Abstract
Grief is a universal emotion, both layered and multidimensional. Grief in Arab cultures center around three ideals: culture, family, and religion. This paper examines the multiple different factors that influence Arabs during their grief, broken down into how different religions process and view death, along with the impact of Westernized ideals and other relationships. We explore physiological responses of grief, gender differences in expressing emotions, self-care practice, and utilizing religion as a strength. The rules and traditions surrounding grief and loss in Arab communities need to be acknowledged by clinicians and incorporated into their practice. Recommendations and future directions for clinicians to support Arab grief within the three lenses of culture, family, and religion.
Grief
Grief often manifests itself in multiple different ways, stemming from a significant loss of a person or object (Pomeroy, 2011). Grief is a common reaction to the feeling of loss; “it is a complex phenomenon, and it transversally affects many cultures; while the experience of grief is unique the whole grief process is personally, relationally, and culturally defined” (De Stefano et al., 2020, p. 493). Grief is a personal experience that is based on traumatic and life-changing events that occur in an individual’s lifetime (Delespaux et al., 2013). Unfortunately, grief is experienced universally by many during the course of their existence (Joe et al., 2010). Grief is normally used to describe an emotional response to the feeling and experience of a death of a loved one, this closeness of a relationship produces grief (King & Delgado, 2021). Grief is a reaction to bereavement (Shear, 2012).
Grief consists of physiological behavioral changes as well as thoughts, feelings that may vary over time (Shear, 2012). Grief is a process that may have biological, social, physical, emotional, mental, and spiritual effects (O’Connor, 2019). This process may look differently for everyone (Pomeroy & Hart, 2012). People react to grief through different emotions like sadness, anger, guilt, and love (Lyness, 2013). Some people may experience physiological responses to grief like having tense muscles or trouble concentrating and others react to grief through having frequent thoughts which surround happy memories of the deceased, worries, or regrets (Lyness, 2013). Some consequences of grief are worsened educational outcomes, emotional withdrawal, symptoms of depression and anxiety, increased irritability, lower self-efficacy and riskier behaviors like self-harming, promiscuity, reckless driving, and/or substance use (Mauk, 2011).
The trauma associated with the death of a loved one can cause psychiatric disorders including mood disorders, anxiety disorders, and substance use disorders (Lyness, 2013). Individuals experiencing grief may also have issues sleeping and eating as well as psychosomatic symptoms and declines in academic performance (Berg et al., 2016). Adolescents are at larger risk during the grieving process because the loss may impact identity formation (Herberman Mash et al., 2013). Since bereavement affects development, the effects of grief and loss on adolescents impacts their lives physically, cognitively, emotionally, behaviorally, and spiritually (Herberman Mash et al., 2013). The way Arabs manage their grief for loved ones who have died is a unique yet overwhelming experience. Mourning is the action and manner of expressing grief and such expressions are contingent upon and differ with every culture (Azzi, 2019).
To contextualize the literature reviewed, the information presented, as well as the recommendations provided, as authors we wanted to be transparent in providing readers our social locations. The first author is Hispanic and Arabian, a heterosexual woman with Ph.D. in Counselor Education and Supervision: Marriage and Family Therapy. The second author identifies as an Arab-American heterosexual woman with a Masters in Counseling. The third author is a Muslim Arab American female student counselor in training. Finally, the fourth author identifies as a Muslim Arab American female student who studies health science in community health. The purpose of this paper is to explore how Arab Americans grieve and provide specific, culturally informed clinical recommendations for clinicians working with this population.
The rules and traditions
The manner in which people manage how they deal with grief and mourning is a helpful window into a culture and people. When focused on losses that are part of everyday life, we can learn a lot about a culture and about our shared humanity (Rubin & Yasien-Esmael, 2004). Influenced culturally, Arabs formed certain rules and traditions that allow for ways to cope with a loss. The effects of race, culture, and family upbringing influence the way people cope with grief and loss; “however, because grief is a personal experience, it is expressed in various ways” (Matthews, 2016, p. 1). When someone has passed away, bereavement is not limited to only the immediate family but it is affecting the entire social framework. Thus, the community copes as a whole (Muhammad, 2016). Those who are bereaved receive the support from their community while coping with the loss, especially from those who are not immediate to the person who died, or they have never known before.
