Unit 3 -- Culture

Grief in a Family Context -- HPER F460/F560

Goals for this Unit

In this unit, we will look at the role of the cultural context within grief takes place. Culture is influential in many ways, at several levels, and we consider and explore a number of these. Finally, in the role of helper, we are affected by our own cultural background and this, too, will be examined.

Preliminaries

As with other terms we've used in this course, "culture" has been defined in a wide variety of ways. This became abundantly clear to me as I started to write this unit and looked for a definition that met with some consistency from source to source. My favorite definitions were "culture is what we study" and "I can't say what it is, but I know when I've experienced it" -- both from practicing anthropologists. Throughout this unit and the remainder of the course, I would like you to think about your own definition of culture. What makes something culturally distinct? Culturally relevant? How would you recognize a culture or cultural group? Who and what would be included? Is it possible that we experience our own culture as "truth" and only become aware of it when it contrasts with another culture? What, if any, value is there in recognizing cultural similarities?

This week, in addition to the Questions for Discussion, you will be given the initial information for a project that is due between the seventh and eighth units. So, be sure to check the link to the Cultural Interview Instructions at the bottom of the page. Also, we will be setting up a Conversation on Oncourse for discussion of any problems or concerns about doing the interview.

Readings

Anthology

Koenig, B. A., Gates-Williams, J. (1995). Understanding cultural differences in caring for dying patients, West J Med, 163, 244-249.

Rosenblatt, P. C. (1993). Cross-cultural variation in the experience, expression, and understanding of grief. In D. P. Irish, K. F. Lundquist, V. J. Nelsen, (Eds.) Ethnic variations in dying, death and grief: Diversity in universality (pp. 13-19), Wash. D. C.: Taylor & Francis.

Shapiro, E. R. (1996). Family bereavement and cultural diversity: A social developmental perspective. Family Process, 35, 313-332.

Web Resources

The link below will take you to a web page that lists a variety of resources I found on the Web. This is only a sampling; you may want to explore further and then suggest sites you already know of or find in your searches. Some of these pages on this link are specifically grief-related; others take a broader look at the cultural group; yet others are personal accounts that are expressed in cultural contexts. You are not required to read all of the content of all of these pages (there are in excess of 1,000 printed pages!), just to sample them.

"Lecture"

In the Preliminaries section, I asked you to think about what culture means to you. It's only fair for me to do the same, as I will be writing this lecture from my own perspective. I see culture something that binds a group together and is seen, at minimum, in the beliefs, attitudes, standards, behaviors, language, traditions, rituals, artifacts and arts that are associated with some group. That group may be quite large or small and, depending on the level at which you start defining a cultural group, I also see subcultural groups, with distinctive and unique variations on the broader cultural themes. A cultural group may be identified by religion, race and/or ethnicity; it may also be defined by age grouping, generation, class, gender, professional association, sexual orientation, and so on.

Being a member of a distinct culture or subculture provides a sense of membership as well as a structure (or philosophy) within which to contextualize one's lived experiences. One of the ways in which we study the relationship between culture and loss is through mourning customs. Here, the term "mourning" is not used, as psychologists often do, as synonymous with grief. Instead, it refers to the public, socially constrained, behavioral response to a loss which incorporates death ritual activities.

When I was preparing this unit, I struggled with the way in which I would present it. I could put forward a "laundry list" of characteristics of different cultures. I feared that, because of the limitations of this medium, the lists of characteristics of the groups I chose to focus on would reflect my own sense of cultural differences (then, viewing that from the perspective of a 54 year old, married, middle-class, university professor living in a rural college town in the midwestern US, a third generation American of Slovak descent, with an urban, blue-collar, Catholic background), I would run the risk of doing exactly what concerns me about much of what I've seen written in text books in this regard. I could reify stereotypes of these groups and limit your understanding of cultural groups other than your own. Additionally, although there are normative characteristics of particular groups, individuals and families in those groups will have some characteristics that are unique to them. As an alternative, I've compiled a list of multicultural resources for this unit and have put together a short list of published resources at the end of this unit that address cultural issues and look at particular cultural groups.

Because there is so much that can be learned from reading the assigned readings and from the multicultural links, I decided to keep this lecture fairly short and to refer to points I found to be especially significant in the readings. You may also want, on Oncourse, to bring up points that you found significant, but that I didn't mention.

Some Thoughts on the Cultural Context of Grief

In writing this unit, I marveled at the wealth of resources now available on cultural variations in grief. At the same time, I felt a sense of being overwhelmed by the mass of it--and an odd sense that I have been skating over the surface of the reality of grief in cultures different from mine. A thought I carried from Shapiro was the risk of cataloguing a list of characteristics of cultural groups and then responding to the list as the totality of the lives of the members of that group, rather than seeing it as a possible starting point in my understanding of their grief experience. We need to maintain vigilance with regard to the range of possibilities in grief among and within different cultural groups. Those of us who do research have only scratched the surface in our efforts to study the diversity of grief between different cultures (and have much that is unexplored regarding diversity within cultures).

We look at life through our own cultural lens and this lens has the potential of distorting what we observe. We may be able to adjust the focus to a degree, but we can not completely "regrind" or replace the lens. Keep this in mind as you explore the links provided to Web resources. As you look at these resources, I encourage you to look at both differences with and commonalities to your own cultural context of grief.


The concept of living systems models, addressed in Unit 2, can be used to understand the influence of culture on families and family members as they grieve a loss. A culture is comprised of component parts that, together, become greater than the sum of their parts. A culture also evolves and changes over time as members of the cultural group are exposed to new information and experiences within their community as well as to aspects of other cultural groups. Individual families and their members will also vary in response to broader cultural themes, because of their unique experiences. In a sense, the family acts as one of the lenses through which we view the broader culture, and influences our specific response to cultural influences.

