Costly Causes of Funeral Dissatisfaction and Satisfaction—Responses to an All-Japan Survey

Abstract

Background: Previous research shows that grief causes medical and psychological problems for a substantial minority of the bereaved, which places stress on modern medical and social welfare systems. Other research demonstrates that funeral dissatisfaction correlates with medical and psychological problems, but does not address what aspects of funerals cause greatest satisfaction or dissatisfaction. We examined anonymized survey responses describing aspects of funerals causing the greatest anxiety or relief to bereaved Japanese individuals—and in turn affecting medical/welfare costs for the entire society. Method: A research team centered at Kyoto University collected over 1400 questionnaires from recently bereaved Japanese, of whom more than 300 volunteered anonymous comments about their funeral experiences. This article categorizes and analyses these qualitative data. Results: We classified their comments into 10 themes: Hospital Interaction; Pre-arrangement; Timing good-byes; Attendance; Friends/relations; Rituals; Crematorium; Ceremonial meals; Costs; Follow-up. Conclusions: The greatest disappointment appeared in attendance, connection to friends and relations and rituals. When lacking, insufficient, or ill-handled, these leave long-standing bad memories and dissatisfaction that aggravate mourners’ psychological and physical ailments. Our research highlights the psychological effects of cremation, and the value of itemization and explanation of funeral costs. Funeral directors can significantly reduce dissatisfaction by awareness of and sensitivity to these issues, thus contributing to national health and welfare.

1. Introduction

Japan has an extremely aged population, wherein 1.6 (out of 120) million people die annually. Not even the most devastating of World War II carpet-bombing campaigns caused Japan so many annual casualties. In the coming decade, one in 7–8 people in Japan will die of natural causes, meaning that almost everyone in the Japanese population will experience a process of grieving associated with the loss of close relatives or friends. This will also be the case for the populations of Korea, China, and many OECD countries in the not distant future. Now grief causes some 15 to 20% of bereaved individuals to encounter psychological and/or physical health problems [1].

Previous Japanese research shows that 11% of the bereaved report new or increased use of two or more services since their bereavement; if 11% of the Japanese population face additional psychological and physical health problems, this will further bankrupt Japan’s socialized medical system [2]. Surely some of these bereaved individuals may have pre-existing health issues, but the point is that bereavement exacerbates the risk to their mental and physical health.

For decades, researchers have maintained that funerals provide important psycho-social resources to ameliorate the grief that bereavement occasions [3,4]. If funerals can help bereaved survivors to endure their grief without psychological and physical health problems, then funerals make an important contribution in terms of social capital. For grieving bereaved facing eating, sleeping, or alcohol disorders, the support of old friends and relatives who gather at funerals may be far more effective and natural than dependence on unknown civil social workers. So it seems reasonable to expect that satisfactory funerals might protect bereaved participants from more severe concomitants of lonely or continual grieving.

Based on the premise that good funerals should be psychologically valuable, researchers then explored the aspects of funerals that the bereaved most valued. A decade ago, O’Rourke, Spitzberg and Hannawa showed that American college students’ religiosity and favorable attitudes contributed to their satisfaction with funerals they attended; funerals facilitated their social support, emotional expression, personal coping, and contextualization of personal experience in social tradition [5]. Holloway and colleagues’ interviews with bereaved individuals concluded that “drawing on religious tradition and… personal meaning-making”, funerals retain psycho-social-spiritual significance, but they noticed a growing variation in preferences and personalization thereof [6] (Like O’Rourke, they did not correlate funeral satisfaction to subsequent health of the bereaved). Tony Walter also proposed that funeral memorials need not immediately follow a passing—they might be postponed or conducted online—but he continued to argue for the psychological benefit of continuing bonds with the dead [7,8].

Subsequent Anglo-European studies failed to correlate funeral satisfaction to health outcomes. Birrell et al. showed unsurprisingly that the 12% of people who responded positively to their lengthy questionnaire showed insignificant health effects from direct cremations [9]. This affirmed that those satisfied with their funeral choices show less grief, but shed no light on the grief or health of the vast majority who declined to respond.

