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RESEARCH ARTICLE |
a Institute for Health and Aging, University of California, San Francisco
Gay Becker, UCSF, Box 0646, San Francisco, CA 94143-0646 E-mail: becker{at}itsa.ucsf.edu.
Decision Editor: Fredric D. Wolinsky, PhD
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Abstract |
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 TOP Abstract Death and the Cultural...Identity and AgingCultural Phenomenology and the...MethodsResultsDiscussionReferences |
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Methods. Three in-depth interviews over a 1-year period were conducted with 126 respondents (48 Cambodian Americans and 78 Filipino Americans). Both open-ended and semistructured questions were asked to determine how respondents viewed their eventual deaths.
Results. Many Cambodian Americans and Filipino Americans expressed a desire to die in their homelands. Whether or not they desired to return to the homeland to die was mediated by the presence or absence of the extended family, memories of the homeland, and the availability of traditional ritual practices in the United States.
Discussion. The preoccupation of respondents with where to die apparently reflects the desire to create continuity in their lives. In their efforts to reconcile issues of continuity, cultural meanings surrounding memory, ritual, and the family were paramount and appeared to reflect a desire to bring closure to unresolved conflicts in their lifetime. This research, including its theoretical framework, has implications for using the concept of transnationality and related concepts in gerontological research.
ALTHOUGH the approach of death is intrinsic to a life course approach to the study of aging, this topic has received limited attention in the gerontology literature, especially when considering how the approach of death pervades gerontological concerns of all sorts. Particularly overlooked is the question of how people who have migrated from one country to another in old age view their homeland and the likelihood of dying away from it. In old age, meanings attached to life and death are closely associated with views of the homeland as well as with the here and now (Becker 1997
; Becker and Beyene 1999; Brod and Heurtin-Roberts 1992). Displacement through migration, whether voluntary or involuntary, invariably affects how people view both the past and the future (Becker, Beyene, and Ken 2000; Mallki 1995), including the anticipation of their own deaths. The question of how people approach the end of life is especially relevant in the United States, with its large number of aging immigrants and refugees. As end-of-life decision making for persons from other cultures becomes increasingly frequent, and as growing numbers of immigrants become frail and infirm, understanding the views of elders about the approach of death becomes increasingly important.
Little is known about how immigrants and refugees contemplate their own deaths in late life. In the era of globalization, transnationality and its effects on people in late life is a prime arena for concern in gerontology. The emphasis on transnationality comes at a time when the movement and displacement of people is taking place on a global scale. Ong 1999(pp. 4–5) defined transnationalism as the cultural specifics of global processes, in which human practices and the cultural meanings that propel those processes are at the center of discussions of globalization. Such a definition encompasses, for example, the many ways in which cultural identity is maintained, people's everyday actions as a form of cultural politics, and the cultural logics that make actions in the global context thinkable, practical, and desirable. Gupta and Ferguson 1997 suggested that the world should be viewed as a global space of relations and that these communities of relations constitute and demarcate themselves within power hierarchies. Appadurai 1996 observed that culturally constructed places of identity often do not coincide with their actual physical locations. He noted that these imagined worlds, constructed on the basis of creative resources, are generated by another quality of globalization—the experience of deterritorialization—in which boundaries become more permeable and sometimes dissolve. Although the construct of transnationality is intended primarily to convey practices that are international and that reflect the current global economy, migration within societies may also occur because of global forces.
At the same time, ideas about place have recently changed, emphasizing fluidity rather than the tendency, historically, to focus on cultural groups as rooted in a specific place (Feld and Basso 1996; Gupta and Ferguson 1997; Hastrup and Olwig 1997). Rather than emphasize cultural boundedness, the emphasis now is on the interrelatedness of cultures (Appadurai 1996; Clifford 1997; Gupta and Ferguson 1997). Clearly defined places may not exist in and of themselves (Gupta and Ferguson 1997).
This recent shift, from viewing place as a locus of culture to viewing cultural phenomena as aspects of globalization, raises questions about how people themselves view their lives in the context of globalization. Hastrup and Olwig 1997 pointed out that people do not necessarily experience their lives as being entangled in complicated social, cultural, and economic processes of a global dimension. Indeed, Olwig 1997 called attention to the difficulty of getting at people's perspectives about this. One approach has been to study transient environments such as motels, airports, and bars (Appadurai 1996; Clifford 1997). Another approach has been to study the activities of recent immigrants, who, positioned as they are as travelers, may experience and observe the complexities of these broad processes (Becker, Beyene, and Canalita 2000; Becker, Beyene, and Ken 2000).
Globalization and transnationalism will undoubtedly have an impact on gerontological perspectives about persons who were born outside the United States in the years ahead, but to date there have been few efforts to link the emerging discourse on globalization with the established literature on ethnicity and aging in gerontology (Becker, Beyene, and Canalita 2000). There have been efforts to look at aging in a global context that have emphasized the experience of age and aging cross-culturally (e.g., Keith et al. 1994; Sokolovsky 1983, Sokolovsky 1997b). Reconceptualizing ethnicity and aging within transnationality is one way to place ethnicity and ethnic identity within a broader field of inquiry in which issues of place, migration, cultural practices, age, and ethnic identity intersect. Doing so would not only heighten the relevance of such discussions by placing them within the contemporary context but could lead to a theoretically rich discussion within gerontology about such phenomena.
Within the broad rubric of transnationality, a distinction still exists between those who immigrate of their own choice and those who are forced out, becoming refugees who live in exile and do not have the choice of returning to their homeland. For most refugees the decision to leave their homeland is made on short notice, without preparation or planning, usually because of war or a political crisis (Yee 1997). Given a choice, they would not leave, whereas those who leave voluntarily often do so to better their life situation or that of their family. In short, immigrants have prospects and resources, whereas refugees tend to have neither of these critical commodities. The manner in which people leave may continue to have an impact on them as they age and grow infirm (Becker and Beyene 1999). Moreover, the manner of departure may significantly shape how they contemplate death.
In this article I examine transnationality with respect to how people in two ethnic groups anticipate the end of life in old age. In particular, I explore the centrality of memory in situating past experiences in relation to the anticipation of death, and I address how the place from which people trace their earlier life continues to figure prominently in how they view the future as they face their death. Drawing on a study of the experience of chronic illness in later life that includes 48 Cambodian Americans and 78 Filipino Americans, I illustrate through these two groups how the circumstances surrounding transmigration shape the anticipation of death in late life.
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Death and the Cultural Life Course |
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; Frank et al. 1998; Kagawa-Singer 1994; Kalish 1985; Kastenbaum 1997; Kaufman 1998, Kaufman 2000; Klessig 1992; Koenig and Gates-Williams 1995; Markides and Mindel 1987; Muller and Desmond 1992). Culture is continuously redefined and negotiated, meaningful only when interpreted within the context of cultural history, family constellation, and socioeconomic status (Koenig and Gates-Williams 1995, p. 245). Ethnographic, anthropological accounts of the approach of death address a wide range of cultural meanings that are invoked by the specter of death. These include the meaning of ritual (Myerhoff 1978); the presentation of self (Wikan 1990); the relationship of the individual to the family (Cohen 1998; Rubinstein 1995); identity and efforts to maintain a sense of continuity (Becker 1980, Becker 1993, Becker 1997; Luborsky 1994b); structural, political, and economic considerations (Kaufman 1995, Kaufman 1998, Kaufman 2000; Scheper-Hughes 1992); and the way that the anticipation of death affects the mundane aspects of everyday life (Becker 1994, Becker 1997).
From the perspective of Western societies, death is often seen as the ultimate disruption, destroying continuity (Becker 1993, Becker 1997). The specter of death not only potentially introduces a sense of disorder, but it may also create a sense of uncertainty about the future and cause people to focus on time left to live (Fiske 1979). But do people necessarily view death as disruption? Depending on cultural background and religious beliefs, death may be seen as continuity, not as disruption. The presence of the life wheel in the cultural traditions of various societies (von Franz 1978) suggests that death may be viewed as not only inevitable but also a form of continuity.
