Setting the scene
Policy documents
* Concern regarding the lack of up take of services by BME communities (Hill & Penso, 1995)
* Recognition of need to provide culturally sensitive services (Gunaratnam, 2007)
* E.g. NICE guidelines regarding spiritual care
Background to study
* Bereavement - the actual loss of a significant other
* Grief - the emotional response to bereavement
* Mourning - the culturally defined actions which express grief
(Stroebe, Stroebe & Hansson, 2003)
* Cultural narratives determine responses to death and bonds to the deceased.
* Religions form part of this narrative and include ways in which a person and community make sense of important deaths
(Klass & Goss, 2002)
* Models of grief stem from Euro-American framework and therefore may not represent grief in other cultures
* People not living in their own country may have a combination of ways of mourning and find difficulty in accessing support (Rosenblatt, 2003)
* People can continue to have a relationship with the person who has died (Silverman and Klass, 1996)
Aims of study
* To explore the nature of relationships bereaved Pakistani Muslims living in the UK have to deceased relatives, and the effect this has on the bereaved.
* To develop an understanding of how relationships to the deceased are influenced by religious and cultural beliefs
* To develop an understanding of the influence of the context in which the bereaved live (i.e. being a Muslim Asian living in the UK).
Design of study
Semi structured interviews using cultural psychology model (O’Dell et al, 2004)
* looks at concepts through the lens of that culture
* assumes psychological processes may not be universal to all cultures
* assumes processes are mediated through specific cultural contexts
Analysis of themes in transcripts to gain a model through constructivist grounded theory (Charmaz, 2000)
Design of study
Participants:
* Adults of any age
* Muslim
* Of Pakistani origin
* English speaking as 1st or 2nd language
* Bereaved in the last 18mth-5years
* Of a relative but not a child
* Not receiving formal support
Interview guide
* Relationship before death, rituals surrounding death, how relationship changed following death, the form this took, how culture, religion and context influenced this, coping.
The sample
* 10 Pakistani Muslims (2men, 8 women)
* Aged 21 – 53 years
* All 2nd generation immigrants
* Bereaved of wide range of relatives including fathers, siblings, cousins, in-laws
* 6/10 described the bereavement as sudden
* 3 deaths in old age and 7 ‘untimely’
Diagram of findings
|
Re-negotiating the relationship
with the deceased
|
|
^
|
v
|
|
The process of grieving
|
Influencing Frameworks:
Family, Culture, Religion
The process of grieving
* Finishing well: communicating with deceased/dying in a good state/being there
* Mourning the loss: carrying out rituals/interaction with community/showing and blocking emotion
* Coming to terms: meaning making/accepting/moving on
* Learning from the death
Finishing well
* Dying in a good state
"I believe there’s life after death and that you either go to heaven or hell depending on what type of
person you are in this life …so it was important that for us when he passed away that he passed
away in the state that he did…he was a good person, and he is going to heaven but we don’t know”
(P3)
* Communicating before death
Sharing emotions and sense of closure
* Being there
Mourning the loss
* Carrying out rituals
* Washing ,funeral prayer, early burial, prayer gatherings
* Culturally and religiously influenced
* Interacting with the community
* Importance of paying respects- expected attendance
'It was quite comforting that we weren’t alone and that there were so many people who were
thinking about us and thinking about my uncle as well…everybody was together and they were
sharing the time, they were sharing their thoughts, feelings and emotions” (P3)
'I just couldn’t mourn with the people cos I don’t think they were mourning for him, for them it
was just a gathering you see, they don’t know the loss the way we know it. So with my brothers
and sisters it was different.” (P10)
Mourning the loss 2
* Showing and blocking emotion
* Expectation of crying
'A couple of my cousins couldn’t understand why it wasn’t affecting me more, that my reaction
should be greater, more emotional, and I almost felt for a little while that do they think that
because I’m not crying my eyes out I didn’t care for my father? That annoyed me a bit…but
they don’t know what it’s like when you’re alone, they don’t know…that you’re actually
weeping when you are on your own, that you are grieving, but that you just don’t want to in front
of them”
*Mediated by family and personality
Coming to terms with loss
* Meaning making
* Especially sudden bereavements
'One of the things well that a lot of people in my family are thinking is that maybe he passed
away at that time a) because he changed and he was a better person and b) because all that
was yet to happen in his family and he was saved from that in a way”
* Accepting the death
* Comfort and strength from God
'It’s basically God’s Will and we can’t do nothin’ about it. If God can give him birth and if
God decided that no one else can have him, then He can take him away. But we can make
