To Die, By Mistake: Accidental Deaths
The Occurrence of Accidental Deaths: Causes, Solutions, and Countermeasures
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- Navigate this page:
- Iatrogenic Mortality: Medical Mistakes and Accidental Deaths
- Motor Vehicle Accidental Mortality
- Accidental Falling Deaths
- Accidental Suffocation Deaths
- The Anatomy of Accidental Death Bereavement and Recovery
- Concluding Remarks
- 5 Accidents (Unintentional Injuries) 93,592
The Occurrence of Accidental Deaths: Causes, Solutions, and CountermeasuresAccidents have consistently ranked among the principal causes of death in the United States (see Table 1), yet when compared to the other leading causes of death for all age groups such as heart disease, malignant neoplasms, and diabetes, accidental mortality receives only scant attention. This might be due to the many subcategories that makeup the “unintentional injury” statistics (see Table 2). Yet, the impact of accidental deaths on society is undeniable. In 2000, there were some 93,592 unintentional deaths (see Table 1), making it the fifth leading cause of death in the United States, and the leading cause of death for all Americans between the ages of 4 and 33 (Minino and Smith 2001). Moreover, accidental injuries and deaths are a tremendous strain on the nation’s economy through wage and productivity losses, administrative expenses, medical costs, property damage, and employer overheads. Estimates for 2000 list the average cost of a single traffic fatality at $1,000,000, the cost for each unintentional death in the home at $780,000, and an average cost of $980,000 for each work-related death (National Safety Council, 2000). Table 1 goes about here It is certainly not a stretch to say that accidental deaths are a major social problem. Yet, Americans do not perceive accidental deaths as such; and, especially among the young, continue to underestimate their risk of dying from an accidental cause (Glik et al. 1999). Perhaps it is a sense of invincibility that leads to us to underestimate our risk of dying by accident. Or maybe, as previously discussed, it is the perception that accidents are fateful events that we have little or no control over. Whatever the reason, we tend to see other morbidities as potentially much more likely to affect us than accidental mortality. Iatrogenic Mortality: Medical Mistakes and Accidental DeathsThe statistical picture on the occurrence of accidental deaths in the United States neglects an entire category of unintentional mortality. Accidental deaths due to medical mistakes are a major social problem. Yet, these deaths are only now coming to public attention and under the purview of political scrutiny. While much debated and disputed by some (Hayward et al. 2001; McDonald et al. 2000; Leape 2000), iatrogenic mortality, or deaths caused by doctor mistakes, makeup between 44,000 and 98,000 deaths per year in the United States, a problem of epidemic scale (Kohn et al. 2000). Yet to date, nowhere in the CDC’s statistical picture of accidental deaths do we find a category called accidental deaths due to medical mistakes (see table 2). But if there were a category for these accidental deaths, iatrogenic mortality would surpass all other accidental mortalities on the list, including deaths caused by automobile crashes. Moreover, Kohn and her colleagues (2000) suggest that iatrogenic mortality could easily be among the 10 leading causes of death surpassing accidental deaths (42,000), breast cancer (43,000), and AIDS (16,000). Finally, this accidental mortality type is also a very expensive burden for economy, with yearly costs between $17 and $29 billion (Kohn et al. 2000). Among the many recommendations that The Institute of Medicine (Kohn 2000) suggests to reduce the incidence of iatrogenic mortality, are the following: (1) the creation of research and pedagogical tools that might bring knowledge of this crisis to the medical forefront; (2) the creation of mandatory and voluntary error-reporting systems; (3) raising the standards of care through the establishment of oversight organizations and professional groups; and finally, (4) at the delivery level, instilling a culture of safety among healthcare practitioners. Motor Vehicle Accidental MortalityTable 2 outlines the subcategories of unintentional deaths in the United States for all ages, all races, and both sexes for the year 1999. What immediately stands out from the CDC’s data on accidental injuries is that motor vehicles (comprising an astonishingly 42% of all accidental deaths for 1999) are responsible for three times as many accidental deaths as the next category on the list, accidental falls. Motor vehicle related accidents account for a huge proportion of accidents in the United States and a rapidly increasing proportion of accidents globally (Grant and McKinlay 1987; Nantulya and Reich 2002; Peden et al. 2001; Roberts 2002). The scope of the problem is immense: there is a traffic fatality every 12 minutes and a disabling injury every 14 seconds, making motor vehicle accidents the leading cause of death and injury for the young, with the 15-24 age group most impacted (National Safety Council 2001; Lang et al 1996; Williams 1995). The National Highway Traffic Safety Administration (2001) reports that on average, about 