Bereavement and Coping of south Asian Families post 9/11

Bereavement and Coping ofSouth Asian Families Post 9/11

Arpana G. Inman, Christine J. Yeh, Anvita Madan-Bahel,and Shivani Nath

Eleven first-generation South Asian family members who lost a relative in theWorld Trade Center attacks on September 11, 2001, were interviewed abouttheir loss and their coping strategies. Data were analyzed using consensualqualitative research (CQR) methodology. Participant responses clearly delin-eated bereavement reactions and coping within a cultural framework.

Once miembros de una familia surasiatica de primera generacion que perdierona un pariente en el atentado contra el World Trade Center el 11 de septiembrede 2001 fueron entrevistados acerca de su perdida y las estrategias que em-plearon para soportarla. Los datos se analizaron siguiendo una metodologi'ade investigacion cualitativa consensuada (CQR, por sus siglas en ingles). Lasrespuestas de los participantes delinearon con claridad sus reacciones anteel dolor sufrido y como lo sobrellevaron dentro de un marco cultural.

The death of a loved one is considered to be the most disruptive of allof life's experiences (Holmes & Rahe, 1967), with the mode of deathhaving a significant impact on the grieving process. When a death is

sudden or violent, the griever not only has to process the loss (Horowitz,1990) but she or he also has to deal with the traumatic nature of the loss(Redmond, 1996). When coupled with immigrant experiences and contrastingworldviews (Marsella & Christopher, 2004), the mourner's capacity to grieveand cope can become challenged.

The Wodd Trade Center (WTC) attacks on September 11, 2001, had a profoundimpact on the South Asian community. Nearly half of the 184 Asian and Asian Ameri-cans who perished in the attacks were South Asian immigrants (defined as peoplefi-om India, Pakistan, Bangladesh, Indo^Haribbean, Sri Lanka, and Burma). As thesevictims' families struggle to recover from deeply personal losses, they are challengedon multiple levels (e.g., emotional, financial, immigration-related). This study soughtto understand the culture-specific bereavement and coping methods used by SouthAsian family members who lost a relative in the WTC attack.

Cultures have their own sets of beliefs about bereavement and death. Forexample, how emotions are felt and expressed, the meaning attributed to loss,types and length of death rituals used, extent to which others are involved in

Arpana G. Inman, Counseling Psychology Program, Lehigh University; Christine J. Yeh, Counseling Psychology

Department, University of San Francisco; Anvita Madan-Bahel, Department of Counseling and Clinical Psychology,

Teachers College, Columbia University; Shivani Nath, Department of Professional Psychology and Family Tlierapy,

Setrni Hall University. The authon thank Janine Scafariafor her assistance mth transcribing the interviews and

Erin Howard for her excellent feedback on this manuscript. This study was funded by the Robert Wood Johnson

Foundation and sponsored by the Asian American Federation of New York. Correspondence concerning this article

should be addressed to Arpana G. Inman, Counseling Psychology Program, Department of Education and Human

Services, 111 Research Drive, Lehigh University, Bethlehem, PA 18015 (e-mail: [email protected]).

© 2007 American Counseling Association. All rights reserved.

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the death rituals, and disposal of the body vary across cultures (Rosenblatt,1997). When death or loss occurs outside of one's community of origin,there is a heightened need to apply beliefs and practices that are culturallymeaningful. Furthermore, when the death is a traumatic one and there isno social structure to assist with cultural practices, the bereavement processcan become complicated.

Traumatic loss frequently disrupts fundamental assumptions of personalsecurity and sense of world order, resulting in prolonged stress. The literaturesuggests that although psychological and biological responses to prolongedstress (in the context of disasters) are universal, the specific stress reactionsrelated to reexperiencing and avoidance of emotions may vary across cultures(Marsella & Christopher, 2004). Thus, understanding how culture may influ-ence bereavement reactions and coping among South Asians who lost a relativein the 9/11 tragedy becomes integral to understanding their experiences.

Understanding how individuals cope with traumatic loss has been the topic ofsignificant empirical research (e.g., Galea et al., 2002). However, researchers ofcoping with trauma (Yeh, Inman, Kim, 8c Okubo, 2006) have noted that previousresearch has focused primarily on an individualistic, traidike conceptualizationof coping that is believed to remain relatively stable regardless of the situationor culture. Such studies minimize the role that a culture's symbolic structuresplay in coping with loss. Coping strategies must be understood according to acultural group's values, norms, and orientadon (Lee 8c Lu, 1989) and must berecognized as being situated in a specific event or trauma. For example. Leeand Lu found that, when faced with catastrophic events. Southeast Asian refu-gees used culturally specific coping strategies (e.g., fatalistic beliefs). Similarly,Yeh et al.'s (2006) study of East Asian American coping post-9/11 revealed thatthis community not only attributed fatalistic nodons to their experience butused similar culturally relevant, collectivistic coping methods such as familialcoping, relational universality, forebearance, spirituality, and indigenous heal-ing methods (see Yeh et al., 2006 for a discussion of these coping strategies).Although coping with trauma has been examined among East and SoutheastAsian groups, there remains a dearth of research on South Asians. Using con-sensual qualitative research (Hill et al., 2005), our study sought to understandhow culture may have influenced bereavement and coping for South Asianimmigrant families within the context of a major traumatic event.

