ABSTRACT DEATH ACCEPTANCE AND INTIMATE RELATIONSHIPS by Hideaki Imai Although researchers have investigated death attitudes since the 1960s, only a few have examined death acceptance as a research topic. Furthermore, most of these studies focused on quantitative assessments without finding consistent results. In this study, I conducted a qualitative investigation on the role of intimate relationships in accepting death. I interviewed four older adult participants about their death attitudes and intimate relationships in semi-structured interviews. From the results, I found that the male participants needed to deepen their relationships before accepting death, whereas the female participants already had intimate relationships and were able to accept death immediately as they became aware of their mortality. DEATH ACCEPTANCE AND INTIMATE RELATIONSHIPS A Thesis Submitted to the Faculty of Miami University in partial fulfillment of the requirements for the degree of Master of Arts Department of Psychology by Hideaki Imai Miami University Oxford, Ohio 2013 Advisor________________________ Larry M. Leitner, Ph.D. Reader_________________________ Ann Fuehrer, Ph.D. Reader_________________________ Vaishali Raval, Ph.D. Table of Contents Introduction 3 My Story 3 Past Theorists and Researchers 4 Death Acceptance 5 Death Acceptance through Experiential Personal Constructivist Psychology 9 Method 10 Participants 10 Procedure 10 Analysis of Interviews 12 Results 12 Brian 12 Brian's Story 12 Brian and Death 12 Death-acceptance and Intimate Relationships 15 Member Check 20 Tammy 20 Tammy's Story 20 Tammy and Death 20 Death-acceptance and Intimate Relationships 23 Member Check 27 Ed 27 Ed's Story 27 Ed and Death 27 Death-acceptance and Intimate Relationships 30 Member Check 34 Quinn 34 Quinn's Story 34 Quinn and Death 34 Death-acceptance and Intimate Relationships 36 Member Check 39 Discussion 39 Summary of Findings 39 Limitations 40 Gender Implications 41 Relational Loss, Death Acceptance, and Intimate Relationships 41 The Experiential over The Intellectual 43 Clinical Implications 44 Final Thoughts 45 References 47 Appendix A 51 Appendix B 53 Appendix C 54 ii Introduction In this research project, I present a qualitative exploration of older adults' acceptance of death and the role of intimate relationships in the process of accepting death. By “death acceptance,” I mean the way in which the participant acknowledges his or her process of dying without being threatened by it. For defining intimate relationships, I use the concept of ROLE relationships within the theoretical framework of Experiential Personal Construct Psychology – relationships in which one person understands the ways in which the other construes the world (Leitner, 1985; Leitner & Faidley, 1995). In the initial conception of this project, I planned to work with terminally ill patients in order to start a conversation about death among the living. However, I have come to find out that I do not need to ask those who are actively dying to investigate death; rather, I can ask older adults who are aware and accepting of death to facilitate a discourse on accepting death and our intimate relationships. Though I initially sought to recruit participants from a hospice setting, I eventually worked with those who are either in a nursing home, or older adult community members. Before discussing the details of the study, I first will introduce my motivation behind pursuing this project. After introducing my personal motivation, I will discuss how my research question can be important for all of us who are living. Once I establish the personal and public importance, I will provide a review on the past psychological literature that investigated death acceptance. Following the literature review, I will discuss the theoretical framework in which this project operates. Specifically, I will present the way the concept of ROLE relationships fits with the concept of death-acceptance. After the theoretical discussion, I will explain how I executed this project in the Method section, introduce what I found in the Results section, and talk about implications in the Discussion sections. My Story As I planned to ask my participants to share their stories for this project, it is only fair that I disclose my story. Moreover, given that this is a qualitative study wherein the researcher’s interpretation of the data is explicit, I will reveal some aspects of my background that are relevant to this project. Hence, I will introduce my personal experiences with death and intimate relationships. My fascination with death started when I learned about the philosophy of death in a class on existentialism. Following my newfound academic passion, I decided to write my senior project on people’s attitudes towards death. The project was a psychological study on whether people’s death attitudes affect their psychological well being. Illustrating my newfound interest, I even dressed up as the grim reaper for the Halloween of 2008. Two weeks after Halloween, I received an email from my father in which he informed me that my grandfather had terminal cancer. During winter break, I flew to Japan to see my grandfather on his deathbed. As I saw him so thin and immobile, for the first time I realized that he was actually dying. As it was my last chance, I asked him questions about the entirety of his life – his childhood, his family, and his reasons for pursuing his profession – neurosurgery. Our last meetings were also opportunities in which I could tell him about my future aspirations – how I wished to be a therapist, a professor, and a psychologist. Essentially, we both sought professions in which we “help” people. Hence, it was meaningful that my grandfather could talk to me about the nature of “helping” from his experiences. Interestingly, it was the first time I felt as though I got to know my grandfather; I learned then the irony of realizing how much another individual means to me only when the relationship comes close to an end. As my winter break approached its end, I had to finish my hospital visits. I remember being nervous about saying goodbye to him. I was nervous, because I did not know what it was going to be like to see a person, a family member, for literally the very last time in my life. What strongly resonates is the image of him staring back at me, as I looked into his eyes – it gave me a convincing impression that he too knew it was going to be his last time seeing me in his life. 3 After returning to the United States, I received an international call from Japan on my birthday, February 16th, right in the middle of my data collection for my undergraduate death project. I heard my father on the other end, weeping for the first time since my childhood. With audible effort, he told me that my grandfather had just passed away. After I hung up the phone, I remained composed as I was in front of students who were filling out my questionnaires. After the data collection, I had dinner with my friends and we celebrated my birthday. After dinner, I finally started crying, and I could not get my tears to stop. As my birthday is also my grandfather’s death anniversary, I consider the topic of death profoundly personal, and one that I feel destined to explore. What was it like to recount his career, relationships, and life experiences to his grandson who was so interested in knowing everything about him, so desperate to keep the connection that he had in the very last minute? Such questions may not find answers, but they inspire a curiosity that I find worth pursuing. In retrospect, I remember my grandfather’s refusing the doctor’s offers for various medications and procedures to prolong his life. It seemed like he was very ready for his death. Hence, frankly, this project is a personal one. Without making my personal motives explicit, I presented my thesis idea to explore death acceptance and intimate relationship at a group meeting. When I asked for feedback for this project, I received a question: “Why should anyone care about this project?” I knew that the person who asked the question did not mean to be caustic, but was just asking to facilitate a discussion. However, never having asked the question in such a way, I found myself in a panic, unable to respond in a coherent manner. Perhaps this study was so personal that I never gave a thought about how it could be valuable to other people. Upon further consideration, however, I realize that the subject matter of accepting death is important for all of us. Religious debate about afterlife aside, death is a universal phenomenon. Every one of us dies. As Heidegger (1962) states, the fact that our life will come to an end raises the question of how we should live our lives in a fulfilling manner. However, as Becker (1972) states, most of us are hesitant to bring up the topic of death. When death is an often-avoided topic, we might be overlooking lessons about life that we can learn only through confronting death. Hence, listening to those who are already aware and accepting of their mortality will start a conversation about death. Past Theorists and Researchers Many theorists and researchers on the subject of death assert the profound influence of confronting death for the way one lives life (e.g., Heidegger, 1962). Such a notion was the basis for Heidegger's argument for authenticity. When death is seen as avoidable, we would live as though there is unlimited time to partake in whatever activity that we like. However, any activity we wish to participate in would eventually lose its value, if there were an infinite number of times we can participate in it.