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The Experience of Chinese Bereaved Persons: A Preliminary Study of Meaning Making and Continuing Bonds

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Title: The Experience of Chinese Bereaved Persons: A Preliminary Study of Meaning Making and Continuing Bonds
Language: English
Authors: Chan, Cecilia L. W., Chow, Amy Y. M., Ho, Samuel M. Y., Tsui, Yenny K. Y., Tin, Agnes F., Koo, Brenda W. K., Koo, Elaine W. K.
Source: Death Studies. Dec 2005 29(10):923-947.
Availability: Customer Services for Taylor & Francis Group Journals, 325 Chestnut Street, Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420 (Toll Free); Fax: 215-625-8914.
Peer Reviewed: Y
Page Count: 25
Publication Date: 2005
Document Type: Journal Articles
Reports - Evaluative
Descriptors: Foreign Countries, Asian Culture, Death, Grief, Counseling, Interviews, Cultural Traits, Intervention
Geographic Terms: Hong Kong
ISSN: 0748-1187
Abstract: This study explores the bereavement process of Chinese persons in Hong Kong, with the focus on how they make meaning of the death as well as how they maintain a bond with the deceased. A review of video- and audiotapes of 52 bereaved persons in bereavement counseling pointed to how these concepts are reflected in key themes that appeared throughout these interviews. The way this bereaved population found meaning in the death was reflected in how they understood the cause of death, their observations at the death moment, their understanding of the life of the deceased after the death, the life of the bereaved after the death, and the burial and mourning rituals that were followed. The continuing bond the bereaved felt with the deceased was experienced by the bereaved as either initiated by the deceased, for example by the deceased appearing in dreams or initiated by the bereaved themselves in their talking with the deceased. These 2 aspects of the bereavement process seem to be similar to those found in other societies, but the ways in which they were manifested were unique to the Chinese culture. Based on these findings, the authors conclude with implications for intervention with this bereaved population.
Abstractor: Author
Number of References: 34
Entry Date: 2005
Access URL: https://taylorandfrancis.metapress.com/link.asp?target=contribution&id=T3747460735X40V2
Accession Number: EJ721465
Database: ERIC
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  Value: <anid>AN0018710976;dea01dec.05;2019Mar28.13:32;v2.2.500</anid> <title id="AN0018710976-1">The Experience of Chinese Bereaved Persons: A Preliminary Study of Meaning Making and Continuing Bonds. </title> <p>This study explores the bereavement process of Chinese persons in Hong Kong, with the focus on how they make meaning of the death as well as how they maintain a bond with the deceased. A review of video- and audiotapes of 52 bereaved persons in bereavement counseling pointed to how these concepts are reflected in key themes that appeared throughout these interviews. The way this bereaved population found meaning in the death was reflected in how they understood the cause of death, their observations at the death moment, their understanding of the life of the deceased after the death, the life of the bereaved after the death, and the burial and mourning rituals that were followed. The continuing bond the bereaved felt with the deceased was experienced by the bereaved as either initiated by the deceased, for example by the deceased appearing in dreams or initiated by the bereaved themselves in their talking with the deceased. These 2 aspects of the bereavement process seem to be similar to those found in other societies, but the ways in which they were manifested were unique to the Chinese culture. Based on these findings, the authors conclude with implications for intervention with this bereaved population.</p> <p>Irrespective of one's own race and culture, the pain of losing a loved one through death is often heartbreaking. Thus, grief is usually considered a universal experience, but ways of reacting to or handling the experience are inevitably shaped by one's own culture through various prescribed rituals, beliefs, and family rules. Rosenblatt ([<reflink idref="bib27" id="ref1">27</reflink>]) has suggested aspects of the bereavement experience that can be used to identify cultural differences: understanding of what has been lost with a death, death rituals, constructions of a survivor's ongoing and future relationship with the deceased, as well as the expression of grief itself. Rosenblatt stated that the goal of cross-cultural studies is to explore and identify the range of responses found in different cultures in order to appreciate how a given culture frames the way grief is experienced and expressed. We undertook the current study of the Chinese bereavement experience to examine the view that the expression and experience of grief is culturally specific.</p> <p>There are two themes that seem to receive a good deal of attention and are the focus of much contemporary grief research. Neimeyer ([<reflink idref="bib23" id="ref2">23</reflink>]) spoke of "meaning construction in response to loss as the core process of grieving" (Neimeyer, [<reflink idref="bib23" id="ref3">23</reflink>], p. 4). Klass, Silverman, and Nickman ([<reflink idref="bib15" id="ref4">15</reflink>]) highlighted the importance of the bereaved's maintaining a relationship to the deceased, in contrast to the notion of letting go that was commonly seen as the goal of grief work. We were interested in how these concepts would be reflected in the experience of a Chinese population.</p> <p>A systematic review of the bereavement experience of Chinese people in Hong Kong is rare. As in the current research some of what we know comes from researchers who are also clinicians who are learning about grief from counseling the bereaved. C. L. W. Chan and Chow ([<reflink idref="bib3" id="ref5">3</reflink>]) have described their experience of facilitating groups for widows in Hong Kong. They noted that the Chinese term for bereavement was used interchangeably with the term for sorrow—<emph>Bei Shang</emph>. The commonly used condolence statement in Chinese is <emph>Jie Ai Shun Bian</emph>, which literally means save the tears and accept the change. Based on these translations, the purpose of bereavement counseling was to limit sorrow and reduce harm. The perceived pain of losing a loved one, however, was seen by the bereaved as permanent. They might even link the intensity of their pain to the love they have for their deceased loved one and would not be ready to consider bereavement counseling, fearing that it might take this pain away. C. L. W. Chan and Chow introduced a new term, <emph>Shan Bie</emph> ("good separation"), hoping to create a new perspective for bereavement counseling work. Chow, Koo, Koo, and Lam ([<reflink idref="bib7" id="ref6">7</reflink>]) have described their experience including extracts from stories and verbatim transcriptions of counseling with bereaved persons. A study of a non-clinical population was carried out by Cheng and Ma ([<reflink idref="bib5" id="ref7">5</reflink>]). They conducted a survey of the relationships between stress, social support, and quality of life of bereaved spouses in Hong Kong, identifying the stressors faced by bereaved persons at different times after the death. Ho, Chow, Chan, and Tsui ([<reflink idref="bib13" id="ref8">13</reflink>]) developed a preliminary measurement tool to assess grief among Hong Kong Chinese. The tool, the Grief Reaction Assessment Form (GRAF), has been found to be psychometrically valid and reliable. Pang and Lam ([<reflink idref="bib25" id="ref9">25</reflink>]) have also carried out an exploratory study of the functions of death rituals for four widowers. The rituals were found to be comforting and were related to maintaining a continuing bond with the deceased.</p> <p>Neimeyer and Hogan ([<reflink idref="bib24" id="ref10">24</reflink>]) advocated the use of methodological pluralism in studying the bereavement experience. They valued both quantitative data as well as qualitative findings related to bereaved persons. They honored the bereaved persons as the "real" experts on loss (Neimeyer & Hogan, [<reflink idref="bib24" id="ref11">24</reflink>], p. 113). Stroebe, Hansson, Stroebe, and Schut ([<reflink idref="bib32" id="ref12">32</reflink>]) also recommended that qualitative, in-depth assessments of bereaved persons should be carried out before any quantitative studies. Following this line of thought, we started our study of bereaved Chinese persons using a qualitative methodology. This article reports on the findings of the first part of the study. We were interested in knowing how bereaved Chinese persons ascribe meanings to the death and bereavement experience as well as how Chinese traditional and cultural beliefs affect the formation of these meanings. We were also interested in how these bereaved people developed and maintained a continuing bond with the deceased. This research provides a basis for further examination of the influence of the Chinese culture on the experience of the bereaved.