method

PARTICIPANTS

Pardcipants were first-generation immigrants who had lived in the UnitedStates for 1-20 years. The 4 male and 7 female participants ranged in agefrom 27 to 59 years. Participants represented a range of relationships to thevictims: 6 wives, 2 husbands, 2 fathers, and 1 sister. In terms of nationality,

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there were 2 Bangladeshis, 8 Indians, and 1 Indian-Cuyanese. As their pri-mary language, 4 participants spoke Telgu, 2 spoke Marathi, 2 spoke Hindi,2 spoke Urdu, and 1 spoke Kannada. Eight participants were Hindus, and 3were Muslims. The participants were highly educated, with 5 having gradu-ated from college and 5 having received graduate degrees; 1 person did notrespond. Pardcipants represented a range of socioeconomic status, with 7idendfying as middle class, 1 as upper middle class, and 1 as working class; 2did not respond regarding socioeconomic status.

PROCEDURE

Approval for the study was sought from each of the universities with whichthe authors were affiliated. Recruitment took 6 weeks from the initiation ofthe project. Contacts were made through Asian/South Asian organizationsin New Jersey and New York. Of 21 families contacted, 11 (one member fromeach of 11 families) South Asian individuals who lost a relative in the WTCattacks agreed to participate in the study. Interviews were conducted approxi-mately 9-10 months following the WTC attacks. Telephone calls were madeto assess participants' preferred spoken language, to describe the intervieweeprocedures (use of a demographic form and a 90-minute audiotaped tele-phone interview), and to obtain informed consent. Next, on the basis of thepreferred spoken language, a questionnaire packet (in English or Hindi) thatincluded a cover letter, the demographic form, and the interview protocolwas mailed to each participant. Shortly thereafter, potential participants werecontacted, informed consents were signed, and three telephone and eightin-person interviews were conducted.

RESEARCHERS' BACKGROUNDS AND BIASES

All members of the primary research team were first-generation Asian Indianwomen and consisted of a licensed counseling psychologist and two advanced-leveldoctoral students in counseling psychology. The auditor was a second-generadonChinese American counseling psychologist. Before coUecdng the data, the teamcompleted two steps. First, recognizing the inherent power differendals in teammembers' academic status, we discussed the importance of having an equal roleand investment in contributing to the consensual process, consistent with theconsensual qualitative research (CQR) method (Hill etal., 2005). Second, eachteam member noted her potential biases and expectations of what the partici-pants might report. We (a) expected pardcipants to be extremely emotionalduring the interview, (b) believed that pardcipants would cope by vacillatingbetween turning to religion and turning away from religion, and (c)expectedthat pardcipants would share their feelings primarily with their family and othermembers of the South Asian community. We also believed that pardcipantswould be more involved with practical aspects of daily living (e.g., financial andimmigradon issues) and less focused on the emodonal aspects of grieving. We

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believed too that participants would not have sought professional counselingbecause of its association with serious mental illness. Finally, we believed thatparticipants would have experienced prejudice post-9/11.

MEASURES

Demographic questionnaire. This questionnaire elicited information on participantgender, age, birthplace, ethnic background, age at immigration, visa statusat the time the participants came to the United States, current visa status,educational level, occupation, religious affiliation, socioeconomic status,previous experience with counseling, and relationship to victim.

Interviews. The interview protocol was developed so that it reflected the pur-pose of the study, authors' clinical and research experience with the groupand previous literature on bereavement, cultural conception of health, andSouth Asian mental health service utilization. Six primary questions guidedthe interviews: How have you been feeling in the past 9-10 months? How hasthe passing of (a significant other) impacted you and your family? If any, whatkind of discriminatory experiences have you experienced since 9/11 ? In copingwith your loss, what kinds of interactions have you found helpful? Did you seekcounseling? How helpful/unhelpful was the counseling process? and What, ifany, gaps did you experience in services received? Interviews were semistruc-tured and included probes to obtain additional information.

Transcription and data preparation. On the basis of interviewees' language prefer-ences, one participant was interviewed in Hindi (the national language), and 10participants were interviewed in English. English proficiency was not assessedbecause English is a language that is generally spoken by educated South Asians.Interviews were transcribed verbatim by the research team and then double-checkedby the primary researcher (i.e., the first author) against the original audiotape. Theinterview conducted in Hindi was transcribed in Hindi, translated into English bymembers of the research team who were conversant with tbe Hindi language, andthen back-translated into Hindi by a team member to ensure semantic equivalence.Participants received copies of tbeir transcripts and were given tbe option to providefeedback on data analysis, but tbey declined this invitation.

