American Attitudes Towards Death and Dying

1
American Attitudes Towards Death and Dying

• Dusana Rybarova
• Psyc 456
• July 2007

2
From Visible to Invisible Death

• Visible death
• Death recognized and orchestrated by the dying
  person, preparing for dying
• Manual for a dying person Ars moriendi to
  achieve peaceful and graceful death (dying and
  funeral as public rituals with personal
  assistance of close ones, forgiveness,
  meditation)
• Filtered death in Early America
• Between 1600 and 1830
• Funeral processions, awareness of death
• Postmortem photography publically displayed
• Increased value in family relationship shifted
  the initiatives surrounding death from the dying
  person to the family
• Shift from personal psychological event to
  collective sociocultural event

3
From Visible to Invisible Death

• Invisible Death
• Current funeral practices adopted by European
  Americans
• Feelings and thoughts are kept private
• health and funeral institutions dominate the
  procedures surrounding death
• Thanatology
• Interdisciplinary study of death and dying
• Established in the wake of WW II
• Has roots in psychology, sociology, anthropology,
  philosophy, theology, biology, medicine, social
  work, ethics, law and other disciplines

4
John D. Morgan Canadian philosopher and
thanatologist

• Our North American death system, is the result
  of our limited exposure, which is a result of our
  high life expectancy, but in many ways, our
  life is no different from that of the peasant in
  the 14th century. The peasant missed a fully
  human life because he or she was inundated with
  death. We do not live fully because we reject
  death.
• (199540-42)

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Factors influencing invisible death

• Industrialization
• Increased living standards
• food production, better housing, expanding public
  education, improving water and sewage facilities,
  new communication and transportation means
• Modern medicine
• New medical technologies, immunization programs,
  sterile treatment facilities, hospitals
• deaths in US. Hospitals (1900 20, 1994
  80)
• Life expectancy and the family
• After WWII life expectancy increased by 20 years
• Infant mortality decreased from 29.2 per 1000
  live births in 1950 to 8.2 in 1992
• We view death as an event that happens in old age

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Factors influencing invisible death

• Geographic Mobility
• Distance often separates family and friends as
  changes in employment and lifestyle require
  moving (decline in personal contact with extended
  family)
• Death and Language
• Approach avoidance conflict
• Obsessive fascination with death in literature,
  TV, film, humor
• Obsessed not to speak about death directly (using
  the word death more often when we are not
  speaking about death than when we are

7
Factors influencing invisible death

• Death and the Media
• Death is abstract and superficially portrayed
• Death is fun and revocable
• Cartoon characters
• Death is brutal but fast
• Death is resolved in 60-90 minutes
• Death is horrible but distant
• Happens to people other than us

8
Attitudes of Invisible Death

• Attitudes
• Relatively lasting patterns of thinking, feeling
  and behaving towards something
• Cognitive Denial
• We refuse to think about death or perceive death
  related issues
• One of the most common and most indirect defense
  mechanisms
• Short-term denial
• Natural coping mechanism right after a traumatic
  event
• Prepares us for grieving and processing of the
  loss
• Long-term denial
• Represses emotions that are too painful
• Destructive in the long run (immune system, heart
  problems etc.)
• Deathbed denial
• A form of cognitive denial
• Descriptions of deathbed scenes (Kastenbaum
  Normand, 1990)
• Majority of respondents expected to die at home
• Almost all expected to be alert, lucid, and aware
  right up to the moment of death
• Surrounded by loving, supporting, even cheerful
  loved ones

9
Attitudes of Invisible Death

• Emotional repression
• Blocks disturbing wishes, thoughts, or
  experiences from conscious awareness
• In relation to death we block out unacceptable
  bodily feelings and emotions painfully connected
  to death or loss
• Respondents describing their death did not report
  any pain, anxiety, fear, sadness etc.
• Emotional repression and cognitive denial of
  death have become necessary in chaotic modern
  society in order for individuals to maintain the
  illusion of normal life (Jasnow, 1985)

