Which of the following is NOT a cultural universal when it comes to death and dying

Abstract

The concept of death is not a single construct, but instead is composed of various components, including universality, irreversibility, nonfunctionality, and causality. A fifth component, noncorporeal continuation, is proposed. The age when most children achieve a "mature" understanding of death is reviewed and found to be more complex than has traditionally been assumed.

Key Words: concepts, death, cognitive development

1. Mark W. Speece, Ph.D., is Assistant Professor, Department of Internal Medicine, School of Medicine, Wayne State University, 4201 St. Antoine St., University Health Center 5C, Detroit, Michigan, 48201. Electronic mail may be sent via Internet to .

   

Death-related experiences are common in childhood, although many adults assume otherwise. Understanding death is an important issue for children, and they begin at an early age to try to understand it. Numerous studies have been conducted to determine what children of various ages understand about death.

The systematic study of children's understanding of death has had a long history, with the first study being conducted by Schilder and Wechsler (1934). To date there have been over 100 studies of children's understanding of death published in the English language (Speece, 1994). Reviews of this literature are provided in Speece and Brent (in press), Speece and Brent (1984), and Stambrook and Parker (1987).

Despite the large number of studies which have been conducted, there has been surprisingly slow progress in this area (Speece & Brent, in press) and the overall results are aptly described as confusing (Stambrook & Parker, 1987). Speece and Brent list a number of reasons for the lack of progress and confusion. Two of the most important appear to be (a) confusion over the names for, definitions of, and operationalizations of the various aspects of the concept of death; and (b) lack of reliable and valid standardized measures for these aspects.

The primary purpose of the present article is to identify and define the key aspects of the concept of death. In addition, the ages when most children are reported to achieve a mature understanding of those key aspects is reviewed. Finally, the validity of the presumed mature adult concept of death is discussed.

The Concept of Death

Since the 1970s it has been generally accepted that the concept of death is not a single, unidimensional concept. Instead it is composed of several relatively distinct subconcepts, referred to as components. Investigators have varied considerably in the exact number of components they have recognized and in how they have defined them. However, four components account for the bulk of research: Universality, Irreversibility, Nonfunctionality, and Causality (Speece, 1994). Over 90 studies involve at least one of these four components. Each of the four components is discussed next, beginning with their definitions and followed by a discussion of children's early views of death, prior to the time when a mature understanding of each component is achieved.

DEFINITIONS OF THE KEY COMPONENTS

Universality. Universality refers to the understanding that all living things must eventually die.

Irreversibility. Irreversibility refers to the understanding that once the physical body dies it cannot be made alive again. In offering this definition the question of whether there is some sort of noncorporeal continuation after death of the body (e.g., concepts such as reincarnation and resurrection) is left open. It has also been useful to distinguish the irreversibility of death of the physical body from the question of whether any kind of life functions continue after death. This latter aspect is the component Nonfunctionality.

Nonfunctionality. Nonfunctionality refers to the understanding that once a living thing dies all of the typical life-defining capabilities of the living physical body (e.g., walking, eating, hearing, seeing, thinking, and learning) cease. Here again, specifying the person's physical body distinguishes this aspect of the concept of death from the issue of whether some noncorporeal aspect of a person, such as the spirit, is capable of any life-like functions (e.g., loving, helping) after death.

Causality. Unlike the other three components, there is no consensus as to the definition of Causality. However, collectively, the various approaches suggest that Causality involves an abstract and realistic understanding of the external and internal events that might possibly cause an individual's death. "Abstract" refers to the fact that the causes specified are not restricted to particular individuals or events but are classes of causes which are applicable to living things in general. "Realistic" refers to the fact that the causes specified are generally accepted by mature adults as valid causes of death.

It is important to note that these four components focus on the biological and scientific aspects of the death of the physical body. We know considerably less about other important aspects, such as beliefs in spiritual continuation after death, and the meaning and significance of death for children of various ages (Klatt, 1991).

