To be used of the Lord to help those grieving is both satisfying and humbling. My personal prayer is that more mourners will be drawn to the gospel of Jesus Christ. The Gospel of Christ is the only thing that can bring true and lasting comfort. Jesus said, “Blessed are those that mourn, for they shall be comforted” (Matthew 5:4, NIV). “The Spirit of the Sovereign LORD is on me, because the LORD has anointed me to proclaim good news to the poor. He has sent me to bind up the brokenhearted, to proclaim freedom for the captives and release from darkness for the prisoners, to proclaim the year of the LORD’s favor and the day of vengeance of our God, to comfort all who mourn, and provide for those who grieve in Zion - to bestow on them a crown of beauty instead of ashes, the oil of joy instead of mourning, and a garment of praise instead of a spirit of despair” (Isaiah 61:1-3). “The mourners shall be ‘comforted.’ Even now they get beauty for ashes, the oil of joy for mourning, the garment of praise for the spirit of heaviness. Sowing in tears, they reap even here in joy. Still, all present comfort, even the best, is partial, interrupted, short-lived. But the days of our mourning shall soon be ended, and then God shall wipe away all tears from our eyes. Then, in the fullest sense, shall the mourners be ‘comforted’” (Jamieson, Fausset, & Brown, 2016).
Contrary to popular myth, the United States has never functioned as a well-stirred “melting pot,” although there has been considerable intermixture among those of originally European nationalities. There has never been a thorough melding of cultural and racial differences to create homogeneity (Irish, Lundquist & Nelsen, 1993, p. 2). The United States was established on an unconscious foundation of ethnocentric monoculturalism. “Ethnocentric monoculturalism is the individual, institutional, and cultural expression of the superiority of one group’s cultural heritage over another, combined with the possession of power to impose those standards broadly on the less powerful group” (Sue & Sue, 2013, p. 123). We, as a nation, are mainly multi-ethnic, and not yet fully multi-cultural. A multi-ethnic society is comprised of identifiable cultural groups (by race, religion, language, national origin, or other traits) that exist quite separately from and subordinate to a majority population. A multi-cultural society contains identifiable groups within it that are different from each other. However, they are able to share fully, or almost fully, in the wider culture’s opportunity structure and resources and are not depreciated by the dominate group (Irish et al., 1993, p. 2). I believe that we are more multi-cultural today than ever before, but we are still multi-ethnic in this country. Even so, this paper will use the words ethnic and culture interchangeably. This paper will focus on bereavement in our multi-ethnic, multi-cultural society.
Since I have defined a multi-ethnic society, it is time to define some important words that will be used in this paper. To be “bereaved” literally means to be torn apart. More specifically, the bereaved are sad because they are suffering the death of a loved one. They are thus, “torn apart” from them (Grace Hospice, 2016, p. 6, 9). Grief describes suffering or distress over a death. Grief can be a term that describes one’s reaction to any loss, but here we use the term grief to describe the experience of one who has lost a loved one to death (Worden, 2002, p. 10). Mourning is the term applied to the process that one goes through in adapting to the loss of a person. Mourning is the outward expression of our grief such as crying, talking about the death, praying, joining in ceremonies, and participating in support groups (Grace Hospice, 2016, p. 9). These 3 words: grief, mourning, and bereavement, will often be used interchangeably.
Sue and Sue (2013) suggest that there are 3 levels of personal identity. On the individual level, they write, “All individuals are, in some respects, like no other individuals” (p. 42). No two individuals are identical. We are all unique. This leads us to the group level. “All individuals are, in some respects, like some other individuals” (p. 43). Each of us is born into a cultural matrix of beliefs, values, rules, and social practices. Markers for this level are gender, socio-economic status, age, geographic location, ability/disability, marital status, sexual orientation, religious preferences, and race. Two of these markers are the central focus of this paper: religious preferences and race. In my opinion, there should also be a family level, bridging the gap between the individual and group levels. “In a sense, the family acts as a lens through which we view the larger culture, and it influences our specific cultural responses to any of life’s events” (Fiorelli & Jenkins, 2009, p. 29). Even so, we are dealing with religious preferences and race. Above the group level is the universal level. “All individuals are, in some respects, like all other individuals” (Sue et al., 2013, p. 44). We are all members of the human race and belong to the species Homo sapiens (Sue et al., 2013, p. 44). Everyone grieves, and although the expression of grief will vary, everyone experiences suffering and loss. The last part of this paper will deal with this level.
Guidance for pastoral and clinical counselors will following the discussion on the religious and ethnic differences in bereavement. “Information without application leads to frustration.” Since we have examined these differences and gained some measure of cultural competency, what applications can we glean and then put into practice? There have to be some practices that are universal and will be effective among all people, the etic persepctive. We also must be aware of the emic perspective and be culturally sensitive and adapt our practices to accommodate cultural groups (Sue et al., 2013, p. 35).
We begin with talking about the subject of religion, as it pertains to the Cincinnati area in regards to bereavement. The world’s largest Christian group, the Roman Catholics, comprise roughly 26.05% of the Cincinnati population (Sperling, 2017). When a Catholic becomes deathly ill, he/she is encouraged to contact a Catholic priest for the Sacrament of the Anointing of the Sick and Dying. This anointing was formerly referred to as “the Last Rites,” but in recent times has taken on the meaning of offering support during serious illness. The rite is administered at the onset of a serious illness, regardless of whether the illness will or will not lead to death. The Biblical basis for this comes from James 5:14-16. All other rituals such as baptism, Holy Communion, Final Confession and Absolution are conducted between the priest and the Catholic before death. This is essential since Catholics believe that those who die before confessing their sins, reside in purgatory until they are relieved of all imperfections before entering heaven (Gonzales, 2014). The Catholic Church recognizes three specific funeral rites. The Vigil Service, sometimes known as the Wake, is usually conducted in the funeral home or church on the evening before the Funeral Mass. Friends and family gather to pay their last respects for the deceased, and to provide comfort and strength to the immediate family. Many individuals who cannot attend the Funeral Mass will be present at this service. Though the service contains prayers, Scripture readings and liturgy, it is a more informal time where remembrances and eulogies are shared. The Funeral Mass is more formally ritualistic, conducted by a priest and held in the church building. Under most circumstances, the body will be present during this service. The Funeral Mass includes the Reception of the Body, the Liturgy of the Word, the Liturgy of the Eucharist, and the Final Commendation and Farewell. The final service is the Rite of Committal, a brief tribute performed at the cemetery, often in either a chapel or at the grave site. The priest will read a passage of Scripture, make concluding remarks of comfort for the bereaved, present a statement of committal of the body back to the earth, and conclude with prayer. After these rites, the priest or someone approved by the priest, is instrumental in providing or coordinating grief care if requested. A cousin to the Catholic faith, the Eastern Orthodox church, has memorial masses after a death. These memorials are held on the 3rd, 9th, and 40th days after the death, as well as 3 months, 6 months, 9 months, 1 year, 3 year, and even on the 10th year anniversary of the death. During these masses, relatives and friends are gathered and share their memories and experiences (Cacciatore & DeFrain, 2015, p. 111).