During the grieving process, there are some instances that women wear black since day one of the event, some wear black for 40 days or a year, and others might wear black even for a longer period (Muhammad, 2016). In conjunction with wearing black clothing, most women do not wear makeup or nail polish. Also, avoiding parties and playing loud, distracting music, postponing weddings, or devoting time to one’s studies to honor the dead are some of the acceptable ways of expressing grief (Kulwicki, 2020). The moment the death of the person is announced, people of the Arab community respond in different ways. Women may respond with shrieking, wailing, pulling of their hair, or clothing (Muhammad, 2016). Women are perceived as more sensitive and more defined by relationships, and less able to separate from either the living or the dead. Women are allowed the freedom to be less constrained, while men face a more rigid role expectation (Yasien-Esmael, 2000). In specific cases, Arabs will honor the person who has passed by doing a traditional wedding zaffeh celebration. A zaffeh is conducted by a group of men who sing, clap, and play instruments at the groom’s house and then take the groom’s family to the bride’s home to escort the couple to their ceremony or reception (Perdew, 2015). This is a Middle Eastern traditional wedding celebration, but also can occur during the funeral prior to the burial setting. This is occurrence is most common when a young male or female (ages 20–40) has passed away, especially if they are unmarried. Usually, this will not occur to males or females over the age of 40 due to their age and younger males and females passing away is not as expected. This is not typical for an older person; in fact, it would be considered taboo.
Further, in relation to gender roles, men and women are separated during the funeral and memorial. This varies across Christian and Muslim religious traditions, for example, Islamic traditions allow only men to participate in the funeral because women are obligated to stay home as they are assumed to disturb the dead (Muhammad, 2016). While it is customary for women to stay home during the funeral procession, strictly speaking, this is not a religious obligation because there is no established law that prohibits the attendance of women at burials (Muslim Women’s League, 2013). Generally speaking, this topic of conversation is controversial among many Muslim scholars who are familiar with Sharia (Islamic) law; although the prevailing consensus on this ruling is that it is discouraged (Al-Azami, 2019). Hence, there is no exact answer or ruling because of the multiple ways scholars interpret the evidence. The rules and traditions of grief and loss among Arabs do vary, especially while taking in consideration the Christian and Islamic practices. There are many overlapping cultural norms in reference to death, although religious practices may further complicate and explain these terms better—it is typically what is followed most often (Figure 1).
Culture and Religion.
Religious practices
Coping with the loss of a loved one has the potential to be a difficult emotional transition for the bereaved, but religion serves to help the bereaved to deal with his or her loss (Rubin & Yasien-Esmael, 2004). Moreover, religious beliefs help reframe death and give it meaning, believing that the deceased is not considered dead but rather living beside God (Varga et al., 2015). Religion influences culture, sets boundaries, and lays the foundation for appraising and integrating new information and situations (Rubin & Yasien-Esmael, 2004). Religious bereavement rules and traditions have quite diverse applications and effects as well, and it is suggested that the churches could be psychologically helpful to many bereaved people if they would offer a clear lead in prescribing a period for mourning, thus saving them confusion and insecurity in their grief (Mantala-Bozos, 2003). Overall, religion and different religious institutions play a role in providing comfort and support to the bereaved. It provides a sense of meaning and purpose, universality, and a meaningful connection to others (Algauer, 2021).
Eastern orthodox christian
Orthodox Christians believe God is their source of faith and that there is no division between the living and the dead. Orthodox Christians on earth pray for one another and ask for one another’s prayers, so they also pray for the departed and ask the departed to pray for them (Ware, 1997). Orthodox Christians duties are to pray for the departed and they are assured that their prayers are helping those who have passed away; customs infuse the lives of people that when someone dies everyone knows what is to be done and how to participate in it (Wood & Rowatt, 2006).
Although there are variations to funerals, the Orthodox funeral consists of three services: the vigil service or the Trisagion, the Funeral Service, and the Memorial Service. The Trisagion Service usually occurs the night prior to the funeral and anniversaries of the departed. This service is a request for God to grant rest to the departed soul so that it receives mercy (Funeralwise, 2018). During this service, the phrase “Holy God, Holy Mighty, Holy and Immortal, have mercy on us” is recited and includes asking Christ to give rest with the Saints to the soul of the person who passed where there will be no pain or grief but life everlasting (Funeralwise, 2018). The following day is the Funeral Service and burial of the departed, in which the Divine Liturgy is celebrated and is the farewell to the deceased (Coriell, 2021). The Memorial Service is a repetitive service that occurs throughout the year; 1 week, 40 days, and 1 year after the death. Orthodox Christians commemorate the departed to recognize gratuity for eternal life and bring a sense of peace for those grieving (Coriell, 2021).
