Tuesday, May 05, 2009
The grief process in different cultural and religions views
This is the final paper I received an A for. I think that it would be helpful for some so I am posting it. Warning it is long.
The grief process in different cultural and religions views
Benjamin Franklin is quoted as saying that the only sure thing in life is death and taxes. Though some may debate if all people have to pay taxes, there is no debate that death is a certainty in life. The mystery of death has fascinated people throughout history, and it is this mystery that has a profound effect on people of all cultures and religions. There are many views on what happens when one dies and this may have an effect on how people who lose someone to death deal with his or her loss. The development of grief counseling has presented an excellent tool for those who face the loss of a loved one. The understanding of the Grief Process Model helps many understand how to deal with their own emotions and even physical responses to their loss. There have been many incredible minds that have done much more research into the topic of grief and in no way will this essay be able to go into the depth of research that has been done. There is no desire to undermine the tool of the Grief Process Model as one can greatly benefit from using it in the time of loss. In part this essay will be educational, though I also hope to help expand the idea that the Grieving Process Model may not be universal to all cultures and religious views. While the Grief Process Model is helpful to Western and European cultures, the grieving process may not be universal to other cultures and religious views. If the Grief Process Model is not universal to all cultures and religious views, then there may be need to understand those other cultures and religious views to modify the Grief Process Model to better help those in other cultures and religious views.
The book “On Death and Dying’ written by Swiss doctor Elizabeth Kübler-Ross, was published in 1970 was first to develop the phrase “the grief process”. Dr. Kübler-Ross became concerned how those dying were “shunned” (2009) by doctors who were not willing to deal with the emotional issues of those who were dying. Dr. Kübler-Ross wrote her book in respond to this unkindness she witnessed. In the next few years Dr. Kübler-Ross began to notice that the grief cycle was not experienced only by those terminally ill, but also by those that lost loved ones due to death. Since then the grief process has been developed from five steps to 10. The most commonly used process is the five step grief process based on the seven step model that Dr. Kübler-Ross first developed.
The five step grief process model is fairly simple to understand. Grief as defined by the Oxford dictionary means “a great sadness caused by trouble or loss and a heavy sorrow.” (1989) In this simplified version the five steps are: denial, anger, bargaining, depression and acceptance. Grief can also be understood as a type of adaptation (Worden, 2009) to the loss of a loved one due to death. The living must find a way to come to terms with the death of a loved one whether the way is healthy or not. By recognizing the different emotional stages, one can better adapt in healthy ways.
Graph 1: The most commonly used form of the grieving process is the five step process. Though they do tend toward this progression, one may also regress or skip a step.
Dr. Kübler-Ross believed that a person passes through each phase as he or she deals with the emotions of dying or losing a loved one to death. Without passing through the phases one may not fully come to healthy terms with his or her loss.
The first stage is denial. There is a sense of unbelief that one faces when he or she first is given the news they are terminally ill, or that the person they love is dying or has died. Denial is simply rejecting the idea that death is happening or happened. This stage can be summed up in the phrase of “This can’t be happening.” There is a sense of numbness or shock that comes across a person and he or she may not accept the idea as reality.
The second stage is anger. Some can become angry at God, the person the grieving person lost, the medical staff or even themselves. In this stage the reality has sunk in, yet the mind seeks out a reason. “Why is this happening?” or “Why did this happen?” may by the common question that is asked.
The third stage is bargaining. Most often this is a reflection on one’s personal beliefs. The grieving person may turn to God or the universe and try to bargain their way out of the loss. “If you heal them I will…” is a common expression.
The Fourth stage is depression. In this phase one may become withdrawn and not want interaction with others. The person grieving will as, “Is life worth living?” and begin to feel the actual loss of the loved one.
The fifth stage is acceptance. In this stage the person has worked through the other stages and has come to terms with their loss. They have accepted the loss as part of their reality and begin to seek out a ‘normal” life again.
One may experience these stages in order or skip over one to another. They may also work through one stage and move to the next and still relapse into a stage he or she previously have gone through. The idea is that one works through each stage in a healthy way and recognizes each emotion as it comes. As one does this is becomes easier to understand why one is so angry or depressed.
Dr. Kübler-Ross was not without her critics. In 1980 Dr. Shniedman and in 1991 Dr. Kastenbuam cited that the research done by Dr. Kübler-Ross did not go far enough and that it was based on clinical impressions and not on empirical data. Shniedman and Kastenbuam also noted that there was suggestion that because Dr. Kübler-Ross was a psychologist, she portrayed the grieving process as a “mental illness” while they contended that it was a biological defense mechanism. (2009). With this in mind the discussion of the 10 step grief process is now appropriate.