CHILDREN'S EARLY VIEWS OF EACH COMPONENT

Before understanding Universality. In general, younger children are more likely than older children to indicate that death is not universal. Exceptions have included the child him-or herself, children in general, the child's immediate family, teachers, and even the investigators. Younger children are also more likely than older children to think that death is avoidable if you are clever or lucky (e.g., Nagy, 1948) and to indicate that death only occurs in the remote future (e.g., Candy-Gibbs, Sharp, & Petrun, 1984; Derry, 1979; Lee, 1987; Swain, 1979). When children (or adults) project the timing of their own deaths into the remote future they are likely to be correct. The key issue here, however, is not whether it is likely to occur at any given time, but whether it is possible for death to occur at any time. Younger children are less likely to understand that possibility.

Schilder and Wechsler (1934) found that children attribute the possibility of death to all other people before they extend it to themselves. Most subsequent research, however, suggests the opposite: that most children understand their own personal mortality before they understand that all other people die (Derry, 1979; Devereux, 1984; Hornblum, 1978; Jay, Green, Johnson, Caldwell, & Nitschke, 1987; Peck, 1966; Robinson, 1977; Speece & Brent, 1992; Steiner, 1965). In addition, these studies found that when children exclude themselves from dying they almost always exclude other individuals as well.

Before understanding Irreversibility. Younger children are more likely than older children to view death as temporary and reversible. Some young children see death as similar to sleep (from which you will wake up) or like a trip (from which you will return). Children who think death can be reversed believe that it can happen spontaneously (e.g., Nagy, 1948), after eating or drinking (e.g., Beauchamp, 1974; Hansen, 1973), through wishful thinking (e.g., Hansen, 1973), by praying (e.g., Weininger, 1979), and as the result of magical or medical intervention (e.g., Speece & Brent, 1992).

Before understanding Nonfunctionality. Younger children are more likely than older children to think that the dead continue to be able to perform various functions (e.g., Hoffman & Strauss, 1985; Kane, 1979). In addition, the understanding of Nonfunctionality appears to differ depending on which function is considered. For example, Kane distinguished between those functions which are external and readily observable to the child (like eating and speaking) and those which are internal and therefore have to be inferred (like dreaming and knowing). She found that at any given age more children understood the cessation of external functions than understood internal functions.

Before understanding Causality. In general, younger children are more likely than older children to provide unrealistic causes (e.g., bad behavior causes death) or specific concrete causes (e.g., guns, poison) (Devereux, 1984; Koocher, 1973; Robinson, 1977), to focus on external causes (e.g., violence and accidents) rather than internal causes (illness, old age) (e.g., Kane, 1979; Karpas, 1986), and to lack an understanding that death ultimately results from a failure of internal bodily organs or functions (Candy-Gibbs, Sharp, & Petrun, 1984).

The Achievement of a Mature Understanding of Death

A considerable number of the studies in this area were designed, at least in part, to determine when children achieve a mature adult understanding of death as represented by the simple definitions. Not surprisingly, age is the most common variable to be examined in relation to children's concepts of death. Overall, this literature suggests that there is a positive relationship between age and children's concepts of death (Speece & Brent, in press). In general, older children's concepts are more realistic and abstract (i.e., more "adult-like") than those of younger children.

On the other hand, the specific age at which children are reported to have achieved an adult understanding of key components has varied between 4 to 12 years or older (Speece & Brent, 1984). This wide variability exists for both inter-study comparisons of a single component and intra-study comparisons of multiple components. Given this fact, one could end up with different conclusions depending upon which set of individual studies were selected for review. The results from the entire body of literature, however, yield a clear picture. The majority of studies have found that by age seven most children understand each of the key bio-scientific components—Universality, Irreversibility, Nonfunctionality, and Causality (Speece & Brent, in press).

This finding should serve as a useful guideline for anticipating what children of various ages understand about death. It should not, however, obscure the fact that many children will achieve a mature understanding prior to age seven. The determination of what a particular child understands will still need to be made on an individual basis. This guideline, taken in conjunction with knowledge of the key components and children's early views of them, serves as a useful framework for exploring an individual child's understanding of death.

