, although surveys suggest this is not the case. This paper describes findings from a research study in which people participated in deliberative discussion groups during which they talked about a range of topics related to death, including talking about death, the good death, choice and planning and compassionate communities. Here we report what they had to say in relation to talking about death and dying. We identified three themes: 1. The difference between talking about death as an abstract concept and confronting the certainty of death, 2. how death and dying presents issues for planning and responsibility, and 3. approaches to normalising death within society. For our participants, planning was considered most appropriate in relation to wills and funerals, while dying was considered too unpredictable to be easy to plan for; they had complex ideas about the value of talking about death and dying.

Does Psychosocial Ego Development Partially Mediate the Association Between Defense Mechanisms and Death Attitude?

Some authors suggest the existence of links between the mechanisms of defense and attitude toward death, however, mechanisms underlying these relationships are not well understood. The objective of the present research was to investigate whether psychosocial ego development is a partial mediator in the association between mechanisms of defense and death attitude. The study included participants (N = 382) aged 19-85 (M = 47.02, SD = 16.19). Three measures were used: Defense Style Questionnaire-40, Psychosocial Inventory of Ego Strengths, and Death Attitude Profile-Revised. Findings partly confirmed the hypotheses. Psychosocial ego development is a partial mediator in positive relationships between maladaptive defenses and fear of death, death avoidance, and escape acceptance. Psychosocial ego development is also a partial mediator in the positive association between more adaptive defenses and approach acceptance. The study provides novel information on the mechanisms underlying the association between defense mechanisms and multidimensional death attitude.

The hospice as a learning space: a death education intervention with a group of adolescents.

BACKGROUND: The denial of death in Western society deprives young people of the tools to derive meaning from experiences of death and dying. Literature shows that death education may allow them to become familiar with this topic without causing negative effects. This article describes the effects of a death education course with adolescents, wherein participants were given the opportunity to meet palliative doctors and palliative psychologists at school and in a hospice, where they were able to converse with the families of the dying. METHODS: This study used mixed methods and included an evaluation of a death education intervention with longitudinal follow-up of outcomes. The course involved 87 secondary school students (experimental group) aged between 16 and 20 years. We also recruited a control group of 76 similarly-aged students to observe differences. The variables we examined were: alexithymia, representation of death, value attributed to life and spirituality. These were measured with the following instruments: the Toronto Alexithymia Scale-20, the Testoni Death Representation Scale, the Personal Meaning Profile and the Spiritual Orientation Inventory, respectively. To better understand how the students perceived the experience, we asked the experimental group to answer some open-ended questions. Their answers were analysed through thematic analysis. RESULTS: The study showed that death education and the hospice experience did not produce negative effects, but rather allowed students to decrease alexithymia, improving their ability to recognise and express emotions. Thematic analysis revealed that all participants perceived the experience as very positive. CONCLUSIONS: Our findings affirm that death education programs can be successfully implemented in high schools, and that they can usefully involve local hospices and palliative care professionals, especially physicians and psychologists.

Journalistic Denial of Death during the Very First Traumatic Period of the Italian COVID-19 Pandemic.

Exactly one year ago, between February and March 2020, the COVID-19 infection went from an epidemic confined to China to a worldwide pandemic that was particularly lethal in Italy. This study examined the media accounts during that period by analysing the representation of death-related constructs in Corriere della Sera, the most widely read newspaper in Italy. A textual and thematic analysis of articles published between period A (epidemic: 23 January-22 February 2020) and period B (pandemic: 23 February-31 March 2020) was conducted using Nvivo-11. A total of 141 articles comprising 48,524 words were collected. The most utilised words and meanings linked to COVID-19 were computed. In the rank distribution, 'China' and 'virus' were the terms most frequently used in both periods. The terms 'death' and 'dead' were completely absent in period A and appeared in the 535th position in period B. The term 'dead' was used primarily to indicate the number of deceased. From a Terror Management Theory perspective, it is possible that the minimal reference to death-related issues was a reflection of death denial and a manifestation of efforts to deny death to manage terror. These findings highlight the ambiguities and ambivalence surrounding any issue pertaining to death; on the one side, undue alarmism may provoke exaggerated reactions, such as moral panic, while on the other denial-based messages that minimise references to mortality may reduce safe behaviour during a pandemic.

Intersections of personal vs. collective trauma during the COVID-19 pandemic: the hijacking of the human imagination.

This paper explores how the deadly shadow of COVID-19 passing over the Earth constitutes a collective trauma that frequently opens up or 'triggers' un-remembered personal trauma, and it provides clinical examples of these intersections. The paper further explores how the human imagination, which we normally utilize to make meaning out of traumatic experience, can be hijacked by fear - leading to avoidance of suffering and to illusory formulations and alternative realities such as conspiracy theories. Alternatively, the imagination can be employed in more realistic and creative ways - leading through conscious suffering to healing and wholeness. Which path the imagination takes is shown to depend on the capacity of individuals to feel the full reality of the human condition in general and the exquisite vulnerability of our existence as fragile human beings at this moment in history. Ernest Becker's analysis of our 'denial of death' and his urgency to embrace our common human vulnerability is explored in relation to Jung's early tendency to deny the body. The author proposes that the more creative uses of the imagination, connected to a more humble and realistic apprehension of our common destiny, may be seen in the 'Black Lives Matter' movement that swept the world in the aftermath of the COVID-19 outbreak.

