Family and Psycho-Social Dimensions of Death and Dying in African Americans
Regardless of our culture, all of us must eventually face at least two fundamental issues. First, we face the realization that life is finite—we will not go on, at least in our present form, forever. Second, the world has no built-in scheme that gives it meaning. It is, at the moment of birth, a meaningless world. We must give our existence meaning. 1(p40) In addition, what defines death as an event may vary from culture to culture. Although death is universal, cultures vary in how participants in a culture conceptualize death—what will be done and how it will be done. Death is defined here as the irreversible cessation of life. From an Afrocentric perspective this article will address the psycho-social dimensions of death and dying in relation to the African American family. The term “family” in this discussion is inclusive of the extended family and church family.
Death and Dying
Death is a subject of relevance to everyone. It is the one fact about the future that can be counted on for certain. 2(p441) Indeed, death is a universal, natural, persistent, inescapable, unavoidable, and undeniable fact of life. Death’s impact on human behavior does not take place in isolation; It takes place in a given social context. In other words, a person’s behavior is a dynamic interaction between the person and the social context in which he or she lives. The social context for this article is the United States, with consideration given to a co-culture of this context—that of African Americans.
Freeman states that there are four types of death, and each type has implications both for the dying and for those left to grieve the loss. 3 The first is social death, which represents the symbolic death of the individual in the world he/she has known. For the person dying and for the survivors, socially and interpersonally, the world as it was known begins to shrink. A second type of death is psychological death. This refers to the death of aspects of the dying individual’s personality. How dying persons move through the grieving process and deal with their losses may bring about changes in the person’s personality. Changes may also take place as a result of the disease process and/or medications. Psychological death may precede biological and physiological death and may be one of the several death losses the bereaved suffer. A third type of death is biological death. With biological death, the organism as a human entity no longer exists. For instance, biological death may be evident when a person suffers a heart attack severe enough to damage the heart beyond repair, causing it to stop functioning. Although the person is biologically dead, advances in medical science allow organs to be kept alive and functioning by means of artificial life support. Physiological death takes place when there is a cessation of the operation or function of all the vital organs. 3 (p3ff)
Changing Cultural Context of Death and Dying Over Time
Culture is the total behavior, beliefs, and values of a group of people. Or to define this term according to Brislin in its broadest sense, culture refers to the worldview, values, norms, and behavior patterns shared by a group of individuals.4 Culture profoundly impacts behavior and the family. It basically shapes how persons make meaning out of illness, suffering, and dying.
When we fail to acknowledgement culture’s power, we may find it challenging to care for, instruct, and learn from those with significantly different cultural experiences from our own.
Culture is vital at all stages of life, so it is just as critical at life’s end. It provides meaning to events, objects, and people. In death, we witness the end state of the physical body. Yet,, what we believe about the meaning of death, how death should be faced and what we believe happens after physical death varies according to our culture and its associated religions. 5
In our culture, dying, in the popular mind, is associated primarily with old age. However, medical advances and increased life expectancy have demonstrated that old age does not directly cause death. Nonetheless, it is increasingly the old who die, making death predictable as a corollary of the aging process. The leading causes of death of Americans 65 years of age and older are: 1) heart disease, 2) cancer, 3) cerebrovascular disease (stroke), 4) lung diseases, 5) pneumonia and influenza, and 6) diabetes. The association of dying of old age has caused death to be regarded as the completion of the life cycle in old age. 6 The process of dying and the prospect of death are universal reminders of our mortality and vulnerability to physical decline.
In discussing culture, we must remember that the African worldview is the means by which individuals interpret and act upon reality. The African worldview that African Americans have handed down to their descendants, though greatly modified, still forms to this day the underpinning of African American society. 7 (p6)
Attitudes Toward Death
As indicated earlier, death is an inescapable, universal, and natural fact of life. Yet, in our society, the fear of death brings an ongoing anxiety into daily living. We fear the inability to predict what the future might bring and the process of dying, particularly of a painful death, more than death itself. Studies show that older adults tend to select quality of life in their end-of-life decision-making, while younger adults tend to choose quantity of life. Older African Americans, however, are less likely to employ advanced directives and more likely to want life-saving technology. 6 cites some factors from Robert J. Lifton’s work on the survivors of Hiroshima that clarify why there are greater challenges within our modern cultural contexts in dealing with death. He offers the following four points as reasons why the process of dying has become more removed and distant within American culture:
- Exclusion of the aged and dying. The movement to segregate the aged and dying away from the general population into nursing or retirement homes causes their societal exclusion. The exclusion factor creates fear of abandonment in the aged and dying, making death even more ominous.