Muslim
A Muslim is an individual who practices the religion of Islam; through the belief in Allah (God) and respecting and believing in all prophets and valuing Muhammad as the last prophet sent by God (Sachedina, 2005). Muslims have beliefs, rituals, and customs that are practiced but are unrepresented in literature and poorly understood by mental health practitioners and health professionals alike (Sheikh, 1998). Death is not a taboo subject for Muslims (Kristiansen & Sheikh, 2012; Sheikh, 1998). On the contrary, Islam encourages Muslims to be mindful of the temporary nature of this life and to focus on spiritual growth (Kristiansen & Sheikh, 2012). Death marks the transition of moving from this life to the hereafter, that life itself is a test (Sheikh, 1998). Moreover, Islam teaches that all souls will taste death, because death is seen as the will of Allah and an inevitable part of life (Khawaja & Khawaja, 2019). The Islamic perspective surrounding death stipulates the underlying belief that one should take comfort knowing that life and death do not occur except with God’s permission and Muslims believe in life after death (Baggerly & Abugideiri, 2010). Moreover, Muslims accept that Allah has reasons unknown to believers, for taking the life of a person (Khawaja & Khawaja, 2019). Muslims regard death, loss, and even illness as tests from Allah, and Muslims turn to Allah as a major source of comfort knowing that Allah is aware of any suffering they go through (Kristiansen et al., 2016). As imperfect beings, these beliefs do not lessen the grief that comes with death.
Muslims are expected to bear their loss patiently in acceptance of God’s will (Baggerly & Abugideiri, 2010). For some Muslims, they may find blessings in the hardship that comes with death and grief, and religious beliefs in relation to death and bereavement serve as strategies to help them understand, react, cope, and even move on from their loss (Kristiansen & Sheikh, 2012). The grieving practice itself varies depending on culture; in some, expressions of grief are quiet and restrained compared to other cultural practices, expressions of grief are more explicit through yelling, crying, and wailing for their loss (Al-Domi, 2015; Baggerly & Abugideiri, 2010). The latter form of expression of grief through excessive and unnecessary wailing is strongly discouraged in Islamic practices but does not mean that sadness and grief are signs of disbelief (Kristiansen & Sheikh, 2012). Islamically, the formal mourning period after the loss of a loved one is 3 days (Ahaddour et al., 2018; Gatrad, 1994). After 3 days, loved ones of the deceased are encouraged to continue their lives as much as possible after those 3 days, but of course, no time limits exist in healing after a loved one has passed. This waiting period is designed to allow the bereaved to grieve, but to also fulfill a religious duty toward Allah [God] (Ahaddour et al., 2018). Religiously, there is a set number of days given to cope with the loss of a loved one, but this does not exempt the grieving process to continue after those 3 days. Remembering death is God’s will and believing that Muslims return to God after death may provide and bring comfort to grieving Muslims by understanding the spirit of the deceased lives on even though the individual leaves their physical body at the time of death (Kristiansen et al., 2016). There are certain death customs to be abided and universally practiced by all Muslims, regardless of culture or ethnic background (Ahaddour et al., 2018; Sheikh, 1998). It is a religious requirement for the body to be buried immediately, following the ritual washing (ghusal) and shrouding of the body (kafan), and ending with the funeral prayer (salat a-janaza/h) and body being buried toward Mecca (Ahaddour & Broeckaert, 2017; Al-Dawoody & Finegan, 2020; Gatrad, 1994; Kristiansen & Sheikh, 2012). The dignity of the dead and their family must be respected at all points during the Islamic burial practices (Al-Dawoody & Finegan, 2020). Therefore, during the washing and draping of the body, it is done almost exclusively by respected elders of the same sex who are well-versed in Islamic burial practices (Gatrad, 1994). When a Muslim dies, graves are dug so the body is faced and buried in the direction of Mecca (Ahaddour & Broeckaert, 2017; Gatrad, 1994), with the eyes and mouth of the deceased closed and turned on their right side (Sheikh, 1998). Often, the dead will be buried within 24 hours (Sheikh, 1998) or preferably as soon as possible in order to preserve the body the way it was created in its righteous state back to Allah, as well as saving the family of the deceased from more distress, burden, and pain (Gatrad, 1994). The funeral itself and the acts leading up to the funeral, such as the funeral prayer, is held in the local mosque (Sheikh, 1998). Family and community members pray for the soul of the deceased by participating in the funeral prayer, also known in Arabic as the janazah. This prayer is not performed in the same manner as the obligatory prayers in Islam, because there is no sujood or prostration. Following the funeral procession to a Muslim graveyard, a final prayer is said and the deceased is laid to rest in a simple wooden box with no decorations (Ahaddour et al., 2018; Gatrad, 1994; Sheikh, 1998); Muslim bodies are always buried and never creamated (Al-Dawoody & Finegan, 2020; Gatrad, 1994). Typically, on the same day and following the funeral, a “wake” (also known as a/an azza in Arabic) is held for both men and women of the deceased’s family, in the form of a meal (Gatrad, 1994). The grieving process for many Muslims is shaped by their understanding of death and belief in an after-life, which provides comfort in knowing that the separation, although painful, is temporary (Kristiansen et al., 2016). These are significant coping mechanisms because Allah is appraised in the Quran as “Ar-Rahman” and “Ar-Raheem, which translates to “The Most Gracious” and “The Most Merciful”; the Arabic term for mercy is rahmah, and the two most important names of God (Allah) are derived from this root (Stacey, 2010). Therefore, Allah is aware of the pain associated with the loss of a loved one, in turn reminding Muslims the promise of comfort, strength, and patience when using religious practices like salah and dua (prayer) and the recitation of Quran to cope during their grieving process (Ahaddour et al., 2018; Kristiansen & Sheikh, 2012). The bereavement process for Muslims who rely on their religious practices during their grief allows for a time of reflection in one’s life accordingly and as needed (Kristiansen & Sheikh, 2012).