However, more recent research emended these ideas on two fronts: first, the idea that lack of social support at funerals was no longer a psychological issue, as “shown” by the cases of those satisfied by direct cremations. Qualitative interviews found reasons for British survivors’ satisfaction with private direct cremation (with little social support)—entirely in line with the self-affirmation tendency of buyers to re-affirm their approval of their former choices. Interviewing a sub-sample of respondents who openly expressed their satisfaction with their choice of direct cremation, Woodthorpe et al. concluded that public rituals are no longer needed for social benefit for the bereaved [10]. However, many of those informants were those who wanted to distance themselves from their relatives or neighbors, and direct cremation allowed them to do so quietly. The vast majority of those surveyed would not respond either in writing or orally to questions about funeral satisfaction and personal health. Yet lack of evidence is not negative evidence; these studies found no statistical correlation between funerals and health, but did imply that satisfaction with one’s own choices were connected to a good grief trajectory.

Secondly, statistical analyses led to a Copernican turn, unsurprising on reflection: the insight that while funeral satisfaction in itself were not sufficient to buffer mourners entirely from grief, funeral dissatisfaction was a significant predictor of subsequent psycho-physical medical issues [11]. This might be analogized to the effects of car maintenance; having a smoothly operating car is not a sufficient condition to guarantee a happy outing, but having a car break down at the outset of a trip is quite capable of casting a shadow on the rest of the outing.

Statistical studies rely on large numbers of bereaved respondents, but do not give clear insights into which aspects of funerals cause anxiety or relief to bereaved participants. To catch more personal glimpses of mourners’ experiences and feelings about the funerals they attended, we examined free-response write-in comments attached to the nationwide Japanese bereavement survey. This article presents the results and analyses of these open-ended comments. The present research is the first to analyze hundreds of negative as well as constructive comments and criticisms about funerals, giving insights into the kinds of funeral dissatisfaction that most connect to ongoing rumination, grief, and subsequent use of medical and psychological services.

2. Method

From 2018 to 2020, a research team centered at Kyoto University and funded by the Japanese Ministry of Education developed and pilot-tested questionnaires for from Japanese mourners bereaved within the previous year. Kyoto University hosted Margaret Holloway, John Birrell, and experts from Bath University for the purpose of discussing those plans and findings. The All-Japan Funeral Directors’ Cooperation^® distributed these questionnaires to about 5500 bereaved who had used their services in the previous year, of which approximately 1400 responded anonymously, using post-paid envelopes mailed back to Kyoto University. The University in turn forwarded these responses to a data-recording agency in Tokyo, double-blinding all responses, not only inputting the numerical responses for calculating correlations (reported in [12]), but also transcribing the handwritten comments of more than 300 respondents who freely volunteered reflections on their funeral experiences.

The large sample widely reflected the overall demographics of Japanese society currently facing bereavement. Most of the respondents ranged from their late 40’s to 70’ in age. 51% of respondents were male and 49% female, slightly reflecting the tendency of males to pay for and preside at funerals. 20% were living alone and 29% unemployed. Compared to national averages, our respondents tended to be just slightly better educated (41% college graduates), with slightly higher income (65% over 4 million JPY per year). 68% reported feeling emotionally “very close” to the deceased (slightly different from the British respondents who chose direct cremation; in Japan, 99% of all deceased are cremated after a Buddhist ceremony).

A small group of funeral professionals from the All-Japan Funeral Directors’ Cooperation^® examined respondents’ anonymized Excel data files and categorized the more detailed comments. These themes were organized chronologically following the order in which the bereaved would likely encounter such experiences. Bilingual experts translated the Japanese comments into coherent English, adding cultural context when necessary. In each category of the following results section, we introduce representative comments and their similarity to previous research when known (Numbers in parentheses refer to anonymized respondents).

3. Results

We identified 10 themes from the responses: (1) Final interactions with the physician/hospital; (2) Pre-arrangement of the funeral; (3) Timing of good-byes; (4) Attendance (size of funeral); (5) Friends and relations; (6) Rituals; (7) Crematorium issues; (8) Ceremonial meals; (9) Costs and explanation; (10) Follow-up after the funeral.

