Grief— both the way we experience it on the inside, and the way we express it on the outside— is inherently impacted by culture and the many identities we hold both as individuals and as professionals. Here, we offer some guidance on how to hold a grief-sensitive frame while working with families of varying cultures.
Culture impacts the internal experience— and external expression— of grief
Just because someone is of a certain culture, we cannot assume precisely how they will grieve. However, individuals do tend to adopt the beliefs and values of their cultural context. As a result, following a death, grief responses will vary from person to person. This is particularly relevant in communities in which there are individuals from various cultural backgrounds. Often, families develop their own practices and rituals when a loss has occurred. It is important to keep in mind that in some instances, an individual or a family may express their grief in ways that appear to be in conflict with contextual norms or with your own beliefs or values. Nevertheless, each individual and each family deserves to grieve in ways that feel right to them. Here are some points to keep in mind around how culture can impact the experience and expression of grief within the families you care for.
Factors that impact expressions of grief
There are several factors that can impact an individual’s expression of grief. The individual’s relationship to the person who died can significantly alter the grieving experience. Individual characteristics such as cultural background, personality, and previous experiences with death and loss are also likely to influence one’s expression of grief. Depending on the circumstances of the death, a grieving family may have been surprised by the death or have been expecting it for a long time. Although this may not change the significance of the loss, it is likely to impact emotions and behaviors in response to a death. A family’s recovery environment will also play a role in their grieving, as some may have little to no access to the deceased, lack social support, or have few opportunities for grieving rituals and practices.
The meaning of death
Although in many cultures beliefs around the meaning of life and death are influenced by religion, this is not always the case. An individual’s beliefs about death and what happens following a death are likely to influence their experience of grief. While having a clear idea of what happens after a death can help some to cope with their loss, others may experience a sense of betrayal or feeling of being let down by their faith. For some, having no clear idea of what comes next may lead to increased uncertainty and distress. You may or may not have your own concept of the meaning of death and you may be asked questions that you find difficult to answer. In these cases, while disclosing a shared belief may be comforting for some families, much of the time, listening and joining the family in their feelings of relief/uncertainty/anger is more important than providing existential answers.
Rituals and practices surrounding a death
Death can create a sense of chaos and confusion. It can be helpful to understand a family’s death related practices because for many, these provide a sense of routine and structure during the time surrounding death. Rituals and grieving practices can offer individuals ways to make meaning, cherish memories, and sometimes, express their grief along with loved ones. These practices may include moments of reflection, ceremonies and gatherings, rituals with the deceased’s body, memory-making activities, etc. As a healthcare provider, it is important to refrain from making assumptions about a family’s wishes and beliefs concerning death and loss. If these are unclear, it is okay to ask the family about their preferences concerning rituals that may be especially important to them.
Practicing cultural humility
Recognizing your own cultural beliefs and experiences surrounding death and grief is important when offering culturally sensitive care to others. It is important to remain curious about the grieving experiences of the families you work with. Some questions you can ask yourself to help you in remaining nonjudgmental and supportive include:
What expressions of grief (e.g., emotions and behaviors) are considered normal within this person’s culture and do these expressions differ by age or gender?
How may the family's expression of grief be similar or different to my expectations or experiences around grief? Are the similarities making me identify with the family in a way that is helpful or harmful? Are the differences confusing me, shutting me down, or impacting the care I provide?
How would the family like their loved one’s body to be handled after death?
Are gifts, condolences or other offerings expected or appreciated?
How can the language I use concerning the death and the deceased person reflect that of the family?
You are not expected to readily be familiar with the grieving practices of every culture of every family you care for. Although it may be most effective to learn about a family’s beliefs and practices surrounding death and grief directly from the family, you can also seek consultation from colleagues and chaplains, or do research to learn about typical grieving customs.
A note on the use of language interpreters
When communicating with families of different cultures, we sometimes need to rely on language interpreters to convey our message. It is normal to be worried that our message will literally get 'lost in translation'. The guidelines described throughout this handout still apply, however. Perhaps most importantly, we should use very clear language and avoid euphemisms that may be specific to our own culture of origin.