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Chinese cultural dimensions of death, dying, and bereavement: focus group findings
Alice G. YickAbstract: The purpose of this qualitative study is to describe Chinese immigrants and Chinese Americans attitudes and practices about death, dying, and bereavement. To this end, three focus groups were conducted with social work graduate students, pastors and religious leaders, and service providers working in the Chinese American community in New York City. The United States is becoming increasingly multicultural, and Chinese Americans are the most rapidly growing Asian American group. Findings from this study revealed that many Chinese attitudes and practices about death and dying are rooted in Asian cultural values such as filial piety, centrality of the family, and emphasis of hierarchy. In addition, strains of Confucianism. Buddhism, Taoism, and local folklore are embedded in these death attitudes and practices. Based on themes extrapolated from the focus groups, recommendations are delineated for service providers in order to implement culturally-sensitive bereavement practices.
Key Words: Chinese and death and dying, bereavement, Asian Americans, death attitudes, death rituals
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A death attitude is a belief system which is comprised of cognitive, affective, and behavioral components that reflect individuals' attitudes related to death, dying, suicide, bereavement, and euthanasia (Kastenbaum and Aisenberg, 1972). Many assume that death concepts are universal, and therefore, death attitudes and rituals vary minimally throughout the world. However, the experience and expression of grief are shaped by the social context (Rosenblatt, 1988). In Kalish and Reynolds' (1976) study, ethnicity attributed the greatest differences in beliefs about death and not other demographic dimensions such as age, gender, or education. Eisenbruch (1984, pp. 315) argued that descriptions of bereavement practices are often portrayed in a static manner, providing a "frozen picture of a living culture." It is crucial to take these snapshots over a period of time to depict the evolving state of the culture, which can reveal the cultural history of a particular cultural group. This information can be used by service providers to understand the context. of their clients, grief, symptoms of any atypical grief, and developing interventions that are culturally-sensitive.
The goal of this qualitative research study is to describe Chinese Americans' beliefs and practices regarding death and dying. To this end, focus groups were conducted in order to provide a glimpse into how participants construct a specific experience, how they think, and talk about a particular topic (Hughes & DuMont, 1993). In addition, the first author's grandmother had passed away during the time this study was conducted. Therefore, some of the first author's experiences and observations during her grandmother's funeral and mourning rituals were used to validate focus group findings. Recurrent themes from focus groups and recommendations for culturally-appropriate interventions are highlighted in the article and discussed in a cultural context.
LITERATURE REVIEW
Chinese Americans in the United States
Chinese Americans are the largest Asian American ethnic subgroup in the United States. Since 1950, they have doubled each decade (Mark & Chih, 1982). They comprise 23.8% of Asian Americans in the U.S. population, with the Filipinos following at 20.4% and the Japanese at 12.3% (U.S. Census, 1993). According to the U.S. Census, the largest concentration (43%) of the total Chinese population reside in California, and New York follows at 17% (Jung, 1998), which is where this study was conducted. Waldinger and Tseng (1992) noted that the middle and upper-middle class Chinese from Taiwan tend to immigrate to Los Angeles, while those from the Hong Kong and China's working class tend to immigrate to New York City. In addition, between 1978 and 1980, there was a large influx of Chinese fleeing from Vietnam due to the political and anti-Chinese sentiment in Vietnam (Jung, 1998).
Religious Influences in Chinese Society
As the themes from the focus groups get extrapolated, readers will see an interaction between superstition and folklore, Confucianism, Taoism, and Buddhism in Chinese's attitudes of death and dying. Therefore, a brief summary is provided; however, it is far from comprehensive.
The Chinese religious system is characterized as polytheistic, where people pray to different gods for different purposes (Jung, 1998). The Chinese religions are a mixture of local folklore, superstition, and magical belief systems (Jung, 1998). China has been an agricultural society, relying on the earth for sustenance. Thus, they have worshiped and offered sacrifices to the local gods of the land (Zhang, 1993). Chenwu, for example, was invoked to protect families from crime, while Kuan Yu was relied on for wealth and protection of businesses (Jung, 1998; Yang, 1961). In part, the Chinese religious traditions developed as a product of village agricultural life, and as a result, they include a combination of ancestral religion, sacrifice, and divination (Lee, 1995). Ancestor worship, for example, entails praying for the lineage on the male's line of descent. These dead ancestors are believed to play a role in a family's wealth, health, and success, and therefore, paying the proper respect means that the ancestors will bless the family. Conversely, misfortune that befalls on a family may be attributed to the ancestors' displeasure.