3.1. Final Interactions with the Physician/Hospital

Some 70% of Japanese still die in hospitals, either after long hospitalization, or in intensive care after families have given up caring for them at home. Earlier research has already reported that “shock at sudden death” is a major predictor of grief, and that in Japan, this shock comes not only from suicide and accidents, but counterintuitively from cancer patients whose families had plenty of time to come to terms with their mortality [13]. One particularly clear comment said: “His doctor had predicted recovery, so we were taken aback by his sudden death, generating deep distrust/suspicion” (513). Another family was furious that the hospital did not allow them time to dress the deceased in proper clothing before he was carried to the funeral home in his hospital pajamas (620).

It is rather rare for Japanese hospitals to stay in contact with families of those who have died in their care. Yet even worse than no contact at all may be thoughtless and insensitive contact, as shown in: “The hospital sent us a DVD of his medical data after his death, which was worse than useless—downright painful!” (273). Conversely, other bereaved expressed their gratitude for ample prior warning (745). Or again, “Sudden death was hard to take, but the funeral helped” (302).

Former studies have also identified the importance of coordination between hospitals and mortuaries [14], but this remains rather rare in Japan, and the above comments underscore the importance of more coordinated interactions.

3.2. Pre-Arranged Funerals

Substantial previous research has demonstrated the importance of advance decision-making and pre-arrangement of funeral plans (cf. [15]). Pre-arranged funerals remain relatively rare in Japan, but in our study, those who failed to plan adequately retrospectively reported feeling too rushed to make good decisions (769). More than a dozen respondents wished that they had discussed more in advance: with the deceased before they passed (B64); with the family, about whom to invite (995); and with the mortuary, to leave clear details in writing (182; 812).

Conversely, another 10 comments expressed gratitude and relief at having consolidated plans well in advance, e.g., “Since the deceased had some previous knowledge, he expressed his wishes in a kind of ending note, which was very helpful” (322). “I was glad that I had prepared the headstone and Buddhist home altar before his death” (488). “Since I had consulted early on about funeral arrangements in case of my mother’s illness, I feel secure and comfortable about her final resting place. I also feel relieved that I can visit her every day in front of the Buddha” (104).

This is neither an original nor surprising finding, but our respondents underscore the importance of advance discussion (493), written plans (322), and even pre-payment (186).

3.3. Timing of Good-Bye

One well-documented purpose of a funeral is to enable families and close friends to “say a proper good-bye” [16]. Seven of our respondents regretted the lack of time for proper farewells (293; 629), feeling rushed and pressured for time (325; 1032), or regretting that the abbreviation of their infant’s funeral left inadequate time to come to terms with their loss (884).

While two respondents felt disturbed by an unexpected delay between receiving the body and conducting the funeral services (219; 382), four respondents felt that having extra days with the body between the time of death and the funeral was helpful to enable them to say their good-byes over several days, improving their acceptance of the death (152; B169; 387). Two more specifically mentioned that embalming (still rare in Japan) was helpful, because it enabled spending longer time with the deceased (1010; 1023).

We cannot conclude that having more time with the deceased is always or necessarily good for all bereaved, but coupling these statements with the previous category suggests the preferability of having too much rather than too little time between the death and the funeral.

3.4. Attendance (Size of Funeral)

Little previous research has documented the importance of the size of funerals, but a number of studies on the abbreviation of funerals due to COVID-19 restrictions suggest that restriction of funeral attendance tends to upset families who wanted to invite more friends and relatives [17,18,19,20].

The tendency to display one’s wealth and popularity by holding large funerals peaked in Japan’s 1980’s, after which the size and opulence of funerals have gradually declined, leading some to infer that funerals are losing their social as well as religious importance. However, this superficial decline in large funerals belies more deep-seated Japanese cultural and personal desires that friends and relations should be informed of the passing and invited to commemorate or commiserate at a formal funeral.

In Japan, failure to have informed or invited an adequate number of friends and relations was by far the largest single item of regret in our write-in sample (367; 997); fully 20 comments mentioned in one form or another that they wished they had informed or invited more people to their funerals. “Few people came—lots of flowers but few attendees. Maybe it was due to the scheduling, but I should have put an obit in the paper” (150; 777). “I think it’s downright sacrilegious to fail to inform friends and relations about the funeral. Close relations would also be better able to accept the death of the deceased if they received invitations” (57).