Cet article explore comment l'ombre de mort de la COVID-19, passant sur la terre, constitue un traumatisme collectif qui souvent ouvre ou ravive un traumatisme personnel non-remémoré. L'article fournit des exemples cliniques de telles intersections. Il explore comment l'imagination humaine, que nous utilisons normalement pour donner du sens à nos expériences traumatiques, peut être détournée par la peur. Ceci mène à l'évitement de la souffrance et à des formulations illusoires ou réalités alternatives telles que les théories du complot. Mais l'imagination peut aussi être employée de manières plus réalistes et créatives, nous guidant à travers une souffrance consciente à la guérison et la complétude. Nous montrerons que le choix du chemin que l'imagination emploie dépend de la capacité des personnes à éprouver la pleine réalité de la condition humaine en général et la vulnérabilité magnifique de notre existence en tant qu'êtres humains fragiles à ce moment de l'histoire. L'analyse que fait Ernest Becker de notre 'déni de la mort' et son insistance à épouser notre vulnérabilité humaine commune est étudiée et mise en relation avec la tendance de Jung, au début de son œuvre, à renier le corps. L'auteur propose que les utilisations plus créatives de l'imagination, reliées à une appréhension plus humble et plus réaliste de notre destinée commune, peuvent se retrouver dans le mouvement Black Lives Matter, mouvement qui a balayé le monde à la suite de la flambée de COVID-19.

El presente trabajo explora como la sombra mortal del COVID-19 pasando sobre la tierra constituye un trauma colectivo que frecuentemente abre o 'activa' trauma personal no recordado. Se proveen ejemplos clínicos de estas intersecciones. El escrito además explora cómo la imaginación humana, la cual normalmente utilizamos para encontrar sentido a partir de experiencias traumáticas, puede ser apropiada por el miedo - conduciendo a la evitación del sufrimiento y a formulaciones ilusorias y realidades alternativas tales como las teorías conspirativas. Alternativamente, la imaginación puede ser empleada en modos más realistas y creativos - conduciendo a través del sufrimiento consciente a la sanación y a la integridad. Cual camino toma la imaginación, se muestra que depende de la capacidad de los individuos para sentir la realidad plena de la condición humana en general y la exquisita vulnerabilidad de nuestra existencia como frágiles seres humanos en este momento de la historia. El análisis de nuestra 'negación de la muerte' de Ernest Becker y su urgencia por acoger nuestra común vulnerabilidad humana es explorada con relación a la temprana tendencia en Jung de negar el cuerpo. El autor propone que los usos más creativos de la imaginación, conectados a una aprehensión más humilde y realista de nuestro destino común, puede ser vista en el movimiento Black Lives Matter que recorrió el mundo en las postrimerías del estallido del COVID-19.

German version of the Death Attitudes Profile- Revised (DAP-GR) - translation and validation of a multidimensional measurement of attitudes towards death.

BACKGROUND: In Germany, only limited data are available on attitudes towards death. Existing measurements are complex and time consuming, and data on psychometric properties are limited. The Death Attitude Profile- Revised (DAP-R) captures attitudes towards dying and death. The measure consists of 32 items, which are assigned to 5 dimensions (Fear of Death, Death Avoidance, Neutral Acceptance, Approach Acceptance, Escape Acceptance). It has been translated and tested in several countries, but no German version exists to date. This study reports the translation of the Death Attitudes Profile-Revised (DAP-R) into German (DAP-GR) using a cross-cultural adaption process methodology and its psychometric assessment. METHODS: The DAP-R was translated following guidelines for cultural adaption. A total of 216 medical students of the Heinrich Heine University Duesseldorf participated in this study. Interrater reliability was investigated by means of Kendall's W concordance coefficient. The internal consistency of the DAP-GR Scales was assessed with Cronbach's alpha coefficients. Split-half reliability was estimated using Spearman-Brown coefficients. Convergent validity was measured by Spearman's correlation coefficient. Content validity was assessed by means of confirmatory factor analysis (CFA). All statistical analyses were performed using SPSS 24 and AMOS 22. RESULTS: The items showed fair to good interrater reliability, with W-values ranging from .30 to .79. Internal consistency of the five subscales ranged from .61 (Neutral Acceptance) to .94 (Approach Acceptance). Split-half reliability was good, with a Spearman-Brown-coefficient of .83. The results of CFA slightly diverged from the original scale. CONCLUSION: Our results suggest overall good reliability of the German version of the DAP-R. The DAP-GR promises to be a robust instrument to establish normative data on death attitudes for use in German-speaking countries.