The Mis-Bereavement of Transnational Deaths: Exploring Grief and Bereavement Experiences among Latinx Immigrants in the United States

I. INTRODUCTION

The continuous growth of the Latino population in the United States draws attention to the importance of providing culturally appropriate clinical services as it relates to grief and loss. The Latino population reports experiencing mental health challenges similar to any other ethnic group in the U.S., however, research shows that this population underutilizes mental health services as a result of many barriers including the lack of culturally competent clinicians (Hacker, Anies, Folb, & Zallman, 2015). Historically grief and loss have been studied primarily among the dominant European American population and it is this gap in research that has made it difficult for clinicians to understand racial and cultural differences in practices related to grief, loss and bereavement (Schoulte, 2011). Thus, this study noted in-group differences in grieving and bereavement experiences among this highly diverse population. This study has the potential to increase the visibility and needs of Latino immigrants dealing with transnational deaths in the United States and provides recommendations for human services and other mental health professionals in the field of social work working with Latino immigrant clients experiencing a death of a loved one in their home country while simultaneously residing in the United States.

II. CULTURAL DIFFERENCES IN GRIEF AND LOSS

Grief symptomology is assumed to be universal, however, bereavement varies across cultures and ethnicities (Rosenblatt, 2008). In order to inform treatment plans for grieving Latino Americans, Schoulte (2011) examined bereavement and mourning experiences among Latino groups in the U.S. The study found that within the Latino culture there is a preference for death at home surrounded by family and friends, with caretaking done by the women in the family. Additionally, bereaved Latinos with high values of familismo, personalismo, and confinanza (family, intimacy, and trust) will mourn the death of a loved one in different ways from what the dominant culture may perceive as a more "appropriate" grieving process.

The study also found that Latino families will exhaust other forms of social support before seeking professional help with issues concerning grief and loss. Most importantly, Latino families grieving the loss of a loved one reported maintaining ongoing relationships with the deceased through dreams, storytelling, faith-based connections, altars, and the use of certain flowers to entice the deceased spirits to return home. This study revealed some culturally specific perspectives on grief and bereavement among Latino groups in the U.S. It is especially important for clinicians to understand these culture influences and the impact it has on people's reactions so that services delivered are culturally appropriate.

III. MIGRATION AND AMBIGUOUS LOSS

The concept of ambiguous loss was first proposed by Boss (1999), Boss defined ambiguous loss as a loss that is unclear, incomplete or partial. According to Boss there are two types of ambiguous loss, the first one is a loss in where people are physically absent but psychologically present (i.e. migrating relative), and the second is a loss in where people are physically present but psychologically absent (i.e. living with a relative suffering from Alzheimer's).

A qualitative study conducted by Solheim & Ballard (2016) used the ambiguous loss framework in order to understand the complex realities of transnational families. The study found that immigrants coped with ambiguous loss by engaging in transnational family practices. These practices included but were not limited to phone calls, money remittances, gifts, and occasional trips back home. This study also found a common theme among participants which included the long-lasting dream of returning home to loved ones. Some participants had plans of returning home quickly and others considered their migration as a potentially lifelong absence. Regardless of their length of separation, most participants reported experiencing emotional tolls as a result of being away from their loved ones, including worry, disconnection, depression, loneliness, and loss. In a later study conducted by Boss (2007), the researcher found that the way in which immigrants cope with ambiguous loss after migration can also impact the way immigrants experience and cope with loss later in life.

3.1 Coping and Processing Transnational Grief

A qualitative study conducted by Nesteruk (2017) examining immigrants' experiences coping with the deaths of family members in their home country found three related themes across participants. The first theme pertained to the stressors of caregiving for aging parents in their country of origin. Participants in this study described a sense of duty to provide direct care or financially contribute to the care of their aging loved ones in their home countries. The second theme across participants was distance and its impact on their ability to participate in death related rituals. Many participants reported grieving alone in their adoptive country because of distance and a lack of familial support. The third theme among participants was anticipatory grief and resiliency as result of coping with migratory losses earlier in life. Immigrants reported experiencing profound losses when they first migrated and lost physical contact with family members, however, immigrant's personal growth and resiliency as a result of coping with migratory loss later served as a protective role and helped immigrants cope with the deaths of family members in their home country.

Another qualitative study conducted by Bravo (2017) took a particular focus on the experiences of undocumented immigrants coping with deaths in their home country. In this study, the author found that the grieving process of the undocumented population is unique to those who are documented because for undocumented immigrants there is no option but to be away during these difficult times. As a result, the author found that more undocumented immigrants were using technologies like Skype, Facebook, and Whatsapp to achieve a virtual co-presence and the illusion of 'being there' when they experienced a death of a loved one in their home country. Although communication technologies did not replace the closure face-to-face interactions provided, participants in this study reported they made life more bearable during difficult times.

