The Culture of Death and Dying

1. The Culture of Death and Dying Life and Death do not wait for perfect theories, definitive studies, and validated intervention procedures.

2. Life and Death • Two of the attributes that all humans share are the experiences of being born and the fact that everyone would eventually die.

3. Thanatologists: those who study the surroundings and inner experiences of persons near death Stages? • Denial and isolation (No, not me!) • Anger, rage, envy, and resentment (Why me?) • Bargaining (If I am good, then can I live?); • Depression (What's the use?); • Acceptance. • Most authorities believe that these stages do not occur in any predictable order and may be intermingled with feelings of hope, anguish, and terror.

4. Death and Culture • Fear of Dying is innate • Death is a socially constructed idea • The fears and attitudes people have towards death and dying are learned from educational and cultural vehicles such as the languages, arts, and religion • Every culture has its own coherent explanation of death which is believed to be right by its members

5. Western vs Eastern Thought • Cultures can be death-accepting, death-denying or even death- defying. In the death-defying West, the strategies for salvation have historically included activism and denial. • In the East, the strategies have often been more contemplative and mystical.

6. No – Not Me! • The United States, and probably most of the societies in the West, is a death-denying/defying society where even the idiom of expression is that of resistance. • People vow not to go gently into the good night (Blake, 1988) or conjure images of fighting illness, or fighting the enemy, death (Kalish & Reynolds, 1981).

7. Death Anxiety Across the Cultures • Death anxiety is not prevalent to the same degree across cultures. • In a study of Hindus, Muslims, and Christians: found that Hindus (who had the greatest belief in life after death) also tested lowest in death anxiety, followed by the Muslims, while the Christians showed the highest death anxiety

8. Don’t Talk About It • Although we are excited about discussions concerning birth, people in all cultures discuss death with extreme reluctance. However, even though we may use the same words to describe death, the actual meaning and conceptualization of death differs widely across cultures.

9. Among Many Cultures • Death signals an abrupt and permanent disengagement • In some instances, people are prohibited from even mentioning the names of the deceased in the fear that doing so may actually endanger the lives of the living or prevent the ghost from leaving this earth and attaining peace.

10. What Scares You? “Death doesn’t scare me. It’s what comes before death that terrifies me.”

11. Dying to Communicate • Interviews and Personal Narratives of over 1250 cognitive terminally ill hospice patients • 60% Female - 40% Male • Ages 3 – 107 • 80% Caucasian • 12% Hispanic • 6% African American • 2% Other

12. Dying to Communicate . . . Concluded that… Terminally ill people are not allowed to talk about their experience of dying even though this research shows they want and need to talk about it.

13. Listen The most basic of all human needs is the need to understand and be understood. The best way to understand people is to listen to them. Ralph Nichols

14. 3 year old Wisdom “I’m not afraid. My bunny is going with me.”

15. 107 year old Wisdom “I loved my children and they’re all dead now. It’s not right to outlive your children. Never in my life did I expect that. That was a shame. I’m very old.”

16. The Death-Defying, Death-Denying Society . . . A death-denying society is characterized by an inability to discuss death and dying openly. A death-denying society is one that views death as a punitive consequence of poor management of the physical self. A death-denying society attempts to regulate death to institutions, such as hospitals. A death-denying society places little value in a dying person.

17. Conclusions . . Death accepting cultures of hospice and palliative care provide an environment in which the terminally ill person can talk about his or her experience of dying with people who not only understand the many dynamics of death and dying but embrace people facing death.

18. Need for Death Mediators A death mediator has to embrace death and dying as a part of life and convey that acceptance in a humane and compassionate way. A death mediator is often found in an environment which values the dying. Death mediators are most often found in hospice and palliative care.

19. Society Does Not Want To Talk About Death and Dying “It sure is strange you wanting to talk to me about dying. What type of study is it? You going to be a mortician? No, my mortician didn’t even talk to me about dying, you must be worse than that.”