Another example of religious bereavement practices which vary from cultural practices is the concept of the iddah (also seen and spelled as idda’ or iddat) in Islam. The iddah, simply meaning waiting period, is the waiting of time that applies to Muslim women whose marriage is broken legally through divorce or physically through the death of a husband (Emhail, 2019). While there is a(n) iddah for when a woman is divorced, the following explanations are focused mostly on the loss of the husband through death. The Islamic waiting period is for a interval of 4 months and 10 days (Emhail, 2019), and the introduction of the iddah is mentioned in the Quran: “And those who are taken in death and leave wives behind, let them [the wives] observe a waiting period of four months and 10 days” (Quran, 2:235).
The concept of the waiting period in Islam is observed as a means of reflection during this grieving time (Yusufi, 2014). During the period of time of 4 months and 10 days (130 days), the widow observes the death of her husband during which she may not marry another man (Ahaddour et al., 2018; Yusufi, 2014). The widowed woman must observe her iddah in the house shared with her husband, to stay at home in mourning and to not leave the house unless for necessities—Islamic scholars have varied on the term necessity to individual circumstance such as work, medical attention, caring for dependents, etc. This period also serves as a means to find out if the widow who was left behind by the husband is pregnant or not (Ahaddour et al., 2018; Gatrad, 1994; Romadoni, 2019). There is an exception to be made if the widowed woman is pregnant, and her iddah is considered complete when she gives birth to her child (Emhail, 2019). Islam considers the iddah as a means of reform and return, allowing for appropriate time for grieving and rethought (Emhail, 2019). Islam gives the iddah to women to grieve properly over her deceased husband without feeling the pressure to worry about other issues (Emhail, 2019); and which more often than not, are taken care of by close family members and relatives. In traditional Muslim communities, family members, and relatives help take care of the widow and any dependents by visiting frequently and bringing food on behalf of the deceased (Emhail, 2019). The Muslim community surrounding the deceased often takes care of the widow in many ways and may provide support through psychological, financial, or material help (Ahaddour et al., 2018). Religious support is also offered during times of grief through dua (prayer) and reading Quran; both acts of religious aid signify a sense of purpose for the bereaved and eases the soul of the deceased through the remembrance of Allah (Ahaddour et al., 2018). The iddah is designated for the widow to grieve, mourn, reflect, until she has gained some strength and clarity to eventually transition into the next stage of her life (Emhail, 2019). This time is set aside to care for themselves and focus on their grief through their spirituality, religion, and remembrance of Allah (Emhail, 2019).
Available treatments
Bereavement service use rates range from 10% to 30% and associated factors included: spousal relationship, younger age, complicated caregiving context, major depressive disorder, and adequate instrumental support (Cherlin et al., 2007). The prevalence of prolonged grief disorder in the U.S. is about 6.7% (Eddinger et al., 2021). Prolonged grief disorder is best explained as, “a person who has experienced death 12 months prior, and experiences symptoms of intense yearning or sorrow” (Eddinger et al., 2021, p. 447). Some forms of treatment include pharmacotherapy, assessment instruments, and psychotherapy (Jordan & Litz, 2014). The pharmacotherapy method did not have a clear treatment approach, or any evidence of benefiting those who suffer from a prolonged grief disorder. Although there is no evidence of pharmacotherapy treating Prolonged Grief Disorder, some researchers say it may be beneficial in conjunction with psychotherapy (Simon, 2013).
The treatment of psychotherapy has shown to produce long lasting benefits for individuals who have prolonged grief disorder, with the involvement of individual therapy, group therapy, and internet based interventions (Litz et al., 2017). The DSM-5 also known as, the Diagnostic and Statistical Manual of Mental Disorders, is used in psychiatry to better justify the difference between normal and deranged psychological functioning (Horwitz & Wakefield, 2007). Bereavement is best described as an individual’s reaction to a loss by death (Zisook & Shear, 2009). The typical emotional and or psychological reaction to a loss of death is grief (Zisook & Shear, 2009). In most cases, individuals often experience mourning which is a social expression of grief or bereavement and is influenced by religious beliefs or cultural customs (Zisook & Shear, 2009). Bereavement is a known risk factor for those who are affected by major depressive syndromes (Karam et al., 2009). Bereavement and its involvement with major depressive syndromes, is best described as being the only life event that has been embedded in the diagnosis of major depression in the DSM-IV classification (Karam et al., 2009).