3.2 Disenfranchised and prolonged grief

Nesteruk (2017) & Bravo (2017) findings suggest that not only do immigrants' earlier life experiences with migratory loss, relationships and contact with family in home countries, and immigration status impact immigrant's grief and bereavement journey, an immigrant's grief can be further prolonged or disenfranchised by the demands of family, jobs, social networks, and other roles in their host country.

A study conducted by Jordan & Litz (2014) examining prolonged grief disorder also known as complicated grief, pathological grief, or traumatic grief in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defined prolonged grief as primarily characterized by an intense longing for the deceased person, difficulties in accepting the death, the feeling of having lost a part of oneself, difficulties in continuing with life, and emotional numbness. Disenfranchised grief defined by Mortell (2015) means individual grief that cannot be openly acknowledged, this type of grief has also been correlated with complicated grief which is grief that remains unresolved. Therefore, an immigrant's grief and bereavement journey can be prolonged if the immigrant is unable to cope with the loss of a loved one and unable to re-engage with their life in their host country. An immigrant's grief and bereavement journey can also be disenfranchised when the loss is not understood, acknowledged, or socially validated by people in their host country.

In conclusion, the grief and bereavement experiences of Latino immigrants can be impacted by many factors including cultural perspectives; previous loss experiences; immigration status; available resources, and support. The proposed study exploring the grieving and bereavement experiences of Latino immigrants has the potential to increase the visibility and needs of Latinos coping with transnational deaths. In addition, to also provide recommendations for mental health professionals in the field of social work with clients who are faced with the loss of a loved one in their home country. Furthermore, the proposed research study will expand on the limited research examining immigrants' experiences coping with the transnational deaths by noting between-group differences in experiences influenced by immigrants' sex, age, and immigration status in the United States. Ultimately, this research will aid in closing gaps in literature examining grief and loss among the Latino immigrant population in the United States.

V. METHOD

5.1 Participants

A total of 10 participants (7 women and 3 men) were interviewed for this qualitative phenomenological research. Participants ranged in age from 31 to 50 (M=43). A total of 8 participants identified as undocumented immigrants and 2 participants identified as Temporary Protected Status (TPS) recipients.

Before beginning in-depth interviews, the researcher read through a "Participant Information Form" and obtained verbal consent from participants. After verbal consent was provided the researcher turned on a digital recorder. A pseudonym was assigned to the audio recordings to ensure participant's privacy, as participants disclosed their immigration status in this country during the interview. These in-depth interviews were conducted in both English and Spanish and lasted on average 25 minutes. Interview questions pertinent to the topic of this research included:

What is your gender? What is your age? What is your immigration status? Describe how you felt after finding out about the death of a loved one in your country of origin? Describe your grieving process? Would this process look any different in your country of origin? Describe your support system in this country? Describe your experience accepting or not accepting the loss of this person? Would this look any different in your country of origin? Do you have any additional thoughts or feelings regarding this topic?

The aim of this research was to explore the experiences of Latino immigrants who have experienced transnational deaths. Information on the sex, age, and immigration status of participants were collected with the purpose to note in-group differences in grieving and bereavement experiences. If deemed necessary, the researcher provided participants with mental health and legal resources at the end of the interview.

5.3 Measures/Material

The researcher used a "Participant Information Sheet" to obtain verbal consent from every participant. The researcher also used the same questionnaire to interview all participants. Additionally, the researcher used a voice recorder to record participants' responses. Voice recordings were transcribed within 14 days and immediately destroyed following transcriptions. Transcriptions were used for data analysis and will be stored on a secure encrypted cloud storage until the completion of this study.

5.4 Data Analysis

The data collected for this study was analyzed using a thematic analysis. Thematic analysis is a method used to identify, analyze, and report themes within a data set (Braun & Clarke, 2006). The researcher used Braun & Clarke's (2006) six-phase guide to conduct this thematic analysis. In the first phase, the researcher familiarized herself with the data by reading and re-reading transcriptions. In the second phase, the researcher generated initial codes, this helped the researcher begin to organize her data in a systematic way. In the third phase, the researcher used codes to begin searching for themes across the entire data set, these codes were later organized into larger themes. In the fourth phase, the researcher reviewed themes back to the original data set and generated a thematic 'map' of the analysis. The fifth phase which consists of defining and naming themes, provided the researcher with the opportunity to generate clear definitions for each theme. Finally, in the last phase, the researcher produced a scholarly report (see Figure 1) of the analysis. The goal of this thematic analysis was to interpret and make sense of participants' responses by identifying themes and patterns that are important in addressing the research topic.

