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M.Div, Psy.D, D. Min

Bereavement:
Focus on Amish Rituals


Charlotte H. Mackey MSN, EdD

Edward F. Mackey CRNA, MSN, PhD




Abstract

Grieving and Bereavement are part of living. How grieving is displayed is influenced by customs unique to each culture. Different cultures have their own views on the meaning of death, as well. Grief is a total response to the emotional experience of loss. It produces behaviors associated with overwhelming sorrow or distress (Kozier, et al., 2004). Some cultures, such as the Anabaptist societies, enjoy strong familial ties. The Anabaptist societies are composed of Amish, Mennonites, Bretheren, and Hutterites. These groups provide physical and emotional support to those suffering loss and grieving through their close-knit communal ties. Death is a part of life that all Amish know from early childhood, and Amish culture dictates that all members of the community assist family members in grieving and bereavement.

Keywords: Amish, Grief, Bereavement, Cultural Competency, Death

Learning Objectives:

  1. Discuss the cultural imperatives available in assisting grieving society members for Amish families.

  2. List three methods Amish community members use to assist grieving members in their society.

  3. Compare Amish beliefs in forgiveness to denial.




Defining Death


“When, where, and how people die has changed historically in the United States. Also attitudes toward death vary across cultures” (Santrock, 2006, p.638). Historically, determining when one dies changes with technology. “Traditional signs of death were cessation of the apical pulse, respirations, and blood pressure, also referred to as heart-lung death” (Kozier, B., Erb, G., Berman, A., & Snyder, 2004). Defining death changes with artificial life support. “In instances of artificial life support, absence of brain waves for at least 24 hours is an indication of death” (Kozier et al., 2004 p.1043). After this waiting period, death is pronounced and the life support removed (Kozier, et al., 2004). Cerebral or higher brain death occurs, when the cerebral cortex fails. The cortex holds the capacity for thinking, movement, and action, and many believe the cortex is the individual (Kozier et al., 2004).

Over time the age group that dies most frequently changes. Due to technological advancements, the definition of “old age” has changed. According to Hetzel & Smith (as cited in Kozier et al., 2004), the number of adults over 65 years of age has increased by 12% since 1990. The oldest age group, over 85 years of age, has grown by 38% since 1990. “As our population has aged and become more mobile, more adults die apart from their families” (Santrock, 2006). Dying individuals receive varying amounts of care, and caregivers may not have the education or training to provide proper end of life care (Santrock, 2006). There is a wide variety of influence on behaviors surrounding death, grieving, and bereavement issues.


Cultural Variations


“Culture influences an individual’s reaction to loss. How grief is expressed is often determined by the customs of the culture” (Kozier, et al., 2004). Many cultures value social support and interaction during times of loss, grieving, and bereavement. “In some groups, the expression of grief through wailing, crying, physical prostration, and other outward demonstrations are acceptable and encouraged” (Kozier, et al., 2004). Some cultures enjoy strong familial ties such as the Anabaptist societies. The Anabaptist societies are composed of Amish, Mennonites, Bretheren, and Hutterites. This group numbers 850,000 members (Amish & Mennonite Culture History, n.d.). These groups provide physical and emotional support to those suffering loss and grieving via their close-knit communal ties (Amish & Mennonite Culture History, n.d.)

In different cultures, death has a more daily presence. “Death crowds the streets of Calcutta in daily over-display, as it does the scrubby villages of Africa’s Sahel” (Santrock, 2006). In many areas around the globe, families have dying members right in the home. In these homes young people experience death of family members early in life. In these families, exposure to aging adults, frequent funerals, and the grieving process help to prepare people with guidelines on how to die (Santrock, 2006). “Most societies throughout history have had philosophical or religious beliefs about death, and most societies have a ritual that deals with death” (Santrock, 2006). Varying cultures have differing views on the meaning of death. Some see death as a release from the trials and tribulations of this world. Other cultures see death as a punishment for sin, or the result of God’s judgment. “Some embrace death and welcome it; others abhor and fear it. For those who welcome it, death may be seen as the fitting end to a fulfilled life” (Santrock, 2006).

