American Attitudes Towards Death and Dying

1. American Attitudes Towards Death and Dying Dusana Rybarova Psyc 456 July 2007

2. From Visible to Invisible Death • Visible death • Death recognized and orchestrated by the dying person, preparing for dying • Manual for a dying person ‘Ars moriendi’ to achieve peaceful and graceful death (dying and funeral as public rituals with personal assistance of close ones, forgiveness, meditation) • Filtered death in Early America • Between 1600 and 1830 • Funeral processions, awareness of death • Postmortem photography publically displayed • Increased value in family relationship shifted the initiatives surrounding death from the dying person to the family • Shift from personal psychological event to collective sociocultural event

3. From Visible to Invisible Death • Invisible Death • Current funeral practices adopted by European Americans • Feelings and thoughts are kept private • health and funeral institutions dominate the procedures surrounding death • Thanatology • Interdisciplinary study of death and dying • Established in the wake of WW II • Has roots in psychology, sociology, anthropology, philosophy, theology, biology, medicine, social work, ethics, law and other disciplines

4. John D. MorganCanadian philosopher and thanatologist ‘Our North American death system, … is the result of our limited exposure, which is a result of our high life expectancy, … but in many ways, our life is no different from that of the peasant in the 14th century. The peasant missed a fully human life because he or she was inundated with death. We do not live fully because we reject death. (1995:40-42)

5. Factors influencing invisible death • Industrialization • Increased living standards • food production, better housing, expanding public education, improving water and sewage facilities, new communication and transportation means • Modern medicine • New medical technologies, immunization programs, sterile treatment facilities, hospitals • % deaths in US. Hospitals (1900 – 20%, 1994 – 80%) • Life expectancy and the family • After WWII life expectancy increased by 20 years • Infant mortality decreased from 29.2 per 1000 live births in 1950 to 8.2 in 1992 • We view death as an event that happens in old age

6. Factors influencing invisible death • Geographic Mobility • Distance often separates family and friends as changes in employment and lifestyle require moving (decline in personal contact with extended family) • Death and Language • Approach avoidance conflict • Obsessive fascination with death in literature, TV, film, humor • Obsessed not to speak about death directly (using the word ‘death’ more often when we are not speaking about death than when we are

7. Factors influencing invisible death • Death and the Media • Death is abstract and superficially portrayed • Death is fun and revocable • Cartoon characters • Death is brutal but fast • Death is resolved in 60-90 minutes • Death is horrible but distant • Happens to people other than us

8. Attitudes of Invisible Death • Attitudes • Relatively lasting patterns of thinking, feeling and behaving towards something • Cognitive Denial • We refuse to think about death or perceive death related issues • One of the most common and most indirect defense mechanisms • Short-term denial • Natural coping mechanism right after a traumatic event • Prepares us for grieving and processing of the loss • Long-term denial • Represses emotions that are too painful • Destructive in the long run (immune system, heart problems etc.) • Deathbed denial • A form of cognitive denial • Descriptions of deathbed scenes (Kastenbaum & Normand, 1990) • Majority of respondents expected to die at home • Almost all expected to be alert, lucid, and aware right up to the moment of death • Surrounded by loving, supporting, even cheerful loved ones

9. Attitudes of Invisible Death • Emotional repression • Blocks disturbing wishes, thoughts, or experiences from conscious awareness • In relation to death we block out unacceptable bodily feelings and emotions painfully connected to death or loss • Respondents describing their death did not report any pain, anxiety, fear, sadness etc. • Emotional repression and cognitive denial of death have become necessary in chaotic modern society in order for individuals to maintain the illusion of normal life (Jasnow, 1985)

10. Attitudes of Invisible Death • Behavioral passivity • We became passive observers to our own dying and to the morning – we leave the behavioral orchestration to physicians and funeral directors • Socialization • We are socialized to conform others • Conformity • High conformity in situations poorly defined • Lack of social support for non-conforming behavior • Lack of social comparison • When personally dealing with death we may feel isolated • Perception of legitimate authority • Authority figures – funeral directors, physicians, nurses, clergy • Inaccessibility of values • When we are distressed by the sadness, despair, and pain of death we don’t see that cognitive denial, emotional repression and behavioral passivity are wrong attitudes

11. Ethnic variations in attitudes towards death • Affrican American attitudes (12% of population) • Life after death: immortality is a given for most • During grief family is more less important than for Asian Americans and Hispanic Americans • Expect to live much longer than other ethnic groups • Preference of care for terminally ill at home • Less formal and more emotional than European Americans • Hispanic American attitudes (9% of population) • More open expression of emotions after death • More visits to the cemetery and more participation in the burial rituals • Strong support of family, less likely to disclose terminal diagnosis to a dying person • Christian Hispanics – death viewed as a beginning, a door passing from one state to another

12. Ethnic variations in attitudes towards death • Asian American attitudes • Marked by tightly controlled communication • Chinese Americans – death as a taboo subject in general • Japanese Americans – often hard to detect when the members are in distress and dying • Belief in the deceased watching over those who remain alive • Restraining themselves from public displays of grief and conservative mourning traditions • Hawaiian visions of the dead

13. Ethnic variations in attitudes towards death • Native American attitudes • Great variability in attitudes towards death across American Indian tribes • Apache • Dead person’s body regarded as an empty shell • Lakota (Sioux) • Death as a natural counterpart of life – the soul journeys to the Spirit Land • Reverence for the body – residence of the person’s essence • Unrestrained grief is appropriate for both men and women • Navajo • do not believe in afterlife • Preference of death at the hospital to prevent ‘home pollution’ • Focus on positive aspects and avoidance of negativity including discussions of negative medical outcomes • Death is often forecast by unusual spiritual or physical events, whi are understood to be natural and in the order of thigs

14. Death, Dying and Acculturation • Vast variability across cultures • Ethnic differences posing questions for hospital care • Hmong Americans refusing some medical practices because of traditional beliefs of spirits residing in body • Need for more information and respect for traditional views • Modifications of traditional views within different ethnic groups in North American society • Acculturations towards the views of the European American tradition • Acculturated Korean Americans and Mexican Americans are more likely to tell a loved one the truth about a terminal prognosis than those not acculturated

15. Final issues • Is America a Death-Denying Culture? • Are we a death-denying, death-avoiding society, or do we reveal a complex mixture of positive and negative attitudes towards death, dying and the mourning after? • Changing Attitudes and Death Education • Field of thanatology established in 1950s • The Journal of Thanatology • Death studies • Increased interest in death in 1960s and 70s • Death-education movement • Death is becoming more human dying is become more humane

16. Herman Feifeleditor of the book ‘The meaning of Death’ – seminal work bringing death and dying to the American scholarly community ‘the death-education movement has been a major force in broadening our grasp of the phenomenology of illness, in helping humanize medical relationships and health care, and in advancing the rights of the dying… Furthermore, it is contributing to reconstituting the integrity of our splintered wholeness…sensitizing us to our common humanity… I believe that how we regard and how treat the dying and survivors are prime indications of a civilization’s intention and target… In emphasizing awareness of death, we sharpen and intensify our appreciation of the uniqueness and preciousness of life.’ From Herman Feifel’s Distinguished Professional Contribution Award address at the 1988 annual convention of the American Psychological Association