Ancestor worship is a cross-cultural phenomenon that connects generations of families. For the Chinese, it has been said the term "reverence" rather than the term "worship" of ancestors is more appropriate. According to Zhang (1993), the worship of ancestors was very fashionable during the Shang dynasty (1700-1100 B.C.). It was not until the period between 1100 to 256 BC, which filial piety was connected to ancestor worship, thereby venerating both living parents and those who passed on (Zhang, 1993). During traditional festivals, such as the Spring Festival, families would set out tablets of the deceased family member and burn incense and tinfoil paper to express their respect. Similarly, during the Cold-Food Festival and the Pure Brightness Festival, the Chinese would go to pay respects at the tombs of their ancestors (Zhang, 1993). Rites of reverence were also held in the home, at temples, and in graveyards. Ancestral shrines containing tablets bearing the names of recent ancestors were maintained in the homes.
The three predominant religious strains include Confucianism, Taoism, and Buddhism, and each play a vital role in community and family life, which is the foundation of Chinese society (Jung, 1998; Lee, 1995). Confucianism has been described as a philosophy that emphasized peace, hierarchy, and order. Confucius arrived in China during a period of economic, political, and moral confucius, and he advocated a highly structured and hierarchical society, where everyone was ascribed specific roles (Jung, 1998). Proper conduct ("li") would naturally flow from this structure (Pedersen, 1991). His most well-known philosophy describes five basic social relationships between (1) sovereign and subject; (2) father and son; (3) elder and younger brother; (4) husband and wife; and (5) friend and friend (Chung, 1992; Pedersen, 1991).
Taoism is considered both a religion and philosophy, emphasizing the independence of the individual and connecting to the natural forces of life (Jung, 1998; Lee, 1995). Instead of trying to change the environment around them, Taoists focused on finding harmony with the natural order of things (Jung, 1998). Through rituals, the individual can achieve the peace and union between the individual and the cosmic forces of nature. Immortality did not necessarily mean eternal life since the Chinese did not adhere to a distinction between spirit and the physical body (Lee, 1995).
Buddhism is another major religious tenet and was dominant in China from the middle of the fourth to the end of the eight century (Jung, 1998). Buddhist doctrine is tied to the Four Noble Truths: (1) life is painful; (2) pain originates from desire; (3) for pain to end, desire must end as well; and (4) the path to end of pain is righteous living (Lee, 1995). The ultimate state is Nirvana, which is a peaceful state, absent of desire (Jung, 1998). Life is viewed as a cycle; each state is tied to another (Lee, 1995).
Chinese Cultural Belief Systems and Worldviews
A cultural group's worldview can be defined as how the group perceives their relationship to nature, other people, society, and institutions (English, 1984). This orientation toward life can assist in understanding why they behave and think as they do. Therefore, in attempting to unravel beliefs of death and dying, it. is important to understand, a group's cultural belief systems and worldviews. As the themes get extrapolated from the focus groups, readers will see that the exercise of death rituals and attitudes toward death and dying are influenced by their worldviews. Table 1 highlights some of Chinese cultural belief systems.
Western and Chinese Beliefs and Rituals About Death and Dying
Western-oriented belief systems emphasize that grief is a fundamental private experience. Grief is also near and time-limited, where the grieving individual "lets go" of the deceased and ultimately accepts the death. Finally, the expression of grief is crucial for healthy resolution and good mental health outcomes (Shapiro, 1995; 1996; Wortman, Silver, & Kessler, 1993). Deviations from this Western model are often viewed as pathological.
In Chinese culture, grief and bereavement are not necessarily private, time-limited, nor does it give the appearance that the grieving family member "lets go." For the Chinese, funerals are usually a public affair, and the degree of elaborateness symbolizes the family's social status and their respect for the deceased (Lee, 1991). In ancient China, the mourning period was seven years, however, mourning rituals currently last 49 days. During this period, family members are expected to display signs of mourning by wearing black bands of cloth on their sleeves, and women are expected to wear a simple flower made of wool in their hair (Lee, 1991). Family members are expected to convene at the gravesite on the third day after the funeral and burn money and food. This occurs also on the twenty-first, thirty-fifth, and forty-ninth day after the death (Tanner, 1995). In many ways, these rituals can be viewed as what Westerners call "grief work" (Klass & Goss, 1998). These rituals help the deceased and the living journey to a new status; provide a forum for the living to express their grief; and the community to provide social and emotional support (Klass & Goss, 1998).