VI. RESULTS

The grieving and bereavement experiences of Latino immigrants in this country can be represented by a preliminary model (see Figure 1) and discussed using three related themes. Theme one pertains to the impact immigration status has on the grieving and bereavement experiences of Latino immigrants, leaving undocumented Latino immigrants in this country with no option but to be away during the death of a loved one in their home country. Theme two examines Latino immigrants' difficulty grieving as a result of others not being able to understand, acknowledge, or socially validate their loss. Theme three explores how Latino immigrants transnational grieving experiences are mitigated by migratory grief and loss experienced prior to the actual death of their loved ones. Representative quotes from participants are used to illustrate each emergent theme.

VII. IMMIGRATION STATUS AND DISTANCE

Eight of my participants identified as undocumented immigrants in this country while two participants identified as Temporary Protected Status (TPS) recipients. However, TPS receipts/participants were both in the process of applying for TPS when they experienced the loss of a loved in their home country. As a result, all participants in this study were unable to legally travel to their home country for the death of their loved one. When participants were asked to describe how they felt after finding out about the death of a loved one in their home country, majority of participants described this experience as "difficult", "overwhelming" and "painful" in addition to feeling "helpless" and "powerless" because their immigration status did not allow them to travel back to their home country.

Participant #1: "It was difficult not being able to travel to my country to be with her"

Participant #2: "I was overwhelmed with sadness because I couldn't go back to my country and say goodbye"

Participant #3: "I was devastated losing my mother and father and not being able to go because I am undocumented"

Participant #4: "I was overwhelmed and felt powerless that I couldn't have that closure of seeing her one last time at her funeral"

Participant #5: "My father was very sick, but we didn't expect him to die so soon, so it was very hard on us and not being able to go back because of all the risks"

Participant #6: "It was very sad because I wasn't able to do anything, I wish I could have left and traveled to see them, but I couldn't leave because I had children and how would I come back? So, I felt hopeless they passed away and I wasn't able to say goodbye to them"

Participant #9: "I felt very sad and disappointed in myself for not being able to go back to my country to see my mother"

Participants #10: "It was a huge feeling of helplessness because you can't go, and you know that if you do you can't come back, and you might never see your family in this country again" For participants in this study, their initial emotional response to a death of loved one in their home country was also influenced by their undocumented status in this country. Participants' responses included feelings of helplessness, disappointment, and guilt for not being able to return to their home country to be with their loved one.

7.1 Disenfranchised Grief

When describing their grieving process in this country participants reported having a "difficult" time grieving as a result of others not being able to understand, acknowledge, or validate their loss. At the same time, some participants described difficulty in grieving as a result of familial and employment demands in this country.

Participant #1: "I didn't think anyone would understand so I didn't speak to anyone"

Participant #4: It almost felt like I was ignoring it, I knew she was gone but there was no space to mourn or cry, so for a period of time I just pretended I would see her again someday"

Participant #6: In this country it is difficult to mourn because you have to continue living your life and working your job, you live day by day. You can go to church and pray but no really knows what you are going through and life keeps going and you just have to keep moving forward"

Participant #7: "My grieving didn't come until months after and I couldn't grieve here. In this country you carry your loss inside, and you can't manifest it, here you have to keep going and you have to keep fighting for your children"

Participant #10: "In this country I struggled a lot because no one understood what I was going through" When asked if their grieving process would have looked different in their home country participants described their grieving process in a different manner with an opportunity to be close to family and participate in traditional mourning and death rituals.

Participant #2: "In my home country I would have had the opportunity to bury and attend her vigil"

Participant #4: "I think it would be different because I would have had the space to be sad, mourn, and pay by respects but because I didn't go through that stage and I didn't see her pass I think maybe she's still there and maybe one day I'll see her"

Participant #6: "In my country it's different because you have the opportunity to mourn and you pray together with your family because everyone gets together, and everyone is feeling your pain. In your village everyone understands what is going on and, in this country, well no really understands"

Participant #7: "In my country everyone is mourning, and we don't listen to any music or watch TV it is very different in this country"

Participant #9: "It would have been different because I would have had the opportunity to see my mother pass away and I wouldn't have been left with the thought of what if. It was frustrating to be so far away without knowing what was going on with her funeral and the novenaries"

Participant #10: "The problem is that I didn't see him when he actually passed away, I missed out on the closure of seeing him being buried and well that's the problem" In sum, the participants' responses show that their grieving process in this country was disenfranchised by social roles, demands, and employment. Additionally, the participants' inability to participate in traditional mourning and death related rituals added to the complexity of their grieving experiences.

7.2 Migratory Loss

For participants in this study previous migratory loss also contributed to their transnational grieving experiences. In fact, prior to the actual death of their loved ones most participants anticipated never being able to see their loved ones again.