sense of why he came into my sister’s life, because they loved each other so much God
wanted to bless him with love before he passed away…but it’s really comforting to think that it
was God who decided, because if it was a divorce or something or someone killed her
husband then it would be far worse. But it was all God. God did everything and He knows
best. ” (P2)
Coming to terms 2
* Moving on
'You expect that you have to go and when the time comes nothing can stop it, the fact is you
have to move on and the person that’s passed away you will want to remember them in the
best of lights, the good things they’ve done in life, and then you’ve got your own family and
work and that keeps you occupied” (P4)
Learning from the death
* Transformational aspects of the bereavement
* Put priorities and important people into perspective
* Becoming stronger or having better character through dealing with the death
*Thinking more about relationship with God and wanting to in a state with which God would be
pleased
'So when my father passed away I thought ‘I’m in no state to meet God’ at the
moment, I need to fix up because I am not as Islam preaches and in the literature you
do not get a second chance” (P8)
Re-negotiating the relationship
* Repairing and Maintaining
* Continuing the relationship
* Dreaming
*Talking with others
*Following their example
*Keeping memories
*Benefiting the deceased
* Projecting into the future
Re-negotiating the relationship
with the deceased
*Importance and respect given to family, especially parents or parental figures
*Ungratefulness of forgetting their influence on their lives
*Belief that these family connections continued after death
'I don’t believe we don’t have a connection with our departed loved ones, I don’t believe that at
all, I do feel we have an eternal connection and that we are all put together for a reason…there is
some deeper to this madness that we call family, I really believe that there is a reason and an
eternal connection there” (P7)
Repairing and maintaining
Repairing: Making amends to a negative relationship through the removal of worldly concerns
'I'm convinced that he realises, that he knows my heart, where as in his life I don’t think he knew my heart, he only saw my actions which were disruptive and counter to the things he believed in…and if I could have seen his heart at the time I would have known that he was never my enemy. But now I think that worldly stuff falls away…it’s like a pure connection, and that’s what I feel now” (P7)
Maintaining: What was important in the relationship before death, remained important following death
Continuing the relationship
* Dreaming
* Talking with others
*Made them feel connected to deceased
'It's reassuring for me cos I see some of these people who sat, drank, lived with my dad so it
’s nice to see them. It makes me feel that these people are very close to my dad and they
talk about my dad and it helps me”
* Hard for some participants
* Changed over time
* Keeping memories and mementos
Continuing the relationship 2
* Following the example of the deceased
*Moral/good behaviour
*Motivating function in life
*Keeping up traditions or habits
'It's like giving sweets to the children then it’s just so that the children will remember him and it
makes us feel closer to him as well and I believe he’ll know somehow and it’ll make him
happy”
Continuing the relationship 3
* Benefiting the deceased
*Most universal form of continued relationship
*Influenced by religious beliefs
*Through charity, knowledge, prayers
'So even if someone has passed away and they can no longer do good in this world they will
still be accumulating good deeds because of the fact they have taught their children about
Islam, and those children are praying for them, and we believe the more you pray for
somebody the better it is for them. And we just pray to Allah to forgive their sins and bless
them with heaven”
* Provided comfort to participants
Projecting into the future
* Relationship would continue to grow
* Fulfilling goals talked about with the deceased
* Wanting attachment to lessen if associated with difficulty
Influencing frameworks
* Culture
*Through community and collectivism- strengthened social support
*Conflicts with being brought up here:
expression of emotion, place of burial and extent of community involvement
* Family
*Respect for relatives, especially elders and parents
*Influencing expression of emotion
* Religion
*Belief in the afterlife – led to stronger literal continuing bonds
*Belief in helping the deceased after death – led to a sense of being able to take action, to
contribute and to make amends
*Belief in the importance of acceptance of the Divine Decree, based on a view of a benevolent
God – promoted peaceful acceptance
Implications for clinical practice
* Individuality of responses to the mourning process
* Acceptance of importance of religious and cultural beliefs
* Being open to finding religious and cultural beliefs helpful, as well as ‘checking out’ assumptions of
helpful social support and religious comfort
* Difficulties can occur in either the continued relationship or in general function- decide on focus on
intervention
Thank you for listening
Our contact details:
n_hussein@yahoo.com
j.r.oyebode@bham.ac.uk >
|
