Chapter 5: Cultural Differences and Death

 

I.                   The Significance of Cultural Differences in the U.S.

 

Many cultures are represented in the U.S. today. Each year new combinations of races and cultures merge, making America more of a “melting pot” than in previous years. Culture is a unified set of values, beliefs, and standards of behavior shared by a group of people.

 

Our culture influences the way we accept, order, interpret, and understand experiences throughout our lives.

          Ex. Being a Czech American – food, family values, and religious rituals

 

Most countries can be describes as being one of the two classifications: &

 

A. Individualism – belief that people are independent of each other; emphasis is concern for oneself, personal autonomy and self-fulfillment; Ex. Western Cultures (U.S.), European Americans

 

B. Collectivism – belief that people are interdependent members of a social group; emphasis is concern for groups’ goals and beliefs, and well-being. Ex. Eastern Cultures (China), Asian cultures.

 

In this chapter we focus on increasing our understanding of minority groups. We will examine four prominent American cultural groups: Hispanic Americans, African Americans, Asian Americans, and Native Americans.

 

We review 2000 census statistics and research findings that tell us on “average” are the attitudes and practices of these cultures. Students are advised to avoid assuming these issues describe all members of these cultures, thus to avoid stereotypes.

 

II.                 Hispanic Americans (HA)

 

A.   Stats and trends

In 2000 HA were the largest minority group in the U.S. (excluding Puerto Rico and Islands), marking a 72% increase since 1990. A large part of the increase was due to high rates of Mexican immigration.

 

The 2000 census was the first time in our history that race/ethnic categories listed several cultures (Spanish, Hispanic, Latino) as well as allowing participants to choose more than one category: Tiger Woods = Caublinasian.

·        New convention reflects true demographics more accurately

·        However, makes understanding and meeting needs for groups more challenging

 

58% of the HA in 2000 reported being of Mexican origin, 10% were from Puerto Rico, and 3.5% were from Cuba.

 

What will our country look like in 10 years, 30 years? Will we have more cultural subgroups or look more like a melting pot?

 

A.   Hispanic American Encounters with Death, Dying & Bereavement

 

Whereas HA make up 13.5% of the total population, they represented only 4.8% of the deaths. Why?

·        Accuracy of record keeping – county offices

·        Return to Country of origin to die

·        Healthier members selected to come here

·        Largest percentage of HA population is young Ex. Texas Population vs. 2002 Student Population

                                                                          i.      Student subpopulation is 8-10% higher than total

 

1.    Causes of Death - #1 heart disease and #2 cancer

·        Young HA – homicide rate and HIV related deaths are high

 

B.   Hispanic American Death Attitudes & Practices

1. HA Attitudes

·        Importance of family – most origin countries are collectivist societies; tightly knit; strong locus of emotional support; important to be cared for by family; caring for ill and dying is an important responsibility;

·        Role of religion – 80-90% are Roman Catholic; belief in relationship between life and death = ongoing cycle; likely to refuse resuscitation and use hospice services

·        Fatalism and anticipatory grief – contraction of serious diseases are often seen as death sentence; helped to prepare for an eventful death; it eases intensity of grief for them.

 

2.    HA Practices

·        Care of the dying – most conducted by females; deal with stress and do not seek professional help with for coping; it is a family responsibility; resist use of nursing homes; expected to change as HA become more acculturated (Acculturation – the process of learning and “using” the language, values, customs, and social skills of a new culture. Historically, immigrants acculturated completely and left much of their native culture behind.) to the dominant culture.&

·        Presence at death – value being with a dying relative so that any unresolved conflicts may be resolved before the death; may die at home but the trend toward institutions as the location of death is rising.

·        Grieving practices – open expressions of grief are acceptable; pronounced lack of emotional expression by males; Males do not grieve openly – to be strong.

·        After-death rituals – generally = open casket, mass in church, procession to burial site; may conduct a death novena – Roman Catholic 9-day prayer with a specific purpose; death novena includes recitation of the rosary (Catholic prayer beads with 5 decades). Occurs at home in period of silence.

o       Understanding the Rosary

·        Variations in mourning – reported occurrences of the deceased visiting survivors in their dreams; spiritual presence of the deceases is expected and not “too frightening.”

 

 

III.              African Americans (AA)

 

A.   Stats and trends

African Americans make up the second largest minority group in the U.S. Many AA have a “link” to the African continent, history of slavery, slave trading, and experiences of discrimination. All of these experiences resulted in increased experience with death for AA. Once in the U.S., AA were treated as property as opposed to humans. These experiences affected their death, dying, and bereavement practices.

 

·        From 1900 to 1970s, death rates for AA were higher than Caucasians. Afterwards, the death rates have remains about the same; and now AA die at a slower rate than Caucasians.

·        Young AA males die at a higher rate than other ages groups, but older AA outlive other ethnicities.

·        High-poverty, high-crime pockets in America yield high death rates among AA males < 65 years old – Harlem, Compton).

·        Homicide rate for AA males ages 15-24 is significantly higher than other ethnicities.

·        Maternal mortality rates and infant mortality rates are higher among AA than Caucasians, but the gap is decreasing.

Most researchers contribute the differences in these rates and patters to socioeconomic factors and education.

 

·        AIDS is the #1 killer of AA males and #3 for AA females (general population = 15th).

·        AA die outside their home more often than all other ethnicities (hospitals).