DATA ANALYSIS

Data were analyzed using tbe CQR method. Coding of the data involved threesteps: developing domains (identifying broad topic areas), constructing coreideas (summarizing statements to capture main ideas in each domain), andconducting cross-analysis (creating categories by identifying patterns acrosscore ideas, within each domain, and across all cases). Tbe core ideas becamesubcategories witbin eacb category. Each step was conducted independently,followed by a group consensus on tbe final categorization of tbe data. Wbendisagreement occurred, we revisited tbe transcribed interviews and biases toensure tbat biases did not negatively affect tbe analyses. Disagreements were

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resolved by a continual discussion of tbe issue until consensus was reacbed.Consistent witb CQR, an external auditor cbecked tbe validity of tbe categoriza-tion at eacb step (for a detailed description of CQR, see Hill et al., 2005).

resultsTbe five domains, categories, and subcategories tbat evolved from tbe dataare described (see Table 1), using Hill et al.'s (2005) criteria. A category orsubcategory was described as general if it applied to all 11 cases; typical if itapplied to more tban balf of, butnotall, cases (i.e., 6-10 cases); and variantii

TABLE 1

Cases Represented in Each Category and Subcategory Within EachDomain Across All 11 Cases

Domain Category and Subcategory Frequency Classification

1. Reactions toand feelingsabout loss

2. Impact of loss

3. Ways of coping

4. Types of sup-ports sought

5. Specific gaps inservices

Psychological symptoms. Missing the victim and questioning

the loss• Mixed feelings and reactions• Laci< of closure

Physical symptoms• An inability to maintain daily

functioning. Increased health concerns• Change in physical appearance

Shifts in roles and responsibilitiesimmigration-related concerns

• Uncertainty about future• insensitivity of the USCiS

Prejudicial experiencesReiationai copingReliving memories of the deceasedUse of distractionsEmotionai/cognitive copingReligious/spiritual copingAvoidant behaviorsUse of indigenous healersPracticai supportEmotional support

• informal counseling• Formal counseling

No support soughtNeed for services irrespective of

immigration statusCultural sensitivity from USCiSLaci< of cuituraiiy sensitive resourcesLack of services from culture-specific

organizations

11 General

11119

11

953

119975

111111101075

111111113

1076

GeneraiGeneraiTypicaiGeneral

TypicalVariantVariantGeneraiTypicalTypicaiTypicalVariantGeneraiGeneralGeneralTypicaiTypicalTypicalVariantGeneraiGeneraiGeneraiGeneralVariant

TypicaiTypicalTypical

Variant

Note. A category or subcategory was identified as general if it applied to aii 11 cases, typicaiwhen applicable to 6-10 cases, and variant for 2-5 cases. USCiS = United States Citizenshipand Immigration Services.

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it applied to less tban balf but more tban one case (2-5 cases). Categories ap-plicable to only one case were considered nonrepresentative of tbe sample.

DOMAIN 1: REACTIONS TO AND FEELINGS ABOUT LOSS

Psychoh^calsymptoms. Tbe first general category, psycbological symptoms, includedbotb emotional and cognitive reactions. Tbis category revealed two general sub-categories and one typical subcategory. Tbe first general subcategory related toparticipants missing tbe victim and questioning tbe loss. Witbin tbis context, par-ticipants idolized tbe victim and wondered wby tbe tragedy bad struck tbe victim.One participant sbared, "He didn't get a cbance to live bis life. Until n o w . . . Hewas starting to see wbat life is, to enjoy bis life, and it was taken away fi-om bim."Relatedly, participants wondered wby tragedy struck tbe participant (Wby me?): "Itwas too bard. . . . I was blaming my own destiny.... It was not my age to becomea widow at 27." A second general subcategory was mixed feelings and reactions.Some participants spoke of feelings of bopelessness. For example, two differentparticipants felt tbat "Life bas no meaning," and "Tbis is a lifetime impact. Notbingcan beal tbe wounds we bave." Otbers reported increased anger, increased sadness,or becoming numb. Otbers spoke of feelings tbat intensified over time.

A tbird typical subcategory was a lack of closure. Some spoke of it as a func-tion of tbeir inability to find tbe victims' remains:

I haven't seen his body.... The mosque . . . they said that we have to do a funeral servicefor him. I was reluctant. I was hoping that we would find his body and do it.

Some struggled witb an inability to conduct rituals in tbe traditional manner.

They [the funeral home] were giving me options of not needing to come back to America. . . Call any of your friends . . . to do the funeral. But this was not feeling good to me.. . . He was not alone in this world; there are many relatives. . . . Why should somebodyelse burn or bury [him]? . . . . [We] have to do [the] funeral as per our tradition.