Others waxed more prescient, acknowledging difficulty in deciding whom to invite (162; 306; 514). Many who held large funerals voiced pleasant surprise at the support they derived, either from those who came (“I could feel the support of the people around me” 117), or from the funeral company supporting them (70; 644).

These responses accord with former research suggesting that larger funerals facilitate community support and activate networks of social capital [21]. Others also expressed gratitude for the support of the Funeral Director when many attendants arrived (31; 117).

Some respondents explained that they conducted a small family funeral directly after the decease, but subsequently a larger memorial service to which they invited larger numbers, or that they immediately informed many friends and relations who, while not present at the funeral, made subsequent supportive house visits (B18; 1039).

3.5. Friends and Relations

The category of friends and relations is particularly important and complex in Japan.

Conflict among relatives is all too common: “Family disagreements precluded an amicable sendoff” (68). Relatives’ preferences about funerals often differ from the desires of the departed or closest of kin (276), while those not invited may subsequently criticize the family (B34).

Others reported a social need to invite and please their neighbors (B111).

In the often confusing and hectic time between the departure and the funeral, the participation of family may be critical to the mental health of the immediately bereaved. Some respondents reported that they wished more family had helped out (308), or that they had taken more time to converse with them at the funeral (477; 537); others affirmed that their family’s help was indispensable (635). Friends’ (685), colleagues’ (B172), and neighbors’ (B148) support was also considered extremely valuable. Not only in the context of conflict or support, but also in terms of those who should feel thanked and gratified by the funeral, many respondents mentioned friends (592; 685), relations (413; B188), and neighbors (B111).

Still others expressed gratitude because the funeral enabled them to catch glimpses of the deceased from former friends and co-workers (B35): “I learned so much about my father’s relationships and lifestyle” (B51); “found out my grandfather was an amazing fellow” (871).

Even more interestingly, numerous respondents said that they designed the funeral in order to please the departed (B109); that they felt the departed was pleased watching their funeral (529; 421); and that they too would want to watch (from the coffin? from above?) a large number of celebrants gather for their own funeral when their own time came (B65). While most Japanese profess agnosticism, neither praying daily nor assembling weekly as is customary in monotheistic religions, this concern for their departed ancestors’ viewing of their own funerals is a fascinating glimpse into the Japanese religious worldview.

3.6. Rituals

Previous research suggests that meaningful rituals can help to assuage or accommodate the bereaved [22]. Researchers at Harvard Business School found that participants who either reflected on past rituals or participated in new ones after experiencing loss reported lower levels of grief [23]. People with greater grief tend to perform more grief rituals, and find them more comforting than other help-seeking activities [24]. These findings derive from the relatively individualistic American and Dutch cultures, leading us to wonder how a relatively collectivist culture like Japan would experience funeral rituals.

While most Japanese profess no deep religious commitment, and hardly anyone participates in weekly religious ceremonies, nonetheless the responses to our survey on the sending off of the dead revealed an extremely wide range of interest in the proper conduct of rituals. The vast majority of respondents expressed strong concern to properly follow the details of rituals, either for religious reasons, or for the way the community would view them.

Many stated that even a small mistake in the funeral rituals had a lasting impact on their memories (27), worrying about doing everything properly (313), or growing upset when rituals were not properly conducted or observed (348). Others averred that properly performed rituals were helpful in coming to terms with the grief of a sudden departure (302).

Some respondents directly discussed local rituals. Some felt that local traditions and customs were too complicated (885) or hard to follow (861), posing a burden on the funeral celebrants. Several thanked their funeral directors for their sensitivity to local customs (63) and for educating the participants about local rituals in advance (319), while others regretted not having used more local goods in their ceremonies (B156). In a rarer case, respondents criticized the funeral home for not adequately knowing the rituals required of a minority religion (454).

Among specifically mentioned rituals, some families wished that they had been allowed to wash the body of the deceased, as is traditional (595). Others were disturbed at the unnaturalness of the final makeup (998) or embalming (686) of the deceased. Some celebrants vacillated over the proper remarks to make at the ceremony (B97). Others regretted not having enough gifts for all those who attended (817) or not knowing the socially acceptable cost for such gifts (316).