The same steps in the five steps are present yet in more detailed:
Graph 2: The 10 step grieving process.
The first stage is Denial which as stated, one will experience shock or numbness.
The second stage is Release which can be expressed with sadness, crying and feeling the reality of the loss.
The third stage is Depression. In this stage there is a sense of loneliness, helplessness and the question of “Why did this happen?”
The fourth stage is Physical symptoms. One will begin to feel fatigued, weak, may experience the physical pain that the dying experiences and insomnia.
The fifth stage is Pain. In this stage one may experience anxiety, fear, develop an illness phobia, become over sensitive to physical illness and preoccupied with health.
The sixth stage is Guilt. Often the person grieving will feel he or she did not do enough for the loved one or say everything they should have while the deceased was still alive.
The seventh stage is Anger. One may experience the impulse to blame others. They may also have hostility toward others though most commonly toward the caregivers.
The eighth stage is withdrawal. In this stage one may experience the loss of interest in daily things and develop a fear of losing control in public.
The ninth stage is Recovery. One will begin to re-adjust to the idea that their loved one has died or is dying. In this there is a release or letting go of the burden of grief.
The tenth stage is Acceptance and peace of mind. A person in this stage has come to terms with his or her loss. They have accepted it and now have peace of mind. (Sahley, 2007, January)
The effectiveness of the grieving process model depends on each person and how one is able to work through each stage. Attitudes about death can have an effect on how a person works through the process. Unfortunately, in western culture there is a “taboo” attached to the topic of death. Seeing death as unnatural or something people just do not discuss may interfere with how people are able to work through each stage. In the USA there seems to be either the glorification of death and violence or the hush that it is only to be spoken about if necessary. Understanding that death is part of life and to view it as part of the life cycle can help one have a healthy understanding of death
Only 100 years ago, it was common that when a person was dying to have his or her family would be present. People would also care for the body themselves and prepare the deceased for burial. Women would dress the deceased in their favorite clothes and care for the body by washing and grooming the deceased as they did when they were still alive. Now people are often not willing to touch a well made up body in a mortuary out of fear. (Wilson, 2009)
People also tend toward dying in hospitals which are often a sterile and impersonal environment. Now we place the body in morgues, have someone else prepare the body or have it cremated and from there it is taken to the cemetery or other place of final rest. In the end society has lost touch with mourning with the association of a body and even mourning has begun to be a lost tradition. Jamie Wilson sums it up this way, “Dying traditions are dying traditions.” (Wilson, 2009)
Currently there is a rise in interest in hospice where those dying are cared for. Yet, still these are mostly utilized for those patients dying from AIDS, cancer, or motor neurone disease. (Neuberger, 2003) Julie Neuberger suggests that using hospices one can study healthy ways to deal with death and dying. (Neuberger, 2003) Neuberger also states that there is a new interest in spirituality associated with those dying in hospice and that this should be a high priority. (Neuberger, 2003)
The grieving process is also useful for other areas in life and one can use it for about any loss. In a sense, the loss of a job can cause many of the same emotional responses that death can, though maybe not as deep. By utilizing the tools of the grief process model one can readjust more quickly to be able to seek out other work.
Another area that the grief process has been found useful is in the case of divorce. In this case it is the death of a marriage. By utilizing the tools of the grief process model one can recognize and monitor his or her emotional state and more readily work through their emotions. When a person recognizes that he or she is experiencing grief over a loss and have the tools to deal and work with, they can find healthy ways to express themselves and work to healthy solutions. Often in the case of divorce one senses the same feelings as one would if there was a death of a spouse, yet there is not the resolution of the burial. By using the tools of the grief process one can come to acceptance of the situation as it is and grow beyond revenge, fantasy or other states of mind that may keep one from growing.
The grieving process is an excellent tool yet is it effective in all cultures and in light of other religious beliefs? Do some religions better prepare some for death than others in helping people deal with grief?
There is not much research that has been done on how the grieving process may differ from Western or European cultures and other cultural and religious views. One study did go into the differences in cultures that are present in the United States. I see that in some of these cultures and religious views that grief counselors need to take into account these differences as they attempt to help someone adapt to his o her loss. The hope of a counselor is that people will come to a healthy adaption to their loss rather than maladaptive. (Worden, 2009) By ignoring or worse forcing another cultural or religious idea on someone already stressed with the burden of grief can cause more stress and possible harm the person.
