Two of the attributes that all humans share are the experiences of being born and the fact
that everyone would eventually die. Although we are excited about discussions concerning
birth, people in all cultures discuss death with extreme reluctance. However, even though
we may use the same words to describe death, the actual meaning and conceptualization
of death differs widely across cultures. The tendency for vast differences to occur in
conceptions about issues or events that, on the surface, seem very obvious is a major
reason why a cultural examination and analysis of every behavioral phenomenon should
almost be mandated. For example, eating is a behavior engaged in by most humans
several times a day. Yet, cultural variations in eating are enormous. Cultures vary in what
they eat, how they eat, when they eat and with whom. Even when cultures agree on what
should be eaten, differences arise in how it is prepared, who is expected to eat the given
item, and at what stage in time and age.
Kagawa-Singer (1998) provides a very fitting analogy of cultural diversity using
weaving as an example. Although weaving is a universal technique, the patterns that result
from this process are culturally unique and identifiable. Thus, even when they use the
same materials, patterns used in Navajo, Chinese, Persian, Japanese and French
tapestries are recognizable not only in terms of colors, but also of patterns and textures.
This range of diversity applies to issues about death and dying. In this respect, then,
issues of death imitate those of life. This reading explores some of the cultural variations in
death and dying, and discusses how these differences at once derive from a given
culture’s world view as well as influences its approach to death. These are manifested in
conceptions about death, death anxiety, bereavement, and burial rituals.
Conceptions of Death
The difficulty of having a unitary view of death or the death experience can be better
appreciated when we realize that it is problematic to even define what we mean by death.
For more than a hundred years, the clinical definition, referring to the absence of heartbeat
and respiration, was the basis on which a person was deemed to be dead. However,
advances in medical technology that made it possible for vital signs to be sustained by
machines, led to the modifications in this definition to whole brain death, which refers to
death as either the “irreversible cessation of circulatory and respiratory functions, or
irreversible cessation of all functions of the entire brain, including the brain stem”
(President’s Commission for the Study of Ethical Problems in Medicine and Biomedical
and Behavioral Research, 1981, p. 4). Established alongside this definition are eight
criteria, all of which must be met before a person is declared dead: absence of
spontaneous response to any stimuli; completely unresponsive to even the most painful
stimuli; lack of spontaneous respiration for at least one hour; absence of postural activity,
swallowing, yawning, or vocalizing; no eye movements, blinking, or pupil responses; a flat
electroencephalogram (EEG) for at least 10 minutes; a total absence of motor reflexes;
and that there ought not to be any change in the above criteria if tested again after 24
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hours. This definition not only represents a largely Western conception of death, but is also
a basically medical definition of the concept.
To complicate matters, there is no complete agreement even within the medical
definition as to what exactly constitutes death, or for that matter, precisely when death is
ascertained to have occurred. Stringently applied, this whole brain death definition requires
ruling out other conditions that might appear similar to death such as a deep coma.
Moreover, some insist that the cessation of brain activity must occur both in the cortex and
in the brainstem. The cortex processes higher level functions such as consciousness, the
kind of things that make us uniquely human. The brainstem, on the other hand, controls
vegetative functions such as respiration. When a person’s cortical functions cease (in
other words, the person is not conscious), but his or her brainstem activities such as
heartbeat and respiration continue, they are said to be in a persistent vegetative state, a
condition from which they are unlikely to recover. This condition can come about from
several causes – massive traumatic head injury, stoppage of blood flow to the brain or
even drug overdose. The person stands almost no chance of regaining consciousness but
is not declared as dead. They are technically alive, in a state that Jennet and Plum (1972)
referred to as wakefulness without awareness, but only as an artifact of modern
technology. Because this can, and has presented family members with serious ethical
challenges, some in the scientific and philosophical communities have called for the
replacement of the whole brain definition with that of cortical brain standard – the
irreversible loss of capacity for consciousness (e.g., Steen, 2007; Truog, 2004). Based on
this proposed standard, a person in a permanent coma who met the criteria for persistent
vegetative state would be declared dead. The same person would be deemed to be alive
under the whole brain dead standard.
The foregoing reflects the difficulty and controversy involved in defining death even
within the medical or Western perspective. Not surprisingly, conceptions and definitions of
death vary widely across cultures. According to Counts and Counts (1985), some South
Pacific cultures believe that life, as is generally construed, departs the body of a person in
different situations, such as when one is ill or asleep. Thus conceptualized, people can be
said to “die” several times before the final death. This also means that a person can be
defined as dead without meeting many of the criteria listed in the above definition or
definitions found in the social and medical literature.