The Western model also prescribes that death severs all ties between the living and the dead (Shapiro, 1995). Contrasting this, the Chinese believe that the dead, although no longer residing on earth, continue to live in another world, and their spirits are with the living. If the deceased is not properly buried, if the burial site is not the best, and if proper respect and offerings are not properly accorded at the time of and after the burial, a hungry ghost will return to plague the living members of the family (Ryan, 1986; Braun & Nichols, 1997). Some families seek a fortune teller for consultation about the best burial site and date since the spirit of the deceased will be more at peace if the final resting place has good soil and facing in an auspicious direction (Lee, 1995). Even though some of the funeral customs have been modified by Chinese immigrant and Chinese American families, many still burn incest and paper money and clothes to guarantee that the deceased soul is taken care of in the next life (Klass & Goss, 1998). In part, the mutual dependence between the spirit and living is reflected in ancestor worship (Lee, 1995).
For the Chinese, death is associated with bad luck. They fear the corpse and the potential bad luck, which they are exposed to at funerals (Hill, 1992). Consequently, they will often turn their backs to the open coffin. The first author remembers vividly when as a young child, her mother told her it was necessary to pay respect to the deceased, but forbade her to look at the body. Candy is given to the guests who have come to mourn and is to be eaten immediately with the wrapper discarded before reaching home so as to ward off bad luck (Klass & Goss, 1998).
Attending funerals in Western society signifies paying respects to the deceased. This is emphasized in Chinese culture; however, respect takes on a slightly different connotation. The performance of funeral rites by the child to the deceased parent conveys filial piety. Filial piety (hsiao or xiao) is a system of obligations of a child to a parent, where the child provides aid, affect, economic and emotional support, and glory or prestige/status to the parent (Lin & Liu, 1993). Traditionally, one of the most vital obligations for children is to perform their parents' funerals appropriately (Klass & Goss, 1998). The more elaborate the funeral ceremonies and procession and the louder the wailing, more status is reflected upon the family.
METHODOLOGY
Three separate focus groups were conducted with Chinese American and immigrant masters-level students in graduate social work program, pastors and religious leaders who work with the Chinese American community, and social service providers from a longstanding social service agency in the Chinatown area of New York City. The students were able to share their childhood experiences of growing up in traditional Chinese families. Because pastors and religious leaders often deal with families and grief and perform funeral ceremonies, we felt they would be able to share specific insights about the practices and the spiritual meanings of the rituals for families. Finally, service providers from the Chinese community were recruited because they provided specific services to grieving families. We believe, that each group offered a unique picture to the social realities under examination.
A key contact person was identified for each group to help recruit focus group participants who met the eligibility criteria of the study. Participants had to have experience working with Chinese immigrants or Chinese Americans on issues of bereavement, death, dying, and grief. A total of seven masters-level social work students participated in the first focus group. All the students were Chinese, born in the U.S. or immigrated to the U.S. during childhood. Six pastors and religious leaders were in the 2nd focus group. All were Chinese immigrants, with the exception of one pastor who was white, but who pastors a church in New York City's Chinatown. Five social service providers participated in the 3rd group, and all were Chinese immigrants. Data was collected from December 1998 to May 1999 in New York City. Refer to Table 2 for brief demographic summary of the focus group participants.
The focus group facilitators (and primary investigators of the study) were a Chinese American female and an Asian Indian female, and both were assistant professors at the same social work graduate program. Often times, direct probes and personal accounts from the first facilitator were provided from her own childhood recollections of her traditional Chinese family and her own recent experience with her grandmother's death. If she shared her personal accounts, focus group participants were queried about its veracity.
A discussion guide was developed to facilitate the groups. It consisted of semi-structured questions, which covered (1) Chinese's attitudes and beliefs about death and dying and the after-life; (2) specific ritual and practices related to death and dying and their meanings; (3) beliefs about organ donations; (4) recommendations for culturally sensitive interventions. Probes such as "how what", and "why" were often used to assist participants to elaborate on the themes.
The focus groups ranged from one and half to two hours. All the groups were audio taped and then transcribed. Content analyses were conducted independently by both researchers for all three focus groups. Hughes and DuMont (1993) noted that because focus group participants cue each other to frame events in a certain manner, it is important to search for convergence in themes across focus groups, rather than across participants within a group.
FINDINGS
Chinese Attitudes and Beliefs about Death and Dying
One recurrent theme is that death is a taboo topic. Focus groups participants mentioned that the Chinese do not like to discuss death because it is associated with evil and bad luck. Because open coffins are common in funerals, some avoid looking directly at the body because of the concern that it will bring bad luck into their lives. The first author remembers her mother whispering in her ear as a child, admonishing her not to look at the body when they went to a funeral. This notion was reinforced by one of the MSW students:
"You don't look at the funerals cars going by. Close relatives did not take me to funerals because it was considered that the death would bring bad luck. You were not allowed to look at the body or the coffin (MV, MSW Student Focus Group)
Consequently, Chinese families will not discuss death and issues of dying for fear of invoking bad luck. When necessary, they will talk about it in an indirect way, employing many euphemisms. Some service providers say that this makes it very difficult to assist the elderly with wills.