</p> <hd id="AN0018710976-2">Methodology</hd> <p></p> <hd id="AN0018710976-3">Study Sites and Participants</hd> <p>The study was carried out in the Jessie and Thomas Tam Centre (JTTC), the Society for the Promotion of Hospice Care in Hong Kong, China. It is the first community-based bereavement center in the region, providing a wide range of bereavement counseling services, including individual counseling, group counseling, memorial gathering, and education programs (Chow et al., [<reflink idref="bib7" id="ref13">7</reflink>]). JTTC has served 1,400 families since its opening in late 1997 (Chan, [<reflink idref="bib4" id="ref14">4</reflink>]). The center has served over 500 families when this study was initiated in 2001. Originally, we planned to recruit our participants from this pool; however, when contact was made with a few of them, most refused to participate in the research. They thought that they had already shared most of the information needed for the research in the counseling sessions. Although taking new cases of JTTC as participants was considered as an alternative, we withdrew the idea because of ethical considerations. Bereaved persons usually need a lot of courage before they approach a counseling service center. The extra request for research might be perceived as subtle pressure. In view of this dilemma, we switched back to the former 500 clients of JTTC who had already received services. We decided to analyze the information from existing database of the 500 clients that were already available, thus to reduce unnecessary revisiting of the grief experience and retrospective response bias. Five bereavement counselors of the JTTC reviewed the cases of all their former bereaved clients and identified those who had attended three or more individual counseling sessions. Clients under age 18 were excluded. Those who had not consented to being video- or audiotaped were screened out as the written recordings were less informative. To protect confidentiality, JTTC destroyed the video- and audiotape of the former clients 2 years after the service was terminated. Anyone who received service more than 2 years ago was thus automatically ruled out. Finally, 60 former clients were identified. They were contacted to obtain their consent to review their taperecordings for research purposes. Eight of them could not be reached as they had changed their address. The remaining 52 bereaved persons all consented to our use of the tapes for our study.</p> <p>Table 1 shows the demographic profile of the participants. The male-to-female ratio was about 1:4 as more women approached the center to receive their services. Over half of them had lost their spouses, whereas the remainder had lost parents, children, or siblings. About half of the total pool did not identify themselves with a religion, although a quarter did worship their ancestors.</p> <p>TABLE 1 Demographic Profile of the Participants</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Group</td><td><italic>n</italic></td><td>%</td></tr></thead><tbody><tr><td>Gender</td><td /><td /></tr><tr><td> Male</td><td>11</td><td char="." charoff="50">21.15</td></tr><tr><td> Female</td><td>41</td><td char="." charoff="50">78.85</td></tr><tr><td>Relationship with the deceased</td><td /><td /></tr><tr><td> Loss of husband</td><td>22</td><td char="." charoff="50">42.31</td></tr><tr><td> Loss of wife</td><td>5</td><td char="." charoff="50">9.62</td></tr><tr><td> Loss of mother</td><td>6</td><td char="." charoff="50">11.54</td></tr><tr><td> Loss of father</td><td>6</td><td char="." charoff="50">11.54</td></tr><tr><td> Loss of son</td><td>4</td><td char="." charoff="50">7.69</td></tr><tr><td> Loss of daughter</td><td>5</td><td char="." charoff="50">9.62</td></tr><tr><td> Loss of brother</td><td>2</td><td char="." charoff="50">3.85</td></tr><tr><td> Loss of sister</td><td>1</td><td char="." charoff="50">1.92</td></tr><tr><td> Other</td><td>1</td><td char="." charoff="50">1.92</td></tr><tr><td>Mode of death</td><td /><td /></tr><tr><td> Chronic illness</td><td>26</td><td char="." charoff="50">50.00</td></tr><tr><td> Acute illness</td><td>11</td><td char="." charoff="50">21.15</td></tr><tr><td> Accident</td><td>6</td><td char="." charoff="50">11.54</td></tr><tr><td> Suicide</td><td>9</td><td char="." charoff="50">17.31</td></tr><tr><td>Education level of the bereaved</td><td /><td /></tr><tr><td> Secondary (High) school or more</td><td>27</td><td char="." charoff="50">51.92</td></tr><tr><td> Primary (Elementary) school or less</td><td>20</td><td char="." charoff="50">38.46</td></tr><tr><td> Unknown</td><td>5</td><td char="." charoff="50">9.62</td></tr><tr><td>Religion</td><td /><td /></tr><tr><td> No religion</td><td>23</td><td char="." charoff="50">44.23</td></tr><tr><td> Traditional ancestor worship</td><td>13</td><td char="." charoff="50">25.00</td></tr><tr><td> Buddhism</td><td>5</td><td char="." charoff="50">9.62</td></tr><tr><td> Christianity</td><td>11</td><td char="." charoff="50">21.15</td></tr></tbody></table> </ephtml> </p> <hd id="AN0018710976-4">The Interview</hd> <p>A counseling interview may be very different from a research interview. We were, nevertheless, comfortable using these data for research purposes because the counseling center adopted the model proposed by McKissock and McKissock, ([<reflink idref="bib17" id="ref15">17</reflink>]). The structure of the counseling process in this model includes the logistic tasks of engagement, contracting, reviewing, and closure. The core components of the counseling process are exploration and facilitation, focusing on a sequence of experiences that are consistent with the bereavement process beginning with the dying experience, then the death moment, then the funeral, and finally the time since (the time after funeral to the time of interview). The latter component focuses on helping the bereaved person recall the memories with the deceased and share their unmet dreams. Further intervention sessions focus on the client's own concerns about the bereavement experience. The counselors in this study were greatly influenced by the Rogerian client-centered approach. Thus, the content of the counseling interviews was compatible with a semi-structured in-depth interview, with the focus on understanding the bereavement process as well as maintaining a continuing bond.</p> <hd id="AN0018710976-5">Procedure for Analyzing the Data</hd> <p>Only 10 participants, out of 52, had all their counseling sessions video– or audiotaped. The tapes of these 10 participants were transcribed for analysis. Phase 1 of the study focused on discovering the themes in the 10 transcribed tapes. As suggested by Silverman ([<reflink idref="bib29" id="ref16">29</reflink>]), the culture of clinicians might be different from that of researchers. We had two teams working together, one consisting of the researchers and the other clinicians from the center. We adopted Silverman's idea of maintaining a continuing dialogue between the two teams in identifying themes and in clarifying our thinking. The two teams formally met three times. In addition they reviewed the partial video or audio recordings as well as all the transcriptions of the remaining 42 former bereaved clients, to see if the same themes were evident in these data. In addition the clinicians were asked to see if their recollections supported these findings. A total of 52 records were used for analysis. The whole team, including the researchers from the university and the bereavement counselors from the center, had two additional meetings to debrief each other to reduce personal bias in the interpretation of the data. Silverman talks of a third culture that is present in working with the bereaved. She reminds us that these are universal human experiences. These meetings allowed us to consider our own experiences and reactions to the material we were studying and to see how these contributed to our understanding of the data.</p> <hd id="AN0018710976-6">Results</hd> <p>Several themes were identified, as shown in Table 2. In this article, we focus our discussion on the themes of meaning making and continuing bonds.