Culture as an Influencing Factor

in Adolescent Grief and Bereavement

By Sandra A. Lopez, L.C.S.W., A.C.S.W., D.C.S.W.
Culture is a complex but vital consideration in the process of helping
people overcome difficulties. In clinical practice, emphasis has often
been placed on understanding that, for assessment or treatment
to be effective, we must view individuals within the context of
their culture. Overlooking or negating the importance of culture
may increase the likelihood a practitioner commits errors by basing
decisions on faulty cultural assumptions or unintentionally
offending clients through disregard or insensitivity to their
cherished values, beliefs, and practices.
Adolescents often need help in overcoming difficulties related to
experiences of loss such as the break-up of a relationship; separation
from a parent because of divorce; death of a parent, sibling,
or friend; atid many other challenging life circumstances. As
integrating an understanding of culture is crucial in helping
people, it can be a key influencing factor to understanding the
experience of adolescent grief and bereavement. This article will
first provide a brief review ofthe literature regarding the influence
of culture on grief, specifically adolescent grief. Second, a framework
for understanding culture and its components will be introduced.
From this framework we will examine the stage of adolescence
as a unique cultural context. Finally, using a case illustration,
practical guidelines for honoring cultural differences for grieving
adolescents will be explored. Since there is little research which
specifically addresses the connection between culture and adolescent
bereavement, 1 will draw on my work in grief therapy with
adolescents and families to provide practical guidelines.
CULTURE AND GRIEF
Culture has notably been recognized as a key factor in understanding
an individual's experience of loss, mourning, bereavement, and
the process of grief (Parkes, Laungani, & Young, 1997; Rosenblatt,
1993). In reviewing patterns of mourning for various cultural
groups, McGoldrick and colleagues (2004) emphasize that "every
culture throughout history has had its own ways of mourning"
(p. 119). Established traditions of mourning may vary for such
practices as decisions about btirial or cremation, funeral or memorial
services, acceptable lengths of time for grieving, expressions of
grief and emotional responses of grievers, use of customs and
rituals, and help-seeking behaviors. Recognizing that there can
be different patterns of mourning presents unique challenges
to cotnpassionate helpers in understanding what is normal and
acceptable behavior for a grieving individual. To add to this
challenge, in the United States, through immigration and exposure
to diverse cultural groups, patterns of mourning and accepted
practices for grieving have changed over time and will likely
continue to change.
Recent changes in demographics in the United States have contributed
to greater attention to cultural diversity in the grief literature. In
addressing bereavement among the two largest racial/ethnic groups
in the United States, Latino Americans and African Americans,
Schoulte (2011) emphasizes familiarity with key cultural constructs
as a way of understanding how individuals and families mourn.
Awareness of salient beliefs and behaviors such as family loyalty
(familismo), spirituality, and open expression of grief and emotions
can promote understanding of differences in grief and convey
appreciation of diverse practices.
Examples of how culture can impact grieving behaviors and beliefs
are evident in Vazquez and Rosa's recent book Grief Therapy with
Latinos (2011). In this book, Vazquez and Rosa use their long time
experience as therapists to convey the importance of identifying
and exploring key cultural values that play a critical role in
understanding and communicating with grieving Latinos. Their
focus is on building a greater understanding of cultural values
which impact the grief experience of Latinos who live in the United
States. They explore culturally inherited beliefs that may impact
the grieving experience for Latinos in positive and negative ways
such as traditionalism, marianismo (manifested in women suffering
in silence and participating in self-sacrificing behavior), machismo
(male role), cultural pride, personalismo (relational and personal
experiences), family, fatalism (a belief that everything is in God's
hands), and simpatia (a belief in conformity and showing dignity
and respect).