115 persons die each day in motor vehicle accidents. Yet, it is important to note that the fatality rate for motor vehicle accidents in the United States remain at an all time low, and continue to decline with the exceptions of alcohol related and motorcycles crashes (NHTSA 2001). Notwithstanding, the number of automobile deaths, approximately 40,000 cases yearly, is still high. Table 2 goes about here The demographic picture of automobile fatalities in 2000 shows that males were 68% of all deaths, that 16-24 year-olds —the age group most impacted by crashes— were 24% of fatalities, that the intoxication rate of male and female drivers who died in crashes were 20% and 11% respectively, and that the rate of seat belt use among male and female drivers involved in fatal crashes were 43% and 29% respectively (NHTSA 2001). Some researchers have linked the pronounced difference in motor vehicle death rates to differential socialization that lead males to assume more risky, health-endangering practices than females (Lang et al. 1996; Veevers and Gee 1986; Vredenburgh et al. 1999), and to increased driving exposure (Farmer 1997; Massie et al. 1995). In addition to gender differences, some studies have reported an inverse relationship between higher social class ranking and decreased accidental mortality risk, with higher death rates among the poor for most categories of accidental death, including automobile accidents (Baker et al. 1992; Hippisley-Cox et al. 2002; Nantulya et al. 2002). But what factors account for the high number of “accidental” motor vehicle deaths in the United States each year? It was Herbert Heinrich (1959) who initially proposed that as much as 85% of all accidental injuries and deaths in industry were attributed to “unsafe acts” by individuals, and only 15% to “unsafe conditions”. This controversial statement started a long-standing —yet to be fully resolved—debate among safety management professionals (Hagglund 1980; Jeffries 1980). In hindsight, it seems that Heinrich should have applied his theory to automobile fatalities and injuries, and not to industrial accidents, because the statistical breakdown of the causes of motor vehicle crashes show three things that lend support to his initial conclusion: (1) that most “accidents” are in fact avoidable; (2) that most involve a great deal of misjudgments; and finally, (3) that accidents are often the result of gross negligence or “unsafe acts”. Every automobile accident can be reduced to three possible causes: (1) environmental factors and driving conditions (namely, weather and the state of the roadway); (2) automobile problems (poor maintenance or equipment failure); and (3) problems with the driver (poor health, risk taking decisions/practices, etc.) (Haddon 1968, 1964; Tabachnick 1973). The statistical portrayal of motor vehicle accidents tells us that the vast majority of all traffic fatalities in the year 2000 were due to driving while intoxicated or driving at excessive speeds, 40% and 29% respectively (NHTSA 2001). Gross negligence and unsafe acts, namely excessive speeding and driving while intoxicated, can account for the vast majority of traffic fatalities in the United States. The link between alcohol consumption and traffic fatalities is an indubitable one (Brewer et al 1995; Haberman 1987; Winn and Giacopassi 1993). According to the National Highway Traffic Safety Administration, there is, on average, an alcohol related fatality every 32 minutes, representing about 40% of the total traffic fatalities yearly. Over 1.5 million Americans were arrested for driving under the influence in 1999 (NHTSA 2000), drivers who are at substantially greater risk of dying in automobile crashes (Brewer et al 1995). In fact, NHTSA data for 2000 notes that, “about 1,400 fatalities occurred in crashes involving an alcohol-impaired or intoxicated driver who had at least one previous DWI conviction,” representing 8% of all alcohol-related fatalities (NHTSA 2000: 12). What’s more, at some point in their lives, 30% of Americans will be involved in an alcohol-related “accident” (NHTSA 2000). Yet, alcohol-related traffic deaths are not the sole purview of intoxicated drivers, but intoxicated riders as well. A recent study by Li and Baker (1995) on 1,711 fatally injured bicyclists age 15 years and older, who were tested for alcohol, revealed that an astonishing 32% were positive for alcohol at the time of their deaths, and 23% were legally intoxicated. Moreover, 28% of fatally injured motorcyclists for the year 2000 were intoxicated (Blood Alcohol Content > 0.10) at the time of their death (NHTSA 2001; Shankar 2001). Excessive speeding is another risk factor that contributes to the roughly 40,000 traffic fatalities yearly. In 2000, excessive speeding took the lives of over 12,000 individuals, and was the cause of 29% of all traffic fatalities (NHTSA 2001). Moreover, the economic cost of speeding-related accidents and fatalities is around $27.4 billion dollars (NHTSA 2001). Speeding is a risk factor that is especially associated with younger male drivers in the 15 to 24 years age group. In 2000, 34% of young male drivers, ages 15 to 24, who were fatally injured in crashes were speeding (NHTSA 2001). The problem of speeding is even more severe among motorcycle drivers. In 2000, there were 