All other Christian groups account for approximately 8% of the Cincinnati population (Sperling, 2017). These groups are so varied that a summary is difficult. Most follow the Catholic observances in some form. However, the rituals are known as “customs” rather than “rites.” Prayers, Bible readings, anointings, sermons, and singing are for the comfort of the dying and grieving and do not bestow any salvific blessings. Eternal life and complete forgiveness are received by faith in Jesus Christ alone, according to most Protestant groups (Gonzales, 2014). Many rituals are typically lead by the minister, and therefore, the family comes to the minister for bereavement care.
Of all the predominant religious groups studied in regards to grief care, the practices of the Jewish faith are the most intricate and comprehensive. Approximately 1.35% of Cincinnati’s population identifies with the Jewish religion (Sperling, 2017). However, Judaism is more than just a religion. Individuals consider themselves to be Jewish, not only when they practice Judaism, but also if they are of Jewish parentage or upbringing, despite claiming a non-religious belief system. Fewer than 50% of those who identify themselves as Jewish, actually adhere to the Jewish religion and practices. Even so, many Jews celebrate Jewish holidays and consider such a celebration a cultural activity rather than a religious one. These individuals still consider themselves Jewish because of the commonality of history, culture, and experiences (Sue et al., 2013, p. 451-452). Judaism encompasses not only religious preferences, but also biological and familial biases. There are two overriding values at the heart of Judaism’s orientation to death and mourning. The first is Kavod HaMet, the requirement to “honor the dead.” The second is Nichum Aveilim, the obligation to “comfort the mourners” (Tramonte, 1996, p. 6; Irish et al, p.115). When death is imminent, a person should be encouraged to recite the Viddui (confession), asking God for forgiveness for past misdeeds and a place with Him after death. Once death has occurred, those sitting with the deceased close her/his eyes and mouth and pull a sheet over her/his face. Most families also call their rabbi at this time. The shomer, a family member or hired servant who has been appointed to stay with the corpse, sits nearby reciting from the Book of Psalms. The corpse must not be left alone from the time of death to the time of burial. In preparation for burial, the Chevrah Kadisha, a group of community volunteers or people hired by the funeral home, cleanse the corpse and perform Taharah. This process is akin to immersion in a Mikvah, or ritual bath. They then dress the corpse in simple white shrouds and a tallit worn during the deceased’s lifetime, place the corpse in the casket, and close it. From that point on, the casket remains closed because it is “disrespectful to look at a person who can’t look back” (Gonzales, 2014). Jewish law stipulates that a casket is to be simple, preferably made of wooden boards and dowels. A person is to be buried as soon after death as possible. Even so, since it is considered an honor for the deceased to have a well attended funeral, burial usually occurs a day after death, thereby giving sufficient time for the family to make arrangements and notify friends and members of the community of the death. Most American Jewish funerals take place in a funeral chapel. While the family members await the start of the funeral, it has become customary for friends to approach and offer words of condolence. Keri’ah, the rending of one’s garment as referenced in the Bible, is practiced either prior to the funeral or the burial. A rabbi or other individual approaches the mourners, asks them to stand, and, with a blade, cuts the garment the mourner is wearing, such as a tie, shirt, or blouse. The mourner then rends the garment with her/his own hands. The mourners wear the rent garment for the entire Shivah, or primary mourning, period. A Jewish funeral service is short, consisting of three parts: readings from Psalms, a eulogy, and the Memorial Prayer. Several pallbearers, usually friends and relatives, then carry or roll the casket to the hearse, and the assembled group follows for a block or two out of respect for the dead. When the hearse reaches the cemetery, the family members and friends again carry or roll the casket to the gravesite, pausing several times on the way. The rabbi usually walks ahead reciting Psalm 91 while all others follow the casket. After it is lowered into the ground, friends and relatives help to shovel earth, either filling the grave completely, or just covering the coffin. The mourners then recite a “burial Kaddish.” Burial, and particularly the act of shoveling the earth into the grave, brings closure. Up until that point, it is hard for the mourners to deal with their feelings because the body has not yet been laid to rest. But from that moment on, they can begin to confront their emotions. It then becomes possible to extend words of comfort to the bereaved family. Friends form two parallel lines, through which the mourners pass and receive condolences as they walk from the gravesite back to the hearse. The family then returns to the place where they will sit Shivah, usually at the home of the deceased. Shivah begins upon returning from the cemetery, and lasts for seven days. Probably the best known of all Jewish mourning rites, Shivah (literally, “seven”) requires all members of the immediate family to interrupt the normal flow of their lives for an entire week and spend time in the home of the deceased, receiving visits from those who come to comfort them. All of their needs are tended to by others. Cut off from the everyday world, the family is given an opportunity to spend all their emotional energy dealing with the death of the person they loved, and absorbing the pain, which is deep even if the death was expected.
Anyone who has sat Shivah knows how comforting and stabilizing- and at the same time grueling- the week can be. The gratitude that a mourner feels toward those who take the time to visit during this difficult period is boundless. Following Shivah, there is a secondary period of mourning called Sheloshim, meaning thirty, because it lasts for thirty days. Although Sheloshim is a period of mourning, it is far less intense than Shivah. The mourners resume normal social and professional duties but are still restricted in certain ways. The end of Sheloshim marks the end of the period of mourning for all relatives. All mourning restrictions are then lifted (Morgan & Laungani, 2002, p. 57-75).
