American Attitudes American Attitudes Towards Death and DyingTowards Death and Dying

Dusana RybarovaDusana Rybarova

Psyc 456 Psyc 456

July 2007July 2007

From Visible to Invisible From Visible to Invisible DeathDeath• Visible deathVisible death

– Death recognized and orchestrated by the dying person, Death recognized and orchestrated by the dying person, preparing for dyingpreparing for dying

– Manual for a dying person ‘Ars moriendi’ to achieve Manual for a dying person ‘Ars moriendi’ to achieve peaceful and graceful death (dying and funeral as public peaceful and graceful death (dying and funeral as public rituals with personal assistance of close ones, rituals with personal assistance of close ones, forgiveness, meditation)forgiveness, meditation)

• Filtered death in Early AmericaFiltered death in Early America– Between 1600 and 1830Between 1600 and 1830– Funeral processions, awareness of deathFuneral processions, awareness of death– Postmortem photography publically displayedPostmortem photography publically displayed– Increased value in family relationship shifted the Increased value in family relationship shifted the

initiatives surrounding death from the dying person to initiatives surrounding death from the dying person to the familythe family

– Shift from personal psychological event to collective Shift from personal psychological event to collective sociocultural eventsociocultural event

From Visible to Invisible From Visible to Invisible DeathDeath• Invisible DeathInvisible Death

– Current funeral practices adopted by European Current funeral practices adopted by European AmericansAmericans

– Feelings and thoughts are kept privateFeelings and thoughts are kept private– health and funeral institutions dominate the health and funeral institutions dominate the

procedures surrounding deathprocedures surrounding death

• ThanatologyThanatology- Interdisciplinary study of death and dyingInterdisciplinary study of death and dying- Established in the wake of WW IIEstablished in the wake of WW II- Has roots in psychology, sociology, Has roots in psychology, sociology,

anthropology, philosophy, theology, biology, anthropology, philosophy, theology, biology, medicine, social work, ethics, law and other medicine, social work, ethics, law and other disciplinesdisciplines

John D. MorganJohn D. Morgan Canadian philosopher and thanatologistCanadian philosopher and thanatologist

‘‘Our North American death system, … is the Our North American death system, … is the result of our limited exposure, which is a result of our limited exposure, which is a result of our high life expectancy, … but in result of our high life expectancy, … but in many ways, our life is no different from many ways, our life is no different from that of the peasant in the 14that of the peasant in the 14thth century. The century. The peasant missed a fully human life because peasant missed a fully human life because he or she was inundated with death. We he or she was inundated with death. We do not live fully because we reject death. do not live fully because we reject death.

(1995:40-42)(1995:40-42)

Factors influencing invisible Factors influencing invisible deathdeath• IndustrializationIndustrialization

– Increased living standardsIncreased living standards• food production, better housing, expanding public food production, better housing, expanding public

education, improving water and sewage facilities, new education, improving water and sewage facilities, new communication and transportation meanscommunication and transportation means

• Modern medicineModern medicine– New medical technologies, immunization programs, New medical technologies, immunization programs,

sterile treatment facilities, hospitalssterile treatment facilities, hospitals– % deaths in US. Hospitals (1900 – 20%, 1994 – 80%)% deaths in US. Hospitals (1900 – 20%, 1994 – 80%)

• Life expectancy and the familyLife expectancy and the family– After WWII life expectancy increased by 20 yearsAfter WWII life expectancy increased by 20 years– Infant mortality decreased from 29.2 per 1000 live births Infant mortality decreased from 29.2 per 1000 live births

in 1950 to 8.2 in 1992in 1950 to 8.2 in 1992– We view death as an event that happens in old ageWe view death as an event that happens in old age

Factors influencing invisible Factors influencing invisible deathdeath• Geographic MobilityGeographic Mobility

– Distance often separates family and friends as Distance often separates family and friends as changes in employment and lifestyle require changes in employment and lifestyle require moving (decline in personal contact with moving (decline in personal contact with extended family)extended family)

• Death and LanguageDeath and Language– Approach avoidance conflictApproach avoidance conflict– Obsessive fascination with death in literature, Obsessive fascination with death in literature,

TV, film, humor TV, film, humor – Obsessed not to speak about death directly Obsessed not to speak about death directly

(using the word ‘death’ more often when we are (using the word ‘death’ more often when we are not speaking about death than when we arenot speaking about death than when we are

Factors influencing invisible Factors influencing invisible deathdeath• Death and the MediaDeath and the Media

•Death is abstract and superficially Death is abstract and superficially portrayedportrayed

– Death is fun and revocableDeath is fun and revocable•Cartoon charactersCartoon characters

– Death is brutal but fastDeath is brutal but fast•Death is resolved in 60-90 minutesDeath is resolved in 60-90 minutes

– Death is horrible but distantDeath is horrible but distant•Happens to people other than usHappens to people other than us