Religious ideas on death vary as well. Religion is an inseparable part of a culture. Native American spiritual and religious beliefs are so ingrained that when caring for this population as a health care provider, it is necessary to understand its individuals’ specific tribal beliefs. If health care providers do not concern themselves with the particular beliefs of the Native American patient, they will not move forward with healing. Many religions see death as simply a right of passage to the hereafter. Many religions such as Hinduism, Buddhism, and many Native American religions believe in reincarnation, seeing death as an opportunity to learn and return at a higher level (Santrock, 2006). Some religions have special rituals surrounding dying and death. Catholics have the Sacrament of the Sick, given to those who are very ill or perhaps near death. “Tibetan Buddhists read the Tibetan Book of the Dead within seven days of the death to release the soul of the deceased from the Bardos or nether worlds” (Kozier et al.,2004, p.1000).


Grief and Bereavement


Grief is a total response to the emotional experience of loss. It produces behaviors associated with overwhelming sorrow or distress (Comer, 2001; Kozier, et al., 2004). “Bereavement is the subjective response experienced by surviving loved ones after the death of a person with whom they have shared a significant relationship” (Kozier, et al., 2004).

Grief as a human experience is both a natural and constructed event. On one hand, core features of our response to loss reflect our evolution as biological and social beings, rooted in the disruption of attachment bonds required for our very survival. On the other hand, we respond to bereavement on symbolic as well as biological levels, imparting significance to the symptoms of separation that we experience as well as the changes in personal and collective identity that accompany the death of a member of the family or broader community (Neimeyer, R., Prigerson, H., & Davies, 2002).

As humans we experience varying levels of loss, whether the loss is personal, social, professional, or physical. We respond to bereavement in symbolic and biological planes. Elisabeth Kubler-Ross (Santrock, 2006) identified the behavior and thinking of dying persons into five stages: denial and isolation, anger, bargaining, depression, and acceptance. Many link these stages of death and dying to the grieving process as well. In grieving we need to work through the same five stages in order to come to a successful resolution. In a study, (as cited in Neimeyer, et al. 2002), Rando found: “grief-specific responses are commonly coupled with predictable physiological symptoms, including shortness of breath, tachycardia, dry mouth, sweating, frequent urination, digestive disturbance, and choking sensations” (p. 238). Grieving is a stressful event. Many individuals do not have good coping skills and may endure a complicated bereavement. These individuals are at risk for more physical and psychological problems. “A considerable amount of evidence links the experience of bereavement to increased risk for mortality, particularly suicide” (Schum, J., Lyness, J., & King, D. 2005). It seems that for some individuals who are unable to move through the stages of grieving, a prolonged and sometimes deadly outcome awaits. “Studies have found rates of suicide among widows and widowers to be 8 to 50 times higher than the general population of approximately 10 per 100,000 per year” (Schum, et. al, 2005). Perhaps it is wiser to think of grieving as an ongoing endeavor. “Grief is a process and not an endpoint” (Clements, P., DeRanieri, J., Vigil, G., & Benasutti, K., 2004). Grieving is essential for good mental and physical health. It permits an individual to endure a loss gradually, and find the balance that needs to be in place, to enable that person to continue in life. “It is quite clear that coping with death and bereavement is often a very individual matter” (Muller, E., Thompson, C., 2003). The goal of successful resolution to grieving and bereavement is the individual’s proper perspective of the loss, and moving forward to see what is enjoyable again.'


Amish Culture and Grieving Ritual


Family and community play important roles in many cultures. “The Amish are a conservative group with approximately 80,000 members in the United States, Ontario, and South and Central America” (Santrock, 2006). According to Amish and Mennonite Culture History (n.d.), the Amish have large families (an average of seven children) and a high church member retention rate (about 80%), so each decade the Amish society has grown by 30 to 48 percent. There are approximately 192,000 Amish. The Anabaptists practice adult baptism, one that is voluntary and of conscious choice. The Mennonites were the followers of Menno Simmons, a Dutch Anabaptist leader. The Mennonites suffered severe prosecution and fled to Switzerland (Amish History, n.d.). “The word Anabaptist means twice baptized because the original members were baptized as infants and again as adults and many of the Anabaptists were martyred, the Amish remember these martyrs in their prayers and religious services” (Amish and Mennonite Culture History, n.d.).

The Amish broke from the Swiss Mennonites in the year 1690. These were the followers of Jacob Amman. To avoid religious prosecution of the time, they traveled to North America, settling in small rural areas. The Amish and Mennonites have similar beliefs, they differ only in practice. Mennonites drive plain automobiles and have telephones and electricity as well as other modern amenities for daily living. The Amish do not have automobiles, electricity, or television or radio.