The differences in conceptions about death extend to what exactly happens when
one is dead, however defined. Some religious and cultural traditions, such as Hinduism,
envision a circular pattern of life and death where a person is thought to die and is reborn
with a new identity. This exit and reentry into life can occur multiple times. This contrasts
with the Christian view where death is believed to occur only once. However, Christians do
not believe that everything ceases at death. The person sheds his or her bodily form but
continues on in spirit where there are consequences: the faithful – believers who kept the
faith – are rewarded with eternal joy in heaven, and sinners proceed to hell where there is
endless pain and suffering. Among some Native American tribes and certain segments of
Buddhism, the dead and the living coexist, and the dead can influence the well-being of
the living. If the dead (ancestral spirits) are properly propitiated, the likely outcome is a
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benevolent spirit that protects the interests of the living. If not accorded the appropriate
treatment, the result is an unhappy spirit that may ignore the wellbeing of the living,
leading to misery. There are, of course, some cultures in which death signals an abrupt
and permanent disengagement. In some instances, people are prohibited from even
mentioning the names of the deceased in the fear that doing so may actually endanger the
lives of the living or prevent the ghost from leaving this earth and attaining peace.
Irrespective of how death is defined, each culture has notions of how death ought to
occur. Kellahear (1990) makes a distinction between an “acceptable death” and a “good
death” for the person who is dying. An acceptable death is said to be non-dramatic,
disciplined, and with very little emotion. This is the atmosphere that seems to exist in
structured settings such as hospitals in the West where most people die. On the other
hand, a good death is said to be one that allows for social adjustments and personal
preparation by the dying person and his or her family. This is a time when the dying person
attempts to complete unfinished tasks, to say farewells, and for the family to begin to
prepare for life without the dying. Among the Kwahu-Tafo of Ghana, a good death is one in
which the dying person has accomplished most of what he or she set out to do and has
made peace with others before dying (van der Geest, 2004). In Nigeria, death of one that
has lived a long, and for the most part a successful, life can often be inferred from the
nature of the captions in their obituaries. In such cases, the preambles go along the lines
of “with gratitude to God for a life well spent....” captions that would never be seen for one
that has died an early death or death that has occurred under very tragic circumstances.
Yet in other societies, a good death may be one in which a person dies in service of his
country or religion; in other words, the person is regarded as a martyr (Rosenblatt, 2008).
It is important to examine these cultural variations in conceptions of death and dying
because they have significant implications on how people act in life, how they approach
death, whether or not they fear death, and on their funeral and bereavement practices. An
obvious implication of how notions about death and dying influence actions is the
phenomenon of suicide bombings. This is a fairly recent phenomenon, believed to have
started in the early 1980’s by Lebanon’s Shi’ite extremist Muslim group Hezbollah, which
was influenced by the way Iran used humans as minesweepers in their war against Iraq.
By 1994, two Palestinian groups, Hamas and Islamic Jihad took up the practice. Initially,
only a few people joined the suicide squads, and even then, with little enthusiasm. They
had to be subjected to several months of training in what appeared to be extreme
indoctrination. Today, people willingly compete for the privilege of being selected into the
suicide squads. The major change from the initial reluctance and the current enthusiasm
seems to be the modification in their conception of death and what awaits them after
death.
According to some Islamic teachings, the great Prophet Mohamed stated that the
sins of a shahid or martyr (as the suicide bombers are called by their compatriots) will be
forgiven when he sheds his first drop of blood. In addition, he can admit 70 relatives to
paradise and will personally be married to 72 beautiful virgins upon his arrival in paradise
(Van Biema, 2001). Although this approach to death is said to be associated with the
Islamic faith, this represents a clear case of how religion interacts with other aspects of
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culture. It also represents the manner in which extended interactions between cultures and
groups, especially in the age of information technology, have influenced cultural and
religious practices around the world. Until just a few years ago, the practice of suicide
bombings appeared to be localized to the Middle East and was almost nonexistent among
millions of practicing Muslims in other parts of the world. However, this practice has spread
to countries such as Nigeria where the Boko Haram, an Islamic terrorist group, has used
suicide bombings to attack churches and other government or symbols reflecting Western
values (e.g., the suicide attack on the United Nations headquarters in Abuja, the capital)
primarily in northern Nigeria (Roggio, 2012). The other implications of the varying
conceptions of death and dying are discussed in greater detail in the next few sections.
Death Anxiety: The Fear of Death
One of the few outcomes that we all share is the certainty that we shall one day come
face-to-face with death. Notwithstanding this reality, most humans would rather not
contemplate the idea of reaching the ultimate end of our sojourn on earth. Thus, the most
common response to the thought of one’s death, or the death of other loved ones, is fear.