CULTURE AND ADOLESCENT GRIEF
While there has been general acknowledgement that culture
is an important factor in understanding grief, mourning, and
bereavement, it is significant to note that there has been very little
attention to how culture specifically impacts the experience of
grief for adolescents. Nonetheless, some authors have addressed
the subject. Corr and Balk (1996) offer a limited treatment of culture
and adolescent grief in their discussion of adolescent experiences
of death and bereavement, emphasizing that it is important to
understand adolescents as being uniquely different from others
based on their community affiliations, which may be social, cultural,
religious, and/or economic. In an exatnination of grief and loss
across the lifespan, Walter and McCoyd (2009) highlight the
importance of what they call cultural understandings and note
Culture has notably been recognized as a key factor
in understanding an individual's experience of loss,
mourning, bereavement, and the process of grief.
10 September 2011 Volume 18(3) -'^ The Prevention Researcher
www.TPRonline.org
that grief is also socially defined by one's cultural context. Several
valuable tips on how to relate to bereaved children and adolescents
from diverse cultural backgrounds were offered by Rabbi Earl
Grollman (1995) in Bereaved Children and Teens: A Support Guide
for Parents and Professionals. Grollman strongly suggests:
Recognition of divergent experiences related to death;
Use of bilingual interpreters when necessary to avoid
miscommunication;
Asking questions and listening rather than making conclusions;
Awareness of diversity within diversity;
With recent immigrants, validate other losses in their
experience such as loss of their homeland, possessions,
traditions, and family;
Sensitivity to cultural differences related to values, beliefs,
expressions, and rituals.
CONCEPTUALIZING CULTURE
In the absence of any specific guidelines for understanding how
culture influences adolescents as they face and cope with a loss, it
is imperative that we briefly connect with a framework for defining
culture. Green (1998) defines culture as a way of life of a society,
consisting of prescribed ways of behaving or norms of conduct,
beliefs, values, and skills. It is the sum total of life patterns passed
from generation to generation. Green views culture as having four
distinct components: collective cultural influences, cultural choices,
cultural arts, and cultural coping systems. Collective cultural
influences are ways of relating within the cultural group: use ot
time, language, beliefs, group experience, group identity, and
way of life. Cultural choices are food, dress, accepted norms and
values, lifestyle, religion, and education. Cultural arts refer to
music, dancing, architecture, and other forms of expression that
may be unique to a particular culture. Cultural coping systems are
unique practices around child rearing, health care practices,
structuring families, networking, specific ways of identifying
problems as well as solving problems, and use of available
resources.
There is limited research to specifically
address the influence of culture as it
relates to adolescence and the experience
of loss and grief.
In considering this definition as well as its components, it is
apparent that culture goes beyond race and ethnicity, and can
include other aspects such as religiosity, spirituality, professional
or occupational status, socioeconomic status, geographic locale,
educational status, gender and sexual orientation, political
identification, developmental stage of life, and a range of other
possibilities. In conceptualizing culture in this manner, it allows
us to see that individuals are best characterized as being composed
of many layers of cultural attachments. Depending on where one
is in his or her life circumstances and what one is experiencing,
an individual may identify more strongly witb one culture than
the others. Thus, as practitioners, it may be challenging to determine
which culture is most valued by an individual at any specific
point in time.
THE CULTURE OF ADOLESCENCE
If we take this broader view of culture to include those aspects or
characteristics that are beyond race and ethnicity, we can see that
adolescence as a stage of development is reflective of a cultural
group. Drawing from the earlier discussed components, we can
identify unique characteristics ofthe adolescent culture. For
example, adolescents typically have a common language and
communication that by design tends to confuse and challenge adults
in their understanding. There are accepted styles of dress, distinct
styles of music and dance, and forms of expression. There are
accepted ways of relating to one another as adolescents and accepted
ways of behaving, identifying problems, and seeking support.
There is growing support and acknowledgement for the perspective
that adolescence is more than a stage of development and that in
fact, it represents a unique culture with common values, challenges,
and characteristics. In an article on the culture of adolescence.
