Cultural Aspects of End-of-Life Studies - Essay Example

END OF LIFE STUDIES End of Life Studies Name Tariq AL-Malki Student No S2721896 Culture and Loss Introduction Culture is something that unites a group together and is seen in terms of beliefs, attitudes, standards, behaviors, language, traditions, rituals, artifacts and arts that are linked to a group. This cultural group can be small or large depending on the defining factor, which can be religion, race, ethnicity, age, gender, professional associations, sexual orientation, and class, generation, among others (Fitzpatrick and Wallace 2005). Being a member of a distinct cultural group gives one a sense of membership and provides a structure within which to contextualize one’s lived experiences. Loss can be defined as the breaking of affection to someone or something, leading to a distorted relationship or simply as the state of being deprived or bereaved of something or someone. There are two general categories of loss; physical and psychological loss. The loss of something tangible can be termed as a physical loss, while the loss of something intangible is a psychological or symbolic loss (Ferrell and Coyle 2006). Losses can be genuine, potential, or physical. The death of a cherished person is referred to as secondary loss. There various types of loss namely: materialistic, relational, intra-psychic, functional, role, and systematic. The parting from a physical object or surrounding is termed as material loss whereas in the relationship loss a person does not have the access of another person. Intrapsychic loss blows an individuals self-image through loss of what might have been, changed perceptions, lost emotions, for example, devotion, hope, or guts or feelings that occur when a major chore is successfully completed. Moreover, when there is bodily decline or weakening in illness or aging this is referred to as functional loss. However, when there is loss of contact with habitual behaviors or functions within a system, like absence from a usual work surrounding is termed as systematic loss (Fitzpatrick and Wallace 2005). Grief is a set of feelings that come up instinctively after a significant death. It is a normal process of responding to a loss. Physical losses, such as a death, symbolic and social losses, such as divorce, can ignite grief reactions (Ferrell and Coyle 2006). All these losses show that the person has had something taken away. For example, as a family goes through a cancer disease, many losses are experienced and each ignites its own grief reaction. Grief may be experienced as an emotional, social, mental or physical reaction. Bereavement is the period after a loss during which grief is experienced and mourning arises. It is the state of having suffered a loss. The time spent anticipating the loss and the level of attachment to the dead person determines the time spent in a period of bereavement (Fitzpatrick and Wallace 2005). The main aim of reviewing this literature is to find out the implication of culture to the dying, grieving and bereavement process. Health care professionals encounter bereaved individuals throughout their personal and professional lives. Individuals experience the progression from the final stages of a terminal illness to the death of a loved one in a different way. It is therefore imperative for health care professionals to understand the various culture of patient for them to come up with appropriate intervention strategies (Larson and Hoyt 2007). The impact of culture on dying, grieving and bereavement Grief is influenced by culture. The culture we are born in to some extent influence the person we are. The manner in which humans express culture is more a product of culture than marital or religious customs. It is the custom of everyone to cry or seem to want to cry after a death of someone that is close to them. Although a significant death might be regarded as a universal trigger of grieving emotions, the value system of a particular culture determines which death is significant. Anger, guilt, anxiety, sadness and despair include some of the mental reactions to grief (Dennis 2008). Sleeping disorders, poor eating habits, sickness and physical problems are some of the physical reaction to grief. Examples of social reactions to grief include feelings about taking care of others in the family, visiting family or friends and returning to work. In short, grief can be described as the presence of physical problems, continuous thought of the dead person, guilt, hostility and a change in the way one normally acts. Even though diverse cultures have different mourning ceremonies, customs and behaviors of expressing grief, individuals experiences grief in a similar way in these different cultures (Tomarken, Holland, Schachter 2008) Culture has been viewed as beliefs and the meaning and purpose of life and the aftermath of death.  It enlightens the meaning of death for an individual and hence the feeling of each individual as they approach death or death of a treasured person. Different cultures practice different mourning rituals which helps individuals to remember their loved ones. While in other cultures craving for the dead person would be regarded with condemnation since this person is on his chosen karmic voyage. Other cultures show respect of the dead by participating in various ceremonies in order to remember the departed and to also assist the soul to go to heaven. The common ceremony among all culture is the funeral.  