- Advances in medical technology. Medical technology has hastened individuals’ sense of control over their lives and death. These advances have also helped increased life expectancy. Death becomes, then, less frequent as terminal illnesses become chronic instead. Advances in medical technology have served to compromise our ability to view death as a natural part of human life.
- Movement toward the nuclear family. The movement toward smaller and nuclear families leaves more individuals without extended family to reduce their vulnerability and limited support following the death of a loved one. Modern American society offers limited opportunities to experience the act of dying with aged relatives as a natural part of the life cycle.
Howard Thurman noted that we are all participants in the modern conspiracy to reduce immediate contact with death to zero except under the most extraordinary circumstances. To many of us, death is gruesome and aesthetically distasteful as a primary contact for our children and ourselves. 8 (p18) In pre-industrial societies, the majority of deaths took place in the home with the entire community often involved in rituals surrounding the death. By the 1930s, the hospital had become the main setting for death. Today, approximately 75 percent to 80 percent of all deaths occur in institutions (hospitals and nursing homes), where aggressive treatment is common and with only a few friends and relatives present.
Even though a number of persons express the preference to die at home and without pain, the older a person is when he/she dies, the more likely that death will take place in a nursing home setting. This leaves death removed from most individuals’ daily lives. Though our sense of personal loss may be great, our primary relationship with death is frequently impersonal and detached. We shrink from direct personal contact with death. 8 (pp18,19)
Social Dimensions of Death and Dying
As indicated earlier, social death represents the symbolic death of the person in the world they have known. The world the individual has known begins to contract socially and interpersonally. Freeman states “the dying may experience social death as a result of anticipatory grief by friends and or family. Separation of the dying individual from others might result in magnification and preoccupation with the malady and grieving for the losses to come.” 3 (p3)
The AIDS epidemic provides numerous examples of social death. A young adult male dying with AIDS in an African American family may experience social death as a consequence of anticipatory grief by friends and family. Although dying may be viewed primarily as a solitary event, the act of dying has wide implications within a dying individual’s circle of relationships. The isolation produced by social death can be quite painful for the young adult male dying with AIDS due to the societal stigma that has often hastened the sense of alienation for AIDS patients. While families of AIDS patients may have genuine concern about the health and welfare of these dying young adults, family members’ experiences with death and dying under more “normal” conditions may be quite limited. The limited exposure to death and dying hastens social death for AIDS patients. Social death restricts the oxygen of relationships by removing the dying individual from the comfort zone of familiar and positive social contacts. The young adult male with AIDS, then, often loses the very conditions that might enhance his health and well-being at a critical point.
Social death also has implications for the bereaved survivor. The caregiver for the young adult male with AIDS may be a spouse, mother, friend, or partner. As his condition worsens, increased demands are placed upon the caregiver.
Freeman observes that “the losses associated with social death may begin with decreased contact with friends or organizations as they (caregivers) care for the dying person.” 3 (p3) Social death reminds us that few occurrences in life take place in isolation. The physical act of dying produces social implications that impact the dying individual’s circle of relationships and, sometimes, beyond.
Psychological Dimensions of Death and Dying
Psychological death is the death of aspects of the dying person’s personality. This type of death may occur due to a traumatic brain injury or stroke, a consequence of medication or a disease process, or how the dying individual handles his/her grieving process. “Psychological death leaves a person permanently psychologically altered or in a vegetative state. The person, though alive, is not the person the bereaved have known and loved. 3 (p4) Norman Cousins may have had psychological death in mind when he noted that “death is not the greatest loss in life. The greatest loss is what dies inside us while we live.” 9
AFRICAN AMERICAN APPROACH TO DEATH AND DYING
To give this discussion a historical perspective, Nancy Boyd-Franklin suggests four main areas where the experience of African Americans in this country has been unique from other ethnic groups 10 (pp7-11) : 1) African legacy, 2) the history of slavery, 3) racism and discrimination, and 4) the victim system.