What is the Mature Understanding of Death?

The discussion to this point has assumed that there is a single mature adult's understanding of death and that we know what it is. However, with one exception (Brent & Speece, 1993) the mature concept of death has not been validated empirically.

This issue is important because studies of the development of children's understanding of death typically compare the children's concepts against a presumed "mature adult" concept of death. This mature concept is assumed to be the end-state toward which the process of conceptual development is directed. In this literature, the presumed mature understanding of each component has been assumed to be its simple definition. Recent research, however, has challenged that assumption for several of the components (Brent & Speece, 1993; Brent, Speece, Lin, Dong, & Yang, 1994). The mature understanding of each component is discussed below.

UNIVERSALITY

The presumed mature adult understanding of Universality is that all living things eventually die. This definition appears to be an accurate representation of the concepts of older children and adults.

CAUSALITY

There is as yet no consensus as to the mature understanding of Causality. Speece and Brent (in press) describe it in general terms as involving both an abstract and realistic recognition of the various general causes of death (e.g., illness, accidents) and the understanding that death ultimately results from the failure of one or more specific internal bodily functions or organs (e.g., heart, kidneys, brain).

IRREVERSIBILITY AND NONFUNCTIONALITY

In contrast, the simple definitions of Irreversibility and Nonfunctionality do not adequately reflect the complexity of how many older children and adults conceptualize death (Speece & Brent, in press; Brent & Speece, 1993; Brent et al. 1994). Most of that complexity appears to be the result of two considerations—the possibility of medical reversal of death and that of noncorporeal continuation after physical death.

Medical reversibility. The issue of medical reversibility first came to our attention in a study of children's understanding of death (Speece & Brent, 1992). When children were asked questions about Irreversibility, a few children referred to accounts of a dead

person being brought back to life in a hospital. These accounts were more likely to be given by older children and were qualitatively different from those of other children who sometimes expressed an unrealistic notion that doctors could make many or all dead people alive again by relatively simple means (e.g., by giving them a pill).

Of course, supposed reversals of death are common in news accounts of contemporary society, including popular television shows like "Rescue 911." Accounts of near-death experiences are also popular and many adults appear to accept their authenticity (cf. Moody, 1975). More recently, similar notions of medical reversibility have been found in both adults' and children's concepts of death (Brent et al. 1994).

Thus, both anecdotal reports and my own research suggest that many children and adults are aware of instances where a supposedly "dead" person was subsequently successfully resuscitated, and that some of these people believe that these instances are bona fide exceptions to the general irreversibility of death. In contrast, others view these same instances as simply "mistaken attributions of death"—that the "dead" person only appeared to be dead. Still others remain uncertain about how to interpret them.

Before continuing, it is important to note that even those children and adults who considered successful resuscitations as examples of reversible death typically emphasized the exceptional nature of those reversals by mentioning things like (a) the availability of the appropriate medical intervention and (b) the time elapsed since death. By doing so they demonstrated that they did not reject the ultimate irreversibility of death.

What are the theoretical implications of these findings regarding medical reversibility? For one, these findings suggest, for at least some adults, that the concept of Irreversibility is more complex than is suggested by its simple definition. Brent and Speece (1993) suggested that the concept of medical reversibility represents a more complex understanding of the irreversibility of death, which has resulted in part from advances in medical technology that have occurred during the past 30 years. These advances in both techniques (e.g., cardiopulmonary and brain resuscitation) and equipment (e.g., respirators) have radically altered our understanding of where to locate the boundary between "alive" and "dead". A second implication is that the mature concept of death may, in fact, have at least three separate end-points characteristic of three different groups of adults. These end-points are that death is either (a) never reversible, (b) sometimes reversible, or (c) possibly reversible.

Surprisingly, few previous investigators have considered the issue of medical reversibility. Of those researchers, most have generally considered such responses as immature (e.g., Robinson, 1977; Walco, 1984, Weber & Fornier, 1985). From a methodological perspective, at a minimum, future investigators should explicitly describe how they plan to code medical reversibility responses. Our discussion here and elsewhere (Speece & Brent, in press) argues for considering at least some of these responses as mature.