The U.S. emphasis on future orientation is part of the dominant model of the cultural life course in the United States as predictable, knowable, and continuous (Becker 1997; Meyer 1988). The course of life can be viewed as a cultural unit and a powerful collective symbol (Fry 1990; Fry and Keith 1982; Meyer 1988; Rubinstein 1990). The anthropological perspective is that each culture has its own expected "cultural life course." Mainstream U.S. society has long been noted for its future orientation (Marsella, DeVos, and Hsu 1985), and the impact of this emphasis on a wide range of issues is well known, from how future orientation shapes views of work and productivity (Luborsky 1994b) to how old age and death are viewed (Sankar 1984). U.S. researchers have much less understanding of how people from other societies think about the future, however; yet views about the future are important in understanding how people contemplate both late life and death.
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Identity and Aging |
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; Kaufman 1986; Marsella and White 1982; Taylor 1989) have given way to a contemporary view of the self as contingent, one that is culturally determined. This view of the self is most often linked to cross-cultural work (Murray 1993) and emphasizes contested and negotiated meanings, diversity, and inner experience (Ewing 1990; Luborsky 1993, Luborsky 1994a; Marsella et al. 1985; Rosaldo 1984; Shweder and Bourne 1984). This model of the self as fluid and ever-changing is especially effective when conceptualizing major life events that unsettle the stream of daily life, such as various sorts of disruptions, traumas, and specific life-changing events such as illness onset and migration. Few people live into old age without the intrusion of such events, so in old age the notion of a "string of selves" is especially relevant.
Ethnic identity in late life has received considerable attention in gerontology, emerging out of the broader topic of ethnicity and aging. Ethnic identity has been defined as both an individual and a collective sense of identity derived from historical and cultural group membership and related behaviors and beliefs (Luborsky and McMullen 1999). Thus, ethnicity is seen as representing a person's most central values and symbols; there is something unchanging or irreducible about ethnic identity, but, at the same time, ethnic identity is situationally malleable (Luborsky and Rubinstein 1997).
An additional way to conceptualize ethnic identity is as embodied. That is, ethnic identity is not layered on, but is embedded in, a person's sense of self. Although the expression of ethnic identity may appear to be situational, ethnic identity may best be construed as part of the body and thus a medium through which people experience their cultural world and a locus of social practice. Such a conceptualization facilitates an understanding of ethnic identity as pervasive and intrinsic to the human experience. Whereas ethnic identity may appear to be latent when people abide in the place they have historically called home, transmigration may bring ethnic identity to the fore, as people are called on by the push and pull of new forces to reassert their identity over and over, both to themselves and to others.
Beginning with gerontological work in the 1970s (Cool 1981; Kiefer 1974; Myerhoff 1978), a literature has developed on the importance of ethnic identity and subculture in old age. Cool 1981(p. 185) noted that ethnicity can provide elders with a source of identity and prestige they can use to make a place for themselves in society. Sokolovsky 1997a, referring to this theme as "ethnic compensation," suggested, however, that literature on ethnicity as a resource has been overly optimistic.
Perhaps the single most important conceptual strand within this literature is ethnicity not as compensation but as continuity. Continuity is apparently a human need and a universal expectation across cultures (Harris 1989). Gerontologists have long been concerned with issues of continuity in later life (Atchley 1989; Becker 1993, Becker 1997; Luborsky 1990; Rubinstein, Kilbride, and Nagy 1992). Although continuity in life may be seen as an illusion, it is an effective one: It organizes people's plans for and expectations about life, as well as the ways in which they understand who they are and what they do (Becker 1997). Kiefer 1974 and Myerhoff 1978 both addressed how people use ethnicity to achieve a sense of continuity in the face of change, a theme that has continued up to the present (Becker 1997; Gelfand 1994; Luborsky and Rubinstein 1997).
People's emphasis may be on efforts to construct a sense of continuity for themselves (Becker 1997). For example, Luborsky 1995(p. 1,457) observed, "The experience of present-day impairment is infused with a sense of being seamlessly connected to past, present, and future experiences and identities, both actual and idealized or expected." Past and present experience thus informs the anticipation of the future, and as people age that anticipation increasingly includes the contemplation of and preparation for death. A heightened awareness of the inevitability of death is present for people from midlife onward (Fiske 1979) and for younger people who have found themselves in death's shadow as well. The presence of one or more illnesses that are chronic poses a constant reminder of the fallibility of the body and its ultimate mortality.
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Cultural Phenomenology and the Anticipation of Death |
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; Luborsky and Sankar 1993; Moody 1988, Moody 1993). The concept of bodily experience has great relevance for older persons because it addresses the gap between how older people see themselves and how others see them (Becker 1994, Becker 1997; Gadow 1986; Myerhoff 1978).
Embodiment, the central construct of phenomenology, refers to being; that is, to living through the body (Merleau-Ponty 1962, Merleau-Ponty 1968). The body is reflexive; it both initiates and responds. The body contributes to the world we live in, but the reverse is also true. The world contributes to the constitution of the body (Dillon 1991, p. xv). People's bodies, as sources of moral and political knowledge, are capable of generating categories of social analysis; people are able to ground their resistance to the power of cultural norms in bodily experience (Levin 1991). The body is thus the medium through which people experience their cultural world (Merleau-Ponty 1962, p. 146). The body can be seen as the locus of social practice (Bourdieu 1977), and bodiliness is relevant to social collectivities as well (Csordas 1994).
The anticipation of death can be viewed as a bodily experience, for death signifies nothing less than the end of the corporeal body. Contemplating death is an embodied process that may be physically felt whenever the body does not perform as it was once known to, and in later life the body frequently does not perform as it once did. Awareness of this change may be in every movement or moment of immobility or in every irregular beat of the heart. Awareness of death gradually becomes ever present, as people become increasingly aware of their faltering bodies' most minute signals.
Bodily practices enact the past and embody cultural memory (Connerton 1989). Ever since Robert Butler 1963 drew attention to the life review in late life, gerontologists have been aware of the importance of memory in reconciling the past and preparing to die. The work of Myerhoff 1978 has been particularly salient in this regard, as she illustrated the intimate connection between memory and preparation for death. Memory is socially and culturally constructed. Memory can best be seen as "memory work"—that is, culturally mediated acts, schemata, and stories that make up memories and the way we think about them (Lambek and Antze 1996, pp. xv). Individual memory is never literal reproduction, but an effort to render the continuity in change realistic (Lambek 1996, pp. 244). Personal memory of events is frequently experienced in imaginal form (Brewer 1986; Casey 1987). Imagination is both a disposition and a powerful tool of self-expression; imagination and perception coalesce in bodily experience (Csordas 1994). Csordas 1994 suggested that healing may occur through imagination. For transmigrants, memory work may be a powerful tool in reconciling the rupture of leaving home, in decisions to return, and in coming to terms with death.
Although cultural phenomenology has been used for analysis of broad societal structures (Becker 2000; Csordas 1993), there is little question that this approach has much to offer as a theoretical and methodological tool for exploring embodied experience. A closely related theoretical and methodological perspective is that of narrative. Csordas 1993, Csordas 1994 suggested that the body be placed in a paradigmatic position complementary to the text and that doing so enables body and textuality to be seen as corresponding methodological fields. Language, as one way of disclosing the phenomenological essence of embodiment (Merleau-Ponty 1962), gives access to these experiences.