"The first thing I learned from the elders is that you don't talk about death in a direct way.".... But for the older folks, you have to find another way to express that fact. For, example, terms like: "That the end of the journey or time to go home." (EL, Pastors Focus Group). "With my father, we approached him with the topic. I said to him that he should consider doing a will ... But they don t want to hear it. They think: What do you mean, do you expect me to die. Talking about it will bring bad luck (IC, Service Provider).
The fear of bringing bad luck to oneself or others is also exemplified in the notion that certain gifts or colors symbolize death. For example, the Chinese would never consider giving handkerchiefs as gifts because they symbolize tears, grief, and death. In addition, the color of white symbolizes death, while the color red conveys luck and good fortune. In ancient Chinese customs, brides wear red gowns to symbolize happiness and good fortunate, unlike Western wedding apparel. Consequently, wearing a white ribbon in one's hair is considered bad luck.
The Chinese also believe that the relationship between the dead and the living is continuous. Although the deceased is no longer on earth, they are alive in the after-life. The spirits of the deceased continue to live on, and the responsibility, of the living family members is to provide care. This is a part of the concept of filial piety. Failure to provide for the deceased will bring bad luck not only to the immediate family but also to the entire family clan. Participants in all the groups consistently mentioned that the spirits continue to remain on earth.
"My family believes that the sprats are still alive. Each year we still pray, and we believe the person is still there and that they re a guiding spirit. (No name, MSW Student Focus Group). "Even ordinary people, after they die, we believe that their spirit will live on. We believe that our ancestors and all our descendants will always have a relationship." (YS, Pastors Focus Group). "We believe that the spirit is still around during this period.... you really want to show respect to the dead during this period, so that they will be left in peace (LT, Service Provider Focus Group).
Although death is considered a taboo and bad luck, when elderly people die, the Chinese believe they have lived along life, and there is some joy resulting from this knowledge. However, when children die, the Chinese believe that this is not consistent with the natural order of life. The Chinese have an adage that says something to the effect that the "white hair does not send dark hair away." When a child does die, the family considers the death very shameful and will condemn themselves, believing that the gods have not blessed them. Participants disclosed that the parents of the deceased child often will not attend the funeral.
"It is not,a natural death ... They will condemn themselves--"I must have done something bad. It is something very bad, something very shameful ... and people with gray hair don t go to the funeral Of young people with black hair (DS, Service Provider Focus Group). "Now if you are good, you will have long life and a lot of kids. All the kids will live long and will be successful. However, if suddenly, your kid dies, there is something wrong. The god did not bless you. So if the parents are white headed and old, older than the dead person, they won't attend the funeral." (EL, Pastors Focus Group)
Rituals Related to Death and Dying
According to focus group participants, there are specific rituals that are conducted during the funeral, prior to burial, and post-burial. However, all cautioned that there is a wide variation in the extent to which these rituals are practiced. Some continue to adhere to very traditional practices, while some perform some, and others not all. Level of acculturation, religion orientation, and place of birth impact the degree to which these traditional rituals are performed.
Table 3 provides a summary of the key findings about Chinese Americans' and immigrants' rituals and practices regarding death and bereavement and the meanings associated with the practices.
Focus group participants reported that Chinese funerals and pre-burial and post-burial practices consist of elements of Buddhist, Taoist, and Chinese superstition and folklore. Most Chinese funerals consist of an open casket, and wreaths of flowers contributed by family members and friends adorn the funeral hall. These wreaths consist of ribbons with short writings commemorating the deceased and the names of the contributors. The more wreaths present, the more prestige and status are associated with the deceased and the family. In addition, the wreaths are placed by the coffin in accordance to the relationship of the contributor and to the deceased. Therefore, the wreaths of close family members of the deceased are placed closer in proximity to the coffin than those who are more distant. During the funeral, incense burns, and close family members will burn paper money and other papers to symbolize material possessions. The burning of paper money and material possessions ensures that the deceased is taken care of in the next world. One focus group participant reported:
"We had to burn a car. We had to burn a driver. We had to burn all this money. We had to burn a house. It is like there is another world down there ... The more we burned, the more rich my grandmother would be there." (EL from Pastors Focus Group)
Meanwhile family members are required to wear specific mourning apparel. Close male family members wear a black band on their sleeves, and female family members wear a colored flower made of yard in their hair. Daughters and wives of the deceased wear white, which symbolizes death. More distant family members will wear blue or green flowers. During the funeral, family and friends will pay respects to the deceased and comfort the close family members. When the guests finish paying respects, they are given a small gift--a piece of candy and a coin wrapped in white paper. The coin is to be spent on something sweet, and that the candy be eaten immediately in order to cast away any bad luck.