20. Does Your Family Know . . . ??? “I think it’s great you’re willing to come here and talk to me about dying. Does your family know you do this?”

21. Patients Want to be Told the Truth “He couldn’t tell me I was dying, either. What’s wrong with being honest? When did it become a bad thing to be honest? I wish he had just told me we didn’t beat it. We tried, but didn’t beat it. I would have understood that, and I wouldn’t have blamed him either.”

22. How Were You Told . . .? “My doctor was so busy, he couldn’t, didn’t tell me in person. He called and left a message on my answering machine. ‘Your MRI shows you have a brain tumor with mets everywhere.’ I think you need hospice now.”

23. Dying to Communicate What the Dying Say about Life “I think my life is ending too soon. I think I still had more in me to go. I wish I had done some things different, but you can’t cry over spilled milk. You look back and wish your eyesight was dimmer. Memory is a rotten thing, you know?”

24. Is It Always BAD News? Finally, somebody knows what is wrong with me. I thought I was going crazy. I’m just dying, that’s all, just dying…what a relief.”

25. NO PAIN PLEASE . . . “ Whatever happens, I don’t want to die in pain. I mean, who does? I don’t care what you guys need to do, I don’t want to be in pain. Don’t make me use a gun (laughs) . . .

26. .… I’m not talking on me, I mean on you guys. If I have real bad pain, I’ll just shoot you.”

27. Tell Them For Me . . . “I think it is going to be very soon and I’m, I am going to be well again somewhere else. Will you tell them that for me afterwards. Tell them I was happy to be leaving. Not leaving them, but released. Tell them that okay, when they are sad.”

28. When Do You Say Goodbye? “How do you say goodbye? I was never good at it and now, well, I’m really having a hard time. How do you know when to say goodbye for the last time?”

29. Death & Dying Simulation 3 Things You Own (Things you would be sadden to lose, include pets here) 3 Personal Attributes (What you like about yourself) 3 Activities You Enjoy (Sex is an activity) 3 People You Love (Children can be grouped into 1)

30. I’m Not Ready . . . “It makes me a little crazy to think about it, but that’s all I ever do. I wonder, I keep wondering is this it? Is this my last day on earth? I don’t want to close my eyes. If I stay awake, I stay alive. I wish I was ready. I wish I could tell you that, but I’m not, I don’t want to die.”

31. 8 Months Later . . . “I’m so tired. I think I’m ready now. I don’t think too much about it anymore. I wish it would just happen. Get it over with and let’s move on. I’m ready now, tell them all that okay? Tell them I was ready finally. Tell them please.”

32. Are You Scared? “Oh heavens no. It doesn’t scare me. It’s rather fascinating if you ask me. I just wish I had more time and energy to explore it and find out where I was going with all of it. I hope there is awareness. . . I don’t want to miss a thing.”

33. Final Wishes . . . “I’ve made myself an urn. I’m painting it bright red. That way nobody will forget where I’m at. . . Somebody will have to date it though. Can you do that for me?”

34. Spell it Correctly . . . “Don’t forget how to spell my name. . . Harry. H A R R Y! You got it?”

35. They Never Forget They may forget what you said – but they will never forget how you made them feel Carl Buechner

36. Analogy of cultural diversity using weaving as an example. • Although weaving is a universal technique, the patterns that result from this process are culturally unique and identifiable. • Thus, even when they use the same materials, patterns used in Navajo, Chinese, Persian, Japanese and French tapestries are recognizable not only in terms of colors, but also of patterns and textures. This range of diversity applies to issues about death and dying.