Still otber participants felt a lack of closure because of tbeir inability to resolvepast conflicts witb tbeir deceased relative.

Physical symptoms. Tbe second overarcbing general category witbin tbis domainwas pbysical symptoms. Tbree subcategories emerged witbin tbis category.Tbe first typical subcategory related to participants' difficulty witb daily func-tioning (e.g., sleeping, engaging in activities, lack of appetite); participantsalso indicated tbat tbey experienced baving poor memory and an inabilityto concentrate. A second variant subcategory endorsed by participants wasan increase in bealtb concerns; tbe tbird variant subcategory was cbanges inpbysical appearance (e.g., loss of bair and darkening of skin color).

DOMAIN 2: IMPACT OF LOSS

Shifts in roles and responsibilities. Generally, participants reported significantsbifts in roles and responsibilities because of tbe loss of tbeir family member.

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One participant said,

Right now I am holding so much responsibility. Before, my work was just to study andchat with friends. Now . . . I have to take care of all the work here and at home [in mynative country].

Others who experienced career/financial dilemmas from the loss indicated,"We were dependent only on him. We used to be assisted financially by mylate [relative]. . . we are trying to get jobs." (Note. The bracketed informationwithin the quotes was included to protect the confidentiality of the participantswhile still maintaining the central meaning intended in the quote.)

Immigration-related concerns. Participants' immigration-related concerns resultedin two typical subcategories. First, participants typically shared an uncertaintyabout their future because of "preoccupation with visa hassles." A second subcat-egory—insensitivity of the United States Citizenship and Immigration Services(USCIS, formerly the Immigration and Naturalization Service [INS])—wasseen as having an impact on participants' ability to bring family members tothe United States. One participant shared, "They [INS] told my mom, you don'tspeak English, what will you do} How will you help your daughter?"

Prejudicial experiences. Variantly, participants spoke of prejudicial or discrimi-natory experiences. One Muslim participant shared.

In front of my house, I wasjust standing on the sidewalk . . . a boy of 12 years of age wasshouting from the bus saying, "Oh you terrorist, you look to be a terrorist. . . . Becauseall the pictures of 24 terrorists came through the media and 19 Saudi nationals all carrythis type of beard. I grew a beard in 1965, was losing eyesight, [having] difficulty shav-ing every day . . . people see this as "beard of terrorist." People say, 'You are Muslim,why yoti hate America?

A Hindu participant said,

A friend of mine who lost his wife was asked if he was from Taliban. Just because we areSouth Asians and have similarities doesn't mean we are related to that.

DOMAIN 3: WAYS OF COPING

Relational coping. The first general category in this domain was relational coping.This involved interactions with immediate family members as well as other victimfamilies. In fact, there seemed to be strong social networking among victim familieswherein participants shared information and resources with each other.

Reliving memories of the deceased. A second general category was reliving memo-ries of the deceased. Participants engaged in this form of coping by recol-lecting memories, by speaking to the deceased, or viewing their photographsand videos. For example, a participant shared, "We are just remembering hisdeeds . . . his life . . . his photographs, birthday recording . . . we always justplay these recordings."

Use of distractions. A third general category was use of distractions. Withinthis context, participants spoke of activities they used to keep themselves oc-

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cupied. For example, participants talked about concentrating on work, spend-ing time with colleagues, taking educational courses, completing paperwork,and caring for family members.

Emotional/cognitive coping. Typically, participants also used an emotional/cognitiveform of coping. Some participants coped by crying, getting angry, or both, whereassome tried to make sense of the tragedy (i.e., rationalization). Still others spokeof self-reliance that was based in a cultural belief. One participant said, "I knowhe [God] is taking my exam, this is our [destiny].. . . I have to do every thing."Another quoted from a religious text:

Dependence always brings fear and anger. Lord Krishna says, real life is based on in-dependence, not dependence. . . . We have to behave in a manner that [is] free fromneed. . . . This is the intelligent lifestyle of Bhagwat Gita.

Religious/spiritual coping. The fifth typical category was related to religious/spiritual beliefs and behaviors. This category reflected specific shifts thatoccurred in participants' religious/spiritual beliefs (e.g., becoming morereligious or having mixed feelings about God) and religious behaviors (e.g.,either praying more or praying less). It is interesting that whereas Muslimparticipants spoke about an increase in faith (e.g., "I pray whenever I havethese kinds offeelings. I have a very strong belief in God He knew what hewas doing, even though I don't know"), the majority of the Hindu participantsspoke about a decrease in their faith (e.g., "Now I have no faith in God. . . .It has decreased a lot. When this happened, I stopped praying").

Avoidant behaviors. Typically, participants also used avoidant behaviors thatwere relational in nature. Participants spoke of wanting to "blank everythingout." Others talked about wanting to avoid interactions or verbalization offeelings, and one participant specifically spoke of feeling suicidal.