Researchers have investigated and implemented numerous treatment outcomes related to those who experience hoisted post-traumatic stress disorder symptoms regarding prolonged grief (Eddinger et al., 2021). Confronting traumatic experiences people endure during their lifetimes has been found to reduce the avoidance of the trigger (Eddinger et al., 2021). This has also been shown to implement further reduction of distress which allows a reconnect in functional, pleasurable, and meaningful activities (Eddinger et al., 2021). Dyregrov et al. (2013) discussed how participants rated grief groups negatively when they felt the groups were not fulfilling their needs or expectations, added to existing personal stress, lacked organization or structure, and had insufficient leadership. Notwithstanding negative ratings, the participants still noted that they would advocate participation for other bereaved (Dyregrov et al., 2013).
Chang et al. (2016) successfully implemented a video conference grief group; participants reported that they would not have gone without mental services without the program, believed the program was as good as face-to-face services, and the program helped them deal with their problems effectively. Furthermore, Knowles et al. (2017) found their virtual reality intervention led to improvement in grief related symptoms and a significant improvement in depression over time. Kersting and Wagner (2012) studied the benefits of using internet-based group grief counseling with mothers who had suffered a miscarriage. Further, an article pertaining to children who have lost a family member due to murder, it was found that in past times, children were not fully capable of grieving due to their limited abilities of comprehension (Shalev et al., 2021). It is contingent upon the child’s environment and if they are able to understand the true concept of death (Shalev et al., 2021).
Recommendations for clinicians
The use of grief interventions has shown to be beneficial in reducing the severity of complicated grief, the subset of the population experiencing a complicated or prolonged grief reaction (Wittouck et al., 2011). Unfortunately, individuals experiencing grief and other mental health conditions are often unable to access mental health services such as grief therapy, particularly Arab Americans. All authors encourage the seeking of therapeutic treatment for grief. The authors advocate that people like us be understood first to then be treated by therapists regardless of their own gender, culture, ethnicity, sexual orientation, etc. Multicultural considerations in therapy are necessary despite setting or population (Finney et al., 2020; Tadros & Owens, 2021; Tadros et al., 2021). For example, Arab Americans who engage in therapeutic services may be hesitant to trust the therapist due to the cultural norms of keeping personal lives confidential (Tadros et al., 2022). Scholars have recommended that mental health professionals educate themselves not only on the stigma experienced by this population, but the rationale for its presence (Tadros et al., 2022). Further, authors urge therapists to be mindful not to not perpetuate stigma that is already present surrounding middle eastern individuals. Lastly, although we believe there is a lot of overlap, we acknowledge that these recommendations may not be as effective or impactful in Arab countries as they are specifically tailored to Arab Americans.
The five stage of grief
In Elisabeth Kübler-Ross’ “On Death and Dying (1969) she documents observations of adjustment among dying patients. The five well known stages—denial, anger, bargaining, depression and acceptance—are often accepted and referred to as if they happen in order, moving from one stage to the other (Avis et al., 2021). Many individuals believe that the process can be explained simply through these five steps, starting with denial and ending with acceptance, but for many there is no telling how and when they will accept the death of a loved one. Grief is a human emotional response to loss (Avis et al., 2021), not to be categorized and checked off strictly by five stages. Attempting to explain something as complex as the grief process to five stages does a disservice to those grieving, considering that the five stages of grief was created for terminally ill individuals and not those who are experiencing severe emotional loss (Avis et al., 2021). The five stages of grief can complicate the feelings of the bereaved by trying to simplify their emotions with putting a label on them. Moreover, these labels may result with bereaved individuals feeling alienated, angry, and guilty that they may not be grieving in the “correct,” “idealized,” or “accepted” way (Avis et al., 2021). The bereaved may initially respond to their loss through denial which is the inability to acknowledge loss.
The grief stages express minimally to “how people might cope with the loss; why they might experience varying degrees and kinds of distress at different times; and how, over time, they adjust to a life without their loved one” (Stroebe et al., 2017, p. 460). Kübler-Ross and Kessler suggest that the grief stages are not stops on a linear timeline in grief, and not everyone goes through all the stages in a prescribed order. Stroebe et al. (2017) explain that although anger is a common grief symptom which is not a universally experienced emotion, it is a necessary stage of the healing process. Clients worry they are not experiencing the stages in the right order and the stage theory promotes an idea of orderly progression through distinct periods of grief and grieving (Stroebe et al., 2017).