Narratives give voice to bodily experience. Viewed as the practice of everyday life, narratives can provide us with important insights into people's experiences and their perspectives on them. Cultural processes are mediated through subjective experience, which enables people to take in and reformulate their worlds; narratives can be seen as cultural documents (Becker 1997). They are a way to articulate and resolve core, universal problems and a way to avoid or heal biographical discontinuities (Turner 1980). People organize, display, and work through their experiences through narrative (Rubinstein 1995). Narrative can be a potent force in mediating disruption, whether the disruption is caused by illness, personal misfortune, or the anticipation of death (Becker 1997; Mattingly and Garro 1994).
One's death signifies the end of the life story in this life. Belief in an afterlife invites the expectation that there will be another story. The story thus needs to be as complete as possible for this life, and people's narratives work toward this end. Narrative is a way of expressing development over time (Freeman 1985; Ricoeur 1980). People's narratives can therefore be seen as a way of expressing not only life unfolding but death unfolding as well.
At the same time, narratives are empowering; they represent action and, thus, agency (Carr 1986; Mishler 1986). Experience is reshaped in the narrative process, and narratives are subject to change. Narratives may especially change as people contemplate the end of their lives, the time elapsing between now and the moment of their deaths. As an analytic tool, narrative enables us to understand how coherence is created and maintained over time (Linde 1993), and this process of trying to create coherence encompasses ways of approaching the idea of one's death.
From a conceptual perspective, then, it is apparent that the anticipation of death has several components that relate to the importance of culture. These include the cultural life course, the relevance of notions of continuity, the role of identity, the individual's embodied experience, the role of memory, and the narratives through which that experience is expressed. In contemplating elders from specific ethnic groups, several additional dimensions must also be considered. These include the dynamics of transnationality, the meaning of place, and the role of ethnicity, specifically the meaning that membership in a particular ethnic group carries. The data on the two ethnic groups that are the subject of this article illustrate how these various conceptual themes interact with each other and are expressed through narrative.
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Methods |
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The sample consists of 126 persons aged 50 years and older in two ethnic groups: 78 Filipino Americans and 48 Cambodian Americans. See Table 1 for demographic information.
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This anthropological study was designed as an ethnographic approach to the topic rather than as an experimental design. Hence, there was no comparison group in this study. This particular kind of anthropological research can be seen as a precursor to quantitative approaches by identifying, characterizing, and examining the validity and completeness of appropriate units of analysis and description. With basic units of analysis confirmed, it is then possible to undertake the design and analysis of studies that feature controlled comparative designs.
The study protocol and consent form were approved by the Institutional Review Board, Committee on Human Research, University of California, San Francisco. Respondents were recruited through individual physicians as well as through 19 sites, including acute care hospitals, home care services, and community health clinics in two counties. The criterion for entry into the study was the presence of one or more chronic illnesses. Exclusion criteria were known or observable presence of confusion or dementia. Attempts were made to induct all persons who met the study criteria into the study consecutively on their referral from the above sources. An effort was made to sample across a range of illness severity, from mild to severe.
Data Collection
To study the processes that individuals undergo in living with a chronic illness, I combined questions to elicit concrete answers with questions that were open-ended so that respondents could describe their experience in their own words. Following key tenets of the in-depth interviewing approach (Spradley 1979), I was interested in respondents' interpretation of their experience and the meanings they attached to it. Within the structure provided by the interview itself, the respondent's narration of the experience is viewed as giving structure not only to the experience but to the research encounter as well. A respondent's statements are reframed as further questions in the interview, thus following the informant's line of thinking and following the respondent's lead (Langness and Frank 1981; Rubinstein 1987). These practices are known as reflexive interviewing (Hammersley and Atkinson 1986).
Respondents were interviewed three times over a 1-year period. Interviews were semistructured (i.e., some structured questions and many open-ended questions). Each interview lasted for approximately 1 to 1.5 hr, and focused on experiences with illnesses, attitudes about death, routines of daily living, the role of family and friends, views about age, economic situation, and use of and access to health care. Each interview was tape recorded and transcribed verbatim.
Respondents were interviewed in their language of choice by interviewers who were members of the same ethnic group. Cambodian Americans were interviewed in Khmer. The word Khmer refers to both the language and the dominant ethnic group of Cambodia—more than 90% of Cambodians are Khmer (French 1994). All Cambodian Americans in this study were Khmer, and this term is the one they use to refer to Cambodia and its people. With the exception of two persons who were interviewed in English, Filipino Americans were interviewed in Tagalog. Interview data collected in Tagalog and Khmer were translated by the interviewer and transcribed into English. It should be noted that some standardized practices in data collection and transcription are difficult to maintain when studying special populations, such as the use of a person other than the interviewer to transcribe data. In this research, it was necessary for the interviewers to transcribe the interviews they had conducted because of a dearth of trained people who were adequately bilingual to conduct such transcription.
Data Analysis
Qualitative content analysis was used extensively (Clark and Anderson 1967). The data were first divided by ethnic group for data analysis. The data were also divided by gender to ascertain any gender-specific patterns within the data. Each group was analyzed separately, then cross-group comparisons were made. A specific data-analytic procedure was followed that is presented in abbreviated form here: First, core categories that reappeared in the data repeatedly were identified and were repeatedly compared with other emergent categories, a process that emerges out of ongoing reading and analysis of transcripts. Out of these preliminary codes generated from meanings in the data (Mishler 1986), an in-depth process of code development was followed: Selected transcripts that appeared to reflect core categories were read by the entire team to generate consensus in coding categories. In a series of meetings, the research team read transcripts of respondents whom they did not interview then met to develop consensus about core and emergent categories and the relationships between categories, which led to the development of codes. Successive phases of trial coding were performed until a 95% or better level of agreement was reached by pairs of coders. A coding lexicon of 97 discrete items was ultimately developed and was entered into QSR NUD*IST (Scolari 1997), a data-sorting software program. The entire data set was coded for specific topics, resulting in codes such as death, disruption, and age. Analysis of data coded as death was the primary means used to develop the content for this article. Research questions that drove the data analysis for this article included the following: How are people's views about their eventual deaths affected by their histories as immigrants/refugees? What is the role of memory in contemplating death? What are the salient factors in decisions about where to die? and How do respondents view the future with respect to their eventual deaths?
I also conducted a case-by-case narrative analysis in which a close reading was conducted of each interview for (a) the repetition of specific words and phrases and general thought patterns, (b) the structure of the overall story, and (c) the topics that dominated respondents' statements, as well as topics that were not raised at all (Kaufman 1986). In addition, the narrative analysis facilitated the longitudinal analysis of change over time, such as any changes that occurred in views about dying. Statements about death, plans and wishes for the end of life, religious beliefs, and philosophy about life and death were closely examined. The narrative analysis also served as a check on coded data (e.g., when statements were read in context, did they have the same meaning?), and showed linkages between various statements about death by the same respondent.
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Results |
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The majority of the sample had more than one chronic illness; many had three or four. In most cases, respondents had at least one chronic illness that was life-threatening. Because people were attempting to manage their chronic illnesses on a day-to-day basis and most had had one or more acute episodes of illness in which they were hospitalized, the subject of death frequently arose in these interviews. It was on people's minds. They raised concerns about death voluntarily as part of their responses to more general questions about illness management, ideas about aging, or sense of well-being.
The anticipation of death raises many issues for people that are elaborated on below. Chief among these are efforts to reconcile the past, plan for the remainder of life, and prepare for death.
Cambodian Americans: Living With the Past
Death was an ever present theme in interviews with Cambodian Americans. In addition to daily management of their chronic illnesses, they had, without exception, been close to death during the Communist Khmer Rouge regime in the late 1970s, when 1.5 million people were killed out of a population of 8 million (20% of the population). Children were taken from their parents, landholdings and other property were confiscated, people were relocated to other areas, and outright killing and starvation of the population was carried out. Hundreds of thousands were executed, resulting in the creation of the infamous "killing fields" in various locales throughout Cambodia; the remainder died as a direct result of Khmer Rouge policies, often of starvation (Kiernan 1996).