Participant #3: "I always carry with me what my parents said before I left "don't leave because you will never get the chance to see us again" but unfortunately I had to leave my country"

Participant #8: "When I came over here, the exact works my dad told me as I left were "you're leaving and who knows if you'll see me again" and those words quickly became my reality"

Participant #9: "I remember the last time I saw my mother and she gave me her blessing and told me "this might be the last time I see you" she gave me a hug and a kiss, and I stay with that. That's how I remember her"

Participant #10: "Some of the things I would tell myself before my dad passed away was that my father was getting older and he was sick, so my mind started preparing for the day he would leave us. The only problem was that I wasn't going to be there"

Participants reported experiencing profound loss when they first migrated to this country and some were aware that their migration to this country potentially meant a lifelong absence from their loved ones. Anticipating the possibility of never being able to see their loved ones again prior to the actual death of their loved ones.

VIII. DISCUSSION AND IMPLICATIONS

The purpose of this research was to explore the grieving and bereavement experiences of Latino immigrants in order to increase the visibility and needs of those coping with transnational deaths. Consistent with Bravo's (2017) study on undocumented Latino immigrants coping with death in their home country participants in this study also shared particular feelings of sadness and guilt surrounding their inability to travel back to their home country to be with their loved ones. Although the participants in this study felt guilty for not being able to be close to their loved one, they reported the journey back to the U.S. was too risky. Participants feared not being able to come back to the United States, leaving them with no other option than to be away during this time.

Participants in this study also explained how the distance between them and their loved ones as a result of their inability to travel back to their home country presented challenges in their grieving experiences in this country. Similar to previous research conducted by Nesteruk (2017) participants in this study described their grief in this country as disenfranchised. Disenfranchised grief defined by Mortell (2015) means individual grief that cannot be openly acknowledged, this type of grief has also been correlated with complicated grief which is grief that remains unresolved. Participants in this study reported having a "difficult" time grieving as a result of others not being able to understand, acknowledge, or socially validate their loss. At the same time, some participants described difficulty in grieving as a result of demands from family and jobs in this country. Nesteruk's (2017) study argued that these family and work responsibilities in the United States played a protective role in the grieving experiences of immigrants distracting them from the loss. However, participants in this study described these demands along with disenfranchised grief as complicating their grieving experiences. Social roles and demands left participants with no time, space, or opportunity to mourn and grieve their loved one's death. The distance between participants and their loved one made it impossible for them to say good-bye to the person who was dying, attend the funeral, and participate in traditional mourning rituals making it not only difficult to grieve but also difficult to accept the loss of their loved one.

Similar to previous research on ambiguous loss by Solheim & Ballard (2016) and migratory grief Nesteruk (2017), the participants in this research described the act of leaving their homeland and family as a profound loss. Additionally, the responses of participants in this study also support the concept of anticipatory grief. Anticipatory grief occurs prior to the actual loss, usually when a loved one is aging or sick. In this study, participants described anticipatory grief early in their migration journey, anticipating their migration to this country as a lifelong absence from their loved ones. As a result, when the death actually occurred, some of these participants described having already prepared to live without their loved ones. This finding is consistent with Boss (2007) study that examined how participants' early experiences coping with migratory loss impact the way immigrants experience and cope with loss later in life.

In order to inform treatment plans for grieving Latino immigrants, the following implications for social workers in the mental field can be offered. Latino immigrant's transnational grieving and bereavement experiences cannot be understood in isolation from their immigration status in this country and whether the individual was able to travel home to say their last goodbye, be present for their loved one's funeral, and participate in traditional mourning rituals. Unfortunately, all participants in this study were not able to travel back to their home country but further research is recommended to determine differences between documented and undocumented Latino immigrants grieving and bereavement experiences with transnational deaths.

Additionally, practitioner's working with this population should be aware of the multiple losses this population experiences in this country. Including migratory loss when Latino immigrants first leave their country, through- out their years of being in this country, and finally during major life losses like the death of a loved one in their home country. Transnational grief and bereavement are complex issues that often go unnoticed, misunderstood, or are not assessed for in clinical settings for this reason it is very important for practitioners working with this population to begin asking Latino immigrants about their migration stories and their experiences with grief and loss that may not be noticed or understood by the dominant culture.

IX. LIMITATIONS

The major limitation in this study is that there were no significant differences between participants immigration status, age, or gender to note in group differences in grieving and bereavement experiences.

X. CONCLUSION

The grieving and bereavement experiences of Latinx immigrants cannot be understood in isolation from their immigration status, social relationships and demands in this country, and prior migratory loss experiences. However, in order to deepen our understanding of how Latinx immigrants grieve and cope with transnational deaths it is vital to note that there are a multitude of other factors that can also affect their grieving and bereavement experiences. For this reason, further research needs to be done in order to aid mental health professionals in the field of social work to further understand the complexity of trans- national grieving and bereavement experiences for the Latinx immigrant popu- lation in the United States.