2,862 motorcycle fatalities, representing 7% of all traffic deaths; and, 38% of those deaths were attributed to excessive speeds (NHTSA 2001). In fact, the National Highway Traffic Safety Administration (2001) reports that motorcycle riders are 18 times as likely as passengers in automobiles to die in a crash. Finally, it is important to note that taken together, intoxication and speeding go hand-in-glove. The National Highway Traffic Safety Administration (2001) reports that 40% of all alcohol-related deaths in 2000 involved drivers who were speeding, compared to only 13% of sober drivers killed in automobile crashes for the same period. The third risk factor associated with traffic fatalities is seat belt and child restraint usage –or, the lack thereof. According to NHTSA (2001) figures, seatbelts have saved approximately 135,000 lives since 1975, and 11,889 lives in 2000 alone. Likewise, the use of child restraints (specifically designed for children under five) has saved 4,816 lives during the same period, and 316 lives in 2000. In fact, the NHTSA reports that safety belts could have saved an additional 9,238 lives in 2000. Moreover, a recent study on the effectiveness of seatbelt usage in preventing accidental deaths in children aged 4-14 found that the odds of sustaining a fatal injury for an unbelted child in the front seat of a car was 9 times higher than a belted child, and for an unbelted child in the rear seat, the odds were 2 times higher than a belted one (Halman et al. 2002). According to one study, seat belt usage reduces the risk of an accidental death by 65%, and by 68% when used in conjunction with an airbag (Cummings et al. 2002). The same study found that seat belts provide much greater protection against accidental deaths than airbags alone, which only provided an 8% reduction in the likelihood of dying in a crash (Cummings et al 2002). A final contributing factor in the statistics on traffic fatalities is sleep deprivation and its affect on accidental motor vehicle crashes (Cohen 1996a; 1996b; 1996c). Cohen (1996c) estimates that sleep deprivation results in about 25,000 accidental deaths and 2.5 million disabling injuries each year in the United States. What’s more, the impact of sleep deprivation is most obvious during the shift to daylight savings time in the spring, where, as a nation, we lose an hour of sleep. Cohen (1996a) found a 6.5% short-term increase in traffic fatalities the week following spring daylight savings time, but no measurable difference in fatalities in the fall, when as a nation, we gain an hour of sleep. Cohen (1996a) concludes that losing an hour of sleep in the spring with daylight savings time results in a measurable short-term increase in accidental motor vehicle deaths. What can society do to lower the number of automobile fatalities? This question is one that is growing in significance especially around the globe. The World Health Organization estimates that by 2020, road traffic accidents will become the third leading cause of disease burden, from its current position of ninth, replacing such causes as HIV/AIDS, diarrhoel diseases, war, and cerebrovascular disease (Peden 2001). Currently, automobile crashes are the leading cause of injury-deaths and the tenth leading cause of all deaths around the globe (Peden 2001). Clearly, this social problem demands a treatment strategy with global reach. Until now, the primary strategies employed to lower the death rate in vehicular crashes have been technological advances (safety restraints, airbags, etc.) and driver education. While the former has been particularly effective in reducing the likelihood of death in vehicular crashes, driver education has not. In fact, a study by Vernick et al. (1999) found that driver education did not reduce the motor vehicle crash rates for young drivers, and that early licensure, which is the goal of school-based driver education courses, was actually associated with an increased risk of crash involvement. The authors of that study (Vernick et al. 1999) suggest that society look to other treatment strategies in addition to traffic education for reducing the death rate in crashes. And the best treatment strategy to date is that of traffic laws and their enforcement –not driver’s education- because, at the end of the day, we continue to underestimate our risk of dying in an automobile crash (O’Neil and Mohan 2002; Williams et al. 1995). The National Safety Council’s “Report on Injuries in America 2000” calls for the primary enforcement of seat belt laws, which only 18 states currently have, and for all states to adopt graduated licensing policies that include the three steps to licensure: learner’s permit, provisional license, then full license. Technological improvements in vehicle safety, strict traffic enforcement, laws such as mandatory helmet provisions for motorcycle riders, which result in near perfect compliance in states that have them, and efforts to lower the illegal drunk driving limit to .08 percent of blood alcohol concentration for all states (see MADD 2002), remain the most effective treatment strategies for reducing the number of motor vehicle accidental deaths: aside from these provisions, very little have been shown to significantly affect the rate of accidental deaths in motor vehicle crashes.