</p> <p>TABLE 2 Themes Identified</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Theme and subtheme</td></tr></thead><tbody><tr><td>Meaning making</td></tr><tr><td> The cause of death</td></tr><tr><td> Observations at the moment of death</td></tr><tr><td> The life of the deceased after death</td></tr><tr><td> The life of the bereaved after the loss</td></tr><tr><td> The rituals used</td></tr><tr><td>Bond continuation</td></tr><tr><td> Initiated by the deceased</td></tr><tr><td> Initiated by the bereaved</td></tr><tr><td>Support</td></tr><tr><td> Tangible/Instrumental support</td></tr><tr><td> Psychological support</td></tr><tr><td> Social support</td></tr><tr><td> Emotional support</td></tr><tr><td> Spiritual support</td></tr><tr><td>Transformation after bereavement</td></tr><tr><td> Physical transformation</td></tr><tr><td> Social transformation</td></tr><tr><td> Emotional transformation</td></tr><tr><td> Spiritual transformation</td></tr></tbody></table> </ephtml> </p> <hd id="AN0018710976-7">Meaning Making</hd> <p>As shown in Table 2, the theme of meaning making can be subdivided into five sub-themes: the cause of death, the observations at the moment of death, the life of the deceased after death, the life of the bereaved after the loss, and the rituals used.</p> <hd id="AN0018710976-8">The Cause of Death</hd> <p>Though the real or explicit cause of death (e.g., illness or an accident), was clear to the bereaved, they still categorized the cause of death in terms of traditional beliefs. The details are shown in Table 3. Death typically is considered as something bad, and therefore usually has negative connotations. Some of the respondents perceived the death as positive because the dying patients were peaceful and painless. In some cases, the deaths were considered as good because they happened at an appropriate time. Further discussions on the concept of good deaths are discussed in another section.</p> <p>TABLE 3 Meaning Making on the Attribution to Death</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Categories</td><td>Positive appraisal</td><td>Negative appraisal</td></tr></thead><tbody><tr><td>Fate</td><td>5</td><td>23</td></tr><tr><td>Karma</td><td>3</td><td>12</td></tr><tr><td>Fate clashes among family members</td><td>2</td><td>6</td></tr><tr><td>Feng shui</td><td>1</td><td>6</td></tr><tr><td>Evil spirit</td><td>0</td><td>9</td></tr></tbody></table> </ephtml> </p> <p>Over half of the participants referred to the death as fate and 15 of them used the Buddhist term <emph>karma</emph>[<reflink idref="bib1" id="ref17">1</reflink>] to explain the cause of death, although only five of them were Buddhist. In this tradition, the death was seen as a result of the bad deeds done by the deceased in this life or even a previous life. Participant A said:</p> <p>My husband is a good person who did a lot of charitable work. He died young probably because of the bad deeds he did in his life before this life. I'm sure he had just finished paying this debt and will lead a good life next time.</p> <p>Nine of the bereaved considered the death to be a result of the influence of "sick <emph>qi</emph>."[<reflink idref="bib2" id="ref18">2</reflink>]</p> <p>They perceived the illness to be in the form of energy that would only pass to those who were unlucky. In Taoism, illnesses are thought to be caused by spirits and ghosts (Cheung, [<reflink idref="bib6" id="ref19">6</reflink>]). Again, for those who are unlucky, they are more prone to attract the evil spirits. Some of them were more fatalistic, considering the illness to be part of the pre-destined pathway of the life of the deceased. Some believed that their pre-destined relationship with the deceased (<emph>yuan</emph>) in this life had ended. Environmental factors were sometimes taken into account as well. Bad <emph>feng shui</emph>—the clashing of features in the living environment—was also considered a cause of death. Participant B said:</p> <p>My husband was well all along. I regretted purchasing such an apartment unit that faced the cemetery. At first, we thought that the price was really good for such a large unit! The bad feng shui was the major cause of my husband's illness, which finally took his life.</p> <p>Eight of the bereaved persons considered that they themselves were the cause of death. They believed in <emph>clashes of fate</emph>, that is, the life of the bereaved clashed with that of the deceased and the weaker one died. Some bereaved persons, especially grieving parents, thought that the death was a punishment for the bereaved's bad deeds.</p> <hd id="AN0018710976-9">At the Moment of Death</hd> <p>What is understood as a "good" or "appropriate" death has its own subjective cultural definition. Among all the ascribed meanings of the observation at the moment of death, the presence of family members, especially the elder son or the spouse, is mentioned most frequently (see Table 4). Without the son as a witness, a father's death is a curse. Some of the bereaved described their intense guilt about being away from the deceased's bed at the moment of death. Though all along they had provided good care for the patient, their absence at the moment of death seemed like a sin to them. Participant C said:</p> <p>TABLE 4 Meaning Making on Observations at the Moment of Death</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Categories</td><td>Positive appraisal</td><td>Negative appraisal</td></tr></thead><tbody><tr><td>Presence of the family members at the death moment</td><td>13</td><td>13</td></tr><tr><td>Appearance of the deceased at the death moment</td><td>10</td><td>14</td></tr><tr><td>Physical condition of the dying patient</td><td>10</td><td>12</td></tr><tr><td>Completion of unfinished businesses of the deceased</td><td>10</td><td>8</td></tr><tr><td>Age of the deceased</td><td>3</td><td>16</td></tr></tbody></table> </ephtml> </p> <p>I felt relieved when my eldest son arrived before my husband took his last breath. Probably, he [the husband] just waited for the son before he let go.</p> <p>By contrast, Participant D said:</p> <p>I should not have gone back home at that important moment. I thought he would not die so soon, as he appeared to be sleeping pretty well. At least, the nurses did not give me a warning! I feel so guilty for allowing him to leave the world without our presence.</p> <p>Bereaved persons tend to rely on facial expressions of the deceased at the death moment as basis of determining the level of suffering the deceased gone through. A peaceful look denotes a pain-free death, whereas a painful facial expression denotes the dying process as agonizing. The bereaved will be overwhelmed by guilt and self-blame if they find themselves unable to facilitate a "good" death for the deceased. If the mouth of the deceased is not completely closed, it will be interpreted that the deceased had words unsaid. Similarly, the incomplete closing of eyes will be interpreted as a reflection of the deceased's unwillingness to leave the world. A full stomach was also an important indicator of a "good" death as the deceased might turn into a "hungry ghost" if his or her stomach was empty. One of the bereaved persons considered that the death of her mother was a "good" death with a very special interpretation: Shortly before participant E's mother died, a nurse had given her some glucose solution through a nasogastric tube. Participant E recounted:</p> <p>The life of my mother was bitter...yet, before she died, she got a sweet taste. I'm sure that she will have a sweet life next time!</p> <p>Similarly, another bereaved person described that she felt glad that her father had been bathed just before he died. To her, the bathing symbolized the washing away of the bad things of this life so that he could start anew in the next life.</p> <p>Aside from the physical condition of the dying patient, the level of completion of the unfinished business of the deceased, as well as the age of the deceased were other themes mentioned by the participants. Participant F said:</p> <p>I did not feel the pain of losing my wife when she died. Only when the patient in the next bed said that it was pitiful to witness such a woman dying so young, with all the unfinished business of bringing up her children, I then felt a sword pierce my heart.</p> <hd id="AN0018710976-10">Life of the Deceased after Death</hd> <p>In Chinese culture, there is a strong belief in the afterlife. The participants usually spent a significant amount of time in sharing their views about the afterlife of the deceased. Table 5 lists these views. Most had a positive sense of the destination of the deceased in the afterlife.