Prior to closing the casket, layers of blanket or cloth are placed upon the deceased to ensure that the deceased will be adequately warm when he/she arrives in the next world. The funeral procession is also elaborate. The coffin is placed in the first limousine, along with the wreaths. The procession usually circles around the neighborhood of the mortuary and then proceeds to the gravesite. Prior to arriving at the cemetery, the procession will travel to the deceased home. The driver of the hearse will pass around the home and proceed to the front door and unlock the door. The Chinese perform this ritual for two reasons: First, if any evil spirits have remained in the home of the deceased, it offers them an opportunity to leave. Second, it is important for the spirit of the deceased to know how to find his/her way back home. After the burial, there is a large dinner banquet. Often, it is held in a Chinese restaurant, and many Chinese restaurants offer a "funeral dinner menu," which is vegetarian. Many Chinese families will continue to commemorate the deceased by placing a plaque or picture of the deceased in a family member's home (i.e., a spouse or the first son), with incense burning. On the anniversary of the deceased--"Ching Ming Festival"--family members visit the deceased at the cemetery. The gravesite is cleaned, and food is placed there. Some families will burn incense and paper money. This ritual serves as a remembrance for the deceased and a way for family members to ensure that the deceased does not go hungry and is well cared for. If not performed, they are concerned that the hungry spirits will bring misfortune and bad luck to the family. One Chinese pastor stated:
"It has to do with remembering. If you saw a grave that was not cared for, you think no one in the family even cared enough to come and clean the grave ... But there is also the spiritual aspect of it. If you don t do it or do it properly, you are going to get bad luck because somebody is going to be angry." (LH, Pastors Focus Group)
These death practices and rituals are performed for a host of reasons. Some tap into traditional Chinese cultural value systems that are embedded not only in death practices but daily behavior. Saving face and filial piety, for example, are longstanding cultural values that the Chinese adhere. However, some of these reasons also provide a glimpse into views about the relationship between the dead and the living. Many of these rituals are performed because the Chinese fear evil spirits and desire to abate them. They believe that their ancestors bring good fortunate or bad luck if these codes of conduct are not adhered. Finally, participants in one focus group noted that these death rituals and practices are not merely religious activities, but they serve to maintain Chinese identity. It is a mechanism to preserve the Chinese culture their new homelands. Table 4 displays a summary of the reasons as to why many Chinese perform these death rituals.
Beliefs About Organ Donations
In general, participants unanimously agreed that the Chinese do not adhere to the practice of donating organs. The Chinese believe that the body should remain whole and dissect parts of the body would compromise the integrity of it.
"The concept of wholeness--you should leave the world whole. Otherwise, you are missing parts. They serve fish with the head. So if you leave the world, you need to be whole, too. It is also the assumption that you do not donate your organs (IC, Service Provider Group). "The Chinese are against organ donation. Actually, Asians are very cautious with the body. It is very important that the body is whole (MV, MSW Student Group).
Implications for Interventions
One of the predominant themes that surfaced in all the groups was that the notion that talking about or ventilating your grief is not common to the Chinese. Service providers cannot assume that a bereaved family not seeking outside help is pathological. This stems from Asian cultural values that emphasize that family problems or issues are private and not shared with outsiders. As a result, support or bereavement groups for Chinese are not common-place.
"The first step is not to fix it. You let the family or person grieve. And if they seek help, that's when you (the service provider) comes in. It is culturally inhibitive to talk about death or grief. They may never talk about it (IC, Service Provider Group). "In Western society, you put your emotions out ... In Chinese culture, the grieving process involves more of showing the respect for the deceased. Except for the immediate family, people do not expect to see a lot of emotion (ST, MSW Student Group).
Because openly discussing grief is not typical in Chinese culture, several participants hypothesized that the rituals serve as mechanisms for grieving and coping.
Finally; because of the tremendous diversity within the Chinese American community, it is important for service providers to. acknowledge that there is no one formula in developing bereavement interventions. In addition to the diversity, there is a mixture of belief systems, ranging from Christianity, superstitions, and local folklore.
"It is important to have background knowledge whether they come from Confucist or Buddhist traditions or if are they Chinese Americans. (FC, MSW Student Group). "In NY, there are so many different Chinese from different regions. Some come from mainland China, and they experienced Communism for many years. Some come from Taiwan There is no standard formula" (YS, Pastor Group). "I think with Christianity there are mixture. Some will follow the chinese tradition of mourning. They might still do the incense burning with money. In think there is a sort of mix, a combination of what they do, depending on religion and what the families believe in (IC, Service Provider Group). "It differs from region to region. In China, it is a big country with different parts, and different rituals. What we are talking about is the common themes. (DS, Service Provider Group).