Attitudes of Invisible DeathAttitudes of Invisible Death• AttitudesAttitudes

– Relatively lasting patterns of thinking, feeling and behaving Relatively lasting patterns of thinking, feeling and behaving towards somethingtowards something

• Cognitive DenialCognitive Denial– We refuse to think about death or perceive death related We refuse to think about death or perceive death related

issuesissues– One of the most common and most indirect defense One of the most common and most indirect defense

mechanismsmechanisms– Short-term denialShort-term denial

• Natural coping mechanism right after a traumatic eventNatural coping mechanism right after a traumatic event• Prepares us for grieving and processing of the lossPrepares us for grieving and processing of the loss

– Long-term denialLong-term denial• Represses emotions that are too painful Represses emotions that are too painful • Destructive in the long run (immune system, heart problems etc.)Destructive in the long run (immune system, heart problems etc.)

– Deathbed denialDeathbed denial• A form of cognitive denialA form of cognitive denial• Descriptions of deathbed scenes (Kastenbaum & Normand, 1990)Descriptions of deathbed scenes (Kastenbaum & Normand, 1990)

– Majority of respondents expected to die at homeMajority of respondents expected to die at home– Almost all expected to be alert, lucid, and aware right up to the Almost all expected to be alert, lucid, and aware right up to the

moment of deathmoment of death– Surrounded by loving, supporting, even cheerful loved onesSurrounded by loving, supporting, even cheerful loved ones

Attitudes of Invisible DeathAttitudes of Invisible Death• Emotional repressionEmotional repression

– Blocks disturbing wishes, thoughts, or Blocks disturbing wishes, thoughts, or experiences from conscious awarenessexperiences from conscious awareness

– In relation to death we block out unacceptable In relation to death we block out unacceptable bodily feelings and emotions painfully connected bodily feelings and emotions painfully connected to death or lossto death or loss

– Respondents describing their death did not Respondents describing their death did not report any pain, anxiety, fear, sadness etc.report any pain, anxiety, fear, sadness etc.

– Emotional repression and cognitive denial of Emotional repression and cognitive denial of death have become necessary in chaotic death have become necessary in chaotic modern society in order for individuals to modern society in order for individuals to maintain the illusion of normal life (Jasnow, maintain the illusion of normal life (Jasnow, 1985)1985)

Attitudes of Invisible DeathAttitudes of Invisible Death• Behavioral passivity Behavioral passivity

– We became passive observers to our own dying and to We became passive observers to our own dying and to the morning – we leave the behavioral orchestration to the morning – we leave the behavioral orchestration to physicians and funeral directorsphysicians and funeral directors

– SocializationSocialization• We are socialized to conform others We are socialized to conform others

– ConformityConformity• High conformity in situations poorly definedHigh conformity in situations poorly defined• Lack of social support for non-conforming behaviorLack of social support for non-conforming behavior

– Lack of social comparisonLack of social comparison• When personally dealing with death we may feel isolatedWhen personally dealing with death we may feel isolated

– Perception of legitimate authorityPerception of legitimate authority• Authority figures – funeral directors, physicians, nurses, Authority figures – funeral directors, physicians, nurses,

clergyclergy– Inaccessibility of valuesInaccessibility of values

• When we are distressed by the sadness, despair, and pain When we are distressed by the sadness, despair, and pain of death we don’t see that cognitive denial, emotional of death we don’t see that cognitive denial, emotional repression and behavioral passivity are wrong attitudesrepression and behavioral passivity are wrong attitudes

Ethnic variations in attitudes Ethnic variations in attitudes towards deathtowards death• Affrican American attitudesAffrican American attitudes (12% of population) (12% of population)

– Life after death: immortality is a given for mostLife after death: immortality is a given for most– During grief family is more less important than for Asian During grief family is more less important than for Asian

Americans and Hispanic AmericansAmericans and Hispanic Americans– Expect to live much longer than other ethnic groupsExpect to live much longer than other ethnic groups– Preference of care for terminally ill at homePreference of care for terminally ill at home– Less formal and more emotional than European Less formal and more emotional than European

AmericansAmericans• Hispanic American attitudesHispanic American attitudes (9% of population) (9% of population)

– More open expression of emotions after deathMore open expression of emotions after death– More visits to the cemetery and more participation in the More visits to the cemetery and more participation in the

burial ritualsburial rituals– Strong support of family, less likely to disclose terminal Strong support of family, less likely to disclose terminal

diagnosis to a dying persondiagnosis to a dying person– Christian Hispanics – death viewed as a beginning, a door Christian Hispanics – death viewed as a beginning, a door

passing from one state to anotherpassing from one state to another

Ethnic variations in attitudes Ethnic variations in attitudes towards deathtowards death

• Asian American attitudesAsian American attitudes– Marked by tightly controlled communication Marked by tightly controlled communication