Nelson and Nelson (2010) provide a unique conceptualization of
adolescence as a cultural context with three major features. They
first note the importance of technology for adolescents to facilitate
their social interactions, such as the increased use of text messaging,
Facebook, and the internet by adolescents. A second core feature
is what they refer to as centrality of peers, which includes how
adolescents can be influenced by close friends, cliques, and larger
peer systems all at the same time. Lastly, Nelson and Nelson note
the universal challenge adolescents face in searching for their own
identity and in individuating from parents. The authors conclude
these three features are key when treating adolescents and can
be used to design effective interventions that are more culturally
appropriate to adolescents. Similarly, others have noted that
although adolescents are influenced by other key groups including
family, school, community, work, religious settings, and the media,
they still remain heavily dominated by their peer group (Noppe
& Noppe, 2004). Because adolescents are so intimately connected
witb their developmental issues, it is critical that we view this
stage of life as a key factor in understanding their grief experiences.
IMPLICATIONS
Thus far, we have considered tbree essential elements in our
exploration of culture and adolescent grief. First, it is generally
understood that racial and ethnic cultural background is definitely
an integral ingredient in our search for understanding of how
individuals are impacted by a loss, how they may grieve, and bow
they may work towards grief resolution. Second, the stage of
adolescence can be viewed as a cultural context as there are common
values, challenges, and characteristics related to this period of life.
Third, we can conclude that if culture is important for understanding
one's experience of grief, then this should notably apply to any
age group, including adolescents. The aim is to integrate tbese
elements into a practical approach that we can then apply to our
understanding of adolescents who are experiencing a significant
loss in life. Perhaps through tbe following case illustration of
"Michael," we can identify key questions to guide our culturally-
informed practice with youth.
The Case of Michael
Micbael Sanchez is a 16-year-old Mexican American male, an
honors student, and in the 11th grade at Foster High School. His
parents were born in Monterrey, Mexico and came to the United
States when they were young adults. His father, Julio, works as a
mechanic and owns an auto repair shop. His mother, Juanita,
worked as a teacher in an elementary school but left her employment
five years ago so she could take care of her elderly parents. Micbael
is the oldest of five siblings. His maternal grandparents, both age
80, are Spanish speaking only and have lived with the Sanchez
family for five years. A few weeks ago, Michael's grandfather had
a fatal beart attack as they were walking to the Catholic Churcb
for Sunday mass. Paramedics were called but were unable to save
his grandfather. Since bis grandfather's death, Michael has had a
really tough time. He misses his grandfather as they were very close.
He struggles witb feelings that he should have done something to
save his grandfather.
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Culture as an Influencing Factor in Adolescent Grief and Bereavement, continued
As the oldest child, Michael feels some responsibility to be
protective of his grandmother, parents, and siblings so he tends
to keep his feelings about his grandfather to himself. He does
share his feelings with his girlfriend Maggie, who is very supportive.
She often sends him text messages to check on how he is doing
and he appreciates her concern. His friends on the football team
attended the funeral services and try their best to keep Michael
busy to show their support. They drop by his house often and
invite him to hang out or play video games. His friends on Facebook
have made supportive comments and periodically check on him
too. Although Michael had been quite active in the church youth
group, he refuses to go back to mass as he is angry with God for
letting his grandfather die.
Michael's grandmother has expressed growing frustration with
Michael as she believes during this time of grief he should spend
more time with his family as opposed to his friends and girlfriend.
She has asked him repeatedly to honor their customs by wearing
black and she can't understand why he has stopped going to church.
His grandmother's disappointment in Michael has created some
tension for the entire family. Michael's parents want to be .sensitive
to the needs of their son as well as respectful of Grandmother
and her customs.
At school, Michael is beginning to have problems because he
can't concentrate. His grades are falling in his chemistry class
and his favorite teacher, Mrs. Shell, who knows about his loss.
Table 2.1
Practical Guidelines for Honoring Cultural Diversity
with Grieving Adolescents
1. Identify your culture/race/ethnicity and explore how
culture influences your life.
2. Examine your experiences with loss and explore how
culture has influenced your grief reactions, responses,
and behaviors.
3. Explore your personal and professional experiences
and exposure to diverse cultural groups.
4. Identify and examine your biases related to
diverse cultures.
5. Identify and examine your biases related to diverse
grief reactions and behaviors.
6. Acknowledge adolescence as a culture in and of itself
7. Be aware that an adolescent can have many cultural
affiliations including adolescence.
8. Recognize diversity within diversity.
9. Allow the adolescent to self-identify their cultural
group(s) as opposed to identifying it for them.