</p> <p>TABLE 5 Meaning Making on the Life of the Deceased after Death</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Categories</td><td>Positive appraisal</td><td>Negative appraisal</td></tr></thead><tbody><tr><td>Go to heaven</td><td>12</td><td>0</td></tr><tr><td>Reincarnation</td><td>10</td><td>5</td></tr><tr><td>Go to underworld</td><td>1</td><td>5</td></tr></tbody></table> </ephtml> </p> <p>When they talked about the deceased in Heaven (for some, this meant that the deceased was flying freely), they seemed to be relaxed and peaceful. To Christians who believe in Heaven, there is a hope of reunion. Participant G said:</p> <p>I think she just went to heaven to prepare our new home there. We will soon meet again! I will try my very best to behave so as to make sure I will get a pass to heaven. That's why I will not kill myself. If I commit suicide, then I have no chance to go to heaven and meet with her.</p> <p>The Christian view poses an optimistic view about the afterlife. Among the 12 participants mentioning heaven, they all have a positive tone. On the other hand, for those who mentioned the underworld that is part of the Chinese traditional beliefs, they tended to have a negative tone. Some believed in reincarnation and thought that the future life of the deceased would be better than the life they had left.</p> <hd id="AN0018710976-11">Life of the Bereaved after the Loss</hd> <p>The belief in the afterlife and in reincarnation fosters hope for reunion or reconciliation of the deceased and the bereaved person. As shown in Table 6, fifteen participants mentioned that their relationship (<emph>yuan</emph>) would be continued. Most of these themes had a positive tone but two of them revealed that they were tired of the marital relationship. Similar to the findings in other cultures, deaths of children seemed to be very difficult to bear. For the bereaved parents, they quoted the Chinese saying "the white headed witnesses the death of the black headed" (the older generation witnesses the death of the younger generation) with great pain. Yet, for those who held strong traditional Chinese beliefs, the pain was compounded by their compliance with the rule forbidding them from attending the funeral of their children. Chinese have clear hierarchical boundaries between generations. The decedents, even though they are dead, should not be "worshipped" by their living antecedents. If this rule is broken, it may bring bad karma on the decedents. Though there is no formal document recording the source of such a cultural rule, this belief is commonly shared among Chinese persons (Chow et al., [<reflink idref="bib7" id="ref20">7</reflink>]).</p> <p>TABLE 6 Meaning Making on the Life of the Bereaved after the Loss</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Categories</td><td>Positive appraisal</td><td>Negative appraisal</td></tr></thead><tbody><tr><td>Relationship (<italic>yuan</italic>) will continue in the coming life</td><td>13</td><td>2</td></tr><tr><td>Painful experience of witnessing the death of the younger generation</td><td>0</td><td>5</td></tr><tr><td>Death in a family will bring bad luck for 3 years</td><td>0</td><td>4</td></tr></tbody></table> </ephtml> </p> <p>Death in a family disrupts its structure and function. Most of the widows felt that the term widow had negative connotations. Sometimes, they were looked down upon by their own family members. Widows are associated with bad luck and thus are not welcome to join in celebrations such as birthdays or weddings within the first year of bereavement. A two-parent family would suddenly become a single-parent family as a result of the death of one of the parents, thus affecting the family's functioning. Participant H said:</p> <p>My husband died a few days before the Lunar New Year. His funeral was arranged after Lunar New Year as the funeral homes were closed during the New Year. There were only a few of my husband's friends who attended his funeral. Most people, even including my family as well as his family, did not want to attend the funeral in the 'happy' time. They did not want to catch any bad luck from the dirty places or the dirty persons [the bereaved persons]. I was so hurt when my mother-in-law told me that she could not attend the funeral, as she was the parent. My husband was all along a responsible son. Did he deserve his mother's care at this final ceremony?...I was very upset when my family told my children they would have no 'red-pockets' ['red pockets' are the small gifts, usually in form of money packed in a red-pocket, for unmarried persons during New Year's time. Symbolically, 'red-pockets' means things with good fortune] in that New Year. Why were my children deprived of good things? I was very angry.</p> <p>Chinese adults are still very attached to the parents. It is common to find adult children living with the elderly parents, or visiting the parents every weekend. Some of the bereaved adult children described the awkwardness of being an orphan when they lost their second parent. They spoke of how they felt hurt when people would talk about going back home to have dinner or having a weekend family gathering. They seemed to lose their home as well.</p> <hd id="AN0018710976-12">Rituals</hd> <p>According to traditional Chinese beliefs, there are different rituals that are used over time in the bereavement process and, in particular, during the funeral. Participation in the funeral is the most frequently mentioned one. Two thirds of the participants perceived that it was good to participate in the funeral. They thought it was good to have the final chance to say good-bye to the deceased. The remaining one third of the participants harbored negative feelings, largely because they had not been able to participate.</p> <p>Chanting is an integral part of a Taoist funeral ritual. The lay priest (<emph>Nahm Mouh</emph>) delivers a low monotonic chant, aimed at placating the spirit of the deceased. The lay priest will also perform sacrificial litanies, aimed at scaring the ghosts and awakening the Gods. Buddhist nuns and monks will also chant the Buddhist sutras, with the same aim of soothing the spirit of the deceased (Watson, [<reflink idref="bib34" id="ref21">34</reflink>]). Twenty participants mentioned this theme and most of them viewed it positively. Only three of the respondents viewed it negatively as they complained about the high cost for chanting as well as the incompatibility with the bereaved person's belief system.</p> <p>As part of the funeral there is a ritual of viewing the body before the final covering of the coffin. The last memory of the deceased will be strongly implanted in the bereaved person's mind, thus good comestic make-up of the deceased will provide for a good memory. Seven participants shared their negative memory. Participant I said:</p> <p>Whenever I close my eyes, the image of my father pops up obsessively. His eyes were half opened, and so was his mouth. His face was white like a cement wall, contrasting with the lips with lip-stick as if he was bleeding. I cannot wash away this awful memory.</p> <p>Some of the Chinese funeral rituals are to be carried out by male family members. The "Soul-flag" ritual is used to guide the deceased's soul to go in the right direction and a "purifying wash" is for cleansing the body of the deceased. Instead of real cleaning of the actual body, the ritual is done symbolically by one family member holding a basin with another holding a piece of the deceased's clothing. They need to throw 2–4 coins and "buy" the water for cleaning. Eight participants mentioned the rituals but only half of them viewed it positively. They treasured the opportunity for the family members to "do" something on their own for the deceased. Yet half of them viewed it negatively as they did not have a son, requiring that the rituals be carried out by nephews or other male family members.</p> <p>In Chinese conceptualization, the living, the dead, and the gods coexist in the cosmic world of the earth for the living, the underworld for ghosts, and a higher world for gods. The underworld consists of hell and its 10 courts (<emph>yamens</emph>)[<reflink idref="bib3" id="ref22">3</reflink>] as well as a larger underworld region that is quite similar to the earthly world for spirits who have no need for punishment. The spirits are being judged and punished in each yamen before they can be transferred to the next (Cohen, [<reflink idref="bib8" id="ref23">8</reflink>]; Tong, [<reflink idref="bib33" id="ref24">33</reflink>]). Burning paper and offerings of paper houses and paper cars is believed to help the spirit of the deceased to live a comfortable life in the afterworld. The offerings of paper money, paper coins, paper gold or silver, and even paper credit cards can help to ransom the spirit of the deceased from the yamens of hell (Cave, [<reflink idref="bib2" id="ref25">2</reflink>]). Thus, the rituals of burning paper money and paper property were therapeutic for the bereaved persons. They thought that they were building a better living environment for the deceased. As the paper money needed to be folded into a special shape, this ritual of folding paper money served as a useful distraction for the bereaved persons.