Consideration of African Americans’ African legacy incorporates such concepts as family kinship and collective unity, the role of religion, and the African philosophy of life.
In order to fully appreciate how African Americans understand death and dying, some principles of African philosophy must be considered. Dr. John S. Mbiti points out that “many words are used all over Africa concerning the act of dying. People refer to dying as returning home, going away, being called away, becoming God’s property, and so on. All these words show the belief that death is not a complete destruction of the individual. Life goes on beyond the grave. Therefore, people combine their sorrow over the death of someone with the belief that that is not the end and that the departed continue to live in the hereafter.” 11 (p119)
Dr. Mbiti also notes that individuals are quite sensitive to how things are done when a death occurs in the family. As death indicates the physical separation of the individual from other humans, death signals a dramatic change, so the funeral rites and ceremonies serve to draw attention to this permanent separation. African customs generally require that meticulous care be given to funeral rites to avoid undue offense to the departed. 11(p119) Psychologically, funerals in the African American co-culture have come to represent a posthumous attempt to achieve dignity and esteem denied and limited in a larger culture in which people often are treated with minimal respect. Thus, African American funerals represent attempts to affirm the self and achieve some measure of positive self-identity, if only posthumously. 12 (p37)
Sullivan adds additional principles of African philosophy that provide relevant background as to how African American families understand and experience death and dying. Sullivan offers these related principles of African philosophy: 13
- The principle of dual unity serves as a core concept. With dual unity, polarities are opposites. As examples, day and night, dead and living are viewed as having reciprocal and unifying functions, rather than dichotomous ones. Dual unity means that although death represents the soul leaving the body, death is still inherently related to life, as opposed to representing the opposite of life. Death is a different dimension of the same phenomenon.
- The second principle is related to the first. This concept asserts that spirit and matter cannot be separated . In traditional African philosophy the material world is seen as a manifestation of the spiritual world. Thus, life and death—the spiritual and material—are not dichotomous.
- The family is also key to understanding African culture. Africans generally include a larger circle of individuals in their family membership compared with families of European origin. Traditional African societies include children, parents, grandparents, uncles, aunts, brothers, sisters, and the offspring of these relatives. Departed relatives remain in the family circle as the living dead. The living dead remain “alive” in the memories of their surviving families. 14 (pp138, 139), 13(p161)
- According to African philosophy, an individual becomes conscious of his/her own being and responsibilities towards self and others through connections to other persons. In this sense, what happens to the individual happens to the entire group, and whatever happens to the whole group happens to the individual. Mbiti points out that the individual can only say, “I am, because we are; and since we are, therefore I am.” 14(pp.138-141)
For Sullivan the three stated principles weave throughout the African American experience of death and dying with spirituality as a core facet to both life and death. 13 A core belief from African cultures that still influences and directs African Americans’ approach to death is that death is a continuation of life. 15
Diversity Among African Americans
Although cultural beliefs from Africa do influence and direct African Americans’ approach to death and dying, other factors also affect African Americans’ end-of-life behaviors and rituals. The cultural diversity of society in the United States impacts African Americans. In the United States, there are increasing contacts with new immigrants, and co-cultures continue to grow in number.
There is also a great deal of cultural diversity within and between African American communities due to social economic status, educational background, and religious belief systems. Boyd-Franklin asserts that “given the heterogeneity of cultural variables that are present in Black families and communities, it ought to be patently clear that there is no such entity as the Black family. The great diversity of values, characteristics and lifestyles that arises from such elements as geographic origins, level of acculturation, socioeconomic status, education, religious background and age reveals such categorization to be inaccurate. Black people in this country are not a monolithic group.” 10(p6) African Americans are a quite diverse group of people. 16
The diversity of African Americans within the United States means that contemporary approaches to death and dying among African Americans should examine the influences of America’s cultural mélange.
