The Languages of Grief and Loss:

Bereavement from a Cultural Perspective

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29 July 2020Youth Health Forum

(02) 9646 6700 www.startts.org.au

Always Was, Always Will Be, Aboriginal Land

We acknowledge the traditional custodians of this land over which sovereignty was never ceded. We acknowledge their elders, past, present and emerging.

We acknowledge the ongoing trauma of colonisation and dispossession.We support social justice for Aboriginal and Torres Strait Islander peoples.

Artist: Harold Thomas, 1971 Artist: Bernard Namok, 1992

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STARTTSNSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors

STARTTS is a specialist, non-profit organisation that for over 30 years has provided psychological treatment and support, and community interventions, to help individuals and communities heal the scars of torture and refugee trauma and rebuild their lives in Australia.

STARTTS also fosters a positive recovery environment through the provision of training to other services, advocacy and policy work.

Healing Refugee Trauma. Rebuilding Lives.

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STARTTS

• Primarily funded by federal and state health departments.

• NSW wide service – 10 offices and many outreach locations including schools.

• Part of a network called FASSTT (Forum of Services for Survivors of Torture and Trauma) with one service in every state and territory of Australia.

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Newcastle

WollongongWagga Wagga

Sydney offices:Carramar (Head office)AuburnBlacktownFairfieldLiverpool

“Since 1988 STARTTS has assisted 70,975 people from 169 countries heal the scars of torture and refugee trauma.”STARTTS, July 2019

Loss is an inevitable part of life. Death is an inevitable part of life.

Loss, grief, death and bereavement are often experiences that young people from refugee backgrounds have had to navigate.

Working in the multicultural context of broader Australian society, it is essential that we have some understanding of the various cultural responses to death and loss.

This understanding, in turn, should help us work effectively with young people from CALD and/or refugee backgrounds, given many have experienced multiple losses and grief.

Bereavement: An important topic

What is culture?

• It informs our identity and meaning making.

• It informs our responses and behaviours towards others.

• It is a mechanism for social cohesion.

• Rituals are often used to mark important events and milestones.

• In some contexts, religious beliefs significantly shape the culture.

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Culture is defined as the shared customs, beliefs, values, behaviours, art, way of life, and social

organisation of a particular group, passed down from one generation to the next.

Refugee and CALDYoung People

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• Often connected to two or more cultures: they may maintain psychological and/or emotional connection to their home country in addition to the culture they are living in.

• The refugee/CALD experience can be marked by a lack of stability and constancy.

• This can result in feelings of rootlessness, alienation, an inability make commitments and a constant state of liminality.

• Often has characteristics of disenfranchised grief.

• Existential losses are experienced: “Who am I?”, “Where am I from?”, “Who and what can I trust?”

• Bereavement can see the onset of changes in mood, sleep and appetite, concentration and productivity.

• There can be feelings of guilt that arise during the mourning process.

• There is no set time for this period. It can take months or years for the bereaved young person to process their grief. It may be revisited at a later stage of their development.

• This process can be further complicated by distance, separation and isolation for young people from refugee and CALD backgrounds.

Bereavement

Bereavement is the period of grieving following the death of someone significant. Mourning is the process

of adapting to a loss.

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Grief

Grief centres around the process of making sense of a loss, irrespective of age or developmental level of the individual.

Different societies have their own systems for responding to death, often accompanied by a complex web of beliefs and customs which on the surface may appear to be diverse, however there are common themes that run across all groups.

The behaviours that mark or indicate the presence of grief are often determined by culture, with clear expectations around how to grieve.

Young people living in a cultural context different to their culture of origin, or young people connected to multiple cultures may develop a set of a rituals that are unique to their situation.

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Death and theAfterlife

Many cultures have a belief system about what happens to the soul, spirit or essence of a person once their physical self has died.

The beliefs are often influenced by religion.

Some belief systems subscribe to the idea of a continued existence in the spiritual realm.

Others believe in the concept of reincarnation.

Many cultures share in the belief that there is a destination for the departed, albeit by different names, e.g. Heaven, Jannah, Tian, Nirvana, etc.

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Idioms of distress

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• Idioms of distress are “alternative” modes of expressing distress, where the reference point is what is accepted in mainstream Western culture.

• They are culturally defined, and often understood from religious and moral perspectives.

• Cultural concepts of distress are defined in the DSM-5 as “ways cultural groups experience, understand, and communicate suffering”.

• What is an acceptable expression of distress in one group may not be acceptable in another.