DISCUSSION
King (1991) noted that Chinese society is founded on principles of "face" and "human obligation, and that these are sociocultural concepts, which lend to the understanding of Chinese social structure. Sociocultural concepts are the key building blocks or templates to daily social behaviors. In essence, they influence the management of everyday life (King, 1991; Schutz & Luckmann, 1973). King (1991) asserts that despite modernization and Western influences in China, Taiwan, and Hong Kong, these sociocultural concepts remain as templates to Chinese social behavior and societal structure.
Borrowing from this concept, we argue that many of Chinese death rituals and practices highlighted in this article are grounded in Asian cultural values and belief systems or sociocultural concepts. The cultural value emphasizing the centrality of the family system and the importance of filial piety, for example, is demonstrated in many death practices. The ritual of burning incense, paper money and material, the remembrance of the deceased during Ching Ming Festival, and the placing of plaques or pictures of the deceased in a family member's home are not merely acts of commemorating the deceased. Rather, they are mechanisms whereby the children of the deceased, particularly, the eldest son, can continue to provide material, psychological, and emotional support to the deceased parent. These "commemorating" practices aid in family, integration, which model. to the future generations about concepts of ethnical behavior, respect, and family responsibility and human obligation.
The specific codes regarding funeral apparel and the positioning of wreaths contributed by family members and friends also highlight the Chinese cultural value promoting the adherence to authority and a hierarchical structure. This was also espoused by Confucius who believed the proper behavior would naturally flow from this structure. Such mourning apparel serves to distinguish family members and their place in the social structure and the social proximity to the deceased. The location of the wreaths also serves as an emblem of the contributor's relative place in the structure.
The social structure of Chinese society also focuses on the paternal lineage. Having a male heir is vital in Chinese culture because of the role of ancestor worship (Wong, 1995). It is believed that immortality can be achieved if the family lineage is perpetuated, and this can only be accomplished if a son, who not only bears the family name, but performs the rites at the ancestral grave (Wong, 1995). The oldest son is responsible for fulfilling the rites performed during the Ching Ming Festival and keeping the plaque and incense burning in his home.
It is impossible not to take into account religious tenets because death attitudes and practices are also grounded in religious tenets. We see that strains of Confucians, Taoism, Buddhism, and local folklore superstition appear to co-exist in death attitudes and practices. It is common to see the Chinese adhere to Buddhist or Taoism tenets and folklore superstitions simultaneously. According to Buddhist traditions, for example, death is not necessarily an end, for the cycle continues in the afterlife. Therefore, the burning of paper money and material possession can be viewed as a form of "social security" for the deceased in the next life. However, the Chinese also sustain this practice because they also fear hungry ghosts. Ancient folklore believes that the soul has two forces--Shen and Kwei. Shen represents the positive attributes of the deceased such as light and warmth, while Kwei represents the primitive, base nature of man as well as darkness and cold. Upon death, the forces of the soul separate and leave the body (Tanner, 1995). If funeral-rites are not properly performed, the Kwei soul reenters the body and haunts family members (Tanner, 1995). Furthermore, these death beliefs and practices are predicated upon the importance of family integration and harmony, which also reflects Taoism principles (Jung, 1998).
Hill (1992) asserts that Chinese funerals and rites do not merely serve to benefit families of the deceased. Chinese funerals rituals are "the expressions of ethnic identity in a social universe where there are choices about which cultural tradition and identity, to claim as one's own" (Hill, 1992, pp. 321). As one of the pastors in the focus groups said, they serve to maintain Chinese identity, particularly, for the Chinese in the United States, where acculturative forces have affected, many Chinese families. "By agreeing to follow rituals, for whatever reasons, descendants tacitly subscribe to the propriety of the rituals which. presume a Chinese worldview and identity (Hill, 1992, pp. 321).
PRACTICE AND RESEARCH IMPLICATIONS
Culture, religion, and social values shape the meanings attached to practices and beliefs systems. Consequently, culturally-sensitive interventions for terminally-ill patients and bereavement services are based upon service providers such as social workers' and healthcare professionals' knowledge about how to harness sociocultural concepts. When working with terminally-ill Chinese patients, service-providers need to ask themselves: To what extent does the family want to talk about or plan for the patient's death? Many traditional Chinese families believe it is bad luck to talk about death because talking about it make it more imminent or will dampen the spirit to live (McLaughlin & Braun, 1998). Service providers may need to listen to the types of euphemisms employed. If euphemisms are used, they are not necessarily indications of denial. Because talk about death is associated with bad luck, discussions about burial plots, living wills, and power of attorneys may evoke uneasiness and resistance.
