This research explores the literature across cultures on death and dying in order to highlight the impact of culture on reactions to death and the dying process. A theoretical framework is established, using Elizabeth Kubler-Ross’s five stages of dying, followed by a succinct discussion of the reactions and attitudes toward death and the dying process of four cultures (Buddhist, Hindu, Native American and American). By illustrating the different reactions and attitudes toward death of these cultures, it is revealed that through increased cultural understanding health care workers can provide more personalized care to the dying.
Fear, Mortality, Burial, Religion, Buddhists, Hindus, Native Americans, Americans Introduction
According to Kart and Kinney (2001, p. 532), “Death is something that must be faced by everyone.” Despite the inevitability and universality of death and the dying process, different reactions and perceptions of death arise in different cultures, from the conventional Judeo-Christian reaction in American culture to the belief in reincarnation in the Hindu culture. Bereavement, grief, and mourning often accompany the death and dying process, but as Kart and Kinney (2001, p. 532) make clear, these aspects of the process are typically “culturally proscribed.” This discussion of different reactions to death and the dying process across cultures will focus on Elizabeth Kubler-Ross’ five stages of dying with a comparison of how different cultures (Hindu, Buddhist, Native American and American) react to death and dying. Literature Review
Death is one of the few experiences shared by all humankind. In her groundbreaking book, Death and Dying, Elizabeth Kubler-Ross begins her book with a discussion of Western man’s fear of death and dying and by pointing out that this subject has become, for many individuals, a taboo. Kubler-Ross (1969) outlines five stages that terminally ill individuals experience through the process of dying: Denial (shock), Anger (Emotion), Bargaining, Depression (Preparatory), and Acceptance (Increased self-reliance). Understanding this process was important to Kubler-Ross, in order to alleviate anxiety and fear of death both in the dying and those left behind. While Kubler-Ross’ stage-process focused mainly on Western experiences and encompassed a Christian ethos, perceptions of death and dying vary significantly from one culture to the next. Buddhists
While one or more or all of Kubler-Ross’ stages may be relevant to other cultures, many cultures view death in a manner that often negates the anxiety and fear experienced by many Westerners with respect to death and dying. In looking at other cultures, it becomes apparent that the view of the afterlife is often a significant factor in how people deal with death and dying. For example, in the Buddhist tradition in Asia, Buddhist Lama Priests preside over a three-day vigil of the dead body, while friends and relatives burn oil, offer sacrifices, and pray with the Lamas. Unlike the denial and anger experienced with Western death, Buddhists believe in holding such a vigil because of their belief that the deceased may return, “This vigil is very important for the Buddhists who believe that upon death the soul leaves the earthly body immediately but hovers around it for three days and that sometimes within this timeframe the soul may decide to reunite with the body causing an instance of miraculous resurrection” (Lama, 2004, p. 1). Because of this, the dying have some hope that death is not final and experience less anxiety and fear during the process. Hindus
Hindus believe in karma and rebirth. Those who are dying also experience less fear, anxiety, and anger than Westerners, because of their belief that a life lived well will result in the achievement of the end of the cycle of birth and rebirth – achievement of nirvana. However, Hindus do not believe in any kind of lengthy vigil similar to a Western wake or the Buddhist tradition. Instead, they believe the body must be cremated quickly after death. As Lama (2004, p. 1) maintains, “The belief that once it sheds its body, the soul prepares to depart immediately on its karmic journey, and as such, it’s very important to cremate the body as soon as practical so as not to provide any allurement for the soul to linger on this side of the world.” In such cultures there is little relating to the bargaining or depression stages of Kubler-Ross’ theory, but acceptance certainly applies to both Hindus and Buddhists. In fact, for the gerontologist, increased cultural understanding of the death and dying process aids overall quality of care. As Barker (1999, p. 161) reports on one study conducted on Hindus in a British community, “…poor communication due to linguistic and cultural distance between relatives and hospital staff, as well as lack of sensitivity involving the latter, may be most distressful to the dying and their relatives.”
