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Culture and grief
Article in Bereavement Care · March 1998
DOI: 10.1080/02682629808657425
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M.s. Stroebe
H.A.W. Schut
Utrecht University & University of Groningen
Utrecht University
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question - the focus of this article - the
component parts of the grieving proc~ss
Deedto be examined. Thus, visible signs
(manifestations), personal perceptions
(symptoms) and health consequencesof
grief wiIl first be described,in particular,
wars of coping and processesof appraisal.
Then, the extent to which thesephenomena - admittedly Western-derivedalles are evident in cultures very different Erom
our own wiIl be explored. This article
focuseson comparisons betweenWestern
'.:'èÇ~
Margaret
Stroebe
PhD
Henk
Assoc;ate Professor
Netherlands
Schut
PhD
Assoc;ate Professor
Utrecht Un;vers;ty, Utrecht, The
andnon-Western
culturesacrosshistorical
periods and acrossthe world; it does not
discussresearchon ethnic group differencesin grief and grieving within individual Western culturess.
There are good reasons to argue that grief is, in a sense,
,
Innate
-
'
I reactlon
'
a natura I and universa
to t he deat h 0f
som eo ne to whom
t
f
one feels close, However,
I
"
h
a study of
d ' f~
pa terns 0 grlevlng across cu tures 5 OWSver f I .erent
warS of reacting to 1055and Western concepts of 'norm al'
reactl ' ons or 'health '
f
'
th -
Y war s 0 coping emer ge as e no
centric constructions,These
I
k
cultural differences led us to
t th t d' t '
I d t d'
f th grlevln
"
g
00 agaln a
e ra I Iona un ers an Ing 0
e
process and to propose a different model of effective
'
coping which takes cultural variation into account.
G
rief as a universalreaction caD be
understood in tenns of Dur
biological heritage and survival of
the species!. Reactions that are identifiable
as 'grief havebeendocumented
in very
diverse societies and even across species2,3:
many species show attachment behaviour
to other members of their speciesand
considerable distress on death or separation.
Not only do animal and human studies
provide empirical evidence for the presence
of grief-likereactions,but theunderstanding that grief is universal makes
theoreticalsensetrom theviewpointof
of grief; rather the reactions to bereavement common to all people provide the
fundamental background Eromwhich
cultural variations should be viewed. Given
the common framework, it is important to
study the cultural patterning of grieving
becausenot only doeslack of understanding make it difficult to interpret the
reactions of those in other cultures, but
potential insight into our own grief
reactions is limited if we remain completely
ethnocentric in our approach.
Are the effects of grief similar or
different acrosscultures? To explore this
sociobiology, attachment theory, and even
transcultural psychiatry, asweIlasfrom the
generalperspective
of emotiontheory
(sadness is also taken to be a universal
emotion).It is beyondthe scopeof this
article to cover these but to iIlustrate,
Bowlbtreasoned that attachment behaviour
bas survival value for many species and that
grief, as the negative aspect of attachment,
is a general response to separation.
17.
Number
1.
Spring
dt
II t db
tbr
I .
a a co ec e yan opa OgIS
t s, for there
hasbeenlittlepsychologicalresearchsofar.
Frequentlyinferenceshavehadto bemade
from thestudy 0f pubIICd.ISpIay 0f mourn'
ingbehaviourratherthanprivateem
reactions to death, and there is also the
'
bI
'
'
f
'
d
d
'
pOSSI I lty 0 mlsun erstan mg because 0 f
inadequate
knowledge
oftheculturein
question,
Thus
is neededin
dr '
I ' caution
.
aWlng conc USlons.
GRIEF IN CULTURAL
PERSPECTIVE
First, we needto define what we mean by
'grief before we talk about its universal
versusculturally specific characteristics,
and we needto specify what human
reactions we are assessingin making the
cultural comparisons.