“Yahrzeit” is the annual anniversary of the death of the person. It may involve lighting a special candle, visiting the cemetery or engaging in special acts of kindness to others (Gonzales, 2014). There are many more laws, rituals and customs concerning mourning in the Jewish faith, but giving equal treatment to all prevents further discussion. “[Judaism] recognizes the preciousness of each individual and for this reason prescribes rites of mourning that proclaim to the world the irreparable loss that a single death brings to the family, the community, the Jewish people, and the entire world. The laws of mourning also recognize the difficulty a mourner has in confronting the rupture of a valued relationship, the finality of death, and the emptiness left in its wake” (Morgan et al., 2002, p. 75).
The defined meaning of the religion, Islam, is “submission to God,” with its followers known as Muslims. Islam is one of the fastest growing religions in the United States with approximately one fourth of U.S. Muslims being converts to the faith (Sue et al., 2013, p. 442). In Cincinnati, only 0.22% claim to be of the Islamic faith (Sperling, 2017). The Imam, or faith leader in Islam, is to be called for someone who is sick. The dying Muslim will wish to face Mecca as he/she dies, with his/her head elevated so that it is higher than the rest of the body. The dying person may wish to have a confession of faith, a confession of sins, or may even do self-injury, as a way of sorrow for sins before he/she dies (Morgan et al., 2002, p. 155). When the Muslim dies, those present must take the following immediate actions: 1- Turn the body to
face toward Mecca, 2- Have someone sitting near the body read the Koran, 3- Close the body’s mouth and eyes, and cover the eyes and face, 4- Straighten both legs and stretch both hands by the sides, 5- Announce the death immediately to all friends and relatives, and 6- Hasten to bathe the body (Taharah) and cover it with white cotton (Kafan). After all of this is accomplished, four people place the four corners of a bier on their shoulders. While carrying the body, the carriers repeat “Allah Akbar” (God is great) and pray for blessing. The grave should face Mecca and the burial should take place between sunrise and sunset on the day of the death or the following day (Irish et al., 1993, p. 142). At the burial, the Koran is read and prayers are said. No eulogies are given (Gonzales, 2014). “No discussion goes on, just crying and praying, because it is believed that people should weep and release their sorrow. Some mourners may faint at the time of burial, and for that reason, tea, sugar, and sugar syrup are available. Muslims believe that once sorrow is released by crying, one’s body system will be relieved and the process of coping and attaining peace can proceed. The body can tolerate only a certain amount of sadness; so, in effect, people become their own healers” (Irish et al., 1993, p. 142). “The people can grieve and shed tears, but are forbidden to wail, beat the breasts, slap the face, tear their hair or garments, or complain, or curse” (Morgan et al., 2002, p. 156). At the graveside, the body is removed from the casket and placed on its right side with the face toward Mecca within the grave. After this the family begins filling the grave with dirt and then others are invited to participate (Gonzales, 2014). “Following the funeral ceremony, all the friends and relatives go to the house of the deceased’s family. Usually a meal is prepared and the guests will remain there for the whole day or night. Close relatives frequently stay for the entire week. During this time, there is a great deal of crying, and the deceased’s immediate family will talk about their sorrow and the problems of adaptation to their new situation. They will be ‘social’ for the entire week and are not left alone. Socializing is seen as a way of reassuring the relatives of the deceased person. On the third day after the burial, a ceremony lasting several hours is held in the mosque, when friends and relatives gather to pray. A religious leader reads from the Koran and prays for blessing. Muslims believe that the more prayers uttered for the deceased person at the time of death, the easier the departed one’s life will be in the afterworld. One year after the person’s death, there is another ceremony to pray for and remember the deceased person” (Irish et al., 1993, p. 142-143). The only thing that Islam encourages in bereavement care after these ceremonies, is the reciting of the Koran and prayers.
The Eastern Religions are made up of Shinto, Confucianism, Taoism, Sikhism, Jainism, Hinduism, and Buddhism. In Cincinnati, 0.36% of the citizens claim an eastern faith (Sperling, 2017). While Hinduism is the 3rd largest religion in the world, Buddhism seems more palatable to the majority of the United States today. Many American soldiers gained their first exposure to Buddhism while stationed in Southeast Asia during the Vietnam conflict. Many of them, often troubled by their wartime experiences, found peace in Buddhism (“Spirituality and Religion”). Two attractive components of Buddhism are its non-theistic orientation and the emphasis on meditation. Health is a holistic connection between mind and body, while illness is the result of karma, or the law of cause and effect. Healing and recovery are promoted by awakening to the teachings of Buddha, summarized as spiritual peace and freedom from anxiety. The main goal is
to reach spiritual enlightenment, or Nirvana, through meditation and conscious living. When discussing death the Buddhist way, the main issue is the person’s state of mind at the moment of death. This state of mind is believed to influence rebirth into the next life, a reincarnation to a higher plane of living, so everything must be calm and peaceful (Wintz & Handzo, 2014, p. 22-23). It is important to be able to say that he/she died peacefully, or was very calm at the time of death. Buddhists generally refrain from using drugs except in extreme discomfort so as not to affect the state of the mind. Chanting in the household might be disruptive, and the visit of a monk may or may not be considered beneficial. The funeral is planned by family members, with relatives possibly coming from great distances to be present. The body of the deceased must be treated with respect and care (Irish et al., 1993, p. 133). Traditionally, there is to be a 3 to 5 day period following the death, when the body is not to be disturbed (Wintz et al., 2014, p. 22). Services may be held at a funeral home, where lay persons, with or without monks, chant the appropriate sutras. Flowers and fruit may be offered and incense burned, as it would be if the funeral were at a temple. It is traditional to have a large photograph of the deceased on a stand or table near the casket. At the final service, family members may wear white headbands and armbands, and may walk with sticks, symbolizing that their grief has left them in need of support. Since Buddhism is more of a philosophy than a religion, many of the rituals practiced among the Buddhists are cultural in nature. The primary emphasis is for “everything be done in the proper way, so as not to cause any additional negative influences” (Irish et al., 1993, p. 133-134). “Traditional cultural practices overlay the starkly realistic Buddhist interpretation of death” (Irish et al., 1993, p. 129). Cultural practices are not the central focus, but rather detaching from the attachments of this life and maintaining a clear mind to attain a good (human) rebirth into the next life.