37. Attitudes and Beliefs Among the cultural indicators to be considered are: • nature of the beliefs toward the meaning of life, death and the hereafter; • funerary rituals and strategies for body disposal; • the physical and symbolic boundaries between the worlds of the living and the dead; • the perceived role of the dead on the affairs of the living; • the degree of social stigma attached to those dying, dead, or bereaved; • orientations toward and rates of suicide, murder and abortion; • death prevention and avoidance as a social goal; • the death socialization of children (including death themes in children's stories and games) and their involvement in funerary ritual; • the taboo status of the topic of dying and death in everyday discourse; • the language used regarding death.

38. Differences • South Pacific cultures believe that life, as is generally construed, departs the body of a person in different situations, such as when one is ill or asleep. Thus conceptualized, people can be said to "die" several times before the final death.

39. Truskesian Culture • The Truskese of Micronesia believe that life ends at 40 years of age, and when you reach 40, you are, in effect, dead. • Given the physically demanding activities engaged in by people in this society, there seems to be a noticeable decline in the ability of the Truskese to perform their socially assigned roles at acceptable standards at this age. • Sensing that the end must be coming, the individual begins to prepare for death and is viewed as being dead even before he or she transitions to that point as viewed from the Western perspective.

40. Western – Christian Thought • Death occurs only once. • Christians do not believe that everything ceases at death. The person sheds his or her bodily form but continues on in spirit where there are consequences. • The faithful - believers who kept the faith - are rewarded with eternal joy in heaven. • Sinners proceed to hell.

41. Mother Teresa • “Death is nothing else but going home to God, the bond of love will be unbroken for all eternity.”

42. Native Americans • Among some Native American tribes (and certain segments of Buddhism), the dead and the living coexist • the dead can influence the well-being of the living. If the dead (ancestral spirits) are properly reconciled, the likely outcome is a benevolent spirit that protects the interests of the living. • If not accorded the appropriate treatment, the result is an unhappy spirit that may ignore the well-being of the living, leading to misery.

43. Navajo Legend • One day, the Navajo people placed an animal hide in water. If it did not sink, then no one would ever die. However, if the hide sank into the water, then death would be part of life. The Navajo did not watch the hide, but turned away from it instead. While their backs were turned, a coyote threw some rocks on top of the hide. Of course, this made it sink down into the water. The coyote's reason was that if no one ever died, there would come a point at which there wouldn't be any more land on which the people would live. This is the reason death comes for all of us eventually.

44. Circle of Life • Die happily and look forward to taking up a new and better form. Like the sun, only when you set in the west can you rise in the east.Jelaluddin Rumi

45. Buddhist • The universal law of karma ... is that of action and reaction, cause and effect, sowing and reaping. In the course of natural righteousness, man, by his thoughts and actions, becomes the arbiter of his destiny.Paramahansa Yogananda

46. Attitudes and Beliefs When you are born, you cry, and the world rejoices. When you die, you rejoice, and the world cries.Tibetan Buddhist saying

47. Death in Hinduism • Some cultures, such as the Hindu, envision a circular pattern of life and death where a person is thought to die and is reborn with a new identity. This exit and reentry into life can occur multiple times. • Death is not viewed as the end of all but only a step in the existence of soul, a temporary cessation of physical activity. Since Hindus believe in reincarnation and the trans-migration of the soul, they approach the subject of death without much fear.

48. Hindu Belief • According to Hindu belief, it is necessary for the skull to be broken by a blow with a cudgel at the cremation ground, to free the soul from entrapment within the skull.

49. Muslim • A Muslim's body must be washed at least three times after death with soap and water. Perfume may be used, or camphor placed, in the orifices and armpits, while prayers are said and passages read from the Qur'an.

50. GyanRajhans Scientist and Hindu Spiritual Thinker • “We brought nothing with us when we came, and would take nothing with us when we leave this world. In fact, we will leave a little extra behind if we lead a life of goodness and philanthropy. If we become soul-conscious, death will be an "ordered" process, carried out in full consciousness and with understanding of cyclic purpose. Once understood, the fear of death ceases. It gives us a certain power to control our passing over to the other side of the veil. Let us approach death with as much normalcy as we can manage.“