Use of indigenous healers. A final variant category was the use of indigenoushealing practices. In keeping with a religious focus, Hindu participants soughtout religious leaders (e.g., swamis), palmists, and astrologers. For example,a participant shared,

I was hopeful. . . . I went to the healer. . . . I never had any faith in healers, but after allthis happened, I used to call and ask what did that healer say.

Participants received "prayers or talismans" from these individuals who wereseen as being "sacred" and having special higher powers.

DOMAIN 4: TYPES OF SUPPORTS SOUGHT

Practical support. Generally, participants received financial, immigration, andmedical support as well as advocacy from agencies that sought out victims'families. The willingness of these providers to advocate for and check in onparticipants' needs seemed to create trust. One participant shared.

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My case manager, she is the one who takes care of [me] now. If I leave a message forEO, even if she can't help, she calls [to] find out how I am doing. At least I cotild relyupon [her] once I give the message.

Emotional support. Our participants also sought emotional support, withtwo general subcategories evolving. The first general subcategory, informalcounseling, was sought from family, friends, other victim families, and indig-enous healers outside of religious institutions. Parallels were drawn by theparticipants between counseling and being consoled, where participants sawfamily and friends serving as consolers or counselors. On the other hand,formal counseling, the second general subcategory, was not sought by any ofthe participants at the onset of the tragedy. Participants believed that counsel-ing would be unhelpful for several reasons, for example, "[it is] importantto resolve own issues" or "[I] will get more depressed." Related to this werecultural perceptions that "counseling is not a South Asian thing," or "[a]counselor will not understand my problems because they are related to myculture." Other reasons for not seeking counseling were" [I] am not psychoticor deranged"; "I feel like they might ask me some personal things, and I don'twant to because American people are different"; "What could they do withme? My grief is my grief. I speak with my friends and my family."

No support sought. Variantly, participants sought no support from anyone.As one participant shared, "Talking will not help—I am the best judge. Youcan say it's better to talk to someone and to release it. No, nothing will lessenthe burden."

DOMAIN 5: SPECIFIC GAPS IN SERVICES

Need for resources irrespective of immigration status. The first typical category inthis domain was a need for resources irrespective of participants' immigrationstatus. For example, participants spoke of needing services for families withchildren or for educational/career assistance. Additional services includedassistance with one's estate and advocacy related to immigration.

Cultural sensitivity from USCIS. The second typical category, need for USGISto be more culturally sensitive, was endorsed by 7 of the 11 participants.Their desire was for UGIS to have been less stringent with providing visit-ing visas to family members so that they could live with them during thisordeal. Participants believed that this would assist them in dealing with theiremotional needs as well as assist them in their daily activities (e.g., "payingbills, shopping").

Lack of culturally sensitive resources. A third typical category, lack of culturallysensitive resources, reflected participants' need for culturally sensitive, bilin-gual counselors, in-home services, and advocacy. For example, the researchinterview was perceived as an important source of advocacy, as exemplifiedin the following quote:

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The way you are helping is really good. You are Indians, like we are. . . . We feel that wedon't have so much talent that we can tell otir side to someone. Through you we canput forward our side. This help [is] good.

Lack of services from culture-specific organizations. Variantly, participants reportedlack of services from culture-specific organizations. Specifically, participantsspoke of an initial lack of help from South Asian organizations (e.g., a con-sulate). These initial gaps affected the sense of trust that these participantsexperienced in relation to these organizations.

disrnssinnOur results contribute to the literature on South Asian bereavement andcoping by presenting aspects of this community's loss, ways of coping, typesof support sought, and gaps in services. These results support some of theprevious literature on trauma and bereavement (Galea et al., 2002; Redmond,1996); at the same time, they offer new perspectives within cultural and im-migrant contexts (Marsella & Christopher, 2004). Of particular importancefor the participants was their difficulty in achieving closure because theylacked tangible evidence of their family member's death. Although severalcommunities that lost a family member were unable to obtain the remainsof their deceased relative, our participants' loss was exacerbated by the lackof a social structure that could assist with mourning practices and furthercompounded by an inability to engage in the culturally relevant rituals typi-cal of this period. Although research using Asian samples has underscoredthe importance of knowing when a loved one will die and being able toprepare for the loss psychologically and practically (Peveto, 2003), cultur-ally specific bereavement supports become all the more important when itis a matter of coping with unexpected losses.

Death within South Asian communities is a communal affair (Laungani, 1996),and elders are typically consulted regarding the rites surrounding this period.Women do not participate in the cremation/burial ceremonies. Moreover, theloss of a first-degree relative among Asian Indians is associated with greatergrief symptoms and the need to participate in cultural rituals associated withthe loss (Girglani, 1999). For Hindus, cremations and other rituals immedi-ately following death are designed not only to dispose of the body but alsoas a way to release the soul from its earthly existence, an aspect that assistswith rebirth. For Muslims, a body is not left alone between death and burialbut is surrounded by loved ones who pray for a safe and painless journey tothe afterlife. Burials are fundamental to the Islamic belief of Judgment Dayand in the physical resurrection of the dead (Rees, 2001). Our participants'inability to perform traditional rituals or have their immediate families orethnic communities accessible in this time of need may have complicated thebereavement process (Rosenblatt, 1997).