It is important to recognize particular cultural practices that are encouraged by various religions. Although they are not based on religious doctrine, or rarely practiced in the United States today, they are still observed in other parts of the world. Isolation and branding of the bereaved, especially widows and widowers, is seen around much of our world. The bulk of this tradition is outlined from a Catholic etiquette book written in 1962, but even Muslims have similar customs (Irish et al., 1993, p. 142). By the 19th century, mourning was distinguished by three periods: 1- Heavy or deep mourning: an all-black costume and no jewelry with colored stones, lasting 1 year for the bereaved spouse, 2- Half mourning: clothing is black with white touches, or white with black touches, lasting 6 months for a bereaved spouse, and 3- Light or second mourning: clothing characterized by black and white mixtures, grey, mauve, violet, lavender, and similar colors, including patterned fabric, lasting 6 months for a widow or widower. Therefore, the total time of mourning for a bereaved spouse would be 2 years. Here in the United States, with the practical abolition of the suit and tie as daily apparel for men, and a corresponding loss of fine tailleur for women, this type of branding displaying stages of mourning has become much more difficult to maintain. Additionally, there are also guidelines of isolation in mourning. One in mourning does not go to large public functions, balls or dinner parties. He/she does not dine out in restaurants or go to parties, nor host parties or social functions in the home during the mourning period. He/she may dine with friends in his home. He may continue such sports as he has always played, but his costume should be dark-colored and suitable to the game he is playing. A widow or widower should not accept or offer attentions to the opposite sex for a year. If this rule is disregarded, all mourning garb should be left off and all pretenses of being withdrawn from society dropped (Horvat, 2008). Some may find these customs to be useless and antiquated, while others propose that these practices help to control anger and aggression among the bereaved and their support systems (Rosenblatt, Walsh, and Jackson, 1976, p. 29-47).
In reference to the cultural component of grief practices, one major area of differentiation between groups is religion. Every region and race expresses grief in unique ways. For example, when comparing bereavement practices among Euro-American Catholics and Brazilian Catholic immigrants, there are several commonalities among the mandated rituals, but beyond this, the similarities are few. A typical American may be surprised that in some cultures a funeral home and a funeral director are non-existent. In the history of the United States, the undertaker became a necessity in urban areas. We often fail to realize that historically, most Americans lived in rural areas on farms. Each family was responsible for the caregiving responsibilities to their sick and aged. “Dying—like being born—was generally a family, communal, and religious event, not a medical one. Because many deaths occurred at home, people were likely to care for dying relatives and, thus, to have a fairly personal and direct experience with dying and death. In the United States, death at home in the care of family has been widely superseded by an institutional, professional, and technological process of dying. That process—its positive aspects not with standing—has distanced the final stage of life from the rest of living” (“A Profile of Death,” 1997). When death came, the family prepared the body for burial and made arrangements with their religious community for the funeral. Furthermore, it was up to the family and community to make the casket and dig the grave. Josh Slocum, Executive Director of the Funeral Consumers Alliance, said, “The most common thing used to be hands-on family involvement. We Americans have completely forgotten that there is nothing universal about calling the mortuary at 3 in the morning,” (Kaleem, 2013, par. 30). In smaller cities, such as the boom towns in the Old West, the undertaker was a part-time job, if it was a job at all. The undertaker was viewed more as a public position of service, rather than a money-making enterprise. Quite often, the undertaker wore many hats; running a local restaurant or hotel, along with an ambulance service or medical care. Not until recent times has the undertaker been viewed as a necessity when someone died. Also, the general view of the undertaker has been changed from that of a public servant to a full-time, profiting, funeral director. A typical funeral today costs between $8,000 to $10,000 (“The Average Funeral Cost”). Because of this expense, many are turning to cremation to reduce costs, even though such a practice may go against one’s religious and cultural beliefs. Some have even cancelled or refrained from having a memorial or funeral service, due to the cost. Others do not have any services on religious grounds because they have abandoned their faith in God altogether. Roughly 52.48% of the people in Cincinnati, Ohio are religious, implying that 47.52% have no religious affiliation (Sperling, 2017). Without any faith to express, some simply opt to have informal gatherings to celebrate the deceased’s life.
This downplaying of funeral rituals is a concern for effective grieving. The funeral ritual helps to meet the 6 reconciliation needs of mourners: 1- Acknowledge the reality of the death, 2- Move toward the pain of the loss, 3- Remember the person who died, 4- Develop a new self-identity, 5- Search for meaning, and 6- Receive ongoing support from others (Wolfelt, 2013). Far greater, from a bereavement perspective, is the prevailing culture’s belief that one needs to “get on with life.” “Suck it up and move on” is the new normal approach. There was a time when a funeral was at least a 3-day event. Today, though the death and funeral may be days apart, a single day is sufficient for both the viewing and the funeral. For the Jews in our culture, sitting “shiva” for seven days is considered a waste of time. We need to get back to work and be productive. “In the dominant North American culture, which emphasizes the centrality of the isolated individual; minimizes the importance of spiritual, as compared to scientific, explanations; and stresses the value of ‘letting go’ and ‘moving on,’ social sanctions are likely to pressure the bereaved into reentering the flow of ordinary life long before they feel psychologically ready” (Fiorelli et al., 2009, p. 30). “The shortened period of time dedicated to mourning may be one of the more adverse effects of industrialization and globalization” (Cacciatore et al., 2015, p. 295).
According to the 2010 census, African Americans totaled 44.8% of the population, making it the largest minority group in the Cincinnati area (“Population Estimates,” 2015). Most African Americans were brought to America as slaves. Even though slavery was abolished in the US in 1865, some from the African American culture still reflect back to slavery times. Slaves preferred night funerals. Why? Simply put, night funerals allowed friends from neighboring farms to attend, and did not interfere with required hours of work. Bury the dead as soon as possible. Why? Slave cabins had no glass windows and the shutters had to be left open most of the year, promoting a reasonable fear that wild animals would come into the cabins to devour the dead. Chanting, singing, shouts, and drums at the graveside was common. Boisterous dinners would follow the ceremony (Irish et al., 1993, p. 55). Despite the fact that much of this has changed through the years, the sense of community that an African American funeral holds is still evident. “No matter how much the customs among mourners have changed, either through the influences of the white culture or as a result of the increased urbanization and education of blacks, the pervasive quality of black mourning customs is their use as a builder of community” (Irish et al., 1993, p. 58-59). As compared to white culture, African American death rituals are seen as less formal and much more emotional. Expressions of emotion are expected and viewed as healthy. Dorothy Crumbley shared the following account in an interview, “I probably wouldn’t have gone through losing weight over here, having an upset stomach for about 6 months because I just don’t deal with my grief that way. Other members of my family like my sister Nancy seems to be making it better than I did. Nancy cried a lot; Nancy cried all the time. She just cried every minute she got a chance, it seems, and we started looking at her funny, you know, like what in the devil is wrong with you, girl? I just assume that Nancy got her crying out, whereas I didn’t and Joyce (another sister) didn’t either” (Irish et al., 1993, p. 59-60). There is a wide difference among the African American culture as to the amount of emotions
that are displayed. The amount of emotionalism shown in public is related to the personality and temperament of the mourners and the traditions of their church (Irish et al., 1993, p. 57). The church is evaluated as more important to African Americans than to Euro-Americans. “Spirituality and religion play an important role in many African American families; church participation provides comfort, economic support, and opportunities for self-expression, leadership, and community involvement” (Sue et al., 2013, p. 370). An African American woman, a pastor of a local Pentecostal church, recently died in hospice care. Her body laid in the house all day until most of the family had said there goodbyes. When the family called the funeral home, I also was called to provide emotional and spiritual care. They were “having church” in the home when I arrived. I came and said the closing prayer before the body was removed. The amount of emotion shown was intense. Some were speaking in tongues and giving loud expressions of praise. Some refused to let the body go with the funeral director, while others wailed and sobbed. A few through themselves down on the floor or on the body. One member of the family had to escort several of the other family members to a separate room until the body was removed, because it was feared that they might injure themselves.
Conversely, a testimonial by an African American woman raised in a Missouri Synod Lutheran Church says, “We always knew outsiders, black or white, when they attended funerals. They were the people who screamed or cried loudly and were quickly ushered downstairs. My mother used to say that the people who fainted and screamed were the guilty ones. They were guilty of neglecting their loved ones, and the funeral was the place where the mourners would
see their guilt masquerading as love” (Irish et al., 1993, p. 23). Without a doubt, there is a strong correlation between the local church environment and mourning expressions among the African American community.
There are several uniform practices within the African American community, regardless of other religious differences. When the funeral is conducted, everyone involved will strive to attend. If one dies, the others are duty bound to attend the funeral, which may be delayed several days to enable all to come (Irish et al., 1993, p. 63). Some from other cultures may find it hard to sympathize when African Americans attend funerals of people they call family, but biologically are not family. Employers may question an African American taking a bereavement leave of absence for someone not directly related to them. “One of the strengths of the African American family is that men, women, and children are allowed to adopt multiple roles within the family. Even those outside the immediate family can be referred to as uncle, aunt, brother, sister, and can fill that role even if not biologically connected (Sue et al., 2013, p. 369). There is a tremendous sense of community emphasized among the African American culture. “Descriptions of African American mourning practices exemplify some of the most organized and elaborate efforts to aid mourners during their various stages of grief. From the moment news is out about a death in a black community, help arrives in the home of the mourner. Rituals are in place- from the church ‘sisters’ who come to bring and prepare meals and do ‘what their hands can find to do,’ to the members of the church who say, ‘their words’ about the dead, to the church ‘nurses’ who accompany family members to view the body individually. These people, along with the pastor and the funeral director and assistants, all assist the mourners to work through their distress” (Irish et al., 1993, p. 58).
Around 2.8% Cincinnati’s population refer to themselves as Hispanic or Latino (“Population Estimates,” 2015). This group covers many nationalities and ethnicities originating from Central and South America, so ethnically speaking, each group can have vast differences from others of Latino origin. Even so, some generalizations can be derived.
Latinos typically have a large network of family and friends, and often live in households having five or more members. Cooperation among family members is stressed. Familismo is a paramount concept. It refers to not only family cohesiveness and interdependence, but also to loyalty and placing the needs of close friends and family members before personal needs. Because of these strong familial and social relationships, Latinos often wait until resources from extended family and close friends are exhausted before seeking help. When a family member suffers from a terminal diagnosis, the family may want to protect the patient from knowledge of the seriousness of the illness due to concern that worry will worsen the health status. Traditionally, women care for the terminally ill at home. Many times, there is a resistance to placement in a nursing home or other facility because of cultural beliefs that this is wrong (Wintz et al., 2014, p. 36).
Religion is important to many Latinos. They often believe that life’s misfortunes are inevitable, and feel resigned to their fate, or fatalismo. Consequently, Latinos may take a seemingly passive approach to problems and lack experience assertively addressing challenges (Sue et al., 2013, p. 414). Health is controlled by God and by fate, assuming a holistic understanding of emotional, spiritual, social and physical factors. A terminal illness becomes a crisis for the entire family. While a person is dying, a family member is present at all times. Extended families are obligated to attend the sick and dying and pay respects. The hospital environment is seen as a hinderance to the family needs because of the limited number of people allowed in the room, and restrictive visiting hours. Prayers offered by a priest or other religious leader is commonly practiced at the bedside of the dying patient. After death, the body is kept with the family for a time before taken to the morgue. A relative or member of the extended family may help wash the body (Wintz et al., 2014, p. 36). “An openly emotional response to death is expected. No one is ashamed to cry and to freely express their grief.... The extended family is united. In rural areas, where the body is viewed inside the family home, drinks are served, and people talk and chat. Not much ado is made over the body itself; the body is simply present…. It is very much like a wake in most other parts of the world: an occasion to bring the family together in sorrow, to foster informal socializing, and to renew friendship and family ties... The casket is always accompanied to the gravesite at the cemetery. People may stay there longer than [other groups] (Irish et al., 1993, p. 76-77). Those who bury their dead may spend many hours at the cemetery speaking to their loved ones (Irish et al., 1993, p. 205). Machismo makes it very difficult to assist Latino males in their grief. Men are expected to be strong, dominant, and the provider for the family. A cultural value that can be helpful for bereavement counselors is personalismo, which refers to a personalized communication style characterized by interactions that are respectful, interdependent, and cooperative (Sue et al., 2013, p. 413, 416). “Although initial meetings may be quite formal, once trust has developed, clients often develop a close personal bond with the counselor, may treat the counselor as a close friend or family member, and may give gifts or extend invitations to family functions. These behaviors are culturally based and not evidence of dependency or a lack of boundaries” (Sue et al., 2013, p. 424).
