Assignment: Developmental Case Study: Death
C is a 65-year-old black, heterosexual female Army veteran who is currently receiving counseling after a recent diagnosis of acute liver failure. She was referred to counseling by her primary care provider. C reported using alcohol, tobacco, and cocaine to ease memories of pain and trauma experienced throughout her life. She has been using multiple substances since she retired from the Army in her late 20s. C expressed anger and disbelief about the diagnosis, saying, "Doctors don't know anything." She was given two months to live if she did not change her health habits, including avoiding alcohol for at least six months. C described this request as "unrealistic and unreasonable" and refused any treatment. She worries about dying and not having much time left to repair her relationship with her daughter. C retired to spend more time with her daughter, A, yet believes that she "failed" in this area. Since her retirement, she has been unable to maintain consistent employment and is currently dependent on the Department of Veterans Affairs for monthly disability benefits. C expressed that she would like to reconnect with her daughter but describes their relationship as "tense." She fears rejection if she tries to connect with her daughter, but she wants to tell A about her condition before it is too late.
Social context: C has two siblings whom she talks to regularly but doesn't feel that they are reliable enough to be put in charge of her end-of-life care. Her siblings use multiple substances and often enable C's addictive behaviors by buying her alcohol.
Developmental context: C's mother gave birth to her when she was a teenager and returned to high school. When C's mother attended college, she left with her maternal grandmother. Her grandmother was physically abusive, and C often felt like she had "no time to be a child" because of how strict her grandmother was. She often felt isolated from her siblings because she had a different father and there was a significant age gap between her and her younger siblings. She enlisted in the Army at age 18 and met her daughter's father there. She married at 22 and was divorced at 24 after the birth of her daughter. Her ex-husband was verbally abusive and cheated on her. C felt "abandoned" and stated that alcohol numbs the pain. She left her daughter unattended for hours at a time, which led her to lose custody of her child. After that, she started using cigarettes and cocaine and stated, "Losing my family was the hardest." Because of negligence, low motivation, paranoia, and addiction, C found it difficult to keep a job and take care of her basic needs.
Living context: C currently lives alone in an apartment. She has few reliable sources of support besides her daughter, who checks in with her from time to time. Her younger brother and sister help her get supplies and necessities once a month.
Task
I. How might the unresolved task of achieving a sense of generativity in the middle adulthood psychosocial stage of generativity vs. stagnation impact the development of C's perspective of death?
II. As a counselor, which earlier stages of development would be worth exploring to find out more information about C's potential for the development of death anxiety (e.g., adolescence, early adulthood, etc.)?
III. Why might it be important to explore attachment in the context of C facing death and her daughter facing the reality of her mother's impending death?