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Furtbermore, tbe loss of tbe family member did not merely refer to an in-dividual loss but also to a sbared collective loss—a loss of role in tbe family(e.g., loss of an income bearer) as well as a cbange in familial responsibility.Tbis is consistent witb a collectivistic-communal Soutb Asian culture, wbereinfamilial obligations and responsibilities are important aspects of one's identity(Ramisetty-Mikler, 1993), and family needs supersede individual desires. Tbestress of being first-generation immigrants witb limited familial supports andresources seemed to bave been compounded by an uncertain future dictatedby visa complications. Several of tbe participants' dependent visas were can-celled wben tbeir partner's work visa became null as a result of tbe deatb.Tbese restrictive immigration policies may bave added furtber to tbe isolationand tbe "minority" experience during tbis crisis. Hence, tbe relational (e.g.,familial) and legal implications of deatb must be factored into a counselor'scultural understandings of tbe bereavement process (Eisenbrucb, 1984).

Otber factors tbat complicated tbis group's experience were prejudicialattitudes experienced in tbe wake of tbe 9/11 event. It bas been noted tbatduring disasters, etbnocultural communities can be at risk because of socialand political barriers (Marsella & Cbristopber, 2004). Being targeted as tbeenemy can create dilemmas related to one's personal autonomy and groupidentity. Tbe need to protect one's group identity can force one to separateit from tbe "enemy's identity" (Nader & Danieli, 2004, p. 402). Tbe politicalclimate of "racial profiling," along witb detention experiences tbat followed9/11, not only added to tbe participants' psycbological distress but madeit increasingly difficult for Soutb Asians to disengage from racial politics intbe United States. Tbe participants in our study kept American flags in tbeirbomes so tbat tbey would appear to be more American.

In coping witb tbeir losses, tbe participants engaged in loss-oriented, emotion-focused coping; during tbis process, tbey oscillated between reliving tbe loss(e.g., remembering tbe deceased); tuning out tbe loss (e.g., avoiding interac-tions); and restoration-oriented, problem-focused processing of tbe loss (i.e.,reevaluating financial/career issues). Tbey also engaged in a combination ofemotion- and problem-focused coping tbrougb tbe development of supportnetworks (Lazarus & Folkman, 1984). Altbougb consistent witb tbe generalcoping literature (Horowitz, 1990), tbese strategies also seemed to be rein-forced tbrougb culturally sanctioned beliefs and bebaviors. Specifically, tbeparticipants' coping was embedded in cultural values and beliefs of familialinterdependence, communal networks, self-reliance, and religious and indig-enous coping. Tbese strategies were similar to tbe collectivist coping metbods(e.g., familial coping, forbearance, spirituality, and indigenous bealing) usedby Asian American victim families in Yeb et al.'s (2006) study. Seeking comfortby talking witb family members is consistent witb Asian American coUectivisticcoping styles, wberein problems are owned and sbared by tbe family as a wbole(Yeb et al., 2006). Furtbermore, tbe importance of a communal culture was


evidenced tbrougb relationsbips tbat evolved among victim families. Tbeserelationsbips were powerful influences in victim families' decisions regardingresources and participation in tbe current researcb study.

Our participants' use of self-reliance, bowever, seemed to suggest additionalmotives for self-reliance in comparison to Yeb et al.'s (2006) study. Altbougbparticipants in botb studies felt tbe need to avoid burdening otbers, tbe use ofself-reliance in tbe current study was consistent witb tbe religious pbilosopbyattacbed to life-and-deatb issues witbin tbe Soutb Asian culture. Tbe belieftbat suffering is "part of one's destiny" and tbat one needs to accept it aspart of God's test of one's endurance was reflected in participants' quotingreligious metapbors and stories. Tbis fatalistic belief served as an adaptivecoping mecbanism for finding meaning in tbe tragedy.

However, religious coping varied witb particular religions. Altbougb tbeirnumber was small in tbe sample, Muslim participants reported increasedritualistic bebaviors (e.g., religious readings) and faitb. Abmed and Lemkau(2000) noted tbat witbin tbe Islamic tradition, daily prayer and tbe recitationof verses from tbe Qur'an become even more important in tbe face of illness.Furtbermore, Muslim participants wbo lost an adult cbild felt tbe need to atonefor tbe sin of tbeir cbild dying before tbem. Conversely, Hindu participantswbo reported decreased or mixed feelings toward God, consulted indigenousbealers. Tbe culturally imbedded meaning ascribed by tbe individual to beror bis predicament (e.g., destiny) or tbe assumption tbat relief from suffer-ing may be acbieved tbrougb spiritual bebaviors may bave influenced tbesebebaviors (Froggett, 2001).