“The Amish are a very conservative Christian faith group” (Amish History, n.d.). The Amish maintain a literal interpretation of the Bible. They reject warfare and military involvement and desire to live separate from the rest of the world. They have traditionally not sought converts to their faith, but recently some Amish groups have begun evangelization (Amish History, n.d.). The Amish demonstrate their plainness with their clothing. Men usually wear a plain dark-colored suit, and women wear plain colored dress with long sleeves, a bonnet, and an apron. The apron is white if they are married and black if single.

The Amish are composed of different groups. “Today there are a number of different groups of Amish with the majority affiliated with four orders: Swartzengruber, Old Order, Andy Weaver, and New Order Amish” (Amish and Mennonite Culture History, n.d.). These groups list in the order from most conservative to most progressive. The Old Order Amish believe in strict obedience and yielding to God, the church, and others. This reflects in their ways of life. The Amish value humility, thrift, simplicity, gentleness, and peace. Traits that are discouraged are pride and self-aggrandizement. The Amish do not like to have pictures taken of them as this is prideful and constitutes a “graven image” (Amish and Mennonite Culture History, n.d.).

“The Old Order Amish have distinct views on family life, old age, and inter-relationships with the dominant society, which are premised on their interpretations of the Bible” (Crist, J., Armer, J., Radina, M. 2002). Old Order Amish are very conservative, doing all farm work with horses and steel wheels. The Old Order still milk cows by hand. New Order Amish are using milking machines, have rubber tires on their farm equipment, yet still use horses for the field work. Amish in general do not own modern amenities, yet they can use their neighbor’s appliances. “Modern technology is considered worldly and not a necessity” (Amish and Mennonite Culture History, n. d.).

Education for the Amish is complete at the eighth grade level. The school teaches English as most Amish speak a German dialect called Deutsch (Amish History, n. d.). Further education is not encouraged. Boys follow in their fathers’ footsteps, and girls learn skills of the home and farm from mothers and aunts. Family roles are defined early in Amish families, children nurture and form relationships with their numerous relatives on a weekly basis. “As young adults, both boys and girls are allowed to “sow some wild oats” and even experience how the “English” live before they are required to settle down and lead exemplary Amish lives” (Amish and Mennonite Culture History, n. d.). During this time young boys and girls attend parties called “hoe-downs” usually located in one family’s barn or field. This period of experience for the young Amish has led to many problems involving drug abuse, alcoholism, and others.

Extended families consisting of several generations may live in one dwelling. The typical Amish House has several additions. “As family members age it is common for grandparents to move to an adjacent home often attached to the main house called the dawdy house” (Amish and Mennonite Culture History, n. d.). The Amish provide care for their elderly through family and order interactions. Care that requires hospitalization or specialist interaction is usually paid for out of pocket and in cash. The elders of the Order respected and revered for their contributions to the society, maintain a place of respect in the community and keep the Amish cultural traditions and rituals alive.


Grieving


At times of death, the Amish community assumes the responsibility of funeral arrangements. “The funeral service is held in the barn in warmer months and in a house during colder months” (Santrock, 2006). Death is a part of life that all Amish know from early in their lives. Living in such a close society, all members attend the funeral of community members in their district. “Calm acceptance of death, influenced by a deep religious faith, is an integral part of the Amish culture” (Santrock, 2006). The community provides a great deal of care to the surviving family. This care continues for a year or more, and various members of the Amish community provide this care. “Visits to the family, special scrapbooks and handmade items for the family, new work projects started for the widow, and quilting days that combine fellowship and productivity are among the supports given to the bereaved family” (Santrock, 2006). Family visits every evening for several weeks followed by Sunday afternoon visits for an entire year (Kraybill, Nolt, & Weaver-Zercher, 2007). All members of the district will assist in caring for the deceased’s family and home. The men of the particular Amish community will work the fields and tend to the agrarian aspects of the widow’s farm until she can manage the activities with her offspring, relatives, or thru barter or payment for these services. Community is an important aspect of Amish living, and is exemplified in times of need. Members of the community console grieving families, and the Amish value of fellowship provides a protective barrier to prolonged grieving and bereavement. Amish women wear black when mourning, and the length of time for wearing the black mourning attire varies with the relationship: three months for aunts, uncles, nieces, and nephews; six months for grandparents or grandchildren; the entire year for spouse and immediate family members (Kraybill, Nolt, & Weaver-Zercher). The whole community assists in working through the grieving period; this was evidenced after the Nickel Mines murders on October 3, 2006. The Mennonite Disaster Service and the Mennonite Central Committee worked together to create The Amish School Recovery fund. The Amish belief of forgiveness and then moving on with life was evidenced quite shockingly too many after the Nickel Mines tragedy.