Families were aggravated by amateurish announcers (B35). Among the most egregious cases were misspelling (582) or mispronunciation (148) of the names of the bereaved or their relatives. Specific faux-pas at the funeral left lasting scars among the bereaved—some as many as ten years after a previous funeral! (260). Conversely, families were gratified when funeral directors remembered them warmly many years after a previous funeral (807).

Other serious failures included:

Wishing that they had prepared things to put in the coffin (114; 1012)

Failing to get the names of those who had sent flowers (990)

Circulating an incense bowl instead of asking each celebrant to offer incense at the altar (491)

Failure to break the deceased’s rice bowl (167)

Poor choice of ceremonial photo (487)

Poor choice of music (348)

Leaving a Buddhist ritual gong and clapper at the foot (!) of the deceased (813)

Inadequate Buddhist chanting (275; 1033).

While not ritual per se, other families were disappointed that they had failed to hire a photographer to record the funeral (560), or that the photographer that they had hired had been unprofessional (252; 283).

On a positive note, funerals which prepared a special corner displaying photos (B190) or videos (626) of the deceased’s life were considered memorable. Similarly, well-chosen songs reminiscent of their life (180) were considered very helpful in addressing grief (1014).

In yet another ritual, before gathering at the funeral, everyone had been asked to recall and write down their memories of the departed, forming a memory-book most gratifying to the surviving family (487).

In overview, personal touches in terms of photos and memories were highly appreciated, while ostensibly minor misses in terms of local customs, Buddhist rituals, or confusing names left long-lasting bad impressions.

3.7. Cremation/Crematorium Issues

In total, 99.9% of all Japanese are cremated today, but typically only the nuclear family and closest of friends or relatives join the hearse to the crematorium. The timing and events surrounding the carrying of the corpse and coffin to the crematorium can be points of great sensitivity for the family, because this is the final time for them to see the face and body of their loved one before receiving their ashes.

Several respondents regretted not having time to personally greet and thank all who attended, before leaving the funeral parlor for the crematorium (477; 537; B139), whereas those who took time to greet everyone felt very gratified and supported by that activity (1045). Some who accompanied the coffin to the crematorium expected to have another chance to say their good-byes at the crematorium, and were disappointed when this did not materialize (339), while those who were informed that this would be their last chance to touch their loved one’s face or body were thankful to have had that last special moment before cremation (606).

An especially appreciated service was that the procession from the funeral parlor to the crematorium did not take the most direct route, but deliberately detoured to pass in front of workplaces and other locations significant to the departed (827).

Previous statistical research suggests that crematoria rituals are among the most shocking and difficult for Japanese mourners to accept [2]. Yet some crematoria ask the bereaved family to close the doors on the coffin or to press the ignition for the funeral pyre, unwittingly creating psychological trauma for the families so instructed (542; 696). When the hot smoking ashes were finally removed from the crem chamber, the businesslike efficiency of one crematorium staff struck the family as irreverently hasty (288).

Committing the body of a loved one to flames, and subsequently receiving the smoking ashes of what had been their body, is particularly challenging for many families. Extra care and tactful approaches from the funeral director and crematorium seem required in this context.

3.8. The Ceremonial Meal

In the hours while the corpse is being incinerated, close family and friends traditionally share a ceremonial meal or banquet at the crematorium—but numerous complaints arise concerning this affair. Some felt that the staff pressured them to eat too quickly (325); others regretted that they had not ordered a more elegant banquet (916). Some had far too much food left over (145); others ran short due to inadequate planning for the number who actually attended (B26).

Previous research has already established the importance of shared meals to funeral gatherings [25], so additional care needs to be taken that those memories are salutary rather than regrettable.

3.9. Costs

Criticisms of costs came second only to write-in responses about the failure to invite enough people. While criticism of high funeral costs has dominated popular literature ever since Jessica Mitford [26], precious little research connects funeral expenses with patterns of grief. In our sample, discussion of costs falls into three categories: (A) disappointment at limited choices; (B) frustration at inability to understand costs; and (C) outright shock at the total cost.