Similar to Yeb et al.'s (2006) findings, participants in our study preferredemotional support sougbt tbrougb indigenous forms of bealing over profes-sional counseling. Specifically, family members in our study perceived profes-sional counseling to be inconsistent witb Soutb Asian cultural values. Inberentwitbin tbis is tbe role tbat natural support systems play witbin tbe Soutb Asiancommunity. Ramisetty-Mikler (1993) noted tbat tbe etbnic social support tbatgoes beyond tbe family provides psycbological, moral, emotional, and pbysi-cal support by organizing religious and cultural activities. Any deviation fromreligious norms and cultural support is not only stigmatized but may also resultin feelings of isolation and rejection. Maintaining connections tbrougb family,kinsbip networks, religious associations, and indigenous bealing metbods isnot only desirable but intrinsic to tbe maintenance of a sense of self witbintbe Soutb Asian community (Froggett, 2001) and can furtber deter a personfrom seeking professional counseling.

According to Sue and Sue (2003), tbe effectiveness of an intervention isenbanced wben it is consistent witb tbe life experiences and cultural valuesof tbe client. One of tbe major gaps in services noted by tbe participants inour study was tbe insensitivity of USGIS in not understanding tbe nature of"kinsbip" witbin tbe Soutb Asian community and its impact on seeking fam-


ily support. Kinship within the South Asian culture goes beyond the Westernconcept of a nuclear family and includes older parents, siblings, in-laws, andaunts and uncles as well as close family friends. The lack of understandingregarding who constituted a family and, more important, its impact on ob-taining visas for family members exacerbated participants' sense of loss andfeelings of discrimination.

South Asians in this sample identified counseling as an "American phenom-ena" and identified the lack of culturally sensitive resources (e.g., bilingualcounselors) to be another major gap in services. However, at the end of theinterview, four participants reported that they were considering seeking pro-fessional counseling in the future. The decision to pursue counseling mayhave resulted not only from having a positive experience with an Asian Indianpsychologist but also because the structure of the interview in and of itselfmay have served as an important therapeutic intervention. Specifically, par-ticipants perceived that the interview was an informal yet structured supportthat was more helpful than any counseling that had been offered to them.The fact that this support was offered by someone with similar cultural andlinguistic knowledge was appealing because participants could express someof their thoughts in their own language and within the context of their ownculture. Additionally, lack of time constraints allowed participants to sharetheir thoughts freely, without a barrier created by a conventional one-on-oneclinical setting.Another aspect that may have contributed to this perception of counseling and

counselors is the need for counselors to develop alternate helping roles (Sue8c Sue, 2003). Persons who served as advocates or brokers and those who wentbeyond the "client" to address "client systems" (e.g., bills, immigration) wereperceived as more helpful and trustworthy. This was evident in the recruitmentprocess as well. South Asians as a community are not comfortable disclosing per-sonal feelings to strangers, and especially to counselors. Furthermore, entry intothe community is based strongly on feelings of trust in the person and a notionthat "actions speak louder than words." This was evidenced by one participantwho agreed to participate in the interview because she heard from other victimfamilies that the interviewers were thoughtful and that the interview had beenhelpful. She spoke of her own experience with the researcher, who helped con-nect her with resources (e.g., dealing with the funeral home) even though it wasnot within the purview of the interviewer's role. This highlights the importanceof a relational interconnectedness that needs to develop before this communitycan address issues of a more personal nature in a counseling relationship.

LIMITATIONS OF THE STUDY

The background and worldview of the researchers was both a strength and apotential limitation. Because the primary researchers were Asian Indian, theywere especially knowledgeable about South Asian bereavement practices that


non-South Asian researchers may have overlooked (e.g., mind/body dual-ity, strong focus on family). It is also possible, however, that the researchers'backgrounds may have limited their perspectives to the primacy of their owncultural experiences. Moreover, we examined the participants' experience asa whole. Although this allowed for internal generalization, the diversity acrossnationality, gender, religion, length of time in the United States, educationallevel, and age differences were not fully revealed. Additionally, because ofthe number of Hindus in the sample was larger, the results may be skewedtoward the experiences of this group.Another limitation is related to self-selection bias. The majority of partici-

pants were recommended by some of the original respondents. The personalconnections between different participants as well as the sources that rec-ommended them seemed to facilitate the interview process. Although thishighlights the importance of a social network, it also suggests difficulties onemight have in entering the South Asian community. In addition, researchers'linguistic limitations restricted access to families who spoke other South Asianlanguages (e.g., Bengali).