Approximately 1.8% of the population of Cincinnati identify themselves as Asian (“Population Estimates,” 2015). Like Latinos, this identification covers a wide range of races and ethnicities, but overall generalizations can still be made. The tendency for Asian ethnicities is to have a family and group orientation. Traditional Asian American families tend to be hierarchical and patriarchal in structure, with males and older individuals occupying a higher status. The primary allegiance is to the parents (Sue et al., 2013, p. 396). Providing excellent end of life care to their elders is the best way for the younger generations to show their ultimate respect. Funerals, and other death related rituals, are considered to be the most important acts and expression of piety; the moment of greatest significance to one’s life cycle. The burial rituals are to be well-planned and conducted. When dealing with death, talking about it openly within the family is not a popular choice, much less seeking therapy. When traumatized by losing a relative or close friends, Asians will try to keep themselves occupied or channel emotions through group events. Mental health services or counseling is not among the traditional options, even when families are experiencing an extremely traumatic process of grief, and not feeling they can cope with it in a healthy manner by themselves. However, failure to address the matter directly does not imply that Asians do not deal with death. Instead, the Asian way of coping with death and dying often involves two key components: family and rituals (Cacciatore et al., 2015, p. 69-77). Strong emotional displays, especially in public, are viewed as signs of immaturity or lack of self control, while control of emotions is considered a sign of strength. Somatic issues also play a pivotal role in the Asian viewpoint. Patients typically focus on somatic complaints and seek treatment for those physical ailments. Physical complaints are a common and culturally accepted means of expressing psychological and emotional stress. Rather than express feelings of anxiety or depression, Asian clients may more likely mention physical aches such as headaches, fatigue, restlessness, and disturbances in sleep and appetite (Sue et al., 2013, p. 398-400).
Coping with abnormal deaths is a universal phenomena, yet handled uniquely among the Asian culture. In the Korean culture, an abnormal death would include those of infants, youth, non married individuals, individuals separated from family through lifestyle choices, and suicides. The bereaved family who has experienced such a death will typically avoid having a funeral service. Instead, the body is to be promptly cremated or buried, because the family is ashamed, and because they want to relieve the uneasiness of neighbors. Families of abnormal death are not to lament or even speak about the death (Cacciatore et al., 2015, p. 89). More often than not, this leads to disenfranchised grief, or as Kenneth Doka (2002) describes, ”grief that is experienced when a loss cannot be openly acknowledged, socially sanctioned, or publicly mourned." In short, while a person has experienced a loss, the person does not have a "right" to grieve that loss since no one else recognizes a legitimate cause of grief (p. 160).
Assuming this cultural competence of the previously discussed ethnic and cultural groups, a new question emerges: How can we utilize this information as effective grief counselors? The etic, or universal, perspective is the best starting point. The first goal is to establish a working alliance between the client and the therapist in an empirically supported relationship (Sue et al., 2013, p. 243). Posturing and facial expressions are seemingly basic fundamentals of counseling, yet easily forgotten over time. Maintaining strong eye contact and allowing our faces to reflect caring is paramount. Appropriate body language, or an “open” body posture is also key; legs and arms uncrossed, body upright and centered. Speaking in a natural vocal style and staying on topic will also aid in the process. As with any counseling situation, exhibiting interventions that foster effective communication such as, open questions, paraphrasing, and reflecting feelings is valuable. Specific to grief counseling, though, counselors must realize that they are not experts; the grieving individual is (Wheeler-Roy & Amyot, 2004, p. 4-5). “So there is no way to apply systems, rules or emotional road maps. Our job is to be a presence, rather than a savior. A companion, rather than a leader. A friend, rather than a teacher” (Welshons, 2003, p. 159).
The Companioning Model of Bereavement developed by Dr. Alan Wolfelt is one in which bereavement caregivers can assist people in integrating life’s losses by being present to them and observing them - companioning. The companioning concept is outlined with 11 tenets:
1- Companioning is about honoring the spirit; it is not about focusing on the intellect,
2- Companioning is about curiosity; it is not about expertise,
3- Companioning is about learning from others; it is not about teaching them,
4- Companioning is about walking alongside; it is not about leading,
5- Companioning is about being still; it is not about frantic movement forward,
6- Companioning is about discovering the gifts of sacred silence; it is not about filling every painful moment with words, 7- Companioning is about listening with the heart; it is not about analyzing with the head,
8- Companioning is about bearing witness to the struggles of others; it is not about directing those struggles,
9- Companioning is about being present to another person’s pain; it is not about taking away the pain,
10- Companioning is about respecting disorder and confusion; it is not about imposing order and logic, and
11- Companioning is about going to the wilderness of the soul with another human being; it is not about thinking you are responsible for finding the way out.
Utilizing this model of bereavement caregiving, the helper:
1- Listens in a supportive manner to individual’s concerns,
2- Helps disaster survivors recognize that, in most cases, their emotional reactions are natural, normal, and to be expected,
3- Assists survivors to reduce additional stress by organizing and prioritizing day to day and recovery related tasks,
4- Helps individuals to understand and recognize the wide range of reactions to trauma, such as numbness, frustration, confusion, anger, anxiety, sadness, and feelings of helplessness,
5- Assists individuals to draw on their own strengths and develop healthy coping mechanisms that permit them to gradually resume their pre-disaster level of functioning,
6- Sensitively and caringly helps individuals to grieve their losses in their own unique ways, and
7- Systematically draws upon an array of recovery resources for appropriate referrals. The end result of this model is simply validation. Grieving individuals need reassurance that what they are experiencing is normal. Counselors can help people understand and identify the ways they are reacting (Wheeler-Roy et al., 2004, p. 1-2).