Grief, mourning and bereavement
In the context of exploring cross-cultural
patterns, it is useful to define and distinguish betweengrief, mourning and bereavement6.Bereavementis the situation of a
person who bas recently experiencedthe
loss of someonesignificant through thai
persons death. Grief is the primarily
emotional reaction to the loss of a loved
one through death, which incorporates
diversepsychologicaland physical symptoms and is sometimesassociatedwith
detrimental health consequences.Mourning is the social expressionsor acts expressive of grief, which are shapedby the
practices of a given society or cultural
group (eg mourning rituals).
Thesedefinitions differ Eromthose of
the psychoanalyticschool, following
Freud7.
see1.Furthermore,
the distinctions
Nevertheless, cultural variations are
manifest. These cultural differences do not
negatethe concept of a universal experience
~Volume
Muchoftheinformationdrawn
the cross-cultural comparisons comesErom
University
1998
of Utrecht.
betweengrief and mourning, and even
bereavement,are somewhatartificial:
BEREAVEMENT
Care
7
clearly they are interrelated. In a culture
that censors crying or any outward manifestations of distress, it is likely that feelings
of distress, though not completely absent,
are at least kept in more control and
stippressed emotionally than would be the
case in a culture that advocated wailing and
weeping. The concept of 'bereavement' too,
in that it implies personal deprivation,
overlaps with 'grief; it becomes evident that
the deprivations that are considered
personal may also vary between cultures
(loss of certain relationships may not be
occasions foT grief in certain cultures).
The above concerns need to be kept in
mind when considering manifestations of
grief in cultural perspective.
Nonnal grief across cultures
'Normal' grief incorporates a myriad of
emotional (affective), behavioural, physical
(somatic or physiological) and cognitive
manifestations4. 8.9. Affective manifestations
include depression, despair and dejection,
anxiety, guilt, anger and hostility, the
inability to feel pleasure (anhedonia) and
loneliness. Behavioral manifestations
include agitation, fatigue, crying and
social withdrawal. Physical manifestations include loss of appetite, sleep
disturbances, energy loss and exhaustion,
somatic complaints, changes in drug intake
and susceptibility to illness and disease.
Cognitive manifestations include preoccupation with thoughts of the deceased,
lowered self-esteem, self-reproach, helplessness and hopelessness, sense of unreality
and problems with memory and concentration.
So are these manifestations universal?
Perhaps the most overt, and maybe most
distinctive feature of grief, crying, is indeed
almost universally found, although it must
also be remembered that grief cannot
always be assumed when crying occurs3. Dn
the other hand, one does not have to look
very far to find different patterns of
reactions in different cultures. There is
evidence that grief is more often expressed
in a somatic war in non-Western cultures1°.
In fact, while only in the Western world is it
usual to view depression following life
events such as bereavement as a psychological process, in most other cultures somatic
symptoms predominate to a far greater
extent.
The impact of the loss of a close other is,
then, manifested in very different wars. A
further example would be the prevalence of
smiling among the Balinese studied by
Wikan11 and, unusually, the absence of
crying. These do not signify an absence of
sorrow or even presence of joy, but a
desperate attempt to manage emotions
8
BEREAVEMENT
Care
among the bereavedin this community. To
show distress is to 'comrnit an injustice to
others', an underlying belief being that
bereavementis so harmful to health that
not to contain it will have dire consequences.Dn the other hand, in another
Moslem community studied by Wakenin
Egypt, crying was encouraged.The bereaved'... dweil profusely on their subjective pain in an atmospherewhere ... others
also immerse themselvesin tragic tales and
expressedsorrow.'
The prevalence of smiling
among the Balinese and,
unusually, the absence of
crying do not signify an
absence of sorrow but
rather a desperate attempt
to manage emotions. To
show distress is to 'commit
an injustice to others'
Harder to understand (and harder,then,
to retain the view that grieving is essentially
a universal phenomenon) are reactions to
personalloss among the Samoanpeople.
Ablonl2 describeshow thesepeople recover
rapidly and comparatively painlessly
foilowing the loss of a loved one, evenwhen
this foilowed a sudden and disastrous fire.
In what was, admittedly; a retrospective
study (five years after the disaster),which
makesthe interpretation lessvalid, Ablon
was repeatedlytold that the symptoms that
he was enquiring about, which were
derived from Lindemann's account!3of
grief in the West,were unknown to bis
respondents:Samoans'do not havethese
things'.