The statistical picture of accidental falls shows that men are more likely to die of falls than women, that 60% of falling deaths occur at home, 30% in public places, and that 10% occur in hospital settings (CDC 2002). Likewise, the cause of falling deaths varies by setting. For example, in the hospital setting, one of the primary causes of falling is physiological disorientation and dizziness from polypharmacy, the use of four or more medications (Morse et al. 1987); while at work, a common reason is worker error, usually the misapplication of equipment or machine (Copeland 1989). Moreover, the risk factors associated with falling injuries are very different for the young and the elderly. Accidental falls among the elderly are most often associated with what Stevens et al. refers to as intrinsic risk factors, or causes internal to the individual, such as chronic pain, musculoskeletal and neuromuscular diseases, and the presence of polypharmacy; while among the young, falling is most often attributed to extrinsic risk factors, such as environmental conditions or hazards and risk taking behaviors. Both of these causes demand different treatment solutions. For instance, among the elderly, improvements in home design, such as the use of wall-mounted lights that can be reached without standing on a ladder or installing slip resistant surfaces in the bathroom, are but a few of the many simple improvements that might reduce the potential of accidental falls (see Rollins 2000 for complete suggestions). Likewise, since most of the accidental falls the affect the young occur at work, and are due to some combination of unsafe acts and unsafe working conditions, prevention efforts have largely focused on the gap in effective communication of the risk of injury on the job (Haskins 1980; Lauda 1980; Reamer 1980). For young children, the use of “energy-attenuating surfaces” at playgrounds that absorb and cushion the impact of falls is a simple prevention measure; also, keeping appliances and furniture away from open windows, especially in high-rise apartment buildings (Baker et al. 1992). Accidental Suffocation DeathsMechanical suffocation and asphyxiation were responsible for some 5,503 accidental deaths in 1999, many deaths that were, for the most part, completely preventable. Moreover, this accidental death category largely affects children under 1 year, who account for around 40% of the accidental suffocation deaths in the United States (Becker et al. 1992). Any small object in the vicinity of a child is potentially dangerous and can lead to an accidental suffocation by ingestion. Foodstuffs, such as popcorn, grapes, nuts, and hard candy all pose a potential risk for children less than 1 year of age (National Safety Council 2001). Mortality from this category, however, is not limited the very young, as elderly individuals over 65 years have one of the highest accidental food-chocking rates, with over 2,500 deaths annually (Becker et al. 1992). Accidental suffocations also pose a hazard for many farmers working among large storage bins for grains, a problem that has been growing in recent years due to the building of larger grain facilities, and the fact that many operators work alone (Loewer and Loewer 2002). Yet, one of the more prevalent categories of accidental deaths under the suffocation and asphyxiation heading receives little public attention by way of prevention strategies: death by accidental autoerotic asphyxiation. Autoerotic asphyxiation, or the application of cerebral hypoxia through self-strangulation, self-hanging, or manual strangulation among sexual partners to enhance orgasm, takes the lives of more than 1,000 Americans yearly, representing close to 20% of all deaths by accidental suffocation (Byard et al. 1991; Byard et al. 1990; Michalodimitrakis et al. 1986). What’s more, the true number of accidental deaths by autoerotic asphyxia might well be much higher than reported because of the potential to mistake these deaths as suicidal or homicidal attempts, or, to systematically mislabel them as suicides to avoid the social stigma of dying from autoerotic asphyxia. The mortality picture of autoerotic accidental asphyxia shows that males are overwhelmingly the victims of this form of death, with a male to female ratio of about 50 to 1, and the typical male victim a solitary masturbator between the ages of 12 to 25 years (Cooper 1996; Gosink 2000). The typical autoerotic death scenario involves a young male who employs a strangulation procedure to the neck, usually self-hanging from a standing or seated position, while masturbating. Unfortunately, when the loss of consciousness accompanies hypoxia, the victim will lose control over voluntary movement, and accidental death is likely to follow. Many practitioners of autoerotic asphyxia incorporate “safety devices” such as knives to cut the noose or slipknots to protect against the possibility of an accidental death by losing consciousness (Cooper 1996). But these escape mechanisms often do not protect against the loss of consciousness, and since the practitioner is usually alone, the risk of an accidental death is punctuated. Accidental death by autoerotic asphyxiation has yet to receive the same prevention-attention afforded to the other accidental injuries, even though it accounts for nearly 20% of all accidental suffocations. Perhaps this speaks volumes to the stigma that accompany sexualities and sexual practices thought to be deviant and dangerous.