In many cultures the view of death is not as taboo as it is in the United States. Yet within the United States alone, there is an extended diversity of cultures and religious views giving us a bit of a perspective as to whether one need broaden the research on the grieving process.
According to Lobar, Youngblut, Brooten, In Mexican American college student “[r]esearchers have found greater expression of grief and more physiological reactions compared to Anglo college students.” (Jan-Feb 2006) Often in Latino communities do not want to burden the family and “will rely on faith, hope and prayer” (Lobar, Jan-Feb 2006 p. 1). to cope with the death of a loved one. In Asian and Latino communities open express grief which could include “wailing” or even mourning clothes are often parts of the rituals in which these cultural groups mourn. (Lobar, Jan-Feb 2006 p. 2) In some Latino expressions of religious faith there will be a mixture of “Catholicism and “folk medicine” such as Santeria, Kspiritismo, or Voodoo” (Lobar, Jan-Feb 2006 p. 2) which may include having a holy man come and help the deceased move into the next life. If a family with these beliefs are not allowed to do this it could add to their own stress and worry over the deceased and keep them from feeling they did not do all they could to help the deceased move into the next life.
In Hindi families there is much more interaction with preparation of the body by family members. They will bath the body, massage it in oils and dress the deceased in new clothes then make sure the body is cremated before the next sunrise to ensure the soul’s transition from this world to the next. If the grief counselor is not aware of this practice they can cause more undo stress to those grieving. By taking the body away as is custom in the United States, we are often not allowing those who practice their beliefs to do so. (Lobar, Jan-Feb 2006 p. 2)
Though some in Western culture may look at many of these as superstitious or even improper religious beliefs, the point in grief counseling is not changing the beliefs of the person grieving, but to help them work through the grief with some additional tools which the Grief Process Model may give. To be flexible with the structure can aid in the person overcoming the immediate stress of the loss. In most cases this is a time when many will cling to their faith and any challenge will not be accepted.
As one looks at the Grief Process Model in light of other cultures and religious views one may not come to the same conclusions. The Grief Process Model is a useful tool that can help people deal with death of a loved one, divorce, or even a loss of a job. Many have been helped by gaining understanding in what they may face in a loss. There still needs to be a respect for other cultural and religious views in how someone understands death and loss. To presume that all groups of people deal with death the same way undermines this respect. Taking time to study these other views can help extend the effectiveness of the Grief Process Model. So the question is whether one sees the Grief Process Model as universal or not? If the Grief Process Model is not universal to all cultures and religious views, then the modifications are necessary to better help those who have a loss due to death.
Dunne, K. (2004, July 21). Grief and its manifestations. Nursing Standard, 18(45), 45-53. Retrieved February 27, 2009, from CINAHL Plus with Full Text database.
Lobar, S L, Youngblut, J M, & Brooten, D. (Jan-Feb 2006). Cross-cultural beliefs, ceremonies, and rituals surrounding death of a loved one. Pediatric Nursing, 32, 1. p.44(7). Retrieved February 27, 2009, from General OneFile via Gale:http://find.galegroup.com/ips/start.do?prodId=IPS
Neuberger, Julie (2003, July 26). A healthy view of dying. A healthy view of dying, 327, Retrieved March31. 2009, from http://www.hawaii.edu/hivandaids/A%20Healthy%20View%20of%20Dying.pdf
Oxford English Dictionary (1989) Oxford English Dictionary, Second edition. Oxford, Oxford university press.
Sahley, B. (2007, January). Coping with Grief. MMRC Health Educator Reports, Retrieved February 27, 2009, from Alt HealthWatch database.
Unknown, (2009). The Kübler-Ross grief cycle. Retrieved March 30, 2009, from Changing minds.org Web site: http://changingminds.org/disciplines/change_management/kubler_ross/kubler_ross.htm
Wilson, Jamie K. (2007, August 02). Unhealthy fear of death: modern westerners don't understand how we end. Retrieved March 31, 2009, from Associated Content Web site: http://www.associatedcontent.com/article/331488/unhealthy_fear_of_death_modern_westerners.html
Worden, J. William (2009). Grief Counseling and Grief Therapy. Retrieved April 17, 2009, from Grief Counseling and Grief Therapy Web site: http://www.springerpub.com/samples/01208_chapter.pdf