</p> <p>Among all the rituals mentioned, one of them was viewed negatively by all those who mentioned it. A group of widows described the pain they felt when participating in the ritual of "breaking the comb." This is a Taoist ritual that is performed before covering the coffin. The comb symbolized the marriage, and the ritual symbolized that the marriage between the bereaved and the deceased was over. Originally, the ritual was designed to legitimize remarriage. Yet for most of the widows, the concept of remarriage was too frightening to consider in the first month of bereavement. In Table 7, the ritual themes are listed.</p> <p>TABLE 7 Meaning Making Concerning the Rituals Used</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Categories</td><td>Positive appraisal</td><td>Negative appraisal</td></tr></thead><tbody><tr><td>Participation in the funeral</td><td>19</td><td>8</td></tr><tr><td>Chanting</td><td>17</td><td>3</td></tr><tr><td>Attendance of the funeral</td><td>11</td><td>4</td></tr><tr><td>Burning of offerings</td><td>8</td><td>5</td></tr><tr><td>Good make-up of the deceased</td><td>5</td><td>7</td></tr><tr><td>Taking up the mourning status</td><td>5</td><td>3</td></tr><tr><td>Carrying out the "soul-flag" and "purifying" rituals</td><td>4</td><td>4</td></tr><tr><td>Good clothing for the deceased</td><td>4</td><td>2</td></tr><tr><td>Things to be put into the coffin</td><td>3</td><td>1</td></tr><tr><td>Carrying out the "breaking of comb" ritual</td><td>0</td><td>8</td></tr></tbody></table> </ephtml> </p> <hd id="AN0018710976-13">Continuing Bonds</hd> <p>In this study, the theme of a continuing bond with the deceased seemed to stand out as a significant aspect of the bereavement process, probably because of its anchoring in traditional Chinese folk beliefs. Traditional Chinese families usually have an altar for honoring their ancestors. When a family member is facing important events like school examinations, interviews for a new job, or even surgeries, it is quite common for the Chinese to report to their ancestors through the altar and to ask for blessings.</p> <p>The participants reported a continuation of their relationship to the deceased that was initiated either by the deceased or by the bereaved.</p> <hd id="AN0018710976-14">Initiated by the Deceased</hd> <p>Most of this group of bereaved reported an appreciation of a continuing connection to the deceased, which they felt was initiated by the deceased. As indicated in Table8, 17 participants reported feeling, hearing, or seeing the deceased. All of them treated this special encounter as a positive experience.</p> <p>TABLE 8 Continuation of Bond Initiated by the Bereaved</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Categories</td><td>Positive appraisal</td><td>Negative appraisal</td></tr></thead><tbody><tr><td>Talking to the photo of the deceased</td><td>23</td><td>0</td></tr><tr><td>Visitation at the graveyard</td><td>18</td><td>4</td></tr><tr><td>Doing the things that were shared with the deceased previously</td><td>17</td><td>6</td></tr><tr><td>Finishing the unfinished businesses of the deceased</td><td>13</td><td>2</td></tr><tr><td>Regular offerings</td><td>9</td><td>0</td></tr><tr><td>Settling down of the ashes of the deceased</td><td>8</td><td>3</td></tr><tr><td>Communicating through spiritual medium</td><td>6</td><td>2</td></tr></tbody></table> </ephtml> </p> <p>The spirits of the deceased are believed to be not completely cut off from the living; they can visit the bereaved from time to time. The Taoist priest usually prescribes that the spirit of the deceased will return home to visit the beloved family around the seventh day after death. About one-fifth of our participants reported that they had had such a visit. The return seemed to confirm that, first, the deceased was still around, and second, the bereaved was still an important, beloved person in the eyes of the deceased. One participant was highly upset when the deceased did not "return" on the seventh day.</p> <p>Instead of experiencing the direct physical return of the deceased, 19 participants reported having a reunion with the deceased in their dreams. They mostly considered these were positive experiences allowing them to clear up any unfinished business they had with the deceased. Similarly, a small group of participants complained that the deceased did not appear in their dreams. Participant J said:</p> <p>All along, I thought that I was the most important person in the eyes of my husband. His last hour of life was spent privately with me.... Yet, I was so angry to know that my husband appeared in the dream of his sister! Why did he go to her place but not mine? I longed to see him so much and I nearly forgot his face. Yet, he did not want to see me and went to his sister's place. He was cheating me all along! He cared for his sister rather than me!</p> <p>Some of the bereaved experienced their deceased family member's return in the form of insects such as moths, butterflies, dragonflies, or even cockroaches. The insects were usually described as being in a special place—on a seat where the deceased used to sit, on a family photograph, on the mouth of a beloved family member (as if kissing the beloved), on the altar that the bereaved prepared for the deceased, and so on. Some of the bereaved also described how these insects rarely flew away, as insects normally do, allowing the bereaved the chance to talk to the insects as if they were talking to the deceased. These long conversations they had with the insects were usually considered a most effective form of therapy.</p> <hd id="AN0018710976-15">Initiated by the Bereaved</hd> <p>The bereaved also played an active role in initiating a continuing bond with the deceased. About half of the participants have talked to a photo of the deceased. Chinese people like to place a large photo of deceased relatives in their dining rooms. Most of the respondents revealed that they talked to the photo from time to time. Whenever they left the house, they would say good-bye to the deceased. Whenever they had a meal, they would invite the deceased to join them. The presence of the photo reminded them of their departed loved ones. They talked to the photo especially when they felt they were being humiliated by others. Participant K said:</p> <p>The eyes of my brothers-in-law mainly focused on the money left by my husband. They tried their very best to force me to give them the money. I felt very stressed. That night, I felt extremely painful and I started to complain about their misdeeds to my husband through his photos. Surprisingly, I saw the eyes of my husband in the photo were wet too. I am not sure whether it is a hallucination or an illusion caused by my own wet eyes. Then suddenly, I remembered the words that he had told me before his death—Be tough, and no one can hurt you—I was much relieved and got back the strength to face the difficulties.</p> <p>Although every participant had placed the photos of the deceased at home, not everyone talked to the photo. Some of them shared that they did not want other family members to know that they were still grieving. They perceived that pretending to be strong was a good way to reduce the worries of other family members. They preferred to "visit" the deceased in the graveyard or cemetery. Most of the participants perceived it as a positive experience as they were physically very close to the deceased. On the other hand, a small group perceived it as a negative experience as the place reminded them that death was a reality. Participant L shared her very special view.</p> <p>When I first went to the graveyard to visit my husband. I got an insight. My husband is not dying young; even children and adolescents can die! He should not be lonely as he has a lot of young neighbors. Yet, I felt extremely angry when I visited him last time. The 'unit' next to my husband's place used to be vacant. Yet, a young lady recently moved in! I was so jealous, and felt betrayed by my husband. Ever since then, I did not want to go to the graveyard! I even planned to move him elsewhere!