R.K. Barrett points out that contemporary African American funeral rites and practices reflect a fusion of traditional African and Western psychocultural influences. West African influences, in particular, permeate the attitudes, beliefs and values that African Americans reflect in their rituals for the dead. It should be noted that the stronger the African American’s sense of cultural identity (positive sense of African American consciousness), the greater the tendency to adopt traditional attitudes, beliefs, and practices toward death and funeral rituals. 17 (pp80, 81)
Not only religious and spiritual beliefs, but the dying person’s personality and temperament, the primary caregiver’s personality and temperament, the family’s resources, as well as other factors, will influence the manner in which African Americans approach death and dying. 15(pp148,149)
In summary, then, African Americans bring their unique perspective to issues of death and dying. African Americans’ uniqueness has been shaped by their African legacy, their ancestors’ slave experiences, their individual encounters with racism and discrimination, and what Boyd-Franklin calls the victim system. 10 Their perspectives are a reflection and synthesis of the African and American aspects of their character development.
The African American Family
“Call it a clan, call it a network, call it a tribe, call it a family. Whatever you call it, whoever you are, you need one. You need one because you are human. You didn’t come from nowhere.” 18(p123) In this, Howard emphasizes the importance of the family unit in our existence as humans. The African American family is an intimate connection of individuals of African descent that are linked in a variety of ways.
These links may be through blood, marriage, formal adoption, informal adoption, or by appropriation. However, the commonality of individuals in the African American family, regardless of the type of ties to a family unit, is the history of common residence in America with lineage traced to Africa and slavery. 19 (p28)
The primacy African Americans give to the extended family versus the nuclear family is a signal feature carried over from traditional African family patterns. Beyond the nuclear family of parents and children, the extended family embraces grandparents, aunts, uncles, cousins, nieces, nephews, and even more distant relatives, as well as some friends and neighbors. 14,19
In addition to espousing the importance of the extended family to the African American family, some researchers of the African American family broaden the definition of the African American family to include the concept of church family.
The inclusion of the concept of the church family recognizes that for a number of African American families, a church that serves persons of African American ancestry functions essentially as another extended family. Boyd-Franklin points out that after the family and extended family, the church becomes the most common source of assistance for African American people. 10
In summary, extended family, friends, church members, neighbors, and fictive kin constitute complementary sources of informal support for African Americans.20 (p439)
This extended network of family, extended family and church family can be considered part of the African American family’s “African legacy.” 10 As Mbiti emphasized, the African American’s ideas of marriage and family life are firmly rooted in African thinking. 14
Researchers on the African American family have provided the consistent reminder that although African Americans are a diverse people, they share a common cultural heritage linked historically to African culture.
Strengths of African American Families
In his classic research on African American families, 12 Robert Hill emphasized that the large percentage of women and adolescents who, through the years have had to work outside the home long before careers for women became more acceptable in society, necessitated the extraordinary versatility in family roles in African American families. 10 Role versatility, as well as extraordinary perseverance and persistence during difficult times, are strengths of African American families that succeed in spite of challenging circumstances.
Langston Hughes’ poem, Mother to Son, captures the voice of an African American mother’s struggles as she challenges her son to face life’s difficulties with perseverance, persistence, and hard work—three strengths of African American families that succeed in spite of economic and social obstacles. The African American mother in Hughes’ well-known poem knew all too well that her life and her family’s lives had been an uneven journey, but that life’s obstacles necessitated diligence and a steady, attentive “hand to the plow of life.” As a fitting tribute to African American mothers and the importance of their roles in African American families, Hughes’ poem echoes the strength and dignity of African American women in providing resilience to African American families and their communities:
Well, son, I’ll tell you:
Life for me ain’t been no crystal stair.
It’s had tacks in it,
And boards torn up,
And places with no carpet on the floor -
But all the time
I’se been a-climbin’ on,
And reachin’ landin’s,
And turnin’ corners,
And sometimes goin’ in the dark
Where there ain’t been no light.
So boy, don’t you turn back.
Don’t you set down on the steps
’Cause you finds it’s kinder hard.