We have already shown the statistical picture on accidental deaths to be incomplete because every year it leaves uncounted between 44,000 and 98,000 iatrogenic mortalities. But among other problems that exist with the statistical picture of accidental deaths are (1) the possibility that it includes incidences of subintentional self-destruction, cases that are neither suicidal attempts nor strict “accidental” deaths, and (2) cases of suicides disguised as accidents. Subintentional self-destructions are ill-defined deaths and practices that lead towards death (Tabachnick 1975; Smith 1980; Shneidman 1973). These practices if continued will eventually result in the death of the practitioner. Yet, unlike suicide, where there exists in the mind of the person a clear intention to die, subintentional self-destructive behaviors lack immediate, or less, intentionality about the possibility of death. In fact, the person may not have complete intentionality despite the fact that her behaviors and choices are reckless, making the possibility of an accidental death omnipresent (Tabachnick 1975; Smith 1980). Consequently, if death is the final outcome of her actions, it does not conform to a strict definition of suicide because it lacks complete intentionality, neither does it fit the parameters of an accident because it was probably expected, totally avoidable, and involved a great deal of misjudgments, negligence, and forewarning. Consider for example, the person who sits on the balcony of 10-story apartment and then falls to death. We naturally assume that this death was an accident, and maybe rightfully so because of the lack of intent, despite the reckless abandon involved in the behavior. Yet, the possibility of falling was certainly entertained in the victim’s mind at some point. Therefore, can we really call this an accidental death without violating the spirit of the concept accident? Certainly, many of life’s events involve risk, some greater than others. But the more risk involved, the more likely a self-destructive outcome. Perhaps then, the label subintentional death is more appropriate because it speaks to the level of obvious risk the person involved in the behavior chose to ignore. Other frequently cited behaviors are parasuicide (where a person might make a false “suicide attempt” as a cry for help, but with no intention of dying), poly-drug abuse, high-risk activities like playing Russian roulette, excessive speeding or reckless driving under conditions that pose a clear danger, and not following a doctor’s advice on life-saving medication (Lester 1988; Kreitman 1969; Tabachnick 1975). To date, we have no consistently effective ex post facto mechanism for differentiating sub-intentional mortality and unsuccessful parasuicide from true accidental or suicidal deaths (Peck et al. 1995). Ironically, the situations that compel individuals into subintentional self-destructive behaviors are often the same the act as impetus for suicide: a sense of hopelessness, helplessness, alienation, isolation, and the like (Cole 1988; Smith 1980). The problem of suicides disguised as accidental deaths is the final area that confounds the statistical picture on accidental mortality in the United States (Chester et al 1977; Lester 1990; Pokorny 1972). While the number of disguised suicides in certain subcategories of accidental deaths is debatable (Lester 1985), there does appear to be strong evidence for them in motor vehicle crashes. Norman Tabachnick’s (1973) decade-long research at the Los Angeles Suicide Prevention Center on the self-destructive impetus behind many automobile crashes found that 25% of the victims of single-car crashes in his study were suffering with depression, and expressed feelings of hopelessness and helplessness around the time of their “accidents”. In another study, Phillips (1979) describes a third day peak in accidental fatalities after a publicized suicide story. Phillip (1979) found that automobile fatalities in California increased by 31% three days after a highly publicized suicide story in the media, thus concluding that vehicular suicides are probably included among the statistical picture of accident vehicle deaths. In a replication of this study, Bollen et al. (1981) found a 35-40% increase in motor vehicle fatalities on the third day after a publicized suicide story in Detroit, lending support to the third day peak theory, while concluding that vehicular suicides might well be hidden in the statistical picture of automobile deaths. Finally, Pokorny et al. (1972) in their intensive review of the personalities, emotional states, and social factors of individuals involved crash fatalities found that 4 out of the 28 fatalities observed were likely suicides. The Anatomy of Accidental Death Bereavement and RecoveryThe nature of accidental deaths, that is, their unexpectedness, suddenness, and, often, violent character, compounds the bereavement and grief recovery experiences of survivors. The survivors of