</p> <p>Other ways in which the bereaved initiated and maintained a bond with the deceased are summarized in Table 9.</p> <p>TABLE 9 Continuation of Bond Initiated by the Deceased</p> <p> <ephtml> <table><thead valign="bottom"><tr><td>Categories</td><td>Positive appraisal</td><td>Negative appraisal</td></tr></thead><tbody><tr><td>Feel, hear, or see the deceased after the death</td><td>17</td><td>0</td></tr><tr><td>The deceased appears in dreams of the bereaved</td><td>14</td><td>5</td></tr><tr><td>Re-visit of the deceased on the seventh day after the death</td><td>8</td><td>1</td></tr><tr><td>Deceased coming back in form of insect</td><td>8</td><td>1</td></tr></tbody></table> </ephtml> </p> <p>Nearly half of the participants feel connected to the deceased when they are doing the things that were shared with the deceased previously. Yet sometimes, they felt pain when they recognized that the deceased was no longer physically present at their side. Some of the participants tried to finish what they saw as unfinished business with the deceased as a way of staying connected. By sharing the same vision and ambition as that of the deceased, they also gained a better understanding of the deceased.</p> <p>One mother who lost her son through a traffic accident visited a spiritual medium in order to communicate with the spirit of her son. She described how she was told by her son that his death was a manifestation of a debt to a female spirit. He could not avoid it, but now the debt was settled and he was free. The meaning that the mother found through the medium was very therapeutic, assuaging the guilt she felt for being unable to protect her child.</p> <hd id="AN0018710976-16">Discussion</hd> <p>At an abstract level, the findings of this study of a group of Chinese bereaved persons in Hong Kong appear to be consistent with those of similar studies conducted elsewhere (Davis & Nolen-Hoeksema, [<reflink idref="bib9" id="ref26">9</reflink>]; Nadeau, [<reflink idref="bib18" id="ref27">18</reflink>][<reflink idref="bib18" id="ref28">18</reflink>]; Neimeyer, [<reflink idref="bib20" id="ref29">20</reflink>][<reflink idref="bib21" id="ref30">21</reflink>][<reflink idref="bib22" id="ref31">22</reflink>]). Golsworthy and Coyle ([<reflink idref="bib12" id="ref32">12</reflink>]) in their study of spiritual beliefs and the search for meaning of nine bereaved elderly spouses found that their beliefs were related to the meaning for the bereaved persons' ongoing lives, ongoing relationship with the deceased persons, attributions of responsibility, the creation of explanations of the death and hope for the future. In a similar manner, these themes unfolded naturally in the counseling interviews of this study. The clients shared their understanding of the cause of the death, the life of the deceased after death, the continuing bond with the deceased as well as their own meaning of life after bereavement. Yet, the content of meaning is unique to Chinese culture. For example, in regard to the cause of death, Chinese people still use many traditional philosophical or religious terms such as <emph>karma</emph> and <emph>yuan</emph>. Traditional Chinese beliefs attribute the cause of death to an external locus of control such as pre-destined rules or a higher power like sick <emph>qi</emph> or evil spirits. The reduced sense of personal responsibility that comes from this identification of an external cause of death decreases the degree of self-blame or guilt. The prescribed traditional beliefs seem to act as a cushion buffering the guilt-driven Chinese personality.</p> <p>The findings about the meaning of the process of death suggest directions for end-of-life care. When caring for dying Chinese persons, physical care that may seem to be unnecessary can improve the psychological well-being of surviving family members. Tidiness of the body and fullness from having eaten symbolize and foreshadow the situation in the next life. According to a Chinese proverb, dying "badly" is a curse. Thus, the Chinese translation of the term hospice care, <emph>Shan Zhong</emph>, means the reverse of this—"dying nicely" or "a good ending."</p> <p>The meaning of the afterlife is a significant factor affecting the life of the bereaved. Different religions prescribe different pathways in the afterlife. For Christians, good deceased persons go to Heaven. For Buddhists, the deceased are believed to continue the cycle of rebirth till they attain enlightenment (<emph>nirvana</emph>). Those Chinese persons who have no religion typically are nonetheless influenced by traditional Chinese beliefs. The afterlife seems to be a dark underworld with hierarchies of administration in different <emph>yamens</emph>. By paying an adequate amount of offerings, the deceased could then be ransomed from hell. This image of the afterlife probably scares not only bereaved persons but also dying patients.</p> <p>More and more attention is being paid to the idea that the bereaved maintain a continuing bond with the deceased (Klass, Silverman, & Nickman, [<reflink idref="bib15" id="ref33">15</reflink>]). Silverman and Nickman ([<reflink idref="bib31" id="ref34">31</reflink>]) suggested that it was normal for bereaved persons to maintain an ever-changing relationship to the deceased over the survivors' lifetimes. Shuchter and Zisook ([<reflink idref="bib28" id="ref35">28</reflink>]) found that more than one third of the bereaved persons talked to the deceased regularly. In our current study, the bereaved persons also shared a good deal about how they continued to connect and relate to the deceased. What they did was consistent with the Chinese practice, for example, of the bereaved talking to a photo of the deceased. Rees ([<reflink idref="bib26" id="ref36">26</reflink>]), in his review, found that bereaved persons often sensed the presence of the deceased. These encounters were perceived as comforting, which is consistent with the findings of the current study. Traditional Chinese culture actually describes such encounters as normal phenomena, thus making these experiences more acceptable. In our analysis of data related to the theme of continuing bonds, we use the dichotomy of such bonds being initiated either by the deceased or by the bereaved. This framework is grounded in the data. Based on observations in the west, Klass and Walter ([<reflink idref="bib16" id="ref37">16</reflink>]) suggested that continuing bonds can be expressed in four ways: sense of presence of the dead, talking with the dead, taking the dead as moral guides, and talking about the dead. Field et al. ([<reflink idref="bib10" id="ref38">10</reflink>]) constructed a Continuing Bond Scale. Based on literature reviews and their earlier findings (Field, Nichols, Holen, & Horowitz, [<reflink idref="bib11" id="ref39">11</reflink>]), the authors included 11 items focusing on fond memories; keeping items as a reminder; sense of the deceased's presence; identification with the deceased's habits, values, and interests; the deceased's positive influence on the bereaved; attempts to carry out the deceased's wishes; use of deceased's viewpoint in decision-making; and reminiscence with others about the deceased (Field et al., [<reflink idref="bib10" id="ref40">10</reflink>], p. 112). Our simple dichotomy might have left out some of the possible forms of expression of continuing bonds. We plan to explore a wider range of continuing bonds among Chinese bereaved persons in future studies.</p> <hd id="AN0018710976-17">Implications for Practice</hd> <p></p> <hd id="AN0018710976-18">Hospice Care</hd> <p>A worker in a hospice care unit can play a significant role in easing the grieving process of Chinese family members. As bereaved persons ascribe meaning to their observations at the moment of death, they see the physical condition of the deceased as one of the determinants of a good death. Ensuring that the dying person is clean and provided with adequate liquid are seen as being good for him or her. Allowing family members to provide bedside care, especially around the moment of death, is of the utmost importance for Chinese persons who are soon to be bereaved. Lastly, "tidying up" the body of the deceased by relaxing the muscles of the eyelids and mouth is also important. Ensuring that the body of the deceased has completely closed eyes and mouth can save a lot of future bereavement work that might otherwise be required to assuage the bereaved person's belief that the deceased's facial expression indicates he or she has much unfinished business in this world.