Don’t you fall now---
For I’se still goin’, honey,
I’se still climbin’
And life for me ain’t been no crystal stair. 22
This poetic tribute is a fitting recognition that African American mothers have been significant strengths to African American families and their communities. Billingsley 19 also notes that evaluating the strengths of African American families should take into account each particular family’s “religion, education, money or property, jobs, family ties, and other community-centered activities.[as] the chief ingredients of strong family life.” 23(p100)
Religion and spirituality are sources of strengths for African American families. The influences of the African continent are evident through the important role of the congregational minister, belief in the supernatural, audience participation during worship, hand-clapping, the rhythms of songs, spirituals and funeral rites. 23(pp112,113) Historically, African Americans’ belief systems have played an important role in shaping attitudes, values and beliefs. Sharon Hines Smith’s study 24(p17) of end-of-life issues also indicated that religious beliefs are important resources during critical periods, such as end-of-life decisions for African American families.
Finally, Hill observed that five factors contributed to the stability, survival, and progress of African American families. 21 These factors are: 1) adaptability of family roles, 2) strong kinship bonds, 3) strong work orientation, 4) strong religious orientation, and 5) strong achievement orientation. Boyd-Franklin cautions that Hill’s five strength factors should be viewed as inherent within African American culture. 10(p16)
The Fluidity of Roles
In the family life cycle, there are differences and similarities between African American families and other majority and minority families. As has been stated earlier, a unique factor of African American family life is fluidity of roles.
Even though the institution of slavery attempted to destroy kinship ties, slaves adapted to this attack by broadening their kinship groups to include non-blood relationships. The pattern of inclusion of pseudo-family members and other relatives in varied family roles continues to this day among many African American families. 25
When death claims a family member and creates a void in the family system, fluidity of roles allows the African American family to reach equilibrium by enabling the family to function, at least in the interim period of early bereavement. Hill pointed out that when the roles in an African American family are flexible, the family appears more likely to cope effectively with changes in circumstances. 21
African American Spirituality and Religion
Historically, religion and spirituality have played significant roles in the lives and experiences of African Americans. Though the majority of African Americans may adhere to a Christian belief system, this does not indicate that all persons of African American ancestry regard death from a religious perspective. This latter point, again, points to the diversity within African American communities.
Recognizing that religion has a quality of universality, that is, all peoples mark the spiritual in some aspects, Mbiti has stated that for persons of color, “it is as if African peoples do not know how to live without religion.” 11(p194) Researchers who study African American families have repeatedly pointed to the central role of religion in these families.
These families’ spiritual beliefs provide important coping and survival resources, especially during critical end-of-life periods, and religion and spiritual beliefs offer adaptive and supportive roles in enhancing the mental health and well-being of African American adults. 10,19,26,20,24
The unique and colorful character of the African American church derives from the African American interpretation of the Western church. As with traditional West African funeral rites, the African American church serves as the wellspring that feeds the African American community its African-inspired religious rituals. 17(p81)
When death occurs in the African American community, the African American church generally serves as the central gathering place for bereaved families. It is not uncommon to find the African American church providing comfort to families that have experienced loss, though the deceased may have been “unchurched” or lacked regular church attendance or membership. If the deceased person’s family members are churchgoers, especially the parents, grandparents, or siblings, enough of a tie may remain for the African American church to extend its collective fellowship and support to the bereaved family. As Sullivan points out, African American churches are major caretakers by serving as both a community and spiritual family. 13
The importance of religion and the spirit in African American families permeates daily conversations in homes. In child rearing, a parent might be heard to say, “Just ’cause folks do bad to you don’t mean God wants you to do bad to them!” 21
What is seen of death is the finality of the physical body. But what is believed about the meaning of death, how it should be faced, and what happens after physical death varies by culture and beliefs.
Though Christianity was seen by slaveholders primarily as a vehicle to control slave behavior and to keep slaves submissive, slaves adapted and reinterpreted Christianity and its music to aid in coping with the vicissitudes of their distressing conditions. The reinterpretation brought forth numerous Negro spirituals. 27
African Americans’ inherent spirituality throughout life and death can be evidenced in the music and lyrics of slave songs. The late theologian, Howard Thurman, who was also a philosopher, mystic and spiritual mentor, provided his insights about African American spirituality as expressed through music in his work, The Negro Spiritual Speaks of Life and Death .