The philosophy that underlies Cambodian Americans' approach to death is key to understanding their views about dying. The majority of those in the Cambodian American sample were Theravada Buddhists. A small number were Protestant or a combination of the two religions. See Table 2 for breakdown of the sample by religion.
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). Suffering is a central notion for Khmer Buddhists; suffering is inevitable, and there is no happiness without suffering (Mortland 1994, pp. 78–79). Karma is the most central belief, the notion that one's actions in previous lives and the resulting store of merit that one has accumulated determine one's current life situation. These ideas underlie many of the most basic Khmer notions of personhood and practical morality (Smith-Hefner 1998). One's actions in a previous life thus inform the next life.
Experiencing the genocide of the Khmer Rouge regime, however, has created a crisis of meaning. The general concept of suffering is completely inadequate to represent the cataclysmic disruption that the genocide caused Cambodians and an entire way of life. As part of an attempt to radically restructure Cambodian society, the countryside was filled with forced labor camps (French 1994; Kiernan 1996; Ledgerwood, Ebihara, and Mortland 1994), and with each passing year, there were increasing numbers of deaths from starvation. When the Khmer Rouge regime ended with the takeover of Cambodia by Vietnam, Pol Pot and his chief supporters escaped to the countryside to continue a civil war that continued until his death in 1998. Meanwhile, when the regime ended, disorder broke out when the majority of the population went in search of their families; the rice crop went untended and famine broke out, exacerbated by a drought. Widespread starvation triggered a massive exodus, involving walking over mountains, passing through jungles and minefields (Smith-Hefner 1998), and culminating in those who were able to escape living in refugee camps for a period of 1 to 10 years. There, life continued to be harrowing, and many more people died.
In the aftermath of this interminable disaster, Cambodian Americans continue to mourn the deaths of loved ones. As they approach the end of their lives, efforts to reconcile the disparity between belief and experience intensify. Mortland 1994(pp. 72–73) observed that traditional Khmer (Cambodian) ways of answering "ultimate" questions, such as why the genocide happened and how to live with its aftermath, no longer make sense, and that new ways of answering these questions do not have the force and permanence of earlier answers. She observed that one answer given by Cambodians to explain the Khmer Rouge regime is to say that to be born is to suffer, to live is to suffer, and that suffering is the first step for many Cambodians to understanding what has happened to them. She stated that Cambodians' experience during the Khmer Rouge regime was an assault on Cambodian notions of proper order and was impossible to reconcile with their notions of karma and individual responsibility. Consequently, a lingering question among Cambodians is not only whether they have done something individually to cause their suffering but whether they, as a collectivity, were responsible for the suffering that occurred during the Khmer Rouge regime (Mortland 1994, pp. 80–81). In her research Mortland found that Cambodians repeatedly raised the idea that the Cambodian people have inflicted this suffering on themselves. Hence, Cambodians' struggle to reconcile this experience continues unabated.
Everyone watched people dying around them during the Khmer Rouge regime. For example, one man said,
My life was so hard, to die. I almost died too many times but I did not. During the Pol Pot regime, you don't have to be in the army. If you are just a student, you will be killed by Pol Pot already. What else was left during that regime? Even babies, they killed them, too. That is why my family is so lucky to be able to have almost all of my children left. I felt so sorry that I lost one of my sons.
Everyone in the sample lost family members, and sometimes almost everyone in their family was killed. They are still processing the horrors associated with this genocide and trying to reconcile their own survival. But as they anticipate death in later life, they are also trying to reconcile the idea that perhaps they have brought this suffering on themselves and their loved ones. Making sense of life is part of people's preparation for death (Becker 1997). Stories of these deaths often intermingle with reflections on one's own eventual death. For example, one woman described the death of her daughter in a forced labor camp during the Khmer Rouge regime, where parents and children were separated from each other:
I would like to tell you about the death of my other daughter. She was eighteen years old. Her face was swollen. It was swollen everywhere on her body. I felt so sorry for her. She asked me to promise her... [sobbing, she stops talking]. No, I don't want to talk about it. Every time I talk about her, I always cry. [She starts talking again.] Maybe she knew. That it was time for her to go. That was why she asked me not to worry about her. "Please take care of the other two and forget about me." I think she knew that she would be gone soon.
A few minutes later she volunteered her thoughts about her own death.
I feel that I am waiting to die because I cannot do anything. I think it is time to die, let it be. If not, then I am still alive for one more day. I don't have any brother or sister. I only have two children here but no one that I can count on when I am sick, anyway.
This woman's narration of her story epitomizes the expression of embodied experience. In reenacting the memory of her daughter's death, she once more experienced her daughter's dying, an experience fraught with emotion, both then and now. The retelling of this story had a visceral effect on her, in which she reexperienced her daughter's death through grief felt and expressed through her body. This woman not only conveyed her sadness over her daughter's death, she demonstrated how death has become a preoccupation through her desire to share the story with the interviewer and thus memorialize her daughter's memory. She missed the presence of her extended family, whom, if she were still in Cambodia and they were alive, she could expect to surround her in a constant stream of companionship. She was mourning this loss as well. Her remarks about her own eventual death suggest that her life has little meaning in the present. She appeared to live in and for the past.
Preparing to Die
Most of this population wanted to return to Cambodia to die—or at least to visit before they die—because there they expected they would be surrounded by family and friends and would not feel isolated like they did in the United States. Even though most lived with their families here, their children were busy working and had little time for them. For most of the sample, this desire to return to Cambodia will be unfulfilled because they did not have the funds to pay for an airline ticket. For example, one woman said, "Oh, God! Please help me to have a little bit longer life. So I can see what is going on with Khmer country [Cambodia]. If it is safe to go, I would like to go visit."
But some would like to do more than visit: They would like to move back to the place they call home. A man evaluated his situation and reached this conclusion:
The living conditions here [in the United States] are two kinds. If we had come here when we were a little bit younger, we think we could maintain a job and our lifestyle would be a little better than this. But we are a little too old, and it is hard to do anything else. We are just waiting for our time. Just like the sun is about to set. My goal is that I want to go back to Khmer [Cambodia] when I am a little bit older. Back home at least when I am sick, I still have my family and my neighbors would come to visit me. The more people come to visit, the merrier. At least for me. I think when a lot of friends and family come to visit more often, that makes the sick person feel a little better. If a lot of people come to visit us, it makes us a little happy, as well. I think that way it will take a little longer for us to die. I know no one can avoid death, it's just sooner or later.
Although this man lived in a household of 13 people and had frequent visitors, he expressed a sense of social isolation that was expressed by many Cambodian elders. The desire for constant social contact was great, and people expressed nostalgia for the homeland through repeated claims that at home in Cambodia they would not be lonely. Although they established new communities in the United States, elders continued to mourn the loss of those old ones that cannot be replaced. In the case of this man, the likelihood that he will ever be able to return to Cambodia is slim because most of his children and grandchildren lived in the United States, and he and his wife were the primary caregivers of his youngest child, a teenager who was severely disabled and who lived with them. This knowledge, that he is unlikely ever to be able to return, deepened his sense of loss.
Cambodian Americans in this study believed dying is part of life: They can't run away from it and they are not afraid of it. They expect to be reborn soon, and hope to be reborn with parents who will be able to educate them. Most of this sample had little or no education and attributed their lack of education to their inability to learn English, which meant that they have been unable to work since arriving in the United States. Consequently, they have been dependent on the federal government and on their adult children for their support, resulting in loss of self-esteem.