For almost 30 years researchers employing the social psychological perspective have
used terror management theory to explain death anxiety (Burke, Martens, & Faucher,
2010; Tam, 2013. Terror management theory (Solomon, Greenberg, & Psyzczynski, 1991;
2004) posits that both humans and other animals have an instinctive drive for selfpreservation. Humans, however, have evolved advanced and complex cognitive abilities
that enable them to not only be self-aware, but also to anticipate future outcomes. These
sophisticated cognitive abilities make possible the awareness of the inevitability of death –
and that it can occur at any time. Thus, the friction between the desire for self-preservation
and the awareness that death is inevitable and unpredictable can induce feelings of
anxiety and terror whenever situations arise that remind them of their mortality. From the
terror management point of view, then, much of behavior is motivated to deal with this
potential death anxiety or terror, and can influence such behavior in both positive and
negative ways. On the positive side, this viewpoint suggests that people who are afraid of
dying tend to do whatever it takes to ensure that they stay alive. Staying alive contributes
to the continuity and socialization of the species because people so driven are more likely
to want to have children and to raise them according to their society’s acceptable
standards. This is perhaps why every president of the United States tries to make an
enduring contribution that would be recorded as a legacy of his administration. However,
the same death anxiety can become a destructive force and could even result in both
physical and mental problems.
Death anxiety is a multifaceted construct that is difficult to define but has been
conceptualized to include: fear of death of oneself; fear of death of others; fear of dying of
self; and fear of the dying of others. In addition, each of these components can be
examined at the public, private, and non-conscious levels. Thus, the fears about death that
we may relay publicly may differ from what we may believe and express privately, which
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may be different from the fears that we may not even be consciously aware that we are
exhibiting. Due to the complexity of this construct, death anxiety is likely to manifest itself
in various ways. One of the most obvious ways in which we display death anxiety is
through avoidance (e.g., Kastenbaum, 1999). Avoidance may involve a public as well as a
conscious manifestation of death anxiety. Some people consciously refuse going to
funerals or visiting friends and loved ones who are dying because it makes them uneasy or
uncomfortable. Unconsciously, the person may avoid doing so because he or she is too
busy to attend to these obligations. Other people may display death anxiety by engaging in
activities that seem to confront or defy death (Kalish, 1984); they may repeatedly engage
in risky activities such as skydiving, and rock climbing, or may become soldiers of fortune.
Other people could express death anxiety through changes in lifestyles, use of humor, or
getting involved in jobs that deal with death such as funeral parlors or retirement facilities
for the very old. They may also make changes in physical appearance. This might account
for why some people may undertake cosmetic surgery – by making themselves appear
younger, it might help reduce the anxiety that death might be approaching (Tam, 2013).
Even though there is some evidence of death anxiety in almost every society,
cultures vary widely in the magnitude to which death anxiety is expressed. Some cultures
appear to manage the idea of dying comparatively well that they are referred to as deathaffirming societies; in other cultures, the aversion to the idea of dying is so strong that they
can be classified as death-denying or death-defying cultures. The United States, and
probably most of the societies in the West, is a death-denying/defying society where even
the idiom of expression is that of resistance. People also conjure images of fighting illness,
or fighting the enemy (death) (Kalish & Reynolds, 1981). On the other hand, other
societies appear to be more accepting of death. Eastern cultural beliefs are said to largely
conceive of death as a mere transition, and that the most effective way to defeat death is
to accept it as a primary fact of life. In contrast, Western traditions incorporate materialistic
views and also equate death of body with death of self, and thus should result in higher
death anxiety. Consistent with this premise, Schumaker, Barraclough and Vagg (1988)
found higher death anxiety scores among Australian (Western cultural viewpoints)
participants than Malaysian participants that displayed Eastern cultural beliefs about
death.
Considering that death anxiety is a multifaceted concept, it stands to reason that
differences would exist between cultural groups or ethnicities on different aspects of death
anxiety. In a study using a multifaceted measure called The Multidimensional Fear of
Death Scale (MFODS; Hoelter, 1979; Neimeyer & Moore, 1994), DePaola, Griffin, Young,
and Neimeyer (2003) found significant differences between elderly African Americans and
Caucasian Americans on different dimensions rather than on more global death concerns.
Specifically, Caucasians showed higher death anxiety on the MFODS Fear of the Dying
Process subscale than their older African American counterparts. According to DePaola et
al. (2003), death anxiety about the process of dying may be higher in Caucasian American
elderly because the majority of Whites are likely to die in hospitals, nursing homes,
hospices, or other institutions (Aiken, 1994). Thus, older Caucasians may fear dying in
hospitals or nursing homes where they are very likely to be isolated from family members.