</p> <hd id="AN0018710976-19">Bereavement Care</hd> <p>When working with Chinese bereaved persons, while paying attention to the objective explicit cause of death, the subjective implicit interpretation of the cause of death cannot be overlooked. By reframing the cause in terms of traditional beliefs of external control, unnecessary self-blame can be avoided. Furthermore, showing a genuine interest in the bereaved's personal stories of sensing the return of the deceased in dreams or in the form of an animal or insect may be therapeutic. It can also help the counselor to establish a relationship with the bereaved.</p> <p>As shared by the bereaved persons, their bereaved status seemed to have a negative connotation and is equated with bad luck. Thus, alongside individual counseling of bereaved persons, group work can be a good way of working on the bereaved's feelings of isolation. Advocacy work to empower the bereaved to face the negative social connotations of widowhood and orphan-hood, which is so much a part of the culture, is also needed. The experience of supporting the widowed learning to advocate for themselves in the United States may be relevant here (Silverman, [<reflink idref="bib30" id="ref41">30</reflink>]).</p> <p>In most cases, bereaved persons in our study perceived continuing bonds as positive and helpful in their grief process. The positive tone might be due to the influence of the positive attitude of the counselors towards continuing bond in the counseling sessions under study. According to the counselors in our research meetings, the appreciation of sense of connectedness with the deceased arose spontaneously and not as a consequence of planned intervention. Future studies on clinical intervention and their sense of continuing bond with the deceased among the Chinese bereaved will enable us to move further.</p> <p>Chinese culture involves many traditional rituals conducted during the grieving process that can facilitate accommodation to death. However, many modern Chinese do not know the actual meaning of such rituals. They just follow them blindly. Studying the meaning of these rituals is rare as it is considered a "professional" part of the funeral business. Thus, research in this area can be an important step toward understanding the Chinese bereavement process and opening up the dialogue, in the larger community, about their place in the bereavement process. In conjunction with the use of these rituals, their meaning should be discussed and elaborated on to maximize their positive impact.</p> <p>This pilot study paves the way for a more systematic study of grief among the Chinese. Systematic biases in the present sample are acknowledged; thus generalization of the findings to the entire population of Chinese bereaved persons should be made with caution. All the participants of the study are those who approached JTTC for bereavement counseling. They have both a high level of distress caused by the death as well as having the insight to seek help. They also have a relatively open attitude since they all agreed to have video- or audiotaping of their counseling sessions that might distinguish them from other bereaved people. Biases are also present in the data collection process as these were therapeutic interviews, and therefore some of the information that might have been of value to the researchers was not included in the interview. Furthermore, the interviews were carried out by the five counselors in JTTC. Differences of styles would affect the data collection process. Despite the presence of the biases as stated above, this study is a meaningful beginning. In addition, the verbatim information can aid in developing a local quantitative measurement tool. It will definitely facilitate further development of bereavement studies in Hong Kong to open a doorway for researchers to explore how culture affects the way grief is understood and experienced as well as to learn more about the bereavement experience in this part of the world.</p> <hd id="AN0018710976-20">Acknowledgments</hd> <p>The work described in this article was substantially supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. HKU 7110/01H). We extend our gratitude to Dr. Phyllis Silverman and Dr. Sam Silverman for their valuable feedback to the earlier drafts of this article. 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(1996). Continuing bonds: New understandings of grief. Philadelphia: Taylor & Francis.</bibtext> </blist> <blist> <bibtext> Klass, D. & Walter, T. (2001). Processes of grieving: How bonds are continued. In M. S.Stroebe (Ed.), Handbook of bereavement research (pp. 431–448). Washington, DC: American Psychological Association.</bibtext> </blist> <blist> <bibtext> McKissock, D. & McKissock, M. (1998). Bereavement counselling: Guidelines for practitioners. Terrigal, New South Wales, Australia: Bereavement C.A.R.E. Centre.</bibtext> </blist> <blist> <bibtext> Nadeau, J. W. (1998). Families making sense of death. Thousand Oaks, CA: Sage.</bibtext> </blist> <blist> <bibtext> Nadeau, J. W. (2001). Meaning making in family bereavement: A family systems approach. In M.Stroebe, H.Schut, R.Hannson, & W.Stroebe (Eds.), Handbook of bereavement research (pp. 329–347). Washington, DC: American Psychological Association.</bibtext> </blist> <blist> <bibtext> Neimeyer, R. A. (1999). Narrative strategies in grief therapy. Journal of Constructivist Psychology, 12, 65–85.[CSA][CROSSREF]</bibtext> </blist> <blist> <bibtext> Neimeyer, R. A. (2000). Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Studies, 24, 541–558.[PUBMED][INFOTRIEVE][CSA][CROSSREF]</bibtext> </blist> <blist> <bibtext> Neimeyer, R. A. (2001). Meaning construction and loss. In R. A.Neimeyer (Ed.), Meaning reconstruction & the experience of loss (pp. 1–9). Washington, DC: American Psychological Association.</bibtext> </blist> <blist> <bibtext> Neimeyer, R. A. (2002). Lessons of loss: A guide to coping. Memphis, TN: Centre for the Study of Loss and Transition.</bibtext> </blist> <blist> <bibtext> Neimeyer, R. A. & Hogan, N. S. (2001). Quantitative or qualitative? Measurement issues in the study of grief. In M. S.Stroebe, R. O.Hansson, W.Stroebe, & H.Schut (Eds.), Handbook of bereavement (pp. 89–118). Washington, DC: American Psychological Association.</bibtext> </blist> <blist> <bibtext> Pang, T. H. C. & Lam, C. W. (2002). The widowers' bereavement process and death rituals: Hong Kong experiences. Illness, Crisis, & Loss, 10, 294–303.[CSA][CROSSREF]</bibtext> </blist> <blist> <bibtext> Rees, D. (2001). Death and Bereavement: The psychological religious, and cultural interfaces (), 2nd ed.. London: Whurr Publishers.</bibtext> </blist> <blist> <bibtext> Rosenblatt, P. C. (2001). A social constructionist perspective on cultural difference in grief. In M. S.Stroebe, R. O.Hansson, W.Stroebe, & H.Schut (Eds.), Handbook of bereavement research (pp. 285–300). Washington, DC: American Psychological Association.</bibtext> </blist> <blist> <bibtext> Shuchter, S. R. & Zisook, S. (1993). The course of normal grief. In M. S.Stroebe, W.Stroebe, & R. O.Hansson (Eds.), Handbook of Bereavement (pp. 23–43). New York: Cambridge University Press.</bibtext> </blist> <blist> <bibtext> Silverman, P. R. (2000). Research, clinical practice, and the human experience: Putting the pieces together. Death Studies, 24, 469–478.[PUBMED][INFOTRIEVE][CSA][CROSSREF]</bibtext> </blist> <blist> <bibtext> Silverman, P. R. (2004). Widow to widow: How the bereaved help one another (), 2nd ed.. New York: Brunner-Routledge.</bibtext> </blist> <blist> <bibtext> Silverman, P. R. & Nickman, S. L. (1996). Children's construction of their dead parent. In D.Klass, P. R.Silverman, & S. L.Nickman (Eds.), Continuing Bonds: New Understandings of Grief. Washington, D.C.: Taylor & Francis.</bibtext> </blist> <blist> <bibtext> Stroebe, M. S., Hansson, R. O., Stroebe, W., & Schut, H. (2001). Future directions for bereavement research. In M. S.Stroebe, R. O.Hansson, W.Stroebe, & H.Schut (Eds.), Handbook of bereavement research (pp. 741–766). Washington, DC: American Psychological Association.</bibtext> </blist> <blist> <bibtext> Tong, C. K. (2004). Chinese death rituals in Singapore. London: Routledge Curzon.</bibtext> </blist> <blist> <bibtext> Watson, J. L. (1988). Funeral specialists in Cantonese society: Pollution, performance and social hierarchy. In J. L.Watson, E. S.Rawski, & Joint Committee on Chinese Studies (U.S.) (Eds.), Death ritual in late imperial and modern China (pp. 109–134). Berkeley: University of California Press.