Most Amish people seek help within their respective communities; however, some find help outside their culture. Grief support counseling is many times available to Amish folks by Amish couples who are trained as group facilitators. These individuals may also assist in translation for early school-aged Amish youth as they do not yet speak English; German dialects are the predominant language spoken in the homes and communal gatherings. It is also not uncommon to have grief counselors brought in to a specific community after tragedy to assist in psychosocial care. It is important that any counselors, psychologists, nurses, or other health care providers understand some of the basic mores and beliefs of Amish communities. It is also important to understand the Amish belief in the power of forgiveness, as much for the Amish individuals, as well as for an “outside” care giver. It can appear that when confronted with apparent denial of anger, frustration, etc., the caregiver can misconstrue true forgiveness on the part of the victim. The Amish use their faith in a matter-of-fact fashion, letting God handle the details they cannot (Kraybill, Nolt, & Weaver-Zercher, 2007). These facts are good to know for those who may become involved with assisting an Amish or other Anabaptist faith member move through the grieving process.

Grieving and bereavement issues are universal, but cultural competence is needed when dealing with differing religious and cultural backgrounds. Understanding the rituals and cultural norms for dealing with loss and grieving is a first step in successful treatment planning. Successful therapeutic interventions can then be designed to assist the individual/s back toward optimum daily functioning.


References

Amish and Mennonite Culture History (n.d.). Retrieved September 12, 2005 from http://www.clark-cty-wi.org/historya&m.htm

Crist, J., Armer, J., & Radina, M. (2002). A study in cultural diversity: Caregiving for the old order Amish elder with Alzheimer’s disease. Journal of Multicultural Nursing & Health 8 (3). 78-85.

Clements, P., DeRanieri, J., Vigil, G., & Benasutti, K. (2004). Life after death: Grief therapy after the sudden death of a family member. Perspectives in Psychiatric Care 40 (4). 149-154.

Comer, R. J. (2001). Abnormal psychology 4th ed. New York: Worth Publishers.

Kozier, B., Erb, G., Berman, A., & Snyder, S. (2004). Fundamentals of nursing: Concepts, process and practice (7th ed.). Upper Saddle River, NJ: Prentice-Hall.

Kraybill, D. B., Nolt, S. M., & Weaver-Zercher, D.L. (2007) Amish Grace: How forgiveness transcended tragedy. San Francisco: Josey Bass.

Muller, E., Thompson, C. (2003). The experience of grief after bereavement: A phenomenological study with implications for mental health counseling. Journal of Mental Health Counseling 25 (3). 183-203.

Neimeyer, R., Prigerson, H., & Davies, B. (2002). Mourning and meaning. The American Behavioral Scientist 46 (2). 235-251.

Santrock, J. (2006). Life Span Development (10th ed.). Boston, MA: McGraw-Hill.

Schum, J., Lyness, J., & King, D. (2005). Risk factors for complicated bereavement. Geriatrics, 60(4), 18 – 24.

The Amish: Massacre of six innocents (n.d.) Retrieved April 27, 2009 from: http://www.religioustolerance.org/amish7.htm



About the Authors


Charlotte H. Mackey MSN, Ed
Dr. Charlotte Mackey has been an RN since 1983. She received her MSN in Burn, Emergency, and Trauma Nursing from Widener University. She received her doctorate in education from Widener University. Dr. Mackey is currently the Chairperson of the Department of Nursing at West Chester University in West Chester, PA. Dr. Mackey has developed courses for nursing education dealing in areas of legal and ethical decision-making, critical care, and emergency care as well as dealing with psychosocial emergent themes..


EDWARD F. MACKEY, CRNA, MSN, PhD
Dr. Mackey received an MS in Nurse Anesthesiology from St. Joseph’s University in Philadelphia, PA. He received an MSN in Community/Public Health Nursing from West Chester University and received a Ph.D. in Psychology from Northcentral University.

Dr. Mackey is an Assistant Professor in the Department of Nursing at West Chester University of Pennsylvania. He is adjunct faculty at Villanova University’s graduate program in Nurse Anesthesiology. He maintains a private practice of anesthesia for outpatient Oral and Maxillofacial Surgery. Dr. Mackey is an Approved Consultant in Clinical Hypnosis for the American Society of Clinical Hypnosis (ASCH), is a Diplomat in the American Psychotherapy Association, and maintains a longstanding private practice in hypnosis/hypnotherapy/psychotherapy in Kennett Square, PA.



Published by Dr. Robert O' Block in The American Association of Integrative Medicine Journal Spring 2015.