Thurman “examines the Negro spirituals as a source of rich testimony concerning life and death, of a people for whom the cup of suffering overflowed in haunting overtones of majesty, beauty and power. 8(p12)
Thurman suggests that Negro spirituals spring from three sources: the world of nature, the African American experience, and the Bible. 8 The reality of death, as expressed through song, occurs within a particularized context. The slave was regarded as chattel property, a tool, a commodity, but not a person. Death always loomed as an ever-present threat. Thurman poignantly writes that “he (the slave) was faced constantly with the imminent threat of death, of which the terrible overseer was the symbol. If a slave were killed, it was a property loss, a matter of bookkeeping.” 8(p14) The situational context of the slave robbed death of any dignity, with the attitude toward death profoundly influenced by life’s experiences.
African Americans as slaves cause these questions to be raised: What were the slaves’ attitudes toward death? How important was death in their thinking? Was death viewed as the worst of all possible things that can happen to a person? Thurman offers his response to the African American slaves’ attitudes and response to death in this familiar spiritual refrain:
Oh, Freedom! Oh, Freedom!
Oh, Freedom, I love thee!
And before I’ll be a slave,
I’ll be buried in my grave,
And go home to my Lord and be free. 8
Of course there are additional spirituals that also reflect the message from the slave song above. The point here is that death was not viewed as the worst thing that can happen to an individual. As the slave song suggests, death would be preferred over slavery because, at least, through death, the captive slave would know freedom. For African Americans, there are some things in life that are worse than death. 8(p15) The historical refrains provided by some African American spirituals inform us that death and dying have loomed heavily in the African American consciousness since the earliest days of Africans on North American shores. The slave songs provide an important window into African American spirituality and beliefs about death and dying.
The Family Tasks of Grief
A family’s cultural roots can deeply impact family members because each family member is part of a family system. Families are systems because of the linkage of the various family members. 16(p35) The African American family unit is a dynamic and interactional system. Though death and dying are natural and universal, these events often occur as solitary events within the family unit. Death brings a profound impact on the family unit that can result in disequilibrium and adversity that reduce the family’s proper functioning. Researchers on the family have repeatedly indicated that the death of a family member is one of the most powerful emotional upheavals that families ever face. 3 How each family responds to death in the family will, of course, vary. The range can be from non-adaptation to extraordinary resilience.
Freeman summarizes the task model of family grief that closely follows that of Worden and Moos. Families’ grief work is an extension of individual grief work. The five tasks of family grief are as follows:
- 1. The first task of family grief is the need for family members to openly acknowledge the death at both cognitive and emotional levels. This requires communication and conversation about the deceased, as well as family members, sharing feelings about the death and surrounding events.
- 2. The second task of family grief is to allow mourning to occur. The pain of mourning necessitates that family members cooperate in aiding other family members in the grieving process.
- 3. The third task of family grief, according to Freeman, is the process of adjusting to an environment in which the deceased is missing. The deceased remains in the family’s consciousness, though the family must now adapt to life without the deceased.
- 4. The fourth task of family grief is the realignment of intrafamily roles. Responsibilities have to be redistributed and roles readjusted with the family unit. Role adjustment faces each family member at some level.
- 5. The fifth task of family grief is the realignment of extrafamily roles. Family members now face the task for establishing new types of relationships with old acquaintances and making new acquaintances without the deceased family member’s presence or input. 3(p145)
As said previously, death is a universal, natural, and inescapable fact of life. Regardless of our culture, every individual must face the fact that life is finite: We will not go on in our earthly form forever. The loss of a family member can be a devastating emotional experience for a family to face. This discussion addressed the psycho-social dimensions of death and dying in relation to the African American family. Consideration in this discussion was given to the changing cultural context of death and dying over time, the psycho-social dimensions of death and dying and the African American perspective on death and dying. Death in the African American community can be viewed as a celebration of life and as a statement of the fact that life’s journey has been completed.