There is little information to enable
further probing of this; an interesting line
of researchwould be to extend the type of
approach of Bonanno and bis coileagues!4
in the USA to non-Westerncultures where
there is little display of grieving. Bonanno
found that among bereavedAmericanswho
were avoidant in their way of grieving,
physiological reactions were more common
than in those who were not. It would be
informative to leam whether, in cultures
where there is little emotional expressionof
grief, such changesin physiological
responsesare neverthelessto be found.
Phasesof nonna! grief
Traditional approacheshaveidentified
'phases'or 'stages'of grief that bereaved
people are said to progressthrough in the
processof coming to terms with the loss of
a loved one. Bowlbt, the best-kn<;>wn
proponent of a phasesapproach, identified
the sequenceas: shock and denial, generally
lasting a number of weeks;then yearning
and protest (also lasting a number of
weeks);followed by despair,accompanied
by somatic and emotional upset and social
withdrawal (for severalmonths or even
years);and finally a period of gradual
recovery,marked by increasingwell-being
and acceptanceof the loss.
Bowlby himself was careful to note that
not all people go through eachof these
phases,nor do the phasesoccur in a fixed
sequence.In fact, it can be alarming for the
bereavedthemselvesto be given rigid
expectationsabout where they should be in
the adjustment process:practitioners even
within our own culture needto be very
aware of the dangersof accepting the
concept of stagesor phasesof grief.
As researchers,our own concern with
formulations in terms of phasesis also that
the image conveyedis of a passivesufferer
enduring one stageafter another;whereas
the grieving processcan better be likened to
an intricately-balanced,dynamic battIe
involving an inordinate amount of energy
and readjustment on many levels.Furthermore, such phasescannot be found
universally.
Examplesof abbreviatedversusprotracted phasesin other cultures and
historical periods are easyto find (for a
review, seeStroebe& Stroebel). For
example,the acceptedpattern of grieving
among the Navajo, a Native American
Indian people,was limited to a period of
four days.During this period only was
expressionof grief and discussionof the
deceasedcondoned,and evenduring these
few days,excessiveshow of emotion was
frowned on by the community. Thereafter;a
return to normallife was the norm; the
bereavedwere not expectedto show any
signs of grief, nor to speakof the deceased
or discusstheir loss. Underlying this is the
fear of the power of the spirit of the
deceasedperson, and the belief that harm
can come to the living if theseprescriptions
are not adheredto15.
Grieving among the
Navajo, a native American
Indian people, was limited
to a period of four days.
Thereafter the bereaved
were not expected to show
any signs of grief
Far more protacted are phasesof
readjustment among the Kota people of
southem India, among whom it is the
custom to hold two ceremonies,the 'green'
and the 'dry' funerals. Theseterms are
analogousto a cut plant, the first green
funeralbeingshortlyafterthecremationof'
thebody,whentheexperience
is newand
freshin themindsof thebereaved,
andthe
secondanextendedceremonyheldannually to commemorate
all thosewho have
diedsincethepreviousODe,
whenlossis
driedup,witheredor sere,Thisdry funeral
effectivelyputsclosureon thegrief
experience,
fot; aftera gatheringcharacterisedby low voicesandpervasivesadness,
whenthemorningstaris sightedthemood
changes,
ritualsareperformed,thereis
dancingandfeastinganda returnto more
normallifebeginsfor thebereaved,
While
weCaDonlymakeindirectassumptions
aboutemotionaladjustmentfrom these
mourningcustoms,Mandelbauml6,
who
describes