• Chinese Americans – death as a taboo subject in Chinese Americans – death as a taboo subject in generalgeneral

• Japanese Americans – often hard to detect when the Japanese Americans – often hard to detect when the members are in distress and dyingmembers are in distress and dying

– Belief in the deceased watching over those who remain Belief in the deceased watching over those who remain alivealive

– Restraining themselves from public displays of Restraining themselves from public displays of grief and conservative mourning traditionsgrief and conservative mourning traditions

– Hawaiian visions of the deadHawaiian visions of the dead

Ethnic variations in attitudes Ethnic variations in attitudes towards deathtowards death• Native American attitudesNative American attitudes

– Great variability in attitudes towards death across Great variability in attitudes towards death across American Indian tribesAmerican Indian tribes• ApacheApache

– Dead person’s body regarded as an empty shellDead person’s body regarded as an empty shell• Lakota (Sioux)Lakota (Sioux)

– Death as a natural counterpart of life – the soul journeys to the Death as a natural counterpart of life – the soul journeys to the Spirit LandSpirit Land

– Reverence for the body – residence of the person’s essenceReverence for the body – residence of the person’s essence– Unrestrained grief is appropriate for both men and womenUnrestrained grief is appropriate for both men and women

• NavajoNavajo– do not believe in afterlifedo not believe in afterlife– Preference of death at the hospital to prevent ‘home pollution’Preference of death at the hospital to prevent ‘home pollution’– Focus on positive aspects and avoidance of negativity including Focus on positive aspects and avoidance of negativity including

discussions of negative medical outcomesdiscussions of negative medical outcomes– Death is often forecast by unusual spiritual or physical Death is often forecast by unusual spiritual or physical

events, whi are understood to be natural and in the order events, whi are understood to be natural and in the order of thigsof thigs

Death, Dying and Death, Dying and AcculturationAcculturation• Vast variability across culturesVast variability across cultures

– Ethnic differences posing questions for hospital careEthnic differences posing questions for hospital care• Hmong Americans refusing some medical practices because Hmong Americans refusing some medical practices because

of traditional beliefs of spirits residing in bodyof traditional beliefs of spirits residing in body• Need for more information and respect for traditional viewsNeed for more information and respect for traditional views

• Modifications of traditional views within Modifications of traditional views within different ethnic groups in North American different ethnic groups in North American societysociety– Acculturations towards the views of the European Acculturations towards the views of the European

American tradition American tradition • Acculturated Korean Americans and Mexican Americans are Acculturated Korean Americans and Mexican Americans are

more likely to tell a loved one the truth about a terminal more likely to tell a loved one the truth about a terminal prognosis than those not acculturatedprognosis than those not acculturated

Final issuesFinal issues• Is America a Death-Denying Culture?Is America a Death-Denying Culture?

– Are we a death-denying, death-avoiding society, Are we a death-denying, death-avoiding society, or do we reveal a complex mixture of positive or do we reveal a complex mixture of positive and negative attitudes towards death, dying and negative attitudes towards death, dying and the mourning after?and the mourning after?

• Changing Attitudes and Death EducationChanging Attitudes and Death Education– Field of thanatology established in 1950sField of thanatology established in 1950s

• The Journal of ThanatologyThe Journal of Thanatology• Death studiesDeath studies

– Increased interest in death in 1960s and 70sIncreased interest in death in 1960s and 70s– Death-education movementDeath-education movement

• Death is becoming more human dying is become more Death is becoming more human dying is become more humanehumane

Herman FeifelHerman Feifeleditor of the book ‘The meaning of Death’ – seminal editor of the book ‘The meaning of Death’ – seminal

work work bringing death and dying to the American scholarly bringing death and dying to the American scholarly communitycommunity

‘‘the death-education movement has been a major the death-education movement has been a major force in broadening our grasp of the phenomenology force in broadening our grasp of the phenomenology of illness, in helping humanize medical relationships of illness, in helping humanize medical relationships and health care, and in advancing the rights of the and health care, and in advancing the rights of the dying… Furthermore, it is contributing to dying… Furthermore, it is contributing to reconstituting the integrity of our splintered reconstituting the integrity of our splintered wholeness…sensitizing us to our common humanity… wholeness…sensitizing us to our common humanity… I believe that how we regard and how treat the dying I believe that how we regard and how treat the dying and survivors are prime indications of a civilization’s and survivors are prime indications of a civilization’s intention and target… In emphasizing awareness of intention and target… In emphasizing awareness of death, we sharpen and intensify our appreciation of death, we sharpen and intensify our appreciation of the uniqueness and preciousness of life.’the uniqueness and preciousness of life.’

From Herman Feifel’s Distinguished Professional From Herman Feifel’s Distinguished Professional Contribution Contribution Award address at the 1988 annual convention of Award address at the 1988 annual convention of the the American Psychological AssociationAmerican Psychological Association