1. Samovar LA, Porter RE. Communication Between Cultures. 2nd ed. New York: Wadsworth Publishing Co; 1995.
2. Koenig HG. Aging and God . Binghamton, NY: Haworth Press; 1994.
3. Freeman S. Grief and Loss. Belmont, Calif: Thomson-Brooks/Cole Publishers; 2005.
4. Brislin R. Understanding Culture’s Influence on Behavior. Orlando, Fla: Harcourt Brace Jovanovich Publishers; 1993.
5. Braun KL, Pietsch JH, Blanchette PL, eds. Cultural Issues in End-of-Life Decision-Making. Thousand Oaks, Calif: Sage Publishers; 2000.
6. Hooyman NR, Kiyak HA. Social Gerontology. 7th ed . Boston, Mass: Allyn and Bacon Publishers, 2005.
7. Harvey AR, ed. The Black Family: An Afro-centric Perspective. New York: United Church of Christ Commission for Racial Justice; 1985.
8. Thurman H. Deep River and the Negro Spiritual Speaks of Life and Death . Richmond, Ind: Friends United Press; 1975.
9. Brainy Quote. Norman Cousin Quotes. Available at: http://www.brainyquote.com/quotes/authors/n/norman_cousins.html. Accessed May 7, 2006.
10. Boyd-Franklin N. Black Families in Therapy. New York: Guilford Press; 1989.
11. Mbiti JS. Introduction to African Religion. 2nd ed. Oxford, England: Heinemann Educational Publishers; 1991.
12. Barrett RK. Reclaiming and reaffirming the value of contemporary African American funeral rites. The Director . 1994.
13. Sullivan MA. May the circle be unbroken: The African American Experience of death, dying and spirituality. In: Parry JK, Ryan AS, eds. A Cross-Cultural Look at Death, Dying and Religion . Chicago, Ill: Nelson-Hall Publishers; 1995.
14. Mbiti JS. African Religions and Philosophy. New York: Anchor Books; 1970.
15. Bolling JL. Guinea across the water: The African American approach to death and dying. In: Parry JK, Ryan AS, eds. A Cross-Cultural Look at Death, Dying and Religion. Chicago, Ill: Nelson-Hall Publishers; 1995:145-159.
16. Pillari V, Newsome M Jr. Human Behavior in the Social Environment. Pacific Grove, Calif: Brooks/Cole Publishing Co; 1998.
17. Barrett RK. Contemporary African American funeral rites and traditions. In: DeSpelder LA, Strickland A, eds. The Path Ahead: Readings in Death and Dying . Mountain View, Calif: Mayfield Publishing Co; 1995.
18. Howard J. Families. In: Alvarez RA, Kline SC, eds. A Family Album: The American Family in Literature and History. Washington, DC: National Council on Aging; 1982.
19. Billingsley A. Climbing Jacob’s Ladder . New York: Simon and Schuster Publishers; 1992.
20. Taylor RJ, Chatters LM, Hardison CB, Riley A. Informal social support networks and subjective well-being among African Americans. Journal of Black Psychology. November 2001:27(4): 439-463.
21. Hill R. The Strengths of Black Families. New York: National Urban League; 1972.
22. Hughes L. In: Alvarez RA, Kline SC, eds. A Family Album: The American Family in Literature and History . Washington, D.C.: National Council of Aging; 1982.
23. Hill R. Research on the African American Family. Westport, Conn: Auburn House; 1993.
24. Hines Smith S. End-of-life care decision-making processes of African American families: Implications for culturally sensitive social work practice. Journal of Ethnic and Cultural Diversity in Social Work, Binghamton, NY: Haworth Press; 2004:13(2).
25. Logan SML, Freeman EM, McRoy RG. Social Work With Black Families. New York: Longman Publishers; 1990.
26. Levin JS, Chatters LM, Taylor RJ. Religious effects on health Status and life satisfaction among Black Americans. Journal of Gerontology . 1995;50B(3): 5154-5163.
27. Dodson JE. An Afrocentric Educational Manual: Toward a Non-deficit Perspective in Services to Families and Children. Knoxville, Tenn: University of Tennessee School of Social Work; 1977.