However, other cultures do not allow expectant women and children to attend funerals (Freeman 2005). The Jewish believes that the way the dead is dressed indicates value although the body is bathed and prepared in ways that pleases the family (Matzo and Sherman 2006). Islam believes that life is a trip through the earth whereas they view death as another journey through a spiritual world (Mohamed, Joseph, Verheijde, Muna, 2009). The earth is depicted as a place for resting with the intention of worshipping. The Muslim culture has no duration of time into which a person is required to recuperate from the loss of a treasured person and especially when the death is sudden or brutal. Christians believe in resurrection after death and therefore they do not mourn for a long period because they believe it is only a matter of time before they get reunited with their dead loved ones (Prigerson, Vanderwerker, and Maciejewski 2008). Other cultures purify the body with saffron and there after they burn incense in order to keep wicked spirits away. The Jewish family members are not allowed to view the body in order to always remember the deceased as living rather than dead. Various ceremonial practices may be done in order to relieve the transition to heaven while others believe cremation helps to relive the passage to another  life where the family keeps  the deceased’s ashes inside the house. Food, prayer or water is believed to relive the soul passage although food and water is positioned at altar or on windowsill. This water is essential to the soul since it gets light while prayer helps the soul to rest. Crying and wailing are a sign which expresses the value of the departed and how much they were treasured. In some cultures, men are not allowed to cry (Stroebe, Hansson, Schut 2008). Religion is the acknowledgment on part of man of higher and invisible power which has control of his destiny, and being at liberty to obedience, veneration and worship where the invisible power is God. Other religions believe that birds of prey are the transporters of the body to paradise (Prigerson, Vanderwerker, and Maciejewski 2008). Various funeral customs exits in different cultures like in some fishing and marine tribes, mourners put the corpse inside the water which is known as burial at sea. While mountain villagers hang the casket in woods and others have locations of how the graves shall be set in the graveyard. There is also the process of cryopreservation of the body into liquid nitrogen temperature which is essential to stop the natural decay processes that arise after death. Animal sacrifice is practiced by many beliefs as a way of soothing a god or spiritual being or changing the way of nature (Prigerson, Vanderwerker, and Maciejewski 2008). Crying, terror and anger are common in many cultures as ways of grieving whereas other cultures provide public sanction for expressing these emotions during funeral rites and customs of grief which follow bereavement. There are some societies where self-mutilation is part of emotional look at a death, where as in other societies catatonic serenity is common (Prigerson, Vanderwerker, and Maciejewski 2008). Although there are no emotional expressions that are generally present at death, the way emotions are felt, expressed, and how they are understood are subject to our culture.  Fainting is common among Filipino funerals, where as African, American and Thai are involved in noisy demonstrations involving crying and wailing which symbolizes importance, according respect and showing love for the dead. The Amish community believes in strong society support and mourners are expected to dress in black clothes and their funeral service is simple with no tribute or flowers while hymns are read without singing (Silver and Wortman 2007). Dying and grief are extremely personal, although these experiences and feelings cannot be alienated from who we are and from the societies that nourish and surround us. A culture can shape each individuals belief as relates to the meaning of death and how we die and mourn. In some Native American society, the name of the dead is not mentioned. Some cultures honor the dead in non-verbal ways. During the Japanese American funeral it’s traditional to offer a financial offering which is put in an envelope and dropped to the family on arrival to the memorial service. The Mexican-American society believes that the dead have godly authorization to visits friends and family on earth, and to share the joy of the living. During the Islamic funeral service, women are expected to cover their heads and the length of their hands, where as people are not allowed to enter the mosque with shoes when the funeral service is being conducted (Bonanno and Boerner 2007). Dying, grief and bereavement spare no one and are normal life events. All cultures have developed means of coping with death. Assisting families to handle death of their loved one involves showing respect for the family’s