A final limitation was the mixed modality of data collection. Even thoughface-to-face interviews were preferred, three participants were interviewedby telephone. Potential problems with telephone interviews are that theymay distance the researchers and do not allow access to participants' non-verbal behaviors. Conversely, telephone interviews provide more privacy invulnerable situations and also encourage less socially desirable responses(Hill etal., 2005).

IMPLICATIONS

This study expanded the current coping literature (Lazarus & Folkman,1984) by exploring South Asian culturally specific coping within the contextof a mass trauma. The study highlights the need to conceptualize copingwithin a collective, cultural, and religious context. Although limited bysample size, the findings suggest that ignoring faith-based coping amongMuslims and the use of indigenous healing practices among Hindus mayinhibit the potential for a meaningful therapeutic interaction (Hilton et al.,2001). However, merely identifying therapeutic practices is not sufficient.New ways to integrate traditional Western and South Asian indigenouspractices need to be developed and implemented. Furthermore, becausecounseling is not seen as a "South Asian thing," provisions of South Asiancaseworkers or in-house services are particularly valuable resources. How-ever, availability of South Asian professionals alone may not reduce barriersto services, because care may still be rooted within a Western perspective.A paradigmatic shift needs to occur in the counseling professions' corebeliefs about healing to include spiritual, familial, communal, and indig-enous values and practices (Yeh et al., 2006).


Ahmed, S. M., &Lemkau,J. P. (2000). Cultural issues in the primary care of South Asians.of Immigrant Health, 2, 89-96.

Eisenbruch, M. (1984). Cross-cultural aspects of bereavement: II. Ethnic and cultural variationsin development of bereavement practices. Culture, Medicine and Psychiatry, 8, 315-347.

Froggett, L. (2001). From rights to recognition: Mental health and spiritual healing among olderPakistanis. Psychoanalytic Studies, 3, 177-186.

Galea, S., Ahern,J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold.J., et al. (2002). Psychologi-cal sequelae of the September 11 terroristic attacks in New York city. Neiu England Journal ofMedicine, 346, 982-987.

Cirglani, H. S. (1999). Experiences of grief and mourning among Asian Indian women: Clinicaland cultural contexts. Dissertation Abstracts Intemational, 6O(1B), 0365.

Hill, C. E., Knox, S., Thompson, B. J., Williams, E. N., Hess, S. A., & Ladany, N. (2005). Consen-sual qualitative research: VpAd^te. Journal of Counseling Psychology, 52, 196-205.

Hilton, B. A., Grewal, S., Popatia, N., Bottorff,J. L.,Johnson,J. L., Clarke, H., etal. (2001). Thedesi way: Traditional health practices of South Asian women in Canada. Health Care for WomenIntemational, 22, 553-567.

Holmes, T, & Rahe, R. (1967). The Social Readjustment Rating Scale. Journal of PsychosomaticResearch, 11, 213-218.

Horowitz, M.J. (1990). A model of mourning: Changes in schemas of self and others. Journal ofthe American Psychoanalytic Association, 38, 297-324.

Laungani, P. (1996). Death and bereavement in India and England: A comparative analysis.Mortality, 1, 191-212.

Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.Lee, E.,&Lu, F. (1989). Assessment and treatmentof Asian-American survivors of mass violence.

Journal of Traumatic Stress, 2, 93-120.Marsella, A. J., & Christopher, M. A. (2004). Ethnocultural considerations in disasters: An overview

of research, issues, and directions. Psychiatric Clinics of North America, 27, 521-539.Nader, K., & Danieli, Y. (2004). Cultural issues in terrorism and in response to terrorism. The

Haworth Press, 9, 399-410.Peveto, C. A. (2003). Death and ethnicity: A psychocultural study: Twenty-five years later. Dis-

sertation Abstracts Intemational, 63(\2V>), 6145.Ramisetty-Mikler, S. (1993). Asian Indian immigrants in America and sociocultural issues in

counseling. Journal of Multicultural Counseling and Development, 21, 36-49.Redmond, L. M. (1996). Sudden violent death. In K.J. Doka (Ed.), Living with grief after sudden

loss (pp. 53-71). Washington, DC: Taylor & Francis.Rees, D. (2001). Death and bereavement: The psychological, religious, and cultural interfaces (2nd ed.)

Philadelphia: Whurr.Rosenblatt, P. C. (1997). Crief in small-scale societies. In C. M. Parkes, P. Laungani, & B. Young

(Eds.). Death and bereavement across cultures (pp. 27-51). New York: Routledge.Sue, D. W., & Sue, D. (2003). Counseling the culturally diverse: Theory and practice (4th ed.). New

York: Wiley.Yeh, C. J., Inman, A., Kim, A. B., & Okubo, Y. (2006). Asian American families' collectivistic coping

strategies in response to 9 /11. Cultural Diversity & Ethnic Minority Psychology, 12, 134-148.


Bereavement and Coping of south Asian Families post 9/11

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