Physiological responses
People react to grief emotionally, physically, and cognitively. Strong emotional reactions to grief and loss include sadness, anger, guilt, relief, love, and hope (Lyness, 2013). Grief is a psychobiological response to the death of a loved one characterized by sadness, yearning, waves of emotional pain, and loss of appetite and sleep (LeBlanc et al., 2016). Recovery from loss is based on the bereaved person’s ability to reestablish self-regulation and if they are unable to do so they may be at risk for Complicated grief (LeBlanc et al., 2016). Complicated grief “is a disorder occurring in approximately 10% of people bereaved by natural causes and is characterized by persistent, impairing grief with difficulty adapting after the loss of a loved one” (Szuhany et al., 2020, p. 2). Evidence suggests that subjective sleep quality, onset, and maintenance may be impaired in patients with Complicated grief due to nighttime rumination about the loss and dreaming of the deceased (Szuhany et al., 2020).
Additionally, insomnia has been commonly associated with bereavement and it has been reported that grief is linked to impairments in sleep (Hardison et al., 2005). Researchers found that disturbances of sleep were more common among the bereaved over a year following the loss with reports of trouble falling asleep or awakening in the middle of the night (Hardison et al., 2005). The entertainment business can play a role in showcasing related symptoms regarding sleep disturbances and related issues. References to similar physiological responses in the music industry are expressed lyrically by the artist Kid Cudi:
Tell me what you know about them night terrors every night. Five AM cold sweats, waking up to the sky. Tell me what you know about dreams, dreams. Tell me what you know about night terrors, nothin’. You don’t really care about the trials of tomorrow. Rather lay awake in the bed full of sorrow.
The emotional trauma of bereavement can be expressed through physical trauma by teeth grinding, breast-beating, and tearing one’s hair out (Harrop-Griffiths et al., 1990). Some people may experience having tense muscles and or have trouble concentrating (Lyness, 2013). Unexpected loss(es) resulted in higher levels of depression and somatic complaints (Rubinstein, 2004).
Expressing emotions
Many grieving individuals feel guilty for moving on with their life because their deceased loved one no longer has meaning in their life nor a life to live (Matthews, 2019). Individuals who are processing and experiencing their grief are still able to grow and find meaning in their life, it does not have to be one or the other (Klass, 2013). The absence due to the death of a loved one can leave an emptiness in the life of the bereaved which results in an additional loss of goals, values, or identity (Klass, 2001). The deep feelings of despair and disorganization may persist as a reaction to the loss (Henry, 2008) due to the relationship the bereaved had with the deceased. The loss of a loved one can become harder to accept when the bereaved have defined themselves through the deceased (Matthews, 2019). Most bereaved individuals are unable to find meaning in the loss, particularly if the loss was unexpected or if they had a close relationship with the deceased (McLean et al., 2022). Because bereavement is a common feeling shared among those who have lost a loved one, the responses to the loss of a loved one varies widely among individuals, especially depending on the relationship (McLean et al., 2022). Thus, recognizing that coping with bereavement is influenced by the nature of the relationship and the closeness to the deceased (Kristiansen & Sheikh, 2012). When people are very close, their emotional bond with someone does not end in death (Matthews, 2019). Therefore, it is important for bereaved individuals to understand what to expect while coping with loss including knowing the reasons behind the feelings of guilt, shame, anger, and shock; while understanding that grief and the feelings associated with experiencing grief are common (Avis et al., 2021).
Death at times leads to emotional reactions, but for many, turning to religious and cultural practices as a crutch during times of hardship may help to make sense of the situation (Khawaja & Khawaja, 2019). The healing process deepens when there is confrontation by a raw emotion (Symington, 2012). The grieving process helps to encourage the bereaved to develop different ways to regulate their emotions following the death of a loved one (Jordan & Litz, 2012). This can occur when the bereaved makes an attempt to slowly return back to the everyday routine in their life (Jordan & Litz, 2012). Even though the grieving process is not fully understood because of how different it appears on everyone, there are similarities shared amongst bereaved individuals (Jordan & Litz, 2012). A common practice associated with how the griever expresses their loss may consist of frequent thoughts that include happy memories, worries, or regrets (Lyness, 2013) triggered by looking at pictures or sharing stories that serve as reminders of the reality and extent of the loss. Bereaved individuals find themselves grieving deeply over the loss of their loved one (Jordan & Litz, 2012); although sharing and expressing the intensity of these emotions varies significantly across gender.