A proposed treatment plan for grief therapy is best outlined in Sophia F. Dziegielewski’s book, [The] Diagnostic and Statistical Manual of Mental Disorders. Bereavement is defined as the clinical attention focused on an individual’s reaction, emotionally, behaviorally, and cognitively, to the death of a loved one. Signs and symptoms to note in the record include characteristics of a major depressive episode including problems sleeping, and eating, weight gain or loss, guilt surrounding the death of the loved one, conversational superficiality with respect to the loved one’s death, excessive emoting when the loved one’s death is discussed, feelings of worthlessness, difficulty concentrating due to domination of thoughts surrounding loved one’s death, possible psychomotor retardation, and/or functional impairment. The goals of treatment shall be:
1- Client will acknowledge and accept the death of loved one,
2- Client will begin the grieving process,
3- Client will resolve feelings over the death of loved one, and
4- Client will reconnect with old relationships and activities.
The objectives of treatment shall be:
1- Client will identify and state steps in the grieving process, such as shock and denial, anger, depression and detachment, dialogue and bargaining, and acceptance (Kubler-Ross, 1969, p. 38),
2- Client will explore and express emotions and feelings associated with this loss,
3- Client will resolve feelings of anger and guilt associated with loss of loved one, and
4- Client will interact with and discuss the death of loved one with others.
This manual and others, such as J. William Worden’s book, Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner, suggest multiple interventions. However, each intervention needs to be evaluated to ascertain if it is culturally appropriate for the client. Empirically supported treatments need to be culturally adapted for effective multi-ethnic bereavement (Sue et al., 2013, p. 239-243).
Pastoral counseling of the bereaved is useful information for any Christian striving to provide care to the mourning. From a pastoral care perspective, there are four things that the griever needs:
1- Intervention and relief. In practical terms, that means stepping in, taking over, and managing someone else’s affairs temporarily, and leaving when the need has passed. These are acts that seek to help people with their grieving, by assisting them to handle ordinary tasks and responsibilities. Grieving individuals should have as little as possible expected of them so that they can have the time and emotional freedom to experience the loss and feel the pain.
2- Support for the recognition and rehearsal of feelings. Practical applications may include simply standing by as a listening presence comfortable with silence, bearing with individuals in their pain and confusion, responding encouragingly when strong feelings are expressed, and lending strength to people when they need an emotional “prop.” 3- Insistent encouragement, or the need to remember. One gains emotional release from what is lost by actively making it a memory. Reminiscing or remembering with another person is the principal means by which we build such a memory, which in turn helps us gain needed emotional distance from the past. Grieving individuals need to be encouraged to recall humorous events, list qualities of the deceased person that impacted them, review the time and events important to both, review the struggles in the relationship, identify change in self due to that other individual in their life (How did I change for the good?), identify how the deceased changed because I was part of their life, list favorite foods, scents, events, teams, holidays of the deceased, so you never forget, and to share the history of that person with others (possibly children and grandchildren). All of the above are intended to reinforce that the loved one has become a part of us due to the relationship experienced (Wheeler-Roy et al., 2004, p. 11-12).
4- Reintegration. The final goal of living through grief is to restore a self depleted by loss, to be able to resume previously significant relationship and activities, and to establish new patterns of living that take into account the loss that has occurred. It also includes rediscovering meaning in one’s life and reforming one’s view of God, since major losses often alter our understanding of God (Mitchell & Anderson, 1983, p. 111-138).
A pastoral counselor often has more freedom to challenge the grieving. It may sound foreign to challenge someone in the depths of grief, but during suffering is an optimal time to be reminded of the basic principles of the Christian faith. The grieving Christian will often need gentle prompting to remember and remain in God’s Word, prayer, fellowship, and friendship with other Christians. By remaining in God’s Word, the grieving soul speaks truth into his or her heart, which naturally believes its own lies. It is important for a person in deep sorrow to be honest with their emotions and wrestle through them biblically. Scriptures that model this process include Psalms 42, 55, 73, and 77. Souls that are overcome with grief must choose to discipline themselves to cast their cares on the Lord, through prayer, while knowing and
choosing to believe the heavenly Father truly cares for them. Praying Psalms 2 and 43, for example, is one way to remain in communion with God, especially when emotions are less than supportive. Without apology, the writer of Hebrews identifies one of the purposes of the fellowship of Christians as “encouraging one another” (Hebrews 10:25). The word encourage literally means “to give courage.” The grieving soul lacks courage and therefore needs to receive courage from other believers by remaining in fellowship with them. Those who are grieving must consciously resist the tendency toward isolation and licking one’s wounds. Though times of aloneness with God are necessary, those times must not be divorced from intentional interaction with other believers they can lean on and trust. The friendship of David and Jonathan is perhaps the most treasured in the Bible. Surely this friendship was a great source of help to David on his saddest days! (Tautges, 2014, p. 63-64).
In reference to the emic, or cultural, perspective, death, grief, and mourning are normal life events. All cultures have practices that best meet their needs for dealing with death. Many cultures have distinct expressions of working through normal grieving processes. Some cultures also have various myths and mysteries about death that affect their attitudes, beliefs, and practices. Cultural issues that affect people who are dealing with the loss of a love one include rituals, beliefs, and roles. Assisting family members as they cope with the death of a loved one includes showing respect for the family’s culture and the ways in which they honor the death. Ask these questions to determine what needs are dictated by the mourner’s culture:
1- What are the cultural rituals for coping with dying, the deceased person’s body, and honoring the death?
2- What are the family’s beliefs about what happens after death?
3- What does the family feel is a normal expression of grief and the acceptance of the loss?
4- What does the family consider to be the roles of each family member in handling the death?
5- Are certain types of death less acceptable (for example, suicide), or are certain types of death especially hard for that culture (for example, the death of a child)? A simple rule is if we do not know, then ask (Grace Hospice, 2016, p. 26-27).