thesepeople,wasconvincedthat
theyservean importantfunctionin
bringingthebereaved
throughtheir shock
andsorrowandbackto a normalstatusin
their society,
In conclusion,thereseemsto be a
universalreactionof grieving(emotional
disturbance)afterthetossof a significant
otherbut, asthesebrief examplesillustrate,
griefis alsoaffectedby theimpositionof
culturalmeaningandcaDvaryin duration
accordingto culturalprescriptions,A
societalbeliefsystemma)lin extremecases,
bepowerfulenoughto obliterateanyovert
indicationsof emotionaldisturbance,In
thesecasesit maybepossibleto identify
physiologicalchanges
whichwouldindicate
grieving,
Com licated oef
If p al ' f d' ffi uIt t d fi
norm gne IS I C
0 ene,
li t d ( th 1
' f '
comp ca e pa 0 oglcal) gne
ISeven
A
al d fi , ti' h b
moreso, geiler e m on as een
th 1 al
f
d '
0ffd
ere 6: pa 0 oglc gne ISa eVIat Ion
fro th
( th "
t
that
m enorm le e gneVlllgreacIon
uld b
t d '
th t
ty f
co
e expec e ,gIven e ex reml 0
th art , ul he
t
t) th
e p IC ar reavemen even m e
t'
,
th ' t ' ty f
' fi
Ime
span,
or mem
ensl
0 specl
c or
al
t
f ' f S btyp h
geiler symp oms 0 gne, u
es ave
b
d t fi d
hr ' d 1 d d
eenI en I e asc omc, e aye an
b t
f
a sen gne
"
~
,
,
'
'
'
'
'
'
'
'
'
'
,
,"
The centralIssue here IS,
1 of course,what
,e
IS norm? From a cross-cu tural perspectlve
effectivecopingthat is differentfrom
traditionalperspectives
formulated
previouslyby bereavement
researchers,
In
this secondpart of the paperthis perspective will bebrieflydescribed,andits
relevanceto the studyof grievingin
differentculturesindicated,
Whatprocesses
havetheoreticiansand
practitionersin theWestassumedto be
effectivefor comingto temlSwith loss?
Underlyingthemostinfluentialtheories
acrossthehistoryof bereavement
research
basbeenthe constructof 'griefwork'4,
7,13,
Griefwork caDbedefinedasthe cognitive
processof confrontingtherealityof a loss
throughdeath,of goingovereventsthat
occurredbeforeandat the time of death,
andof focusingon memoriesandworking
towarddetachment
from the deceased26,
Accordingto Freud7,Lindemann13
and
Bowlbt, griefwork is essentialin coming
to termswith toss,Withoutit adjustment
cannottakeplace,andit is thereforethe
focusfor therapy,Furtheringof griefwork
in thetreatmentof thosesufferingcomplicatedreactions
isindeedthebasicunderlying
principlethat manywell-established
interventionprogramshavein common27,28,2
However,
if ODelooksbeyondWestern
culture,it becomes
evidentthat other
prescriptionsexistwhichleadto good
adjustment,Totakejust ODeexample,it
wouldhardlyseemadvisableto encourage
griefwork or to advocatea therapyprogrammebasedon thenotionof 'flooding'
{encouraging
peopleto confrontsuppresse
our own culture, Parkes8pointed out that in
feelings by 'flooding' them with images
earher
tImesin Westerncultures,when
,
mfantmortalitywasmuchmorefrequent,
grief overthe deathof a babywasnot as
extremeasit is today,Thesedaysour
relatedto thosefeelings)amongthe
Balinesepeopledescribedabove,
Theconclusiondrawnfrom theseconsiderationswasthat wemustlookat other
expectationsare that babieswi1l survive to
adulthood and not predeceasetheir parents,
dimensions of the processof coping with
grief, Whereasthe grief -work hypothesis
,
In
,
conclusion,
more
needs
examples
wi1lillustratethis point, Selfnfli t '
f
h d h f 1 d
to
be
learned
concentrated
aboutwhatotherculturestaketo be
"
comphcations
of bereavement:
arethere
parallels to the sub-typesthat havebeen
'
THE PROCESS OF CO PING IN
"
on
the
necessity
to
confront
grief,thereis a Deedto look at processes
of
,
,
,
regulationandavoldanceof gnef,
A reVlsed mo deI "lor cross-cuit ur al
0
suggested
in theWest,chronic,absentor
d Iayed gne' fI9' 20, 25":' Is there even te,
h
f
ul
f th 1 , al
concept 0 pa 0 oglc gne m c tures
diff
fro
very erent m our own?