cultural heritage and encouraging then to choose how to respect the death. The grieving process can be interfered by any interference of these practices. It is therefore imperative for physicians to understand different cultures’ reaction to death as this will help them to recognize the grieving process of their patients in other cultures (Larson and Hoyt 2007). Cultural views influence individuals’ reactions to dying. A person who believes in heaven and hell and who fears everlasting damnation will respond to dying differently from a person who believes in reincarnation. Negative reactions to dying are not universal and individual philosophies shapes individual responses to dying (Stroebe, Hansson, Schut 2008). Cultural differences in grief are quite significant and counselors need to be both aware and respectful of cultural diversity (Funnell, Koutoukidis, Lawrence 2008). Attitudes to dying differ widely across cultures. For example, the Hindus believe that one should die on the floor to be closer to Mother Earth and therefore for them, dying on the floor, with family members praying and chanting is certainly not a big issue as it may be in British Hospitals. However, failing to allow for cultural traditions to be followed can make the dying process and consequent bereavement much more problematic. The fact is that the death of a loved one entails not only the loss of that person but the loss of self, the self that is so inextricably associated with the dead person. The way in which nurses provide care to those who are dying and their significant others is influenced by their personal experiences. Therefore, examining personal experiences can assist nurses to understand their own fears and anxieties as relates to dying and bereavement. Understanding the implication and importance of relationships assist in putting the loss in perspective. When working with patients who are dying, the nurse must have the ability to articulate feelings as regards good and bad death. The nurse can enhance his/her competence by exploring personal values and biases as this will help the nurse to better understand the patient’s healthcare attitudes and behaviors and thereafter provide quality healthcare services (Dunn and Stephens 2005). People who are dying do not move toward death in the same way or at the same rate. The diverse patterns of dying are linked to the various causes of death. These patterns are referred to as dying trajectories and they indicate the path of a person’s experiences of dying. The perception of the patient’s dying trajectory strongly shapes the attitudes and behaviors of people taking care of them (Dunn and Stephens 2005). These trajectories also influences the types of emotional responses and coping mechanisms expressed by patients and their families, as well as the interventions that will be initiated. It is therefore important to understand the patient’s dying trajectory in order to develop and implement appropriate interventions. The dying process can be defined in terms of length and shape. Length refers to the period between the inception of dying and the arrival of death. Shape determines the course of the dying process in terms of whether one can forecast how the process will proceed and whether the estimated timing of the death is anticipated or unanticipated (Matzo and Sherman 2006). Research studies have found out that women express an intuitive grieving style, with more grief, guilt and despair compared to men (Maciejewski, Zhang, Block 2007). Men are socialized to handle instrumental tasks, for example, those linked to the memorial service, funeral, finances and property. Women are more expected to take on care giving tasks, which entail taking part in both of the dual processes. However, it has been found out that widowers experience greater depression and health consequences than widows, despite differences in social support. The socialization of men interferes with active grief processes making them have unrecognized problems. Generally, men respond to grief by adapting coping styles that mask fear and insecurity, such as remaining silent; engaging in secret mourning, immersion in recreational activity, displaying addictive behaviors, for example alcoholism among others. Societal expectations are such that men will contain their emotions in order to protect and comfort their wives; however, men cannot heal their own grief without sharing their feelings. Though gender-based differences in grieving are not well understood, they seem to be shaped by expectations and socialization. There are a few studies which have been conducted to help us understand gender-based differences in grieving (Bonanno and Lilienfeld 2008). Cultural differences in terms of values and practices continue to exist and present a wide variety of normal responses to dying, grief and bereavement. Common areas with profound differences include extent of rituals attached to dying, for example the significance of attending burials, the degree to which burials should be expensive and kinds of acceptable emotional expression; need to see a dying family member; openness and kind of emotion expression; emphasis on verbal display of feelings and public versus private display of grief; suitable