Answers to the previous questions are potentially textbook in matters of uncomplicated or normal grief. However, complicated grief may bring other pressing questions to the surface. Considering cultural perspectives, should we accept the practice of Suttee, where the widow of a Hindu deceased throws herself onto her husband's burning funeral pyre where she dies? Among the Ifaluk, a Pacific atoll people, after a good cry, one is supposed to forget the person who died. Continued grieving is seen as a failure to replace the person who died and is defined as ‘pathological.’ Among the Kaluli of Papua New Guinea, the grief of men may be transformed into anger and action. Many deaths are thought to be caused by somebody, even deaths that would by the standards of the dominant American culture be called accidental or natural. There are even situations where, if a person with whom he is on friendly terms reminds a Kaluli man of a past loss, it is legitimate to injure the ‘reminder’ (Irish et al., 1993, p. 15-16).
We cannot comment on these ethnic situations that seem inappropriate to our dominate American culture. However, we can define “complicated” (also called prolonged, pathological, unresolved, abnormal, or disenfranchised grief) with certain notable factors: “Since the death, at least one of the following on most days to a clinically significant degree for at least 12 months
after the death:
1- Confusion about one’s role in life or diminished sense of self,
2- Intense sorrow and emotional pain in response to the death,
3- Preoccupation with the deceased, and/or
4- Preoccupation with the circumstances of the death.
Since the death, at least six of the following occur on most days to a clinically significant degree for at least 12 months after the death:
1- Marked difficulty accepting the death,
2- Disbelief or emotional numbness over the loss,
3- Difficulty with positive reminiscing about the deceased,
4- Bitterness or anger related to the loss,
5- Maladaptive appraisals about oneself in relation to the deceased or the death (self blame),
6- Excessive avoidance of reminders of the loss,
7- A desire to die to be with the deceased,
8- Difficulty trusting other people since the death,
9- Feeling alone or detached from other people since the death,
10- Feeling that life is meaningless or empty without the deceased or the belief that one cannot function without the deceased,
11- Confusion about one’s role in life or a diminished sense of one’s identity, and/or
12- Difficulty or reluctance to pursue interests or to plan for the future (as in friendships, activities) since the loss” (Grace Hospice, 2016, p. 11-12).
In addition, a persistent complex bereavement related disorder may cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, with bereavement reactions out of proportion, or inconsistent, with cultural or religious norms (Grace Hospice, 2016, p. 13). Furthermore, it is now recognized that the bereaved can experience the worst grief reactions as much as two years after the loss. The ordinary grief counselor, once complicated grief is suspected, should make a professional referral. This role is often called the ‘gatekeeper’ role. For some people, grief counseling or the facilitation of grief is not sufficient and the loss, or the way that they are handling the loss, may give rise to more complex problems requiring special interventions. Due to the specialized techniques and interventions, as well as an understanding of psychodynamics, dealing with such a disorder may not be within the purview and skill of the grief counselor. It is imperative for grief counselors to recognize their limitations and to know when to refer a person for grief therapy or other psychotherapy (Worden, 2002, p. 67).
A common complaint among the grieving is that after the funeral was over, the bereaved felt alone and abandoned by their communities. Some groups have formal rituals to remember the death, but many do not. Michael Norton and Francesca Gino suggest that using rituals can help people relieve negative feelings (Vitelli, 2014). Dr. Kenneth Doka has identified four functions of ritual that may help in a variety of situations:
1- Rituals of continuity- This type of ritual implies that the person is still part of my life and there exists a continuing bond;
2- Rituals of transition- This marks that a change has taken place in the grief response;
3- Rituals of affirmation- This is a ritual act whereby one writes a letter or poem to the deceased thanking the person for the caring, love, help and support;
4- Rituals of intensification- This type of ritual intensifies connection among group members and reinforces their common identity.
Group rituals may include eating a favorite meal of the loved one, planting flowers, a tree or a flowering bush in memory of the loved one, enjoying a toast to the loved one on a birthday, anniversary or holiday, looking through photo albums and reminiscing about shared times and memories, visiting the burial place, or volunteering for an organization in memory of the loved one, and many others (Wheeler-Roy et al., 2004, p. 13-14). This is not an exhaustive list of ideas, but rather a springboard for a family or group to consider.
The Dali Lama once said, “No matter what part of the world we come from, we are all basically the same human beings. We all seek happiness and try to avoid suffering. We have the same basic human needs and concerns” (“Acceptance Speech,” 1989). All who live beyond the womb will experience grief in some form. Individual cultures and religions express their grief differently, but all “seek happiness and try to avoid suffering.” “From the outsider’s perspective, grief in a particular culture outside our own may look very exotic or strange or just simply wrong. However, if we can develop our skills in seeing the world from other people’s vantage point, we can learn quickly that the basic human dynamics of grief are very much alike. We all suffer, and we all struggle to find a way through our suffering.... With compassionate support from our tribe and through learning how to deal with the dreaded tragedy of loss, we find a way, in our own time and in our own unique way, to create a satisfying, hopeful, and meaningful life built on the ashes of our loss” (Cacciatore et al., 2015, p. vi).
As grief counselors, may we be used of God to help to heal the broken hearts of grieving people, no matter their faith or ethnicity. “There are characteristics of the clinician that are important in providing culturally competent care. The first is the clinician’s awareness of his/her own multi-cultural heritage and his/her values related to grief and loss. Next is awareness of how these values might play a part in the relationship with the mourner. We look at life through our own cultural lens and this lens has the potential of distorting what we observe” (Fiorelli et al., 2009, p. 30).
In conclusion, “think of yourself as a guest in their world. Ask about their customs and traditions. Identify the degree of acculturation and assimilation the individual appears to have toward the dominant culture. Assess the degree of involvement with both the culture of origin and the host culture. You may need to give them permission to experience some things that we may define as normal, but they may define as unacceptable, or vice versa. Even people whose faith or cultural tradition is familiar to you, may vary regarding their understanding of what it is acceptable for them to do and experience. Be careful not to evaluate culturally relevant mourning behaviors as abnormal. Listen to what they have to say. Observe their reactions. Ask leading questions. Ask them what they want- they will tell you. Don’t assume you know what people may want to do or may want from you. Do not talk or lecture them on what they need until you hear what they are experiencing. Pass on what you have learned to others who may be encountering this family. Lastly, remember, there is great power in just being present with a mourner. Visiting, calling, showing concern, and offering help and suggestions based on your assessment of their needs goes a long way. Often, all people need is to know that someone cares” (Fiorelli et al., 2009, p. 30-31). Be present.
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