Most gender differences occur around death, with women showing their grief more than men (Rubinstein, 2004). These vast differences exist between men and women with regards to emotional expression (Varga et al., 2015). Crying is a way to express and release negative emotions like grief and sadness (Al-Domi, 2015). There are times, especially while grieving the loss of a loved one, where words are unable to fulfill the role of expressing emotion; and crying becomes the manifestation of emotion through the soul (Al-Domi, 2015). In Arab cultures, it is common for women to verbally express emotions of grief and loss through sadness, wailing, and keening (Varga et al., 2015). While it is human nature to express sadness after experiencing the loss of a loved one, the expectations for men are to control their emotions and maintain their grief quietly (Varga et al., 2015). There should not be any stigmatization in expression of grief and emotion based on gender, because grief is an emotion-focused process. Individuals need to feel safe in expressing their emotions since withholding them is proven to exhibit both physically and physiologically. Guilt in bereavement is a powerful emotion, one that tends to be felt and expressed significantly by both genders, especially when coping with unexpected loss (Wagner et al., 2021).
According to a recent journal article pertaining to prolonged grief disorder, it has been found that one common characteristic people share is having developmental maladaptive thoughts (Skritskaya et al., 2020). Similarly, to an irrational belief, a maladaptive thought tricks the bereaved individual into thinking that they are forbidden and cannot move on, move forward, or manage without the presence of the deceased (Skritskaya et al., 2020). Ruminating on the idea that the only solution available to managing the emotional burden of grief and bereavement is the return of the deceased constitutes a maladaptive thought (Skritskaya et al., 2020). When it comes to prolonged grief disorder, maladaptive thoughts play a huge role because these types of thoughts have clinical research significance regarding prolonged grief disorder and the treatments associated (Skritskaya et al., 2020). It has been found that the definite grief related maladaptive thoughts differentiate between the types of loss an individual endures and due to this, it increases the rate of suicidality (Tal et al., 2017). Further, maladaptive cognitions have been found to be present in individuals who have prolonged grief disorder (Skritskaya et al., 2020).
Utilizing religion as a strength/coping
Losing a loved one and experiencing death hurts no less with spiritual, religious, or cultural practices, but these play an important role during the grieving process (Khawaja & Khawaja, 2019). Religious and spiritual beliefs regarding those who undergo the process of overcoming grief, can be considered strengths clients already possess. Strengths can contribute to solutions for presenting problems such as grief. Grief looks different for everyone, and while Arabs share similar cultural beliefs when it comes to death and bereavement, no two Arabs will process their grief in the same way. Bereavement goes beyond the individual or the family inflicted with the loss, it involves the religious community that is expected to support the person who has passed away by aiding the bereaved and helping them cope with their loss (Kristiansen & Sheikh, 2012). For some Muslims, religious beliefs serve as resources helping them understand, react, and eventually accept their loss when dealing with grief and loss. Muslims may be less likely to suffer the adverse effects on physical health and psychological well-being associated with the responses to bereavement when they find the blessings in their hardships (Kristiansen & Sheikh, 2012). Many Muslim Americans value and set their faith on a higher standard and believing in the healing power of Islam is enough for some Muslim Americans (Tadros et al., 2022); moreover, those with a strong belief system that faith in God is the true healer to the mind, body, and soul tend to express that therapy is unnecessary and at times, ineffective (Smith, 2011).
Solution Focused Brief Therapists (SFBT) enlighten clients to observe the client’s own self, possibly through religion. Christians believe in the power of God to provide solutions to their problems and by integrating the Christian values into a SFBT approach allows for humility and a positive view of the world. The cosmology of SFBT and the Kingdom of God overlap with the idea of the here and now (Frederick, 2008). The Kingdom of God is an important dimension of theology within Christianity; Jesus Christ is the first sign of God’s future Kingdom (Frederick, 2008). God sent His only begotten Son to enter the human world and to initiate God’s Kingdom indicating His intervention from the future to impact our present (Frederick, 2008). SFBT encourages Christians to see the Kingdom of God in the now rather than in the future when one goes to heaven. As for Muslim clients, empowerment is facilitated in Islam involving collaboration, context, critical consciousness, competence, and community. SFBT therapists collaborate to define problems and together create solutions for them. Further, competence seeking minimizes shame and disappointment which is commonly linked to Muslim clients seeking therapy. The therapist can then empower the client to explore their own strengths and resources. “SFBT offers the possibility of living in a more satisfying and diverse sense of experience and narrative” (Frederick, 2008, p. 416).
Self-care
Regarding self-care, it is understood that having healthy self-care methods are effective during an individual’s journey through grief and loss. However, self-care tends to be not as prominent when an Arab or Arab American is dealing with the loss of a loved one because the focus is on other family members, the community, the funeral, services, and other cultural events that take place during the funeral. Also, self-care methods and counseling are already stigmatized within the Arab American community as is, which leads to barriers for individual’s to cope with grief and loss, and to seek support from clinicians. Those who are not part of a culture do not always understand or appreciate the ways individual’s mourn, and when applying Western norms regarding grief to non-Western individuals without learning how that population deals with grief is inappropriate (Moore et al., 2020). Moore et al. (2020), suggest that counselors should be able to listen instead of insisting on how the client should feel, and attune themselves to the impact that death can have on families financially.
Journaling
Daily journaling about an individual’s grief process, however it may look, can assist them in understanding their grief while providing an outlet for expression (Edgar-Bailey & Kress, 2010). Journaling has been found to assist individuals in expressing certain emotions surrounding grief they may not feel comfortable talking about (Edgar-Bailey & Kress, 2010). Journaling is an undemanding way of approaching a sensitive topic, eventually helping an individual begin being able to talk about something (Matthews, 2019). Writing offers a way to overcome the physical complications (e.g. health problems) of not expressing grief and trauma, because for many, the experience of losing a loved one can leave the grieving feeling as if their lives no longer have meaning (Matthews, 2019). Journaling is a tool that can be beneficial in aiding bereaved individuals with identifying what they may be feeling, allowing them a safe place to express what they may feel is too shameful to say.
Westernized ideals
Similarly to adults, children experience the consequences of grieving someone they have lost (Shalev et al., 2021). It was indicated that camp-based interventions for individuals experiencing traumatic grief in addition to posttraumatic stress disorder (PTSD) symptoms were beneficial with the healing process (McClatchey et al., 2008). With support growing for the use of bereavement groups, Rice (2015) discusses important therapeutic factors that contribute to the outcomes for group participants. Specifically, it was noted that social support, interpersonal learning and attachment, and meaning making were characteristics related to positive bereavement group outcomes. Similarly, in a qualitative study by Dyregrov et al. (2013), participants identified the following aspects that led to positive experiences in grief groups: normalization of experience, meeting with peers, sharing thoughts and feelings, exchanging information, and sharing hope.
A few ways individuals can overcome their identity and grief they experience would be to introduce them to grief camps. These camps have been found to alleviate grief by providing ways to normalize it and implement ways to promote positive behaviors individuals endure.
According to Clute and Kobayashi (2013), children and adolescents experiencing grief who attend grief camps had numerous opportunities to build relationships with those who are also grieving, engage in play, and were able to process their emotions. In addition, camps are beneficial in normalizing grief and strengthening connection. Although these camps may be beneficial, in Middle Eastern culture, many caregivers stray away from ever thinking of putting their child in these types of camps. This is largely due to the culture being collectivistic, especially in a tender process of grieving Arab American caregivers may find it better to keep their kids around family.
The general idea of a grief camp has been shown as beneficial to the healing process but is still considered a Western ideal and when suggested, may come off as insulting to an Arab or Arab American. Arab cultures are tightly knit and often don’t think about sending their kids away especially in times of need for family and cultural reset. Some Arabs believe in not allowing their children to participate in grieving processes like funeral processions or ask questions about death (Varga et al., 2015). Moreover, there are different cultural norms and practices around grief that influence the way people react (Varga et al., 2015). This must be understood before recommending a Westernized ideal during a critical time of staying close with family and practicing religious and cultural tradition. It should be considered that not all individuals in a family grieve the same way. What loss and change means to each individual matters just as much systemically as a family (Tubbs & Boss, 2000). It is vital to note that these grief camps are in the U.S. and atypical in Arab countries. Therefore, suggesting a grief camp to an Arab or Arab American caregiver ignores the fact that the child or adolescent themselves may not want to participate in a grief camp.
Future directions
As for Arab Americans, grief and loss is heavily influenced culturally and religiously. This paper demonstrates the cultural perspective of when an Arab American experiences the death of a loved one through the influence of family, community, religious beliefs, and traditional norms. It has been established in this paper the differences between Arab American Muslims’ and Orthodox Christians’ rules and traditions in a religious perspective of when an individual has passed, the arrangement of funeral services, and the norms the family and community abide by. Similarly to recent literature, we recommend psychoeducation, workshops, peer-reviewed research to allow for the proper training for clinicians working with Arab American individuals, couples, and families (Tadros et al., 2022).
Future research can be done through both quantitative and qualitative studies. Through a phenomenological lens, one can understand Arab Americans’ lived experiences with death, grief and loss, coping mechanisms, and religious beliefs on death. Also, quantitative surveys can be analyzed on Arab American grief and loss to provide more information while including other religious backgrounds. Furthermore, there is a lack of empirical studies, on the Eastern Orthodox Christian perspective; there are magazines and nonacademic articles but few peer-reviewed articles (Tadros et al., 2022). This indicates the need for awareness of death and grief through not only the Arab perspective, but through the religious lens as well.