</bibtext> </blist> </ref> <ref id="AN0018710976-22"> <title> Footnotes </title> <blist> <bibtext> <sups>1</sups> <emph>Karma</emph> means action. It is one of important concepts of Buddhism that determines one's experiences in their lives. For people doing good deeds, they will have good consequences and vice versa. Good karma is action motivated by non-attachment, benevolence, and understanding whereas bad karma is motivated by greed, hatred, and delusion. One's fortune is solely dependent on oneself. Yet Karma can be accumulated and experienced in later lives. The analogy of seed and fruit is usually referred to when talking about Karma. Karma is the seed that planted under the soil and the consequence is the fruit yielded in special circumstances (Keown, [14]).</bibtext> </blist> <blist> <bibtext> <sups>2</sups> <emph>Qi</emph> is a central concept in Chinese cosmology. It can be translated as "vital energy" or "life force," but this does not capture its essence. Qi can be understood from three perspectives. From a Chinese medical point of view, accumulation of orthopathic qi is life-nurturing. On the other hand, pathogenic external qi (such as cold, heat, damp, and wind) causes illness. The sick qi mentioned by the informant partly referred to this concept. Secondly, qi can be viewed as alchemy, in which special herb or exercise can transform the qi as beneficial. Thirdly, qi can be viewed as geomancy. Cosmic qi can be facilitated or blocked according to the configuration and natural environment with the buildings, thus further affecting the peoples who live or work there (Bray, [1]). The sick qi mentioned by the informant embraced both the first and third points of medical and geomancy.</bibtext> </blist> <blist> <bibtext> <sups>3</sups>In each court of the hell, there is a magistrate and a team of secretary-attendants (Cohen, [8]). The deceased will be tried based on his actions and deeds on earth. Each court has its own mandatory punishments for specific wrongdoing. For example, the second court is for doctors who malpractice; they will be cut into pieces. The fourth court is a bed of sharp nails for pinning dishonest merchants. The tenth court is the court of reincarnation, where the magistrate will decide whether the deceased to be reincarnated into an insect, animal or human in the next life and to which family they to be born as well as into a male or female (Tong, [33]).</bibtext> </blist> </ref> <aug> <p>By CeciliaL. W. Chan; AmyY. M. Chow; SamuelM. Y. Ho; YennyK. Y. Tsui; AgnesF. Tin; BrendaW. K. Koo and ElaineW. K. Koo</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib27" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib23" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib15" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib13" firstref="ref8"></nolink> <nolink nlid="nl5" bibid="bib25" firstref="ref9"></nolink> <nolink nlid="nl6" bibid="bib24" firstref="ref10"></nolink> <nolink nlid="nl7" bibid="bib32" firstref="ref12"></nolink> <nolink nlid="nl8" bibid="bib17" firstref="ref15"></nolink> <nolink nlid="nl9" bibid="bib29" firstref="ref16"></nolink> <nolink nlid="nl10" bibid="bib34" firstref="ref21"></nolink> <nolink nlid="nl11" bibid="bib33" firstref="ref24"></nolink> <nolink nlid="nl12" bibid="bib18" firstref="ref27"></nolink> <nolink nlid="nl13" bibid="bib20" firstref="ref29"></nolink> <nolink nlid="nl14" bibid="bib21" firstref="ref30"></nolink> <nolink nlid="nl15" bibid="bib22" firstref="ref31"></nolink> <nolink nlid="nl16" bibid="bib12" firstref="ref32"></nolink> <nolink nlid="nl17" bibid="bib31" firstref="ref34"></nolink> <nolink nlid="nl18" bibid="bib28" firstref="ref35"></nolink> <nolink nlid="nl19" bibid="bib26" firstref="ref36"></nolink> <nolink nlid="nl20" bibid="bib16" firstref="ref37"></nolink> <nolink nlid="nl21" bibid="bib10" firstref="ref38"></nolink> <nolink nlid="nl22" bibid="bib11" firstref="ref39"></nolink> <nolink nlid="nl23" bibid="bib30" firstref="ref41"></nolink>
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  Data: The Experience of Chinese Bereaved Persons: A Preliminary Study of Meaning Making and Continuing Bonds
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  Data: <searchLink fieldCode="AR" term="%22Chan%2C+Cecilia+L%2E+W%2E%22">Chan, Cecilia L. W.</searchLink><br /><searchLink fieldCode="AR" term="%22Chow%2C+Amy+Y%2E+M%2E%22">Chow, Amy Y. M.</searchLink><br /><searchLink fieldCode="AR" term="%22Ho%2C+Samuel+M%2E+Y%2E%22">Ho, Samuel M. Y.</searchLink><br /><searchLink fieldCode="AR" term="%22Tsui%2C+Yenny+K%2E+Y%2E%22">Tsui, Yenny K. Y.</searchLink><br /><searchLink fieldCode="AR" term="%22Tin%2C+Agnes+F%2E%22">Tin, Agnes F.</searchLink><br /><searchLink fieldCode="AR" term="%22Koo%2C+Brenda+W%2E+K%2E%22">Koo, Brenda W. K.</searchLink><br /><searchLink fieldCode="AR" term="%22Koo%2C+Elaine+W%2E+K%2E%22">Koo, Elaine W. K.</searchLink>
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  Data: <searchLink fieldCode="SO" term="%22Death+Studies%22"><i>Death Studies</i></searchLink>. Dec 2005 29(10):923-947.
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  Data: Customer Services for Taylor & Francis Group Journals, 325 Chestnut Street, Suite 800, Philadelphia, PA 19106. Tel: 800-354-1420 (Toll Free); Fax: 215-625-8914.
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  Data: 25
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  Data: 2005
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  Data: Journal Articles<br />Reports - Evaluative
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  Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Asian+Culture%22">Asian Culture</searchLink><br /><searchLink fieldCode="DE" term="%22Death%22">Death</searchLink><br /><searchLink fieldCode="DE" term="%22Grief%22">Grief</searchLink><br /><searchLink fieldCode="DE" term="%22Counseling%22">Counseling</searchLink><br /><searchLink fieldCode="DE" term="%22Interviews%22">Interviews</searchLink><br /><searchLink fieldCode="DE" term="%22Cultural+Traits%22">Cultural Traits</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink>
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  Label: Geographic Terms
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  Data: <searchLink fieldCode="DE" term="%22Hong+Kong%22">Hong Kong</searchLink>
– Name: ISSN
  Label: ISSN
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  Data: 0748-1187
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: This study explores the bereavement process of Chinese persons in Hong Kong, with the focus on how they make meaning of the death as well as how they maintain a bond with the deceased. A review of video- and audiotapes of 52 bereaved persons in bereavement counseling pointed to how these concepts are reflected in key themes that appeared throughout these interviews. The way this bereaved population found meaning in the death was reflected in how they understood the cause of death, their observations at the death moment, their understanding of the life of the deceased after the death, the life of the bereaved after the death, and the burial and mourning rituals that were followed. The continuing bond the bereaved felt with the deceased was experienced by the bereaved as either initiated by the deceased, for example by the deceased appearing in dreams or initiated by the bereaved themselves in their talking with the deceased. These 2 aspects of the bereavement process seem to be similar to those found in other societies, but the ways in which they were manifested were unique to the Chinese culture. Based on these findings, the authors conclude with implications for intervention with this bereaved population.
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  Data: 2005
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 25
        StartPage: 923
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Asian Culture
        Type: general
      – SubjectFull: Death
        Type: general
      – SubjectFull: Grief
        Type: general
      – SubjectFull: Counseling
        Type: general
      – SubjectFull: Interviews
        Type: general
      – SubjectFull: Cultural Traits
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Hong Kong
        Type: general
    Titles:
      – TitleFull: The Experience of Chinese Bereaved Persons: A Preliminary Study of Meaning Making and Continuing Bonds
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            NameFull: Chan, Cecilia L. W.
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            NameFull: Chow, Amy Y. M.
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            NameFull: Tsui, Yenny K. Y.
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            NameFull: Tin, Agnes F.
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            NameFull: Koo, Brenda W. K.
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            NameFull: Koo, Elaine W. K.
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