 

B.   African American Encounters with Death, Dying & Bereavement

§        Importance of family- AA are also considered collectivists; the concept of “family” consists of extended relatives as well as individuals are not blood kin; reply on family, friends, neighbors, and church members during times of loss; so blood-related family is less important than in other ethnicities; more likely to die at home than in institution; resist nursing homes if possible.

§        Suspicion of the medical community – exhibit a mistrust of medical professionals; suspicion may be due in part to the legacy of the Tuskegee syphilis experiment, in which AA males infected with syphilis were prevented from receiving penicillin once it was known to treat it (1932-72).

 

Can you think of any other historical events they may have contributed to AA mistrust of medical field?

 

C.   African American Death Attitudes & Practices

§        Advance directives & organ donation – resist advanced planning, living wills, plans for after death. They are less likely to use hospice care, donate organs after death (brain), and terminate life support.

§        Mourning practices – funeral services are important and outward expressions of grief and emotion are acceptable; funeral directors have high status; the deceased’s abilities to be strong in the face of hardships is exonerated; number and who attends the service says something about the individual’s character.

§        Importance of storytelling – important strategy for handling grief; coping mechanism; origin is the oral tradition of African heritage; storytelling is dramatic – includes changes in voice and volume, emotional expressions, and hand and body gestures to make the story come to life.

 

IV.             Asian & Pacific Island Americans (APA)

 

A.   Stats and trends

Asian and Pacific Islanders make up the third largest minority group in America. These are collectivist societies.

§        24% = Chinese American

§        18% = Filipino American

§        16% = Indian American

§        11% = Vietnamese American

§        10% = Korean American

 

Death rates of APA are lower than Caucasians and causes of death are very similar.

Infant mortality rate among APA are lower than Caucasians.

APA live longer than Caucasians, especially once old age is met.

 

B.   Asian American Encounters with Death, Dying & Bereavement

§        Communication issues – restrain communication; often withholding important information for health care providers; talking about bad things can make them happen; death is a taboo subject among Chinese Americans; many prefer for the dying individual to not be told that they are dying.

§        Decision making – APA cultures are patriarchal (fathers have primary responsibility for the welfare of families) and hierarchical. If no dad, then oldest male makes decisions; they make decisions regarding care of dying, death, services, and set mood for mourning.

§        Physician-assisted suicide – trend that resembles Caucasians; older generations with religious ties resist it and favor DNR orders; later generations are more accepting of physician-assisted suicide.

§        Funerals – variety of attitudes; many different traditional customs; funeral rituals are very important; help create healthy relations between living and the dead; many believe in reincarnation, which could support this attitude in part; deceased may become a beneficial ancestor.

 

C.   Asian American Death Attitudes & Practices

§        Mourning customs – very conservative; many believed that one married one for life, thus no re-marriage after spouse’s death; dating may even be inappropriate

§        Bi-culturalism – blending Western and non-Western elements into APA funeral rituals; gift-giving and Christian ceremonies; family members line up in hierarchical order for processional; food offerings are taken to graveside and burned; paper money is thrown out windows of hearse to ward of evil spirits; large banquet for survivors follows

§        Graveside visits – believe in a continued interaction between living and the dead; well-being of survivors is affected by how deceased was cared for; grave visits are frequent; gravesites are well kept.

 

V.               Native Americans (NA)

 

A.   Stats and trends

Native Americans make up approximately 1% of the U.S. population. Most (55-60%) no longer live in tribal communities; they live in urban neighborhoods. There is considerable diversity in this subpopulation. They are very heterogeneous – system that consists of a diverse range of different parts.

 

B.   Native American Encounters with Death, Dying & Bereavement

·        Death rate = 403.6/100,000

·        Causes of death = communicable diseases, diabetes, cirrhosis, accidents, cancer

·        Infant mortality rates (8.1/1000) are higher than Caucasians; NA infants die from SIDS more other than any other ethnicity

·        Alcohol abuse is prevalent – linked to alcohol-related deaths (homicide, cirrhosis of liver)

·        Poverty levels and lack of education contributes to many of these stats

 

C.   Native American Death Attitudes & Practices

·        Attitudes toward death – death is not linear path but circular; depicted in oral tradition, legends, and pictures; attitudes include acceptance with low – to high anxiety (fear); many death rituals and customs that are tribe-specific; they value self-reliance, independence, and “keeping” to oneself.”

·        Communication issues – believe talking about death may cause it to happen; no advance directives (DNR orders nor living wills); keep personal issues to oneself; difficult grieving period for children as the yare taught to withhold or hide their emotions

·        Survivor actions and postdeath journey – what survivors do after someone’s death may affect his journey into the next world; thus elaborate and important post-death rituals occur.

·        Caring for the dying – the dying are removed from homes; now sent to urban hospitals; need for cultural mediators and interpreters

·        Hopi mourning – death often associated with auditory, tactile, and visual hallucinations and dreams

·        How grief is expressed – punctuated; immediate, shared, emotional release; with mutual support for those with most loss and at risk; then return to “calm” (at least outwardly).

·        Postdeath rituals – survivors have 4 days to: cleanse and prepare body, bury, mourn, and dispose of deceased’s belongings. Body is washed and face is painted with chei – war paint made of soft red rock mixed with animal fat and corn mill; dressed in best clothes; hair is tied with eagle feather to symbolize return to home; after burial, survivors cleanse selves of evil spirits and events of burial. Many tribes have also adopted Christian rituals as well.