The varied beliefs and practices used by cultural groups to cope with death have common, underlying themes that extend across cultures. Kagawa-Singer (FYI, we will read this in a few weeks--we'll just refer to it here) described integration and function as the warp and woof of all cultures. Regardless of the particular cultural practices related to grief and mourning, they serve a functional purpose (i.e., the business of "getting things done") and to promote the integrity of the group. In Grief as a Family Process, Shapiro (1994) discussed the utility of cultural practices (e.g., rituals) as a means of helping families as they cope with a loss. This would help the family to move through the tasks they need to accomplish in order to successfully deal with the loss (e.g., recognition of the loss, reorganization and reintegration of the family, discussed in Unit 2). The funeral ritual serves the purpose of recognizing the loss, affirming the continuity of family, the altered relationship with the deceased (sometimes continuing, sometimes not--depending on the culture), and the closure on a past life. Yet, in clinical practice and social science research, one often sees a Western bias in that which is "normal," healthy, and appropriate grieving. The reading by Rosenblatt encourages sensitivity to cultural variations in the response to loss, including the idea that the concept of grief might be alien in some cultures.


Shapiro (1994) writes about the goodness of fit between the broader culture and the individual family. She notes, "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 (the bereaved) feel psychologically ready" (p. 221). This concern is echoed in the reading by Koenig and Gates-Williams. I wonder about the goodness of fit between an industrialized society that needs its "component parts" to be back in working order quickly and the need of the bereaved person to work through the varied tasks of grief. Are other cultures better at providing support after a loss? One curious question also comes to mind: Might it be better, easier, possibly emotionally safer to live in a society in which there is less exposure to alternative cultural views?


Many of you are or will be active in the helping professions, which also have developed as unique subcultures within the broader cultural context. These subcultures can be at odds with the needs of the bereaved, particularly of culturally appropriate grief is seen as evidence of pathology. In his article on small-scale cultures, Rosenblatt addresses this nicely. Culturally appropriate grief may range from muted through quite dramatic displays. Grief may be expressed through somatization or in psychological or emotional ways. In the US, the tendency is to view grief through a scientific lens, with spiritual aspects ignored or viewed with suspicion. I wonder how a therapist, living in a Western, industrialized society, trained to recognize "continuing hallucinations of the deceased's presence" as evidence of pathology would respond to a father who describes vivid, ongoing dream visits from his long-deceased son.

Members of the health care profession also may face a conflict between the needs of a person facing death and her/his family and the pressures they feel from their professional subculture. Kagawa-Singer describes the culture of hospitals in this way: "In the hospital, the human experience of dying is decontextualized from cultural tradition, lineage, and accepted dogma for death is antithetical to the mission of health care"(p.102). Her view is of the mission of health care conflicting with the needs of dying patients and their families. This results in a clash between the spiritual and the technical, the personal and the impersonal, the subjectivity of the cared for and the objectification by the caregiver. An alternative model, increasingly used, is that of the hospice. In this model, the family often is seen as the care unit and the approach is more closely tied to the spiritual, personal and subjective.

Instructions for Cultural Interviews -- to be completed and turned in between units 7 and 8 (there will be a separate folder on Oncourse for this assignment)

Questions for Discussion

Post your response to the following questions on the Class Discussion..

  1. n the Koenig and Gates-Williams article, they discuss cultural sensitivity in patient care, but there are legal implications for these cultural practices and beliefs  In particular, patient confidentiality and the breaching of patient confidentiality with the family must be considered. What are your thoughts on how far medical professionals can and should go to accommodate the cultural practices of a particular family? What are the implications for grief of people who are of different cultures?
  2. You've had a chance to read about a variety of cultural approaches to loss and grief, especially on the Multiculture link page, and that brings up this question: Do some cultures seem better at providing support after a loss than others? Might it be better, easier, possibly emotionally safer to live in a society in which there is less exposure to alternative cultural views (i.e., an insular culture in which other cultural influences are not experienced)? One thought you might explore with regard to this question is: Is it realistic to even consider the idea of an insular culture where there is no influence from other culture

INTERVIEWS

General Conclusions

These will be generated out of the discussion on Oncourse.

Published Resources

Counts, D. R. & Counts, D. A. (1991). Coping with the final tragedy: Cultural variation in dying and grieving. Amityville, NY: Baywood Pub. Co., Inc.

Irish, D. P., Lundquist, K. F., & Nelson, V. J. (Eds.). (1993). Ethnic variations in dying, death, and grief : diversity in universality. Washington, DC : Taylor & Francis.

Johnson, C. J. & McGee, M. G. (1991). How different religions view death and afterlife. Philadelphia, PA: The Charles Press.

Kapp, M. B. (1993). Living and dying in the Jewish way: Secular rights and religious duties. Death Studies, 17, 267-276.

Kleinman, A. (1985). Culture and depression. Berkeley: University of California Press.

McGoldrick, M., Almeida, R., Hines, P. M., Rosen, E., Garcia-Preto, N., & Lee, E. (1991). Mourning in different cultures. In F. Walsh & M. McGoldrick, (Eds.), Living beyond loss: Death in the family. New York: W. W. Norton & Co.

Shapiro, E. (1994). Grief as a family process. New York: Guilford Press. Stroebe, M., Gergen, M. M., Gergen, K. J., & Stroebe, W. (1992). Broken hearts or broken bonds. Love and death in historical perspective, American Psychologist, 1205-1212.

Wieland, D. (Ed.) (1994). Cultural diversity and geriatric care : Challenges to the health professions. New York : Haworth Press.

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