(A) Some respondents wished for more options to customize their funeral to their own tastes (301); desiring more information about choices (B185); or wishing they had been offered choices rather than standard packages (1041). (B) Many others lamented the lack of itemization (322; 409); unexplained bills caused great frustration if not anger (257; 358; 369; 814; 890). (C) A third substantial group were shocked at the high costs (479; 596), exacerbated by inadequate billing and receipts (579; 677). Although statistical modeling of this same sample showed that working bereaved in their 40–50s were more likely to begrudge funeral expenses than were retired elders [11; 12], within the write-in comments, it was elderly pensioners who found funeral costs particular burdensome (219; 443).

A few exceptional bereaved thanked the funeral director for a very kind and polite explanation of all the costs involved (78), or for preparing them psychologically for subsequent temple donations (634).

Respondents expressed particular anger and frustration against those Buddhist priests or temples who appeared to be collecting large fees without providing desired or satisfying services: the priest was unhelpful (407); the temple fees exorbitant (479); the posthumous Buddhist name costly but meaningless (936).

Dozens of similar comments document the need not only for careful explanation and itemization of costs, but for ample freedom for the bereaved to choose for themselves only those options that they really desire.

Money offerings, not to the funeral staff or temple, but to the attendants, further complicated matters, e.g.:

“The funeral and dinner that followed were disappointing, conducted without consulting relatives or neighbors. I gave folks thousand-dollar incense offerings as thanks for their help throughout the deceased’s life, but almost no one thanked me or responded. I wonder if this marks the end of our relationship, but I tell myself it was good that I could greet them properly at the funeral” (1045).

On the one hand, many regretted not inviting everyone who should have been invited; on the other, others lamented the high cost of funerals. This is not necessarily an outright contradiction; if funeral homes provide clear and detailed explanations itemizing what each expense is for, and give mourners ample choices of what as well as whom to include or not, then the families themselves may conclude that the costs are not exorbitant.

3.10. Follow-Up after the Funeral

In Japan, the role of the funeral director and temple priest do not end with the funeral. Typically, funeral directors retain contact with the bereaved families (beyond mere billing), and temples provide locations for repeated memorial services on the 49th day, 100th day, first summer, and anniversaries of the passing. Many bereaved families highly valued such follow-up (325).

In some regions of Japan, priests visit the homes of bereaved parishioners every month on the anniversary of the death (164); in other cases, the funeral home itself sends flowers (180) or food (286). One funeral home went “above and beyond the call” by sending a birthday cake (1060); another by helping the bereaved to mail the deceased’s artwork to acquaintances some months after the funeral (B123).

One respondent said she felt “saved” by the kindly contact from the funeral home (676); an elderly widower confessed that he would have committed suicide had it not been for the friendly support of his funeral director (B187).

Conversely—and statistically all too commonly—we have reports of bereaved spouses falling sick directly after their partner’s departure (B104).

Death and grief can present tremendous challenges to the physical and psychological health of the bereaved, so the continuing contact and follow-up of funeral homes is highly valued, and in some cases may even be life-saving!

4. Discussion

Previous research has suggested the importance of: (1) Interaction with the physician/hospital; (2) Pre-arrangement of funerals; (3) The chance for proper good-byes; (6) Properly conducted rituals; and (8) Ceremonial meals. The present data reinforces the importance of all of these items; when these are lacking, insufficient, or botched, they can clearly create long-standing ill-memories and funeral dissatisfaction which may aggravate mourners’ psychological and physical ailments. In addition, this research highlights for the first time the importance of issues such as: (4) Funeral size and number of attendants; (7) Psychological aspects of the cremation; and (9) Itemization and explanation of funeral costs.

Concern with rituals (6) is of particular interest in the Japanese context. Japan is considered a highly secularized modern country; less than 1% of Japanese attend regular religious services. Nevertheless, the respondents in this nationwide sample were very concerned not only to please their friends, relatives and neighbors, but also that their funerals should please their departed ancestors, as if the ancestors were present or watching from above. Comments about the placement of the Buddhist gong, the way the incense burner was used, the failure to break the deceased’s rice-bowl, the length of Buