caregivers to have a better understanding on how to apply culturally competent care. Approximately 290,000 Amish people live within 30 states of the United States and in the Canadian province of Ontario. Two-thirds of this population are located within Pennsylvania, Ohio, and Indiana (Therivel & Smith, 2016). The major cultural patterns of the Amish include the strong religious beliefs that they hold, their agrarian life-style, patriarchal authority, their distinctive language and apparel and overall separation from the world, and mutual assistance (Bryer, 1978). As family and the community as a whole is valued by the Amish, it is important to the Amish that a person who is dying is cared for in the home. If the dying person must be in the hospital, family and community members often accompany and visit the individual in the hospital. The Amish may choose to use hospice services if they are comfortable with the provider and feel that they will provide culturally-competent care (Therivel & Smith, 2016). Bryer (1979) says, “In Amish society most individuals can face death confidently, with the assurance that they will be able to live out their days at home, surrounded by loved ones who will help them to plan and organize their own deaths.” When an individual dies, the body of the deceased individual is washed by members of his or her family before being delivered to a mortuary (Therivel & Smith, 2016). Most Amish will choose to embalm the body, but some conservative communities do not embalm (Cates, 2014). Family members dress the body in homemade funeral clothing which consists of a vest, shirt, and pants for males, and a long dress, cape, and apron for women. Often the clothing is what the individual wore on his or her wedding day (Therivel & Smith, 2016). The clothing is typically white, which symbolizes the “final rite of passage” into a new and better life (Bryer, 1979). In Bryer’s (1979) study, several Amish woman said that making the clothing that the deceased wore for the funeral was a “labor of love” that represented the last physical thing they could do for their loved one. Once the body is dressed, it is placed in a simple wooden box casket (Cates, 2014). Visitation at the home of the deceased by family and community members starts as soon as they are made aware of the death, and can continue up to three days following the death. Members of the church make the funeral arrangements in order to relieve the immediate family of this duty to provide time for grieving (Therivel & Smith, 2016). Visitors come to the home dressed in black and greet the family and then are taken to the coffin if they wish. A white cloth is pulled back for the visitor to view the face of the deceased. Some Amish communities also engage in a night wake in addition to daytime visits (Therivel & Smith, 2016). The Amish view the constant presence of visitors as proof of the support of their community, or Gemeinschaft. The community provides great care to the family for up to a year or more following the death (Mackey & Mackey, 2015). An Amish community consists of about 20 to 30 Amish families. This group of families functions as a large extended family and provides social support to individual families within the community (Missouri Department of Mental Health, 2014). Some of this support includes visits, homemade scrapbooks and other items, new work projects, meal preparation, and quilting. The men will work the fields and take care of the mourner’s farm until the mourner or a family member is able to manage these duties. Often times, community members will dig the grave and continue to visit the family each Sunday for months following the death (Mackey & Mackey, 2015). A funeral church service is held at the home of the family.
In the warmer months, the service is often held in the barn (Mackey & Mackey, 2015). The funeral service is typically held three days after the death. The primary focus of the funeral is to praise God (Missouri Department of Mental Health, 2014). The minister often tells the story of creation, and reads biblical passages on resurrection of the dead. At the gravesite, the minister will read a hymn while the deceased is being placed in the grave. The church members silently recite the Lord’s Prayer. Following the ceremony is a meal at the family’s residence (Therivel & Smith, …show more content…
2016). Verbal expression of grief may not be expressed strongly or openly (Therivel & Smith, 2016). The Amish often portray a sense of stoicism that masks the intensity of their emotions (Cates, 2014). The Amish often place value in public grieving being more quiet and reserved, with emotional expression occurring in a private setting (Missouri Department of Mental Health, 2014). Formal grieving in public is rather displayed through the wearing of black clothing. Formal grieving can be expected to last an extended amount of time, as female mourners continue to wear black for one year following the death of an immediate family member, six months following the death of and aunt or uncle, and six weeks after the death of a cousin (Therivel & Smith, 2016). Because of the heavy reliance on the community within the Amish culture, many will turn to their community in times of need, though some do find help outside of their culture. Sometimes Grief Support Counseling will be offered by Amish couples who have sought training to be group facilitators. Outside grief counselors may also be brought into the community to assist with psychosocial care during a tragedy (Mackey & Mackey, 2015). However, Amish individuals may be hesitant towards using outside professionals as