The Chinese culture is collectivistic in their orientation, where family is paramount. Therefore, when working with terminally-ill patients, service providers must remember that decision-making will be group-oriented (McLaughin & Braun, 1998). Decisions about treatment and funeral arrangements will be made by the family, with the eldest son taking charge. Again, this does not mean that the patient is in denial or resistant. In addition, saving face" is a very important cultural value, and when family duties have not been adhered to, it perceived not only shameful but negative ramifications might occur since the ancestors are displeased. Therefore, the concept of obligation and guilt takes on a different nuance. Consequently, there is great importance attached to family members, fulfilling their obligations for the deceased. Family members may experience lingering guilt if they believe they have not fulfill these obligations (Lee, 1991).
Service providers should be knowledgeable about patterns of culturally accepted and prohibited responses following the death of the patient. For example, what is cultural permitted and what is not after the death of a loved on? Furthermore, service the providers need to assess the degree of acculturation of the family and the patient. Questions to consider include: To what extent does the family or patient what to adhere to more traditional ways beliefs? To what extent does the family or patient want to adopt more mainstream norms? Finally, to what extent do they want to maintain dual relationships that incorporate both the mainstream culture and their ethnic roots (Panos & Panos, 2000)? The Chinese immigrant and Chinese American population in the United States are very diverse. Education, level of acculturation, age-of-immigration, socioeconomic status, and religion contribute to this great heterogeneity. Even within a family: there will diversity due to inter, generational forces. The children may be more acculturated and Westernized than their parents, and some have been influenced by Protestant religion. Consequently, service providers will need to be knowledgeable not only to general beliefs about death and death rituals, but will also need to be attuned to intergenerational conflicts about funeral and burial arrangements.
Service providers can serve as brokers of information for the hospital staff and physicians about cultural differences in their own attitudes, beliefs, and practices about death and dying and the family's (Tanner, 1995). In addition, service providers such as social workers and nurses can act as a facilitator and mediator, assisting the family in negotiating the many collateral points of contacts (Tanner, 1995). If the patient's death is imminent, service providers can help families navigate with nurses and hospital procedures. Family members will want the opportunity to say their final good-byes, and therefore, it is not uncommon to see more than two family members at one time in the patient's room even if it goes against hospital regulations.
This research study represents a descriptive study that is far from representative to all Chinese immigrants or Chinese Americans in the United States. Ideally, focus groups would have been conducted with Chinese groups categorized by acculturation level, religious beliefs, age, socioeconomic status, and educational attainment in order to obtain a glimpse how these factors affect death attitudes and practices. However, this study offers preliminary insights, which may, assist in implementation of larger scale studies. However, one of the barriers in conducting large-scale studies on death and dying is that the subject matter is a taboo. It would be vital for researchers to collaborate with community informants and cultural experts about how to approach sampling, recruitment strategies, and interviewing. For example, to schedule an interview about death and dying during the Chinese New Year holiday would be an affront to the family. More culturally-sensitive research approaches to this topic is needed in order to obtain data, which can be used to further assist in the development of more culturally-relevant bereavement assessment guidelines and interventions.
Table 1 Traditional Chinese Cultural Values and Norms
Chinese Cultural Values Underlying Principle
and Norms
1. Collectivity versus Identity is rooted in the group collective
Individuality and the family. Precedence of values and
behaviors are placed on the group over
individual interests.
2. Emphasis on the Family Family provides the individual his/her
frame of reference, personal identify, and
emotional security.
3. Hierarchical versus Authority is centralized and leadership
Engalitarian comes from the top. The five basic
Social Structure relationships are ruler and subject, father
and son, elder and younger brother, husband
and wife, and friend and friend.
4. Specific Gender Roles Chinese women hold secondary status in
society. Wives are to be submissive and
obedient to husbands. Husbands are viewed
the primarily breadwinners and the head of
the household.
5. Saving Face Shameful or improper behavior affects not
only the individual; rather, the entire
family lineage.
6. Harmony & Conformity Harmony is crucial in influencing behavior.
of Behavior Conforming to the rules is important.
7. Emphasis on Paternal Father-son dyad is the most important
Lineage relationship. Son bears the family name,
and he also performs the burning of the
incense at the ancestral grave.
8. Importance of Filial Children are taught early on the importance
Piety of providing material, emotional, and
psychological support to their parents.
Filial piety also encompasses paying proper
respects to parents.
9. Restrained and Controlling emotions is vital for proper
Indirect behavior. Nonverbal behavior is a vital
Communication Styles component of communication.