Noncorporeal Continuation. Noncorporeal continuation responses (e.g., heaven) are common among children. However, the importance of this issue for the development of the concept of death became apparent in an attempt to validate the presumed adult concept of death (Brent & Speece, 1993). Brent and Speece found that some adults gave responses which explicitly or implicitly suggested the possibility of some sort of personal noncorporeal continuation after death. The existence of such beliefs was not surprising; however, the extent to which they occurred in this particular study was surprising. Such responses occurred despite the fact that the instructions and questions dealt specifically and exclusively with the death of the physical body. Thus, our findings highlighted the importance of non-naturalistic understandings of death, in addition to naturalistic (bio-scientific) understandings, for some adults.

Noncorporeal Continuation has seldom been identified as a separate component in the research literature (notable exceptions include Anthony & Bhana, 1988; Black, 1979; Blum, 1976). However, there are indirect references to this component by some investigators who either mention it in passing, illustrate it in the sample responses they provide for other components, or include it as a subordinate part of the coding system for Irreversibility or Nonfunctionality (e.g., Hagey, 1991; Swain, 1979). When such responses are a part of a coding system, they generally are considered a less mature understanding of Irreversibility and/or Nonfunctionality.

The failure of most investigators to identify Noncorporeal Continuation as a separate component and the tendency to consider such responses as immature appear to be primarily the result of the emphasis (often bias) in the child development literature on the bioscientific (naturalistic) aspects of children's conceptual development in general, and of children's concepts of death in particular.

The existence of noncorporeal continuation responses raises both theoretical and methodological issues for the study of children's concepts of death (Fetsch, 1984; Hagey, 1991). One important methodological implication, and which was shown by Brent and Speece (1993), is that even researchers who intend to focus on the bio-scientific aspects of death (e.g., children's understanding of Irreversibility and Nonfunctionality) should expect some children to give noncorporeal continuation responses. Consequently, researchers will have to consider how they wish to score such responses. The appropriate methodology for exploring children's understandings about nonnaturalistic aspects of death, as separate from their understandings of the Irreversibility and Nonfunctionality of physical death, remains an interesting challenge.

In an attempt to correct what was considered an oversight, Speece and Brent (in press) proposed Noncorporeal Continuation as the fifth key component of the concept of death. As they discuss it, Noncorporeal Continuation refers to thoughts about whether some form of personal continuation exists after the death of the physical body (e.g., reincarnation in a new body, or ascension of the soul to heaven without the body). They point out that the mature understanding of Noncorporeal Continuation needs to be further investigated and articulated and that the description of the mature adult understanding of Noncorporeal Continuation will have to include a number of alternative views, including the view that there is no continuation. All of these views will need to be considered equally mature from a developmental perspective.

SUMMARY

The issues of medical reversibility and noncorporeal continuation do not involve a rejection of the simple definitions for Irreversibility and Nonfunctionality, but rather suggest that the simple definitions do not adequately reflect the complexity of the mature understanding of either component, or that there may be a multiformity of developmental endpoints for each component. In addition, both issues highlight the need for the development of a methodology to appropriately measure all of these aspects.

Conclusions

1. Variability among investigators as to how the various components are selected, defined, measured, and scored are primarily responsible for the confusing nature of this empirical literature as a whole.

2. The concept of death is best viewed as composed of a number of relatively distinct components. Most of the research on children's concepts of death has focused on four bio-scientific components: Universality, Irreversibility, Nonfunctionality, and Causality. Noncorporeal Continuation was proposed as a fifth component.

3. With increasing age, children's understanding of the bio-scientific aspects of death becomes more like the presumed mature adult concept. The majority of studies suggest that by age seven most children have achieved a mature understanding of the four key components. This finding will provide a useful guideline for individuals working with children around death-related issues, although a particular child's understanding will need to be determined on an individual basis.

