CRITICAL THINKING AND CASE ANALYSIS
1. What is the point of view about life and death that Morrie is developing?
2. Why is it difficult for most people to listen to a dying person express his or her thoughts about death?
3. What does this conversation suggest about Morrie's psychosocial development? To what extent are issues of intimacy, generativity, and integrity reflected in this dialogue?
4. How might the conditions of Morrie's illness influence his outlook on death?
5. What issues would you want to discuss if you had a mentor like Morrie who was willing to help you learn about living and dying?
The formulation of a point of view about death requires the capacity ro absorb the loss of one's close relatives and friends and to accept one's own death. The former task may be even more difficult than the latter, in that the death of peers begins to destroy one's social group. Losing one's friends and relatives means losing daily companionship, a shared world of memories and plans, and a source of support for values and social norms. The circumstances surrounding the deaths of others may also be very frightening. Older adults observe their peers suffering through long illnesses, dying abruptly in the midst of a thriving and vigorous life, or dying in absurd, meaningless accidents. After each death, the surviving adults must ask themselves about the value of these lives and subsequently about the value of their own life.
Death Anxiety
Fear of personal death, or death anxiety, is natural and normal. Death may be feared for a variety of reasons, some
The ritual of a graveside service helps mourners separate from their loved one before the burial. Many elements of a traditional U.S. funeral are depicted here: the casket and flowers, and the mourners gathered with a religious leader in a grassy, tree-lined cemetery.
of which relate to the actual process of dying and others to the consequences of it. Concerns about the process of dying include fears of being alone, being in pain, having others see one suffering, or losing control of one's mind and body. Concerns about the consequences of dying include fears of the unknown, loss of identity ("People will forgel about me") the grief that others will feel, the decomposition of the body and punishment or pain in the hereafter (Tomer & Eliason 2000).
Several researchers have considered the sources of personal anxiety about death and the changes in preoccupation with death at various ages. Although older adults seem to think about death more frequently than do young adults they do not appear to feel more threatened by it. In comparison to middle-aged adults, older adults experience lower death anxiety (Smoff, losipovici, Almog, & Barnett-G^ens, 2008). Among the elderly, it appears that the e who hym higher levels of self-worth and sense of masti ry o haw lower levels of death anxiety (Ron, 2010). In compari^B to those in early or middle adulthood, those in lat«_r aduh-hood know more people who have died and are more likely to have visited a cemetery or attended a funeral. Those in later adulthood are more likely to have made some specific arrangements related to their death, including purchasing cemetery space, writing a will, or making plans for their funeral. Their concrete experiences with the events of death, coupled with their own sense of mastery in preparing for their death may allow them to cope more effectively with their fears (Cicirelli, 2001).
What factors help older people cope with fears about death? Several resources have been identified. Psychosocial theory predicts that through acts of generativity, people experience satisfaction in guiding and nurturing future
generations. Achieving a positive resolution to the psychosocial crisis of generativity versus stagnation should help reduce death anxiety. One study designed to test this hypothesis found that the relationship of generativity to the fear of death was mediated by ego integrity, the positive pole of the crisis of later adulthood. Among those who were described as generative, the older adults who also had high levels of ego integrity had the least fear of death, supporting the theoretical notion of a progressive integration of ego strengths from one stage of life to the next (Bringle, 2007).
In addition to the achievement of a generative orientation, people who describe themselves as religious, those who have a strong social support system, and those who have a strong sense of self-worth are less likely to be preoccupied with the fear of death (Tomer & Eliason, 2000). Frey (2003) extended this perspective by focusing on the relationship of self-beliefs to death anxiety. Older adults who have a positive sense of self-efficacy have less fear of the unknown following death and less fear of the pain and suffering associated with dying. In particular, the sense of spiritual self-efficacy—one's perceived ability to generate spiritually based faith and inner strength—was strongly associated with low levels of death anxiety.
The Psychosocial Crisis: Integrity versus Despair
Objective 5. To explain the psychosocial crisis of integrity versus despair, the central process of introspection, the prime adaptive ego quality of wisdom, and the core pathology of disdain.
The conflict of integrity versus despair is resolved through a dynamic process of life review, introspection, and self-evaluation. Contemporary factors, such as health, family relationships, and role loss or role transitions, are integrated with an assessment of one's past aspirations and accomplishments. Thoughts of the past may be fleeting or a constant obsession. Memories may be altered to fit contemporary events, or contemporary events may be reinterpreted to fit memories. The achievement of integrity is the culmination of a life of psychosocial growth. Psychologically speaking, it is the peak of the pyramid, in that it addresses the ultimate question, "How do I find meaning in life given the ultimate reality of death?" Achievement of integrity in later adulthood inspires younger age groups to continue to struggle with the challenges of their own life stages.
Integrity
The term integrity, as it is used in psychosocial theory, refers to the ability to accept the facts of one's life and face death without great fear. As people get older, they need to
step back and find a way to integrate or reconcile the events of their life with the hopes and dreams they may have had in their early or middle adulthood. This process of meaning making involves an assessment of one's life and the extent to which worthwhile goals were sought and achieved. In a search for life's meaning, a person looks for a way to assemble a coherent story of order, purpose, and value out of the complex puzzle pieces of a life (Reker, 1997; Krause, 2004). The attainment of integrity is ultimately a result of the balance of all the psychosocial crises that have come earlier, accompanied by all the ego strengths and core pathologies that have accumulated along the way. Integrity comes only after some considerable thought about the meaning of one's life. Older adults who have achieved a sense of integrity view their past in an existential light. They appreciate that their lives and individuality are due to an accumulation of personal satisfactions and crises. Integrity is not so much a quality of honesty and trustworthiness—as the term is used in daily speech—-as it is an ability to integrate one's past history with one's present circumstances and to feel content with the outcome.
Most people have some regrets. One may look back and wish that one had taken advantage of certain opportunities, been smarter about saving or investing money, or spent more time with one's children while they were young (Baum, 1999). The challenge in achieving integrity is to face the decisions and experiences of the past with acceptance. In this process, a person seeks to find an integrative thread that makes sense of the life one has led without belaboring past mistakes.
Given the very abstract and subjective construct of integrity, how can it be measured? One approach was devised by Neil Krause (2007) who created a four-dimensional measure of meaning in life. These dimensions included: (1) having a system of values, (2) having a sense of purpose, (3) having goals to strive for, and (4) reflecting on the past to reconcile one's accomplishments with ones goals. Taken together, these four dimensions comprised a meaning in life scale. In a longitudinal study of older adults, Krause examined how various lorms of social support as well as anticipated social support related to meaning in life over a 4-year period. Those older adults who received high levels of emotional support had higher meaning in life, but those who received tangible social support bad lower meaning in life. Anticipated support, that is believing that you could call upon close family and friends for help if it were needed, was the strongest predictor of meaning in life. Over time, anticipated support was also a significant predictor of changes in a person's sense of meaning. When older adults are confident that they will be able to count on others for help in the future, their sense of meaning in life is bolstered. This finding speaks to the role of the radius of significant relationships in predicting and sustaining a sense of integrity in later adulthood. It also suggests a continuing role for trust and hope, the very earliest psychosocial concepts of infancy, in fostering integrity in late life.