10
Attitudes of Invisible Death

• Behavioral passivity
• We became passive observers to our own dying and
  to the morning we leave the behavioral
  orchestration to physicians and funeral directors
• Socialization
• We are socialized to conform others
• Conformity
• High conformity in situations poorly defined
• Lack of social support for non-conforming
  behavior
• Lack of social comparison
• When personally dealing with death we may feel
  isolated
• Perception of legitimate authority
• Authority figures funeral directors,
  physicians, nurses, clergy
• Inaccessibility of values
• When we are distressed by the sadness, despair,
  and pain of death we dont see that cognitive
  denial, emotional repression and behavioral
  passivity are wrong attitudes

11
Ethnic variations in attitudes towards death

• Affrican American attitudes (12 of population)
• Life after death immortality is a given for most
• During grief family is more less important than
  for Asian Americans and Hispanic Americans
• Expect to live much longer than other ethnic
  groups
• Preference of care for terminally ill at home
• Less formal and more emotional than European
  Americans
• Hispanic American attitudes (9 of population)
• More open expression of emotions after death
• More visits to the cemetery and more
  participation in the burial rituals
• Strong support of family, less likely to disclose
  terminal diagnosis to a dying person
• Christian Hispanics death viewed as a
  beginning, a door passing from one state to
  another

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Ethnic variations in attitudes towards death

• Asian American attitudes
• Marked by tightly controlled communication
• Chinese Americans death as a taboo subject in
  general
• Japanese Americans often hard to detect when
  the members are in distress and dying
• Belief in the deceased watching over those who
  remain alive
• Restraining themselves from public displays of
  grief and conservative mourning traditions
• Hawaiian visions of the dead

13
Ethnic variations in attitudes towards death

• Native American attitudes
• Great variability in attitudes towards death
  across American Indian tribes
• Apache
• Dead persons body regarded as an empty shell
• Lakota (Sioux)
• Death as a natural counterpart of life the soul
  journeys to the Spirit Land
• Reverence for the body residence of the
  persons essence
• Unrestrained grief is appropriate for both men
  and women
• Navajo
• do not believe in afterlife
• Preference of death at the hospital to prevent
  home pollution
• Focus on positive aspects and avoidance of
  negativity including discussions of negative
  medical outcomes
• Death is often forecast by unusual spiritual or
  physical events, whi are understood to be natural
  and in the order of thigs

14
Death, Dying and Acculturation

• Vast variability across cultures
• Ethnic differences posing questions for hospital
  care
• Hmong Americans refusing some medical practices
  because of traditional beliefs of spirits
  residing in body
• Need for more information and respect for
  traditional views
• Modifications of traditional views within
  different ethnic groups in North American society
• Acculturations towards the views of the European
  American tradition
• Acculturated Korean Americans and Mexican
  Americans are more likely to tell a loved one the
  truth about a terminal prognosis than those not
  acculturated

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Final issues

• Is America a Death-Denying Culture?
• Are we a death-denying, death-avoiding society,
  or do we reveal a complex mixture of positive and
  negative attitudes towards death, dying and the
  mourning after?
• Changing Attitudes and Death Education
• Field of thanatology established in 1950s
• The Journal of Thanatology
• Death studies
• Increased interest in death in 1960s and 70s
• Death-education movement
• Death is becoming more human dying is become more
  humane

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Herman Feifel editor of the book The meaning of
Death seminal work bringing death and dying
to the American scholarly community

• the death-education movement has been a major
  force in broadening our grasp of the
  phenomenology of illness, in helping humanize
  medical relationships and health care, and in
  advancing the rights of the dying Furthermore,
  it is contributing to reconstituting the
  integrity of our splintered wholenesssensitizing
  us to our common humanity I believe that how we
  regard and how treat the dying and survivors are
  prime indications of a civilizations intention
  and target In emphasizing awareness of death, we
  sharpen and intensify our appreciation of the
  uniqueness and preciousness of life.
• From Herman Feifels Distinguished
  Professional Contribution Award address at the
  1988 annual convention of the American
  Psychological Association