The death ritual for Cambodian Americans who are Buddhist follows a specific process. Following a person's death, a monk comes from the temple daily until the following Saturday when the funeral takes place. Food is continuously provided up until the funeral. In addition, when a person dies, a son, grandson, or nephew becomes a monk for a day to help the deceased go to heaven. If no male descendent is available, a daughter or niece may become a nun and fill the same role. This is done to facilitate the deceased's passage to heaven and to prevent the spirit from harming the family. If an offspring refuses to carry out this duty, it is believed the deceased will stay in hell. Early on the day of the funeral that person has his or her head shaved, then, dressed in a Buddhist robe, prays with the monks at the temple. The adult child is often accompanied by an older relative who has served as a monk in the past and who coaches the person in the correct responses. These prayers are followed by a ceremonial feast at the home, in which more prayers are offered on behalf of the deceased. A further service is held at the funeral home, where the family prays over the casket and says goodbye to the deceased. Each person at the funeral places a flower inside the coffin and offers a prayer for the deceased before the lid is closed. Monetary offerings are given by the participants to the immediate family to provide food for the family and for visitors. The adult child then accompanies the deceased to the crematorium, where the child is responsible for personally pushing the casket into the flames, thus completing the task of assisting the deceased in the journey to heaven. (In Cambodia bodies are usually burned in the fields because there are few crematoria.)
One hundred days after the death (or on a Saturday or Sunday in the United States), the monk comes from the temple to the family home for prayer. It is believed that the spirit will come back at this time looking for family and food; the monk is there to prevent the spirit from causing harm. He returns for a 2-hr ceremony on Sunday morning to pray, speak, and sprinkle holy water on everyone who is present and on the outside of the dwelling. He then eats a bite of all the food that has been prepared, and that food goes along to the deceased spirit.
One reason people express the wish to die in their homeland is the question of how their remains will be kept. Traditionally in Cambodia, people were cremated and their ashes kept at the temple. But temples in the United States are too small to store people's ashes. Moreover, the temple in the city where the majority of data were collected is far from the neighborhood most Cambodians live in, and consequently most people participated in ritual activities in their own homes, visiting the temple only on religious holidays. Because the temple lacks space, families kept ashes at home, creating a shrine by placing a Buddha and flowers around the container. Some families were afraid of ghosts, however. They wanted to send their loved one's ashes back to Cambodia and place them at the temple. When a person dies in the United States, a family member tries to eventually take the ashes to Cambodia, to store the ashes at the temple in the family's village.
Poverty intervenes in planning for death among Cambodian Americans, as well. The cost of storing ashes in U.S. cemeteries is considered to be expensive, and is unaffordable for most families. One woman said,
Back home there are a lot of places for us to bury our bodies. Over here there isn't enough empty ground to do so. But if there is, it is so expensive. People like us don't have any money to pay for that piece of land to bury us with.
When they see others dying around them, facing death becomes prominent in people's thoughts. For example, one man who had diabetes and heart disease brought up his own dying each time he was interviewed. At the first interview, he began talking about people around him who had died, and then volunteered, "I think I am old now and it is time for me to go. The longer I live, the harder for people to take care of me. I don't have anything to enjoy life any more, anyway." Six months later he mentioned another friend who had died a month earlier:
I used to have a friend who did not give himself the shot regularly. Now he died already. He was only 57 years old. He had the same thing as I do. He did not follow their instructions very well. Now he passed away. He has been gone for about a month. I think my time is getting shorter and shorter. You know, as our old folks have mentioned to us when we were young; they said that the life of old folks is just like the sun passes the noon time. When time goes by, the sun is getting lower and lower. Pretty soon the sun sets and our life will be ended.
Cambodians expect to be reborn soon. For example, one woman who was incontinent and had multiple chronic illnesses said, "There is a nerve that is so painful, it goes toward my lower back. That is why I can't control my urine sometimes. I am going to be 69 years old, no, 70 years old." Her friend interjected, "Why do you want to be 70 years old? Do you want to die soon?" She responded,
What are you saying to the oldie? I am old. I will be dead. I want to be dead soon so that I can be reborn again. I am not going to be born with anybody else. I will be born with you [to interviewer]. You are such a nice and sweet person. Who does not want to be with you or your children? I want to run away with a guy, be fourteen or fifteen years old, and things like that. I don't want to stay too late [live too long].
Cambodian Americans feel they have lived longer than they were intended to because old age starts at 40 years in Cambodia (Becker and Beyene 1999). They frequently responded to questions about their age and illness by saying, "I properly die already," going on to talk about how if they were in Cambodia they would have died of their illnesses or old age, if not in the genocide of the Khmer Rouge regime. For example, one man said,
Every time I decide to go to the hospital, I am inserted with an IV blood bag. If I lived back home, I properly die long time ago. As you know, poor like me, how can I afford to go to the hospital? Our money was so little to support the family. We did not have anything else to buy those modern medications.
People approach their own deaths in relation to their lived experience and to whether they view their death as remote or imminent. Death is openly discussed among Cambodian American elders. For example, a 60-year-old Cambodian Buddhist who spent time in his youth as a monk was very sick with diabetes. He felt the closeness of death and took death very seriously. When asked how he compared his condition since the preceding year, he said,
Oh, Goodness! I am so different from last year. Last year, I could do a lot of things and go to a lot of places. This year is worse than last year. Some other people said that they are afraid of dying. I am not because I will go to heaven. I look at myself—I feel okay—but other people look at me and they say I am dying. You know, some of my family and people in the community, they mention the same thing.
This man's story is an example of embodied experience, in which he experienced his body as different from before and compared his body in the present with the past. He expressed an awareness of the fallibility of the body and the impending loss of the self, which is embodied. This man was confronting the changed body, addressing the question directly of his decline and anticipated death. Gerontologists have referred to the process of coming to terms with pending death as anticipatory grief (Hill, Thompson, and Gallagher 1988; Moss and Moss 1989), yet it must be recognized that grief may not be salient in coming to terms with death, especially for those whose cultural traditions are markedly different from those of the mainstream United States. In this example it can be seen how Cambodians talk about death openly.
When people are diagnosed with certain life-threatening illnesses, death may seem more imminent. People make preparations for death at the same time that they continue to emphasize living, thus calling attention to the uncertainty of life and the dual preparedness that people undergo: preparation for death at the same time as they prepare to continue living. Cambodian Americans view their lives as having been extended by living in the United States and by the steady availability of food and medicine. Some respondents wanted to die here because they think the medical technology in the United States would keep them alive and intact longer or because it is less chaotic than their memories of the homeland. For example, one man said,
But still it is better here than in Khmer [Cambodia]. Because over here we can have enough to eat and we can sleep very good. Unlike back home where we have to worry about the gun sounds all over. The chaos happens every day. That is why our family back home always said that we are living in heaven here. If we compare ourselves with them, yeah, that is right. But if we compare our living here to others [non-Cambodians], it is heaven on the bottom step. We are not on the top of the stairs yet. But the younger folks will have a better life than we do.
In making this statement, this man alluded to the low socioeconomic status of Cambodian American elders in relation to the general American population. Cambodian Americans are living in exile from their homeland, and the loss of their homeland and their disrupted lives means that for many, they are simply waiting to die to be reborn.
Filipino Americans: The Lure of Migration
Everyone in the Filipino American sample was born in the Philippines, and half of them have immigrated permanently, whereas the other half saw their life in the United States as temporary. This latter group was composed of Filipino American veterans of World War II and their wives who immigrated in late life. The Immigration Act of 1990 enabled these veterans to become citizens. In the intervening years they immigrated, either alone or with their spouses, to receive the health and welfare benefits that accompany citizenship (Becker, Beyene, and Canalita 2000). Veterans' benefits were signed into law by President Clinton in 1996.
Veterans often connected their memories of warfare with their own eventual deaths. They congregated in groups to talk on a daily basis, and two of the recurring topics were World War II and when it would be time to go home to the Philippines. One man remembered:
We used to fight hard and it was no joke. You were lucky if you were not hit by a bullet. I mean, you just turn around and they are dead. You are talking to someone one minute, and the next minute they are dead. Because a lot of people were hit with artillery shells. Sometimes you would just be there, and all of a sudden you will hear a bomb go off, and then some people speaking in Japanese. Then you know that they are there. We acted like turtles going back to hide in their shells. Then when the bombing is done you look around, and you wouldn't even know what hit you. You would not see a whole person, maybe just their hand or something.