length of mourning period; significance of anniversary events; coping strategies, social support for hospice patients; and barriers to trusting professionals (Maciejewski, Zhang, Block 2007). Family rituals and meaning are very useful in understanding a family’s response to dying, grief and bereavement. The family solvency, structure, style of coping, support and communication mechanism can influence how family members react to loss. Language provides the means by which family develops cultural rules. Family members struggle to make sense of their loss by communicating to each other. In this way, they attach meaning to their losses (Kissane, McKenzie, Bloch 2006). Mourners perform therapeutic rituals following the loss of someone close, as demonstrated in burials and religious proscribed behaviors. Some of these rituals have specific healing properties such as enabling the individual to do something apart from falling victim to the emptiness and hopelessness; facilitating emotional and physical expression; presenting symbols and openings to focus feelings, emotions and behavior; creates a sense of enhanced emotions manageability; and providing experiences that permit the contribution of other group members and assert kinship and social harmony among other (Kissane and Lichtenthal 2008). There are three types of family rituals; customs, celebrations and patterned family relations. Examples of family rituals include festival meals, visit to a grave and recognizing items and pictures of the dead person exhibited around the house (Kissane, McKenzie, Bloch 2006) Age in relation to dying, grief and bereavement Dying, grief and bereavement are also influenced by age. There are great differences between the grieving process of children and that of adults. Research studies have found out that intense emotional and behavioral expression of grief in children is not continuous as in adults (Mallon 2008). An adult’s grief may seem less intermittent and briefer than that of a child and do not last for long. Hence, the work of grief in childhood needs to be tackled constantly at different developmental and chronological milestones. The bereavement process is continuous and therefore children will re-examine the loss time after time, particularly during important life events, such as marriage and birth of their own children (Mallon 2008). Adults do not respond to loss in the same ways as children and may express their emotions more openly than children. Apart from verbal communication, children may employ play, school work, drama, stories, and art as their grieving coping styles. Grieving children may not withdraw into obsession with feelings of the death person; they regularly immerse themselves in activities. For example, a child may be sad for one minute and the next minute he/she is out playing with other children. Bereavement reactions are intermittent since children cannot discover all their thoughts and emotions as logically as adults can (Maciejewski, Zhang, Block 2007). A bereaving child’s behavior can tell more than any word she/he could talk. A bereaving child’s behavior can be marked by strong feelings of anger and fear of death. Children may play death games as a way of expressing their feelings and anxieties in a moderately secure environment. As one gets old, his/her personal views become consolidated and life’s changes can be liberating. When aged people experience loss, they have to cope with many complex emotions and are vulnerable to impeding changes. Therefore, they should be provided with the same resources and opportunities as their younger counterparts, such as, grief counseling, support groups among others, to enable them explore complex emotions and problems (Matzo and Sherman 2006). It is important to note that our values, attitudes and believes as regards dying and bereavement are not rigid, but are receptive to and tailored by dynamic historic, economic and social forces. Individuals’ attitudes to dying are socially constructed and therefore, what we expect of mourners varies across cultures. Moreover, loss includes taking on new, perhaps undesirable roles, such as widow and orphan, and ways of life formerly unfamiliar. Hence, bereavement counselors and others should not stick to a inflexible theory which dictates what is right or wrong manner of grieving for the loss of a loved one (James 2007). Conclusion and recommendations Culture plays a significant role in the dying, grief and bereavement process. Different cultures have different values, attitudes, beliefs, behaviors, rituals, traditions, arts and artifacts as relates to dying, grief and bereavement. As a result, health care professionals, especially, dying, grief and bereavement counselors should make efforts to understand and recognize the different culture of their patients if they are to develop appropriate intervention strategies. There is need to conduct more research studies as relates to cultural diversity in dying, grieving and bereavement as only a few studies have been conducted. Gender-based differences in dying, grieving and bereavement are not well understood and therefore it is important to conduct further research in this area. 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