Bereavement Reactions, Consequences, and Care (1984) / Chapter Skim
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Pages 197-212
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Sociocu] tura]
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lo' Every culture has Steads to mark the deaths of its members and to assist survivors. These outward expressions of mourning may be solemn or joyous, depending on the group's beliefs about death.
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In preindustrial societies mortality rates were high, concentrated in the early years of life, and subject to great fluctuations due to epidemics and famines. Life expectancy ranged between 20 and 30 years.
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200 / Bereavement: Reactions, Consequences, and Care
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Sociocultural Influences / 201 Over the years, there have been great changes in the social phasing of mourning in America. Until fairly recently, people in mourning were expected to wear dark clothes, often black, and to sequester themselves; to attend a movie a month or two after a spouse's death would be shocking.
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Social Support The concept of social support has a rich and varied set of meanings. Insofar as it suggests a stable and reliable interpersonal scaffolding that sustains an individual's morale, well-being, or functioning, the term
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Kaplan states: "A large number of environmental and individual characteristics interact to produce a person's social support system at any one point in time land] the nature of all these determinants changes with sequential role changes and other life events as an individual proceeds through the life cycle."20 In its broadest sense, social support refers to optimum personal and social integrationi° and may include the following elements: · supportive religious and other social rituals · supportive values and beliefs by which individuals and families are comforted · supportive shared norms that provide "meaning · social networks that supply supportive needs · the fit between the roles of the bereaved and the meeting of acute dependency needs at death and recovery time · the availability and supply of nurturant others · the availability of support that "protects" the self · the function of self-supports in terms of the ability to seek and get support · the availability of supportive others who "permit" or elicit emotional release · structural supports such as community, work, and the liked .,, Four aspects of social support-enhancing self-esteem and a feeling of being loved, problem-solving, networking, and providing relationship resources for meeting life cycle transitions are thought to modify the effects of traumatic loss and to facilitate recovery from bereavement.7 is 2l As discussed in Chapter 3, social relationships are an important determinant of self-esteem.
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When a family member dies, the only "community" that might be available for support is that of new friends and co-workers. It is not known whether this kind of social isolation automatically places such individuals at risk following bereavement.
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The consequences of the stress of bereavement may vary because of the genetic predisposition of particular groups, relative vulnerability of members of the culture owing to cultural and psychological processes in development, relative stressfuiness of particular kinds of loss in particular cultures, differential efficacy of cultural resources, and varying categories for assessing outcome. Where there are no postbereavement expectations or categories of illness, none will be labeled as illness, even if the survivor has a poor outcome following bereavement.38 4i Another label, such as religious or moral, will be applied.
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In addition, because it is very difficult to predict in advance whether members of a given ethnic group have maintained traditional values, modified them, or replaced them entirely with those of the dominant culture, elicitation of bereavement beliefs and norms is essential if health care providers are to determine whether such practices are relevant in a particular episode of bereavement. Uprooting, migration, and acculturation may leave first generation members of an American minority group few traditional resources for carrying out culturally expected bereavement practices and yet not make it appropriate for them to use mainstream bereavement practices.l l2 l9 For Southeast Asian refugees, for example, funeral homes are not an expected means of dealing with death, and bereavement counseling by health professionals is unprecedented.
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Comparisons of bereavement outcomes across social class and cultural lines are
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208 / Bereavement: Reactions, Consequences, and Care important precisely for this reason: as natural experiments on the impact of different social circumstances on the bereavement process and its effects. Finally, a cultural approach to bereavement should make researchers and clinicians sensitive to their own potential bias and barriers.
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Sociocultural Influences / 209 express their sorrow dramatically through displays of seizure-like attacks and uncontrollable emotions. Various Southeast Asian-American groups participate in public displays of wailing and open expression of sad emotion, but in private are expected to be contained and stoical, demonstrating their endurance and forebearance in the face of life's tragedies.
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The suffering is then worked through in a process involving religious rites which create an image of the deceased as an immortal and recast social relations of the living so they are no longer dependent on the deceased.23 34 CONCLUSIONS AND RECOMMENDATIONS Considering the heterogeneity of American society, health and mental health professionals should use great caution in interpreting the bereavement experience of refugees, immigrants, and traditionally oriented ethnic group members as deviant because of the possibility that the norms for these groups may differ from their own and from those of the mainstream culture. Bereavement specialists should make an effort to be aware of and accommodating to alternative cultural practices for handing bereavement, and should be instructed in cultural differences in the bereavement process in an attempt to reduce the potential for cross-cultural miscommunication and iatrogenic effects.
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Psychosomatic Medicine 38:300-314, 1976.
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Correlates of enduring distress patterns following bereavement: social network, life situation and personality. Psychological Medicine 12:783-788, 1982.
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