In remembering his participation in this war, this man recaptured his embodied experience at the time, expressing his fear, his feelings of having no control over who would die, his reaction to finding that he had survived, and the incomprehensibility of seeing body parts rather than a whole person.
A few minutes later, when this man was asked if he ever wanted to go back to the Philippines to live, he responded by talking about dying.
To tell you the truth, when you are here, you don't have any money, and you die. Where do you go? You get cremated because you don't have money to get back to the Philippines. I mean, you would spend like $10,000 doing that. As for if you are cremated, it won't even cost you $5,000. And then, you know, the government will not help you.
This man was referring to the dilemma of where to die and how dying is expensive no matter where it occurs. Making his point that dying is not affordable, he gave inflated figures for the cost of cremation in the United States or the shipment of a body to the Philippines.
Deciding Whether to Return Home
Migration history affects how men and women view death and the plans that they make. Those who immigrated to the United States late in life viewed their stay as temporary (Becker, Beyene, and Canalita 2000). They expressed a desire to be back home in the Philippines before they die. Those who have recently arrived rarely had many family members in the United States. They did not want to die in the United States. They wanted to be close to family and friends and die in the familiar settings in which they spent most of their lives. Like Cambodian Americans, recently arrived Filipino Americans often live in extremely modest circumstances, but unlike the other ethnic group, Filipino Americans manage to find the money for an airline ticket because they manage their own incomes rather than turning their incomes over to their extended families as Cambodians do.
One man reflected the views of many when he said,
I really want to go to the Philippines when I am really old and near to death. I would like it better there. Here if you don't have any money you will be cremated. There you have a nice burial.
Meanwhile, almost all Filipino Americans in this sample viewed death as happening in the distant future. They placed high emphasis on being youthful. Once their physical independence is gone, however, people anticipate that they will opt to go home to be around family who can care for them until death. For example, a woman said,
I told him [husband] that when we are old, like maybe 80, and we have the shakes, of course we are going to think about going home to our children so that we can be taken care of there. And then I tell him that if he dies, then there will be someone that will visit his grave and take care of his grave. And of course I want to be with my children. And you see others here, they are already really old and shaky but they are still here. If I get like that I will just go home. What will you do with the money here [from government assistance] if you are already old? You will just have a hard time. And you can't take the money with you if you die. So that is why I will just go home to my children.
Religion has served as the idiom and provided the concepts for articulating significant relationships in the Philippines (Pertierra 1995). Following colonization by Spain, religion and politics merged into religiopolitical movements that drew their inspiration from indigenous and Catholic sources, in which the use of magical, animist, and Catholic ideas merged and became widespread (Pertierra 1995). The majority of Filipino Americans in this study were Roman Catholic. A small number were Protestant. The root metaphor of balance in religion and in health is expressed in the key value of reciprocity in social interaction (Anderson 1983). Catholicism is imbued with religious and cultural features particular to the Philippines, just as it has become culturally specific in other parts of the world. Pertierra 1995(pp. 126–128) noted the importance of ritual in the Philippines and observed that death is transformed into a cultural event through ritual, in which mortuary rites are large public affairs that reorient social relationships and articulate significant structural changes.
For those Filipino Americans who are Catholic, there are customs they hope to follow for the soul to survive and pass on into the next world. Many view these customs as carried out most fully in the Philippines. A funeral in the Philippines is no simple affair. It is a ritual that lasts for weeks on end and carries on to yearly death anniversaries. But regardless of whether death occurs in the Philippines or in the United States, people want to know that when they die family and friends will surround their body 24 hr a day. They want to be assured that someone will carry on a vigil for them and that candles will be lighted, flowers kept fresh, and their memory kept alive. There are nightly prayers for the deceased for 9 days straight, then again on the 40th day, when it is believed that the soul is going to ascend to heaven. A prayer or gathering occurs on a yearly basis to commemorate the death anniversary. One 64-year-old man described this set of rituals in detail:
Well, for me, I think I will go back. That's where my mother, my father, my brother, and my sister are buried. When I am really old, like 72 or 73, I will go home to the Philippines. All people will die, and I don't want to die here. I'll tell you why I don't want to die here. In the Philippines, if I die there, my family will watch me all the time. There are people praying, there is singing, and when they bury you there, if you are rich they will hire a musical band that will escort you. It's really different when you die in the Philippines. You are there for 3 days, and every night they will pray for you. I have cousins there in the Philippines and they died there. They were American citizens and they all went home.
He compared practices in the United States unfavorably with those in the Philippines.
They really take care of your body there. The dead are really watched. Here they don't. They put the dead person in the morgue and then at 10:00 people have to go home. That's it. It's just the security guard. In the Philippines it's not like that. Even if it's in the chapel. Overnight in the chapel, there are a lot of people that gamble, a lot of mourners, and a lot of people playing mahjong and cards. They do not leave the body or fall asleep while watching the body.
Rituals associated with death do not end there, however:
And then after you are buried, 9 days after that you will again have a gathering. It doesn't matter. You could have a lot of food but if you are poor you will always have noodles, bread, and coffee. And then after 45 days, that means that the soul of the person is going up to heaven, and then you have another gathering. And that is the tradition for someone that dies in the Philippines. And another thing is, this is nice, what I am about to tell you. Back home the popular superstition is about ghosts that come back, and the children, the grandchildren are the ones to be visited by the person's ghost. So what they do is they put red clothes on the children so that the spirit cannot go near the children. That is our way.
He concluded, "Well, for me it's still a long time off. I'm only 64. I think it will happen at 70 or 72. Then I will go home."
In this recitation of customs that are followed in the Philippines, this man was not only reaffirming tradition, he was affirming his identity as a Filipino through memory work of past death rituals. The rituals themselves have not only religious but also cultural significance.
Sometimes people go to great lengths to return family members who are ill to the Philippines, but the primary reason for doing so is not the comfort of ritual and tradition surrounding death but to reunite the family in life. For example, one woman demonstrated her determination to take her ill husband home to the Philippines so he could see their children before he died.
My husband just died in May. I was able to bring him home. I went on vacation. He was sick for four years. I had such a hard time here because I was the one doing everything. He had cancer in the pancreas. The doctors spoke to me and told me that there was no hope for my husband so they will not try to treat him anymore. I said that I was going to bring him home to the Philippines. I really needed to bring him home because my children called and wanted me to bring their father home. Because all of my children are in the Philippines. I only have one that is here. So I strengthened my insides.
In this story, this woman expressed how her determination to take her husband home was a felt, embodied process as she steeled herself for this ordeal. Determined to take her husband home, she overcame the obstacles.
The doctor said that I could not bring my husband home to the Philippines because he can't get on the airplane. Because he was already in a wheelchair. I told him that I had to. I asked if the doctor could give us a certificate so that if something happened while we were on the plane then I could show someone the certificate. He gave me one. We left at 6:00 in the evening from our apartment, and I brought him home to the Philippines on the plane. I was able to buy a ticket. And then I took him on the plane. With the mercy of God no one asked us, "What's wrong with your husband, is he sick?" Because he looked strong. When we got to the Philippines, on May 4, at 3:00 he died [a few days later]. He was so happy to see his kids, that he was very happy when he died.
Some of this sample arranged to have enough insurance coverage so that their bodies can be sent back to the Philippines for burial. A 73-year-old man, when asked what he thought would make him start to feel old, responded,
I think that when I am old is when God will take me. That's the time that I will consider myself as old already. To have a new life with the Lord. At first I thought that I would not last very long here. I am ten years older than my wife.
