As people approach the end of life, changes occur and special challenges arise. Growing older means confronting many psychological, emotional, and social issues that come with entering the last phase of life.
Erikson: Integrity versus Despair
As people enter the final stages of life, they have what Erik Erikson termed as a crisis over integrity versus despair. In other words, they review the events of their lives and try to come to terms with the mark (or lack thereof) that they have made on the world. People who believe they have had a positive impact on the world through their contributions live the end of life with a sense of integrity. Those who feel they have not measured up to standards, either personal or societal, develop a sense of despair.
People perceive death, whether their own or that of others, based on the values of their culture (Figure 1). People in the United States tend to have strong resistance to the idea of their own death and strong emotional reactions of loss to the death of loved ones. Viewing death as a loss, as opposed to a natural or tranquil transition, is often considered normal in the United States. Theorists have proposed that people go through five distinct stages upon dealing with death and dying, known as the stages of grief. The stages of grief are as follows:
- Denial- People believe there must be some mistake. They pretend death isn't happening, perhaps live life as if nothing is wrong, or even tell people things are fine. Underneath this facade, however, is a great deal of fear and other emotions.
- Anger- After people start to realize death is imminent, they become angry. They believe life is unfair and usually blame others (such as a higher power, or doctors) for the state of being they are experiencing.
- Bargaining- Once anger subsides, fear sets in again. Now, however, people plead with life or a higher power to give them more time, to let them accomplish just one more goal, or for some other request.
- Depression- The realization that death is near sets in, and people become extremely sad. They may isolate themselves, contemplate suicide, or otherwise refuse to live life. Motivation is gone and the will to live disappears.
- Acceptance- The realization that all forms of life, including the self, occurs, and people accept that life is ending. They make peace with others around them, and they make the most of the time they have remaining.