10. Once you have a good grasp of the adolescent's cultural
affiliations, develop an awareness of their cultural
beliefs, values, and practices related to the experience
of grief.
11. Acknowledge and value the uniqueness of the
adolescent's culture.
12. Develop culturally competent strategies and
interventions for working with the adolescent from
the context of their culture.
13. Celebrate diversity by exploring specific strategies for
developing a culturally competent approach with your
adolescent clients.
suggested he talk with the school counselor. His football coach
has remarked that Michael is not playing with his usual enthusiasm
and suggests he use the game to work through his grief.
As his grandfather's birthday nears, Michael is having an even
tougher time in keeping things together. He posted a message on
Facebook: "Tomorrow is my grandfather's birthday and we had
planned to have a big party for him. I really miss him." His Facebook
friends reached out to him. A friend from the church youth group
suggested Michael talk with Father Bob as he is easy to talk to
about stuff like that. A good friend of Maggie's suggested the
high school grief support group which helped her when she was
dealing with the loss of her grandfather. That night when Michael's
head hit the pillow, he thought carefully about all the valuable
suggestions that had been shared with him, and he wondered
what he should do.
Cultural Considerations and Practical Guidelines
for Honoring Cultural Diversity
Michael's case is a common scenario depicting an adolescent faced
with the significant loss of his grandfather and struggling to cope
with the myriad of thoughts and feelings that are characteristic
ot the journey of grief. He has now reached a place in his grief
and mourning that possibly requires a decision to openly share
his emotions, ask for help, and seek support.
If Michael decides to follow through in contacting Father Bob,
the school counselor, or the grief support group, the critical
challenge then becomes identifying how best to support this
young man through his experience of loss and grief and to
simultaneously honor his cultural values, beliefs, and practices.
In working with adolescents who have faced similar losses, I strive
to make the critical connection between the stage of adolescence,
the experience of grief, and the influence of culture, as these are
the essential components in appreciating and acknowledging the
unique aspects of these youth. Based on my clinical experience
with a broad range of adolescent clients who have experienced
a variety of losses, I have developed Table 2.1 and 2.2 as a means
of providing practical guidelines which help to direct my work
with these clients. Table 2.1 provides practical guidelines for
honoring cultural diversity with grieving adolescents and reflects
a step by-step approach guiding practitioners in a culturally
competent manner. Table 2.2 includes ten key areas which are
culturally influenced and critically important to explore with
individuals who have experienced a significant loss in their lives.
Exploration of these cultural considerations creates a greater
understanding of many vital aspects of one's grief journey from
the point of loss, through their continued adaptation and struggle
with the loss, to the practices and rituals which promote healing
and comfort.
Table 2.2
Major Cultural Considerations Related
to Adolescent Grief and Loss
Perception of loss, death, and dying
Perception of grief and mourning
Beliefs and accepted practices
Expression of grief
Perception of helpers and resources
Use of helping resources and natural support systems
Engagement and rapport
Communication patterns
Common rituals for mourning
Role of family, patterns of kinship, family involvement
12 September 2011 Volume 18(3) -".^ The Prevention Researcher www.TPRonline.org
Assuming that Michael is our identified client and we are the
provider he has reached out to for help, we can begin by drawing
from some ofthe guidelines suggested in Table 2.1. As a crucial
first step with any adolescent, it is important for providers to
take a look at their own world prior to working with a client in
his or her world. Personal reflection to identify your cultural
background and understanding how culture has influenced your
life will prepare you for viewing the adolescent and his or her
issues with a "clearer" lens. When we .skip this crucial first step,
we are likely to deny the importance of culture and to practice
from a mindset of cultural ignorance or cultural blindness.