When asked if he would like to live in the Philippines for good, he said, "If God calls me I want to be buried in the Philippines, so we have death insurance."
The desire for the person to return to the Philippines, whether dead or alive, is so great that families and friends will go to great lengths and expense to see that their wishes are carried out. One man recounted the steps he took on behalf of a friend who died.
I told my wife that we will just try to save money so that in case our bodies are not so good, then we will go home. I want to die in the Philippines, not here in America. It is different here. We have a friend who died, and I was the only one who helped. I mean, there are others who helped but I was not embarrassed to ask for donations to send the body back home. I begged for it so that the body could be sent home. I didn't want him to be cremated here. And so then the children sent around $3,000 [from the Philippines] but what was needed was $4,200. I worked it out at the mortuary. I went to the Philippine consulate and not even a centavo, they didn't help at all. I even got mad at our consulate because the money that his wife [in the Philippines] sent through foreign affairs, they sent somewhere else and they wouldn't give me the money. They issued the check and paid the mortuary. So the letterhead of the check was the Philippine Consulate. As if they were the ones who paid it. They just took sides. So we were finally able to bring him home. His wife sent $3,000, plus the $1,400 that I begged for from our friends until I could bring the body home. It's a big difference to be able to help your fellow man out. That is all.
But not everyone goes home to the Philippines. What determines which country to die in is the presence of the extended family. If most of a person's relatives are in the United States, the likelihood that they will die and that their remains will stay in the United States is much greater. One woman, whose religion was Pentacostal, explained how she made her decision about her husband's funeral and her satisfaction with the religious service. In her case, the major decision was whether to have his funeral in a Catholic church or in a Pentacostal church. In her comments, however, she compared the funeral with what would occur in the Philippines, illustrating how the point of reference in such decisions is the Philippines, whether a choice is made to return there or not.
Sometimes I just remember him and I start to cry all of a sudden. But you know, Jesus said that we shouldn't cry because when his second coming comes, we will see our children and our husbands that have already died. And he said that he loves all those that have accepted him in his life. When I read that, my tears roll down my cheeks.
I talked to my pastor here. Because some of them wanted to do it in a Catholic church but you have to pay $200. But with the pastor you don't pay. Anyway, I didn't want a big to-do. In the Philippines it is also the same. So my pastor was there for 2 days, and it's like that in the Philippines too.
Asked if her children are also Pentacostal, she said,
Yes, but my in-laws are all Catholic. Except for one. My husband's burial was a good one. It's nice because there was a good talk and the praise and worship songs were nice. And then we were in the front. The pastor told us to go in the front because my husband was already dead, we were the ones that were going to send him off. He said that he didn't want the dead body to go first, and us be in the back because he said that was not good, it's like the dead body is escorting us. So it was good. We walked because it was walking distance from my in-laws' house to the cemetery so it was a good funeral for him. People were probably saying that Christians have a good burial. Even the music. Because you know when others get buried they play all sorts of music. Things that are worldly and that make you sad. It's different when you have the word of God and you praise and worship. The songs come from the Bible. You know, music can really touch people's hearts.
Almost all Filipino Americans have made some kind of arrangements in the case of unforeseen circumstances. They have invested in insurance companies that allow them to pay a small amount each month so that they are ensured a gravesite and a proper burial. For example, one woman, whose children lived in the United States and who planned to be buried in the United States reported,
Now, you know, I am weak. I already have a burial plot there at Skylawn. Can you imagine that burial plot? It's been five years that I have been making payments on that. Because I have one child that used to work for the bank, and I called him. And he looked for someone who could help me, and this person called me. I said I would like to buy a burial plot. And he told me to put a down payment of $1,000. And so my son said it was okay. And then the rest of it I pay monthly. That is for five years. My children asked me, why did I think to do that? And I told them that I may die, and then you might just throw my body somewhere. It is better with this because you know me, I am always giving money to you [to her children]. Well, I feel sorry for myself. Because I want to have just a cheap casket. You know, whatever my casket is, it doesn't really matter to me because I won't even see it. But you know, I will be okay. And then you know, it's hard to die when there is no place for you to be buried. That is why everyone knows that my burial plot is all fixed. I have a plot to go to—all they have to do is put me in it. It's not really underground—it's one of those things that are in a wall. Because I said that my children may fight with each other because I live with one child. I explained to my children that people will die but it will be a long while for me. It may be another eight years. I may reach the age of 88 years old. And I said that when they bury me, they have to put some clothes at my feet in the casket. So they asked me, "Why?" And I said, "What? You don't think I am going to change my clothes?"
When the interviewer queried, "What did your children say?" she responded, "They will do it."
In making this final statement this woman affirmed her belief in the hereafter. In expressing her expectation that for this final journey her soul would need a change of clothes, she affirmed the importance of traditional rituals. This is also an expression of embodied experience being projected into the future, as she imagines her death and her subsequent change into other clothes.
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The question of where to die is clearly pivotal in the contemplation of death for both Cambodian Americans and Filipino Americans. The complicated business of living in two worlds is made still more complex by the need to choose one in which to die. These two ethnic groups portray transnationality in action. Cambodian Americans and Filipino Americans look on the homeland differently. Whereas for Cambodian Americans the homeland is a source of painful memories of destabilization and chaos, for Filipino Americans, the homeland, not torn apart by internal strife on the same scale, represents stability and predictability. Although Cambodians yearn for their homeland, that desire is tempered by the memories of what they have endured there and the long-term conviction that they could never go home. Filipino Americans, in contrast, are much more likely to idealize the homeland. Moreover, many of them have come to the United States for the adventure of the journey and for the economic benefits they anticipated, never planning to spend the rest of their lives in the United States and always anticipating the time when they would return home.
The dilemmas of transnationality are exemplified by the complexities of decisions to return home. The desire to return in many cases is likely to be thwarted by lack of resources. Not only do people lack the funds to return, in almost all cases they have health coverage in the United States that they would not have in either Cambodia or the Philippines, raising the question of whether, by returning home, they would hasten their own deaths without the health care and medications on which they depend (Becker and Beyene 1999; Becker, Beyene, and Canalita 2000). The question of whether to stay in the United States or return home is more directly about death than may be apparent, as returning to the homeland may signal the recognition that doing so is likely to hasten death.
Transnationality is at work in other ways as well. In both groups we have seen complex ways in which cultural identity is maintained. Cambodia and the Philippines are continuous reference points underlying people's thoughts, plans, and actions as they compare living in the homeland with living in the United States. As they rethink their lives and make plans for the future, they illustrate cultural logics that make sense of life. Filipino Americans are actively planning their deaths. Their lives are more unsettled in the short-term than are those of Cambodian Americans, who are, for the most part, waiting for death to overtake them.
The difference in how the two groups talk about death reflects cultural and religious differences in how people prepare for death as well. The emphasis in Filipino Americans' narratives is on the public aspects of death—the ritual that surrounds the passage out of life, thereby underscoring the importance of social status and social connectedness for Filipino Americans (Becker, Beyene, and Canalita 2000). Whereas Cambodian Americans also have ritual in their funerary rites, the emphasis in their narratives is not so much on the public engagement with death as it is on life as transitory and leading to the next life.
It is only through their identity as Cambodian or Filipino that any of these experiences and plans matter to people. Every phrase they utter about death links them back to their ethnic identity. In this sense, this work echoes that of other gerontologists who attest to the centrality of ethnic identity as a key aspect of how people age (Gelfand and Barresi 1987; Luborsky and Rubinstein 1997; Stanford and Torres-Gil 1994). What this work suggests additionally, however, is that examining ethnic identity in relation to transnationality and place lends greater breadth in contextualizing ethnic identity and enables the inclusion of complexities that could otherwise be overlooked. Conceptualizing ethnic identity as embodied gives this construct added depth by showing how fully integrated ethnicity is into sense of self.