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Rituals

• All societies have their own customs and beliefs surrounding death, including how to express grief and how to mourn.

• Grief responses within a culture can vary from person to person within a culture.

• Rituals provide a sense of routine and normalcy. Carrying out rituals and customs associated with loss can offer a sense of security and stability.

• There is no universal way to grieve – the rituals and traditions of one cultural group may seem odd to another.

• There is much variation in the way that funerals and burials are organised.

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Practices and rituals vary across all religions and cultures

Grief and loss beyond death

The types of losses experienced by young people from refugee/CALD backgrounds can extend beyond the death of a loved one, and include:

• Loss of significant relationships

• Disappearance of loved ones

• Separation from loved ones

• Loss of identity

• Loss of freedom

• Loss of culture and customary way of life – “cultural bereavement”

• Los of status and material wealth

• Loss of connection to place and homeland

• Loss of health and vitality, in self and/or a loved one

“Cultural bereavement is a more severe form of grief related to the loss of social structures,

cultural values and self-identity which negatively impacts on a person’s cultural

transition and daily functioning in their new country. The person retains a non-adaptive ‘place

attachment’ to their home country and fails to develop a healthy ‘place attachment’ to their new

country”

Maurice Eisenbruch, 1991

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Traumatic Grief

Traumatic grief is the grief resulting from the loss of a loved one in a traumatic situation. For example, a natural disaster, act of war, terrorism or mass murder, etc.

It is often a loss sustained as a result of a sudden, traumatic event.

Traumatic loss is likely to activate the attachment system as this can be a way for young people to cope with the adversity they are facing, and to regain their sense of security.

Transnational loss

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Transnational young people and their families have to deal with various life-cycle changes and transitions across borders and large geographic distances.

The physical absence can be a source of sadness, anxiety, and guilt for members of transnational families in both countries as they learn to live with a lifelong experience of ambiguous loss — loss that is unclear, incomplete, or partial.

Advancements in technology allow for more frequent communication in families separated by long distances, however they do not replace in-person interactions.

The physical absence of family members can result in feelings of chronic loss, often contributed to by a tradition of censorship.

Working with cultural sensitivity

Culturally sensitive practice include actions which recognise and respect the cultural identities of others, and safely meets their needs, expectations and rights.

This can be achieved by:

• Awareness

• Knowledge

• Attitudes

• Skills

An essential ingredient of culturally sensitive practice is reflective practice.

Image source: STARTTS Client Diary (Eleanor Jenkins)

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Challenges of working with grief and loss

It’s important to acknowledge that as clinicians our own loss and grief experiences may be activated when working with bereaved young people.

Feeling emotionally moved is a normal response to a distressing situation, and can help us feel empathy for the young people we are working with, but there may be a danger that it prevents us from being effective in our work.

Working cross-culturally also requires us to remain aware of our own culture and that of the young person and their family.

Presented on behalf of STARTTS by

Julie-Anne YounisSenior Child and Adolescent Counsellor/ Trainer (02) 9646 6700

www.startts.org.au

stts-training@health.nsw.gov.au

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ReferencesDesai, G., & Chaturvedi, S. K. (2017). Idioms of Distress. Journal of neurosciences in rural practice, 8(Suppl 1), S94–S97. https://doi.org/10.4103/jnrp.jnrp_235_17.

Gilbert, K. (2008). Loss and Grief between and among Cultures: The Experience of Third Culture Kids. Illness, Crisis, & Loss. 16. 93-109. 10.2190/IL.16.2.a.

IES (2020). The Cultural Atlas. Retrieved from: https://culturalatlas.sbs.com.au/.

Kemp, A. R. (2019). Death, Dying, and Bereavement in a Changing World. New York: Routledge, https://doi.org/10.4324/9780203732465.

Nesteruk, O. (2018). Immigrants Coping with Transnational Deaths and Bereavement: The Influence of Migratory Loss and Anticipatory Grief. Family Process, 57(4), 1012-1028. https://doi.org/10.1111/famp.12336.

Parkes, C. M., Laungani, P., & Young, B. (1997). Death and bereavement across cultures. London: Routledge.

Ribbens McCarthy, J., & Jessop, J. (2005). Young people, bereavement and loss : disruptive transitions? National Childrens' Bureau.

Thompson, N., Cox, G., & Stevenson, R.G. (2017) Handbook of Traumatic Loss: A Guide to Theory and Practice. New York: Routledge.