Given that we are working with an adolescent who has recently
experienced a significant loss that has impacted his life, we want
to examine our experiences with loss and to explore how culture
has influenced our grief reactions, responses, and behaviors. For
example, using my own cultural background as a Mexican American,
I see the strong connection in how culture has influenced my
experiences of loss and grief, and note also that there may be
some real connection for me witb Michael given our similar
ethnic cultural backgrounds. However, as is noted in Table 2,1,
there is diversity within diversity, so I cannot assume that my
experiences are exactly the same for Michael. For example, as a
child attending funeral services in the Mexican culture, I learned
that funerals were times to be open, public, and expressive with
emotions and tears. These experiences impacted me as an adult
in that now when I attend a funeral service I expect open expressions
of grief, lithe experience is counter to that, for me it feels like
something is missing. This is an example of how our own
experiences of grief tben become our lens for understanding
others' experiences.
Important to the case of Michael is understanding that adolescence
is a culture in and of itself. His response and behaviors to the loss
of his grandfather convey some ofthe key information as reflected
in the works of Nelson and Nelson (2010), Michael, as an adolescent,
is actively participating in the world of technology as shown
through his girlfriend's supportive text messages. He also uses
Facebook to connect with peers from different support networks,
such as his church youth group and friends from high school.
At the same time, his connection to technology conveys the second
core feature noted by Nelson and Nelson, in that there is some sense
of centrality around Michael's peers, Michael is to some degree
influenced by his peers in that he takes their advice offered on
Facebook and begins to consider potential options for seeking
help. His peers do play a vital role in guiding and supporting
Michael through his grief process even if it is at a distance, Michael
is also an adolescent, challenged to form his identity and to
individuate from his parents and family.
As noted in the case illustration, although Michael is hurting, he
doesn't tell his family about his emotions or that he might need
help. He feels a sense of loyalty and responsibility to his family
so he plays a protective role and holds his emotions in check until
he can no longer do so. These behaviors are all about individuation
and identity formation, yet could in some ways link with his
cultural values and beliefs about what it is to be the oldest child
and oldest male in a Mexican American family.
At this point, we have learned of Michael's cultural connections
or affiliations which relate to his adolescence, his culture and
ethnicity as a Mexican American, gender issues in that he is a
young male, and his faith and/or religion in that he appears to be
a practicing Catholic, Yet we must practice cautionas we talk
with Michael we may learn there are other cultural affiliations
that we are not aware of. We have identified Michael's cultural
affiliations, without assuming or identifying those for him, which
is another guideline for honoring cultural diversity.
Now that we have some grasp of Michael's cultural background,
it is important for us to develop greater awareness of what it means
to be Catholic, Mexican American, and an adolescent male, Michael
would provide the narrative for helping us to understand the culture
that seems to be strongest for him at this point in time. Again
through his guidance, we remain open to hearing how these cultures
influence his experience of loss and grief. Through conversation
we can draw from Table 2,2 and develop an understanding of
critically important elements such as how his cultures perceive
loss, death, and grief; what beliefs and practices are common and
accepted; what expressions of grief are acceptable; and especially
as he deliberates his next steps, how his cultures feel about talking
to someone outside ofthe family about issues that are impacting
his life. These represent key issues to explore with Michael which
will enhance our understanding of his experience of loss, his cultural
beliefs and values, and appreciate his cultural context of adolescence.
CONCLUSION
Michael's case reminds us that adolescence is a significant
developmental stage of life and loss is a life experience encountered
by many culturally-diverse adolescents. There is limited research
to specifically address the influence of culture as it relates to
adolescence and the experience of loss and grief. Greater attention
should be paid to the interrelations between culture and the stage
of adolescence in shaping the adolescent's experience of loss and
subsequent grief.
This article has briefly examined culture as an influencing factor
in adolescent grief and bereavement. Through the case illustration
of Michael, we see the considerations and guidelines that must be
taken to honor cultural diversity and the lifestyle of adolescence
and especially how the two intersect. -'.-
Sandra A. Lopez, M,S.W., L.C.S.W., A.C,S,W D,C.S.W,, (slopez@
uh.edu) is Ciinicai Professor at the University of Houston Graduate
Coiiege of Sociai Worl<. As a Ciinicai Sociai Wori<er, she aiso maintains
a ciinicai practice where she speciaiizes in provi di ng grief therapy to
adoiescents and famiiies after the experience of a traumatic ioss.
Copyri ght 2011, integrated Research Services, inc.
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