As an experience, transnationality does not diminish in its importance in late life but remains of vital concern to recent transmigrants. Both groups continue to live out cultural politics with respect to the homeland. As Cambodians continue to mull over the events in their lives during and after the Khmer Rouge regime, they are continuing to protest the inhumanity they lived through by memorializing the family members who died and their own experiences. Similarly, Filipino Americans are quick to protest when they see their good deeds in raising money for burials being usurped and credited to the Philippine government.
Questions raised by the contemplation of transnationality reflect the related concern with place. Although gerontology has long been concerned with issues of aging in place, an increasingly small proportion of older people are aging in place as migration in later life becomes increasingly common. Nevertheless, it is apparent from this work that the loss of places that signify home, community, and identity is not taken lightly and may constitute a profound lifelong loss. Casey 1996 contended that place is the most fundamental form of bodily experience—the site of a powerful fusion of self, space, and time. In this study it was shown how this fusion is multisited and enormously complex. The remembered place takes precedence over the current site of people's lives. Memories of life lived in another place color people's views not only of the past but of the present and the future as well. This research has shown that despite a shift to deterritorialization globally, people continue to cling to cultural meanings they associate with a given place, and that memory is a powerful tool for keeping the place they call home alive in their thoughts.
The underlying theoretical perspective that has linked these conceptual domains is cultural phenomenology. This work demonstrates the relevance of a phenomenological, experientially grounded approach in adding girth to our gerontological knowledge base. The phenomenological approach outlined here made use of narrative to explicate the contemplation of death. These narratives call attention to how people, regardless of their ethnic background, are simultaneously addressing a multiplicity of issues that begin with their culturally experienced bodies. Illness and age are considered carefully as people listen to their bodies and attempt to integrate that bodily knowledge with their ongoing plans and desires for both life and death. Having a chronic illness has a significant impact on how people confront their mortality. We have seen how people interpret bodily signs as signifying the approach of death. Cultural responses to bodily phenomena differ by ethnic group, and, from exploring salient cultural categories, it can be seen how different meanings emerge. Whereas cultural attitudes about age also play a role, these attitudes appear to be less important than the experiential one of illness itself.
Death and the Pursuit of Continuity
Facing death is among the last of life's challenges. As this research has demonstrated, the approach of death does not simply signify a narrowing of one's field of vision to one's immediate surroundings and life situation. Rather, the approach of death provokes a desire to integrate the various aspects of one's life and to create a culturally specific form of continuity for oneself, however complex the task may be.
As we have seen, the nature of the disruptions that people in each group have experienced have differed considerably. Difference epitomizes their cultural histories, religions, impetus for migration, and current life situations. Consequently, difference also characterizes the losses they mourn and the efforts they make to mend disruption. Comparing the differences in emphasis between Cambodian Americans' and Filipino Americans' statements brings to the fore critical elements in the struggle for continuity in life and extending into death. Efforts to create continuity take a variety of forms.
The effort to resolve disruptions that have occurred throughout life is a compelling force in shaping how people approach death in late life. Ruptures in life, whether cataclysmic, as they have been for Cambodian Americans, or planned, as they have been for Filipino Americans, require that people work to heal the rupture to experience a sense of order and integration in their lives. One way that the desire to heal the rupture expresses itself in both groups is through the reestablishment of a tight-knit social group in the United States. Both Cambodian Americans and Filipino Americans have sought to recreate a sense of community in an innercity setting. Shared traumas, as well as cultural sharing, bring Cambodian elders and their extended families together, whereas for Filipino Americans, the social group assuages their loneliness and isolation from loved ones in the Philippines. Ongoing contact with peers not only reinforces sense of self and ethnic identity, it provides a visible means of reassurance that the culture one has been separated from continues and is embodied in the self.
Cambodian Americans in this study, almost without exception, lived with their extended families. In contrast, Filipino Americans who had recently immigrated, were in the United States without their families. But family is extremely important to Filipino Americans, and many have come to the United States in order to help their families out economically (Becker, Beyene, and Canalita 2000). Not only do those in the United States without families miss their families and wish to be reunited, they worry that cultural and religious traditions will not be honored in the same way as they would be at home. Those who have extended families in the United States, however, are much more easily able to reconcile altered traditions because they live with or near their families. Family comes first, whether in Filipino or Cambodian society, and is a primary vehicle through which people hope to realize continuity. Although the continuity of the generations has been threatened by historical events—genocide in Cambodia and out-migration in the Philippines—elders in both groups pin their hopes for the future on younger generations. They therefore place high priority on the maintenance of cultural traditions to serve as glue for younger family members. In contemplating death in late life, longing for the homeland may be mediated by the presence of the family, who may symbolize place, tradition, and continuity. In short, the family imbues life with cultural meaning. In the absence of nearby family to represent these meanings, people shift their gaze back to the homeland, where the family resides.
Despite the presence of extended-family members in the United States, Cambodian Americans continue to struggle with questions of suffering at the hands of the Khmer Rouge. That experience continues to provoke suffering in the here and now and constitutes an ongoing moral dilemma revolving around issues of collective responsibility. Memorialization of the experience and of those who died can be seen as an effort to create continuity with the past as well as an attempt to reconcile this experience before dying. Many Filipino Americans seek to bring the suffering they endure as a result of being separated from their families to an end through plans to return home. In contrast to Cambodian Americans, they seek a concrete, rather than existential, end to their suffering through the continuity they would experience by being reunited with their families.
The precise ways in which people interpret their experiences reflect how people's views of death are shaped by culture. For example, Cambodian Americans appear to view death as a form of continuity rather than as a discontinuity. Not only do they emphasize the continuous aspects of life rather than the finality of death through their religious belief in rebirth, they anticipate a better life in the next life. Luckmann 1991(p. 62) observed that "Biographical schemes cannot avoid the problem of death, and they [people] attempt to solve the problem by linking existence to something that transcends it." We have seen how the question of death is embedded in the myriad cultural nuances that shape biography and how cultural practices that bear little obvious relationship to the anticipation of death may be directly related.
The community plays a critical role in people's anticipation of death; in particular, in the powerful images of continuity that are evoked through ritual, both as practiced in the here and now and in expectations about the future use of death rituals. Collective mourning of people's deaths is expected in both groups and serves an integrative function for both groups as a whole. Expectations about continuity are expressed in both ethnic groups primarily through rituals, such as those that will take place immediately after death as well as those that will occur over time. A person's embeddedness in the community in life is central to expectations about the fulfillment of these rituals in death, calling attention to the importance of salient cultural practices in providing reassurance and community support during people's lifetimes. Ritual is a vehicle for continuity. That is, ritual promises continuity into the unknown.
The concern of respondents in this study with the details of death and dying can also be seen as a way of combating the uncertainty surrounding the future. One way this uncertainty expresses itself among Filipino Americans is through a focus on ritual. Not only do death rituals help to speed the soul on its way, ritual is known and predictable and thus comforting in the face of uncertainty. Cambodian Americans, in contrast, are more likely to focus on rebirth than on the specific death rituals because they assume that their families will carry out the complex rituals associated with death properly. Although they are far from their homeland, certain traditions, such as death rituals, continue to be carried out in the Cambodian American community in the same manner as in the homeland, adhering as closely as possible to tradition.
Examining views about death by elders in these two cultural groups facilitates an understanding of some of the issues these elders confront in late life as they anticipate their deaths. The longing they express for the homeland can be seen as a desire to bring closure to some of the unresolved conflicts with which they live in their lifetime. In their efforts to reconcile these dilemmas and connect the past with the present and future, cultural meanings surrounding memory, ritual, and the family are paramount. In conclusion, the effort to contemplate the end of life is not only about death, which is, in the end, unfathomable. The contemplation of death in late life is, most of all, about how people desire to complete their lives.
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Acknowledgments |
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Received for publication December 19, 2000. Accepted for publication June 12, 2001.
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