4. The adult concept of death itself, as a developmental endpoint by which children's concepts of death are measured, needs further specification and validation. The presumed mature adult concept, as represented in the simple definitions of the components, does not adequately reflect the richness, complexity, and diversity of the concepts of many older children and adults. For the components Irreversibility and Nonfunctionality, the issues of medical reversibility and noncorporeal continuation are especially important.

References

Anthony, Z., & Bhana, K. (1988). An exploratory study of Muslim girls' understanding of death. Omega Journal of Death and Dying, 19, 215-227.

Beauchamp, N.W (1974). The young child's perception of death (Doctoral dissertation, Purdue University, 1974). Dissertation Abstracts International, 35, 3288A.

Black, C.F.P. (1979). Young children's understandings about death as perceived by parents, teachers, and a recorder (Doctoral dissertation, Texas Woman's University, 1978). Dissertation Abstracts International, 40, 157B.

Blum, A.H. (1976). Children's conceptions of death and an after-life (Doctoral dissertation, State University of New York at Buffalo, 1975). Dissertation Abstracts International, 36, 5248B.

Brent, S.B., & Speece, M.W. (1993). "Adult" conceptualization of irreversibility: Implications for the development of the concept of death. Death Studies, 17, 203-224.

Brent, S.B., Speece, M.W., Lin, C., Dong, Q., & Yang, C. (1994). The development of the concept of death among Chinese and U.S. children 3-17 years of age: from binary to "fuzzy" concepts? Manuscript in preparation, Wayne State University.

Candy-Gibbs, S.E., Sharp, K.C., & Petrun, CJ. (1984-85). The effects of age, object, and cultural/religious background on children's concepts of death. Omega Journal of Death and Dying, 15, 329-346.

Cotton, C.R., & Range, L.M. (1990). Children's death concepts: Relationship to cognitive functioning, age, experience with death, fear of death, and hopelessness. Journal of Clinical Child Psychology, 19, 123-127.

Derry, S.M. (1979). An empirical investigation of the concept of death in children. Unpublished doctoral dissertation, University of Ottawa.

Devereux, W.C. (1984). Children's understanding of the physical realities of death (Doctoral dissertation, The University of North Dakota, 1983). Dissertation Abstracts International, 44, 3523B.

Fetsch, S.H. (1984). The 7- to 10-year-old child's conceptualization of death. Oncology Nursing Forum, 11(6), 52-56.

Florian, V. (1985). Children's concept of death: An empirical study of a cognitive and environmental approach. Death Studies, 9, 133-141.

Florian, V., & Kravetz, S. (1985). Children's concepts of death: A cross-cultural comparison among Muslims, Druze, Christians, and Jews in Israel. Journal of Cross Cultural Psychology, 16, 174-189.

Hagey, S.L. (1991). A developmental study of terminally-ill, chronically-ill and physically-healthy children's concern with and cognitive evaluation of death (Doctoral dissertation, The University of Texas at Austin, 1990). Dissertation Abstracts International, 51, 3363A.

Hansen, Y.F. (1973). Development of the concept of death: Cognitive aspects (Doctoral dissertation, California School of Professional Psychology - Los Angeles, 1972). Dissertation Abstracts International, 34, 853B.

Hoffman, S.I., & Strauss, S. (1985). The development of children's concepts of death. Death Studies, 9, 469-482.

Hornblum, J.N. (1978). Death concepts in childhood and their relationship to concepts of time and conservation (Doctoral dissertation, Temple University, 1978). Dissertation Abstracts International, 39, 2146A.

Jay, S.M., Green, V., Johnson, S., Caldwell, S., & Nitschke, R. (1987). Differences in death concepts between children with cancer and physically healthy children. Journal of Clinical Child Psychology, 16, 301-306.

Kane, B. (1979). Children's concepts of death. Journal of Genetic Psychology, 134, 141-153.

Karpas, R.J. (1986). Concept of death and suicidal behavior in children and adolescents (Doctoral dissertation, Pace University, 1986). Dissertation Abstracts International, 47, 3136B.

Klatt, H. (1991). In search of a mature concept of death. Death Studies, 15, 177-187.