'
, amp1
'
s:
It, IS
yeVI' dent t hat w hat IS
norm al lor
ultu '
t f,
h A f,
ODec
re ISno so or anot er, ew
'
the deceased
aretakento belossof part of
one'sownbody,Self-mutilationbecomes
moreunderstandable
to uswhenthis
culturalbeliefis understood,
It is alsowell-accepted
amongresearchersin Westerncultures19,20,
21that absence
of griefwhenthe deceased
hadbeena close
attachmentfigureis a potentialindicatorof
pathology,Contrastthis with orthodox
Rastafarians
of Jamaica,asdescribedby
Owens22,
for whomdeathis nothingness:
'Thosewhohavefaithfully servedJahwi1l
succeedin finding ever-livinglife, but those
who fail in their servicewi1lfadeawayinto
the forgetfulness
of death',Thereis no grief
because
deathsignifiesa non-event,
the
deadhavingbeenunfaithful,Whileit is
difficult for usto graspthis notion,it seems
to meanthat,thereis no 'death',sothere
caDberio conceptof bereavement
andno
reactionof grief,
Anotherexampleof an apparentabsence
of grief is Johnson's23
{citedin
Eisenbruch24)
accountof theYorubaof
Nigeria,whoapparentlyunfeelingly
disposedoftheir deadbabiesby throwing
theminto thebush,This,howevet;basto
dowith thebeliefthat the deadbab)lif
buried,woulddeeplyoffendthe earth
shrineswhichbring fertility andwardoff
death,Thisaccountsaysnothingof Yoruba
reactionsto othertypesof toss,It is also
possiblethat attachments
arenot formedin
this cultureuntil the dangerous
infant stage
is successfully
passed,
Perhapsa paralleloccurredformerlyin
0
0
application
Not only caDoDeexpectvery dIfferent
f d'
1 , lf '
patterns 0 a Justmentto ossItse m
different m
'
diVI' duals and cultures, but tbe
extentof changesin everyday
life andits
hi
h
'
organlsatlon, w c ISpart 0f t he bereave"
I C Ion 0 mJury on t e eat 0 a ove
,
"CULTURAL
PERSPECTIVE
ODewould be conslderedpathologlcal m
our own culture, Among Australian tribal
It bas already becomeevident that different
peoples,however,cutting or mutilation of
cultures havevery different ways of coping
the body bas been reported to be widewith grief; whereasexpressionof grief is
spread,Cawte17
maintained that selfexpectedand considerednormal in ODe
,
ment expenencethat CaDcausemuch
additional stress,caDalso be expectedto
vary greatly betweenindividuals and
cultural groups, In our view, theseaspects
Deedto be integrated into any analysisof
infliction still occurred among thesepeople,
and that this was motivated by fear of
culture, its suppressionis advocatedin
another,In fact, scrutiny of cultural
the phenomenaof coping with bereavement, and we havetried to do this in the
blamewhichcompounded
'true'feelingsof
grief,In a recentaccountof the1iwi, an
Aboriginalpeople,Venbrux18
explainsthat
differences
wasa majorreasonfor usto
modelthat will bedescribedbrieflynext
takea closelook at accepted
waysof coping (for a moreextensive
account,seeStroebe
in theWestandto proposea modelof
andSchut31),
Volume
17
.
Number
l'
Spring
'
1998
BEREAVEMENTCare
9
THE DUAL PROCESS MODEL OF
COPING WITH LOSS (DPM)
1. Loss-orientation versus restorationorientation
According to this perspective,bereaved
personshaveto capewith two different
types of stressful aspects,which are
describedas 'loss-oriented'and 'restorationoriented', but they will undertake thesein
varying proportions, according to individual and cultural variatiollS.
1oss orientation cao be defined as the
dimension withinwhich a bereavedperson
is concentrating on, dealing with, or
processingsameaspectof the loss experience itself. The grief work concept of traditional theories falls within this dimension,
as doesrumination and longing for the
person who bas died, reviving memories, or
crying about the death of the loved person.
There are clear cultural differencesin the
extent to which the loss experienceis dwelt
on: we Deedthink no further than the
Navajo Indians, where grieving was limited
to a few days,in comparison with the Kota
Indians, where it is still expressedat the
annual 'dry funeral'.
By contrast, restoration-orientation
signifies thenecessity to focus toa on other
aspectsthat come about as a result of lasso
When a loved ODedies, not only do we
grieve for him or her, we also have to adjust
to other substantial changesthat co-occur:
In many bereavementstheseadditional
sourcesof stressacidconsiderably to the
burden ofloss, and causeextreme additional anxiety and upset. In our culture
theseinclude doing many of the things that
the deceasedperson had beenresponsible
for, such as shopping or paying the taxesin
spousalbereavement.It also involves the
establishmentof new roles and patterns of
social interaction, now that ODeis alone as
widower or widow. 1ikewise, the transition
from 'parent' to 'parent of a deceasedchild'
brings with it not only the devastation over
the loss itself, but additional upset through
having to adapt to this status among other
parents and their children (it is noteworthy
that there is no single word in our society
for tros tragic changein identity).
Again, there are cultural differencesin
the degreeof restoration that is appropriate
or required. Developmentof a new identity
was, for example,a very different concern
for members of the Ubenatribes of Africa,
where the widowed were provided with new
mateson the death of their husbands32,
trom the readjustment that would be
neededin a societywhich had adopted the
role model of a life-long widow, as in
Victorian England. Here many widowed
wamen followed the exampleof Queen
Victoria, who lived as a widow, never
remarried and dressedalways in bláck for
decadesafter the death of her spouse,
PrinceAlbert.
2. Approach-avoidance
It seemstrue to saythat samepeople, and
samecultural groups, adopt a wayof
coping by confronting their experience,
whereasothers will rather tend to avoid
memories, distract themselves,and keep
busy with other things. Avoidanceof loss
caD,but doesnot always,take the form of
an approach towards restoration. It caD
also be a respite trom coping at all, simply
taling time off trom dealing with any
aspectof the experience.
A central construct in the model isthat
of oscillation. Grieving is a dynamic process,
in which bereavedpeople move betweenthe
two orientations of coping. At times they
will be confronted by their loss, at others
they will avoid aspectsof it. They do this for
a number of different reasons,and cultural
norms will be a powerful determinant of
the amount of approachversusavoidance
ofloss and restoration orientation.
A Dual Process Model of Coping with Loss (Utrecht Universtiy)
10
BEREAVEMENT
Care
The appraisal process in coping
Central in detennining the balance of lossversusrestoration-orientation in any
particular culture will be the 'meaningbasedprocesses'33
thai individuals in their
society use to capewith bereavement.The
Hopi of Arizona are afraid of death and the
dead and so their 'sovereigndesire is to
dismiss the body and the event' 16,whereas
for the Japaneseof Shinto or Buddhist
religions the deceasedbecomeancestors,
which meansthai contact with the departed
person may be maintained. As Yamamoto34
described:'The ancestorremains accessible,
the mourner can talk to the ancestoI;he can
offer goodiessuch as food or evencigarettes,
altogether the ancestoris revered,fed,
watered, and remains with the bereaved'.
CONCLUSIONS
Despitethe fact thai reactions identifiable
as 'grief - as we know it - are recognisable
in very diversesocieties,manifestations of
grief in different cultures havebeen shown
to vary in major wars. The cultural nature
of relationships, bands and meaning
influence patterns of responseto lassoThe
expression,manifestations, duration of
grieving and wars of coping with loss are
shapedby cultural factors. Our genera!
conclusion is thai, while there is ample
e:videnceof such cultural patterning, grief
can be consideredas essentiallya universal
human reaction to loss when a significant
person dies.
ID
Partlyadaptedfrom a paperpresentedat the
Conference
of theSocietyfor the Careof
Childrenand FamiliesFacingIllnessand
Death,Athens,Greece,
28 September;
1996.
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