Table 2 . Summary Description of Focus Group
Participants
Student Pastor Service Provider
Focus Group Focus Group Focus Group
# of
Participants 7 6 5
Gender 3 males, 5 males, 1 male,
Ratio 4 females 1 female 4 females
Age Range 21-24 44-74 31-50
(in years)
Range of
years
working in
Chinese
community N/A 2-34 1-25
Table 3. Chinese Americans and Immigrants Rituals and Practices Related
to Death and Bereavement
Types Rituals and Practices Meanings Associated
Funeral Practices
1. Burning of incense 1. To memorize the dead and to worship
2. Burning of paper money the ancestors
and other symbolic 2. To ensure that the deceased has
material possessions adequate material possessions and
3. Hiring of professional money in the next world.
wailers or criers 3. To show respect for the deceased
4. Specific mourning 4. White symbolizes death.
apparel (i.e, white 5. To ensure that the guests leave with
flowers in hair) a "lucky token" and to take away the
5. Giving small gifts to bad luck.
guests who attend the 6. The more wreaths around the coffin
funeral show respect for the deceased and
6. Large wreaths of flowers status of the decease's family.
with ribbons are placed
by the coffin
Pre-Burial Rituals
1. Layering of blankets on 1. To ensure that the deceased is warm
deceased body before when he/she passes the next world
closing the casket 2. To show respect for the deceased and
2. Elaborate funeral symbolizes the extent of family
procession wealth.
3. Procession passing 3. To guarantee that the spirit of the
deceased home before decease will not remain in the house
going to cemetery and to ensure that the spirit will
know how to return
Post-Burial Rituals
1. Large dinner banquet 1. To show respect to the deceased and
after the burial a way to comfort the family of the
2. Plaque or picture of deceased
the deceased in the 2. It is important to worship family's
family's home ancestors.
3. "Ching Ming" 3. To demonstrate remembrance and respect
Festival--This entails and worshiping of ancestors.
visiting and cleaning
the gravesite on the 4. To show respect and honor to the dead.
anniversary of the Some burn paper money to ensure the
deceased. deceased is cared for.
4. "Hung Sun" (Walking the
mountain) in visiting
the gravesite.
Mourning Restictions
1. Visiting friends or Will bring bad luck to others.
family members is
restricted
2. No celebrations such as
weddings
Time Period for Mourning
Maximum is 49 days N/A
Origins of Rituals
A blending of Buddhism and N/A
Taoism and Chinese
folklore and superstition
Table 4 Reasons Stated to Performing Death abd Bereavement Rituals
1. SAVINGS FACE
"Chinese really like to save their face. So the more people you have crying there, that means you have more relatives. You have more ... You are showing of to other people that we really love this person. It is really to show other people; a lot of time, it is not really coming from the heart" (LT, Service Provider Group)
"Showing other people that you have enough people that when your family member dies, that there are lots of people grieving for you that is basically a face thing ..." (MV, Student Group)
2. FILIAL PEITY
"Part of the duties of relatives was to constantly provide things to the next world." (BL, Pastors Group)
"To show them (the deceased) filial piety. This (the funeral) is the moment." (DS, service Provider Group)
3. TO INVOKE LUCK, BLESSINGS, AND FORTUNE FROM THE ANCESTORS
"Because Buddhism believe life after life. You know, a cycle. You're dead; you pass away; but then ypur spirit is still there. We believe that their spirits are still there with us ... they must be in heaven, watching over us. They will have us protected and bring us luck." (LT Service Provider Group)
"That is a practice for blessing. To bless the living and to bring good fortune out of bad fortune." (EL, Pastors Group)
4. TO APPEASE THE SPIRITS
"Thinking that the dead will see it because we believe that the spirit is still around during this period. And if you really want to show respect to the dead during this period, they will be left in peace." (LT, Service Provider Group)
"My family believes that the spirits being still alive. Each year we still pray, wr believe the person is still there and that they're a guiding spirit." (No name, Student Group)
5. TO MAINTAIN CHINESE IDENTITY
"No, it is not just religion. It is really embedded in the thingking of Chinese people." (YS, Pastors Group)
"They are more Chinese here than in China. Then there is all kind of mixture. So I thinl it has to do with the immigration history, our sense of self-identity, to preserve our culture." (EL, Pastors Group)
"All this to maintain your Chinese identity ... So some anthropologists noted that the death ritual is distinctly identity embracing." (BL, Pastors Group)
Acknowledgements: This study was supported by research funds from the Moses Fellow Postdoctoral Fellowship, Hunter College School of Social Work. Appreciation is extended to Dean Bogart Leashore at Hunter College for his support of this study.
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Alice G. Yick, PhD, MSW, is Core Faculty, School of Human Services, Capella University, Minneapolis, MN. Rashmi Gupta, PhD, LMSW, is a member of the India Association of North Texas. Correspondence should be sent to Dr. Alice Yick, 970 Norham Place, Glendale, CA 91206 (818) 790-3501; e-mail: ayick@videosymphony.com
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