Koocher, G.P. (1973). Childhood, death and cognitive development. Developmental Psychology, 9, 369-375.

Lazar, A., & Torney-Purta, J. (1991). The development of the subconcepts of death in young children: a short-term longitudinal study. Child Development, 62, 1321-1333.

Lee, W. (1987). Children's conceptions of death: A study on age and gender as factors in concept development (Doctoral dissertation, Harvard University, 1987). Dissertation Abstracts International, 48, 2119B.

Moody, R.A., Jr. (1975). Life after life. New York: Bantam.

Nagy, M. (1948). The child's theories concerning death. Journal of Genetic Psychology, 73, 3-27.

Orbach, I., Gross, Y., Glaubman, H., & Berman, D. (1985). Children's perception of death in humans and animals as a function of age, anxiety and cognitive ability. Journal of Child Psychology and Psychiatry and Allied Disciplines, 26,453-463.

Orbach, I., Gross, Y., Glaubman, H., & Berman, D. (1986). Children's perception of various determinants of the death concept as a function of intelligence, age, and anxiety. Journal of Clinical Child Psychology, 15, 120-126.

Orbach, I., Talmon, O., Kedem, P., & Har-Even, D. (1987). Sequential patterns of five subconcepts of human and animal death in children. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 578-582.

Peck, R. (1966). The development of the concept of death in selected male children: An experimental investigation of the development of the concept of death in selected children from the point of no concept to the point where a fully developed concept is attained with an investigation of some factors which may affect the course of concept development (Doctoral dissertation, New York University, 1966). Dissertation Abstracts International, 27, 1294B.

Robinson, R.A. (1977). The development of a concept of death in selected groups of Mexican-American and Anglo-American children (Doctoral dissertation, California School of Professional Psychology - San Diego, 1976). Dissertation Abstracts International, 38, 4478B.

Schilder, P., & Wechsler, D. (1934). The attitude of children towards death. Journal of Genetic Psychology, 45, 406-451.

Schonfeld, D.J., & Kappelman, M. (1990). The impact of school-based education on the young child's understanding of death. Journal of Developmental & Behavioral Pediatrics, 11, 247-252.

Schonfeld, D.J., & Smilansky, S. (1989). A cross-cultural comparison of Israeli and American children's death concepts. Death Studies, 13, 593-604.

Smilansky, S. (1987). On death: Helping children understand and cope. New York: Peter Lang Publishing.

Smilansky, S., & Weissman, T. (1978). A guide for rehabilitation workers with orphans of war casualties and their mothers. Jeruselem: Henrietta Szold Institute.

Speece, M.W. (1994). Compendium of studies of children's concepts of death. Manuscript in preparation, Wayne State University.

Speece, M.W., & Brent, S.B. (1984). Children's understanding of death: A review of three components of a death concept. Child Development, 55, 1671-1686.

Speece, M.W., & Brent, S.B. (1992). The acquisition of a mature understanding of three components of the concept of death. Death Studies, 16, 211-229.

Speece, M.W., & Brent, S.B. (in press). The development of children's understanding of death. In C.A. Corr and D.M. Corr (Eds.), Helping children cope with death and bereavement. New York: Springer.

Stambrook, M., & Parker, K.C. (1987). The development of the concept of death in childhood: A review of the literature. Merrill Palmer Quarterly, 33, 133-157.

Steiner, G.L. (1965). Children's concepts of life and death: A developmental study (Doctoral dissertation, Columbia University, 1965). Dissertation Abstracts International, 26, 1164

Swain, H.L. (1979). Childhood views of death. Death Education, 2, 341-358. Walco, G.A. (1984). Fatally ill children's comprehension of death (Doctoral dissertation, The Ohio State University, 1984). Dissertation Abstracts International, 45, 2706B.

Weber, J.A., & Fournier, D.G. (1985). Family support and a child's adjustment to death. Special Issue: The family and health care. Family Relations Journal of Applied Family and Child Studies, 34, 43-49.

Weininger, O. (1979). Young children's concepts of dying and dead. Psychological Reports, 44, 395-407.

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