Native Americans also had and still have a unique perspective on death. It is doubtful Native Americans relate to any of the phases outlined by Kubler-Ross, save for acceptance. For Native Americans perceive death as merely one facet of what they view as the “Sacred hoop of life,” (Turner-Weeden, 1995, p. 11). This is because of their unique worldview with respect to what happens to the soul after death. Native Americans view life and death as a circular movement, wherein the process merely represents a transformation and not finality. As Moffett (2004, p. 1) explains, “Since life is movement, but movement that is cyclical and not linear, physical death is nothing more than a change of both worlds and forms, because it is a circle from birth to death to rebirth.” While there is much to be said for Kubler-Ross’ stages of death and dying, both for their applicability to Western attitudes toward death and dying and as a means of supplication and solace to both the dying and those left behind. However, the above examples demonstrate that such a process may not be universal and is largely unnecessary for cultures with differing perspectives on the process of death and dying. Americans
America tends to be a “death-defying” culture, embracing a philosophy that not only is death unnatural but that avoidance of the subject may actually forestall what is inevitable. For many Americans the quest for immortality, or the belief that immortality in some form or manner is possible, takes a form very different than presented in religious doctrine. Many Americans continue to view death as something to be feared, postponed, and held off as long as possible through any means possible. According to Kant and Kinney (2001, p. 531), such attitudes stem from a desire to maintain “personal autonomy” among individuals. This penchant for denying death as the termination of physical being has spawned several disparate movements in U.S. society that are widely used to eliminate fear of death or to delay or extend it for as long as possible. The ever-increasing ability of medical science and technology to enable individuals to physically exist for extended periods of time has reinforced American attitudes of denial.
From hospices and living wills to advance directives, even Americans who accept death increasingly distance themselves from what they view as “routine” and “depersonalized” care as they die (Kant and Kinney, 2001, p. 522). As a culture, we abhor aging and fight the ravages of time with an increasing arsenal of medical procedures and cosmetic products. We create retirement communities to extend individual control over aging through assisted living. We continue to carve a widespread national belief that crosses cultures and religions that somehow existence continues after death. Many believe in reincarnation, others hope for the possibility of freezing the dead body to be brought back to life, and others put their hopes in the future improvement of cloning. If celebrities are considered American “royalty”, then they also demonstrate an American unwillingness to let people die. Abraham Lincoln and John F. Kennedy come to life daily at theme parks like Disneyland. Nat King Cole sings duets with his daughter through music and video technology. Harley Earle still designs Buicks, a reincarnated ghost of automobile legend.
Elvis impersonators abound, but we cannot even accept the death of the “King” of rock-and-roll, as many Elvis “sightings” keep alive the rumor that he has not even died. Like Jim Morrison, many argue that Elvis merely grew tired of the trappings of fame and is comfortably eating peanut-butter and bacon sandwiches somewhere in seclusion. As Siegel (1999, p. 56) suggests, American culture views “Elvis as the only cultural icon to have inspired a passionate denial of the fact of extinction.” Unlike almost any other developed nation, Americans fight both the physical reality of death as an ending and acceptance of it as natural. American culture continues to defy and delay the inevitability of death through four main movements: 1) A widespread belief in life after death; 2) Societal commitment to extending life; 3) A culture that promotes symbolic immortality; and 4) The belief in science to re-create life or cheat death, (Kearl, 2004). In a 1997 poll reported in Time magazine, 81 percent of Americans agreed with the question, “Do you believe in the existence of heaven, where people live forever with God after they die?” (Kearl, 2004, p. 2). Despite this belief, the overwhelming majority of Americans are in no rush to enter the Kingdom of Heaven. Summary
It is readily apparent that the death and dying process is reacted to differently across cultures. From mourning and bereavement to grief and burial, gerontologists are well advised to become aware of the socio-cultural influences on attitudes and reactions toward death and the dying process to provide better care in an increasingly diverse society. Even Kubler-Ross’ Death and Dying is written largely within the framework of the Christian ethos. Because of this, Moller (2000, p. 5) argues that the book advocates “death as the final stage of living”, promoting the idea that death is “not the cessation of life…rather it is the transition of life from earthly existence to unearthly, spiritual existence.” Gerontologists hoping to provide comfort and care to the dying and those close to them must continue to learn how culture impacts reactions and attitudes toward death and the dying process. As Kant and Kinney (2001, p. 532) assert, “It is hoped that added understanding of the dying process will allow health care professionals and family members to provide for personalized care to the dying.”
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