traditionally, many Amish rely on the advice of their minister or bishop. Outside therapists should be aware that full rapport may not be possible as there are barriers to having deep emotional ties with individuals outside of the community. Cates (2005) suggests that in working with this community the therapist should aim to achieve the individual’s respect rather than emotional closeness. Bryer (1979) says that the Amish rituals and customs surrounding death serve two important functions. First, the Amish lessen the frightening aspects of death by their belief in immortality. Second, the Amish reliance on the support of the extended family and community provides resources and nurturance to those who have lost a loved one (Bryer, 1979). Pearlman, Wortman, Feurer, Farber, and Rando (2014) define social support as the emotional and physical comfort that the people receive from others in their network or community such as family members, neighbors, colleagues, friends, etc. “Social support reduces the impact of major life events or chronic strains on health and well-being” (Pearlman, Wortman, Feuer, Farber & Rando, 2014, p. 172). The great reliance of the Amish on social support assists in their mourning process. Rando defines a ritual as a “specific behavior or activity which gives symbolic expression to certain feelings and thought of the actor(s) individually or as a group” (Rando, 1993, p. 314). Therapeutic rituals can be used to validate the mourner’s expression of emotions and feelings (Rando, 1993). As the Amish generally remain stoic and do not express their emotions publically, rituals can provide them with an alternative means to express their emotion, such as through wearing black in public, or through the making of clothing for the loved one.
Rando mentions that rituals can assist the mourner in moving through the six “R” processes of mourning (Rando, 1993). The viewing period in the Amish community, in which the individuals of the community are able to view the face of the deceased, can allow the individuals to work through the first “R” process of “Recognizing the Loss” as they have the opportunity to visually see the deceased. Rando identifies that those who have the opportunity to view the body of the deceased typically have better outcomes and do not regret their decision (Rando, 1993). The Amish community assists the mourner in moving through the fifth “R” process of “Readjusting” with their rituals of continued weekly visits and support. Through this ritual, the survivor has the assistance of the community in adapting to life without the loved one.
The community also assists with their ritual in what Rando describes as “Prescription of actions for dealing with emotional or social chaos” (Rando, 1993, p. 317). The community assists the bereaved which allows them to have reduced stress, more energy, and maintain structure. The community also assists in providing the social interaction needed for successful mourning, and it promotes the reintegration of the survivor into the community. While the community assists with their rituals, rituals also help solidify the community and the family relationship as roles are rediscovered and the community finds ways to mourn in healthy ways (Rando, 1993).
In developing additional rituals to assist an Amish individual in mourning, rituals that promote emotional and physical ventilation may be helpful, even if it occurs in the individual’s private home. Amish individuals who have struggled with finding meaning in the loss, may find that the loss violated their assumptive world as they have submitted to God and still experienced a loss. They may struggle to share this within their community who may view the violation of the assumptive world as a wavering in faith. Rando (1993) suggests that rituals of ventilation validate the expression of mourning for the bereaved. This is especially helpful for individuals who have been socially conditioned against expressing emotion, which is plausible in the Amish community as an expression of grief can portray that the individual has not been submissive to the will of God (Rando, 1993).
Amish communities have made meaning out of tragedy through public acts of kindness and forgiveness. In Lancaster County, following a tragic Amish school shooting in which five children were killed and several others injured, families sent kind words to the widow of the man who shot the children, expressing sympathy and asking her to stay within the community. As financial contributions were given to the community, leaders distributed the funds between the victims’ families as well as the family of the shooter (Kasdorf, 2007).
It is important to acknowledge that stereotypes and beliefs formed about a certain cultural or ethnic group may not apply to all members of the group.
There may be variations found within different communities of the Amish. Therefore, it is important to assess the individual’s personal attitudes toward life and death, expression of emotions, acceptance of outside assistance, expectations of family responsibility, and beliefs on gender roles (Rosen, 1990).
As demonstrated through the mourning traditions above, the Amish do rely on rituals to move through the mourning process. Although, they may not call it or see it as a mourning process as much as celebrating the individual’s passage to eternal life and moving on with daily life. Therefore, in working with a bereaved Amish individual, it is important to be sensitive to Amish principles regarding life and death and to work with the individual to partake in rituals that he or she feels as comfortable and culturally
appropriate.