loved ones who die accidentally do not have a period of anticipatory grief, that may last weeks, months, or years as in the case of acute mortality, and which might enhance coping and bereavement recovery (Dane 1991; Hill et al. 1988; Huber 1990). The shock and traumatic emotions that accompany the news of the death might last for weeks, and is a common feature of this type of bereavement (Hogan et al. 1996; Sanders 1982). Accordingly, Raphael (1983) lists several features of accidental deaths that make the grieving process more intense than chronic or acute illness, and these are: (1) the possibility of an accompanying traumatic stress response because of the shocking and unexpected nature of the news that a loved one is dead; (2) learning of the violent nature of the death that compounds trauma and shock; (3) seeing the loved one in intensive care in a dehumanized state before death; and, (4) identifying a body that is often severely mutilated and damaged by the accident. In fact, Reed et al. (1991) found that survivors of accident victims in their study experienced more shock and emotional distress than survivors of suicide victims. Still, there is the problem of guilt, and this is especially associated with the parents of children who died accidentally, where self-blame and guilty feelings are common occurrences (Rosof 1994). In one study, 78% of accident bereaved parents reported feeling guilty for the death of their children (Miles and Demi 1991), while another study found that blame was more common among parents who lost children to accidental death than those who lost children to suicide (Thompson and Range 1992). And for Miles and Demi (1991), a signature feature of the guilt that bereaved parents experience concerns death causation; that is, thinking about how their parental decisions might have inadvertently led to the death of their children, for instance, their decisions to allow them to use the automobile and to stay out late at night with friends. And because of the suddenness of accidental death, which literally freezes the relationship in time, there is often parenting guilt that stems from unresolved fights, emotional problems, or simply, not saying “I love you” frequently enough (Miles and Demi 1982; Rosof 1994). But feelings of guilt were not the sole province of parents. Lehman et al. (1987) found that 53% of bereaved spouses believed that if they had done something differently, their spouses would be still be alive today. While the topic of bereavement in accidental death has received considerable attention in the thanatological literature, the issue of recovery, especially for the survivors of situations involving an accidental death, has received only scant attention. One study, on drivers who survived a collision involving a fatality, found that a third of the interviewees experienced depression, disturbed thinking, and other psychic pains that continued from one month to several years after the accident, while 55% of the respondents reported a personal crises in their lives directly related to their involvement in the accidental fatality (Foeckler et al. 1978). And for the victims’ survivors, Lehman et al. (1987: 218) found that as much as 80% of their respondents were still ruminating about the vehicle crashes that took the lives of their spouses and children, and “appeared to be unable to accept, resolve, or find any meaning in the loss,” and this, some four to seven years after the accident. With regard to accidental death bereavement, detachment seems to be a signature feature for the survivors of this type of mortality, one that carries with it profound implications for close relationships. The survivors of loved ones killed by accidental means often withdraw emotionally in the face of insurmountable grief and the inability to explain, or make sense of, the suddenness of the loss. Moreover, this tendency toward detachment can adversely affect marital relationships by creating a “polarization effect” where the sudden bereavement either strengthens or dissolves the marital bond (Lehman et al. 1989). Men and women experience the grief of accidental deaths differently. Among men, there is a stronger tendency toward detachment in sudden death bereavement, and this, according to Reed (1993: 218), is because “Men tend to feel the loss as a void and seek solitude. On the other hand, women tend to feel the loss as isolation and seek support from others. Women may therefore be extrasensitive to the distance between spouses precisely at the time the man is seeking solitude.” The varied styles of grieving, where men tend to suppress communication on their feelings and where women seek comfort in others and through emotional expressions about the meaning of the accidental loss, naturally lends itself to marital discord. So then, what factors can affect recovery in the case of sudden bereavement, or, stated otherwise, what can we do to make our accidental death bereavements more bearable? Grief from accidental death bereavement is intense and extremely painful, especially in cases where the survivors are unable to find meaning in the experience, and where the level of survivor-victim attachment was high (Reed 1991). Here, religion plays an important role in assuaging the impact of intense grief, and this is the first recovery resource that might assist the survivors of accidental death. Reed (1993) believes that religion enhances the grieving process in cases of sudden bereavement in three ways. Religious institutions provide crucial emotional support through friendship networks that mimic primordial ties, and this encouragement is helpful to the bereaved. Moreover, religious beliefs often strengthen self-esteem by creating new self-awareness and by building up the self-worth of individuals, and for Reed (1993), the strongest predictor of bereavement outcome is the psychological resource of self-esteem. Finally, religion enhances “existential certainty” by offering meaning to a seemingly meaningless death, and by answering questions on the uncertainty of an after-life, while giving meaning to life and living (Reed 1993). Friendship networks, an implicit part of membership in religious, or other social, institutions, are also an important resource to the suddenly bereaved. Since the mourning process typically extends for eight months or longer (Hardt 1978), detachment and communicative isolation are potential problems for the survivors of sudden bereavement. Research on grief recovery by Sanders (1982) point to the importance of having support systems (friends, religious institutions, families, etc.) that extend months after the funeral to counter the harmful implications of social isolation, alienation, and detachment so common to sudden bereavement. Having a long-term support system is an extremely important resource in grief recovery, and its importance punctuated under the accidental death context. With over 95,000 accidental deaths each year, it in not a stretch to suggest that grief recovery is a feature that deserves much further attention, especially more research on the range of factors that might assist survivors in coping with the grief of accidental deaths, and the problems that the various styles of grieving are posing for men and women in close relationships. Concluding RemarksAccidental deaths are a common feature of life that affects tens of thousands of Americans yearly. Yet, taken together in all of its manifestations, accidental deaths do not hold the same public sway as the other leadings causes of death. Perhaps, as argued elsewhere in this essay, the word accident is linked too closely with the idea of a fateful event, and this impedes our understanding of the antecedents of “accidents”, and at arriving at effective treatment strategies to reduce the occurrence of accidental mortality. Edward Suchman (1961: 249) understood this quandary well when he said the following: “When the public is willing to accept the same type of preventive program for accidents as it demands for the communicable diseases, we may expect to witness tremendous gains in removing accidents from its current position as one of the major causes of death and disability.” Obviously, we’ve yet to achieve such as a preventive program for accidental deaths, and until that time, we can expect accidental deaths to remain a leading cause of mortality. Perhaps a name-change, from “accidental deaths” to “deaths by mistake –human mistakes”, is in order. 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Rank Cause of Death Number of Deaths 1 Heart Disease 709,894 2 Malignant Neoplasms 551,833 3 Cerebrovascular Diseases 166,028 4 Chronic Lower Respiratory Diseases 123,550 5 Accidents (Unintentional Injuries) 93,5926 Diabetes Mellitus 68,662 7 Influenza and pneumonia 67,024 8 Alzheimer’s Disease 49,044 9 Nephritis 31,613 10 Septicemia 31,613 11 Intentional Self Harm (Suicide) 28,332 12 Chronic Liver Disease 26,219 13 Hypertension & Renal Disease 17,964 14 Pneumonitis due to Solids or Liquid 16,659 15 Assault (Homicide) 16,137
Table 2: Unintentional Injuries in the United States, 1999 Rank Cause of Death Number of Deaths 1 Motor Vehicle 40,965 2 Falls 13,162 3 Poisoning 12,186 4 Unspecified 7,459 5 Suffocation 5,503 6 Drowning 3,529 7 Fire/Burn 3,471 8 Natural/Environment 1,923 9 Other Land Transport 1,867 10 Pedestrian 1,502 11 Other Transport 1,408 12 Other Spec., Classified 1,310 13 Other Spec., (Not elsewhere classified) 955 14 Struck by or Against 894 15 Firearm 824 16 Machinery 622 17 Pedal Cyclist, Other 185 18 Cut/Pierce 74 19 Overexertion 21 ------------------------------------------------------------------------------------ Total 97,860 Source: Center for Disease Control and Prevention, 2002. Directory: vigilant vigilant -> Draft not for circulation vigilant -> Draft not for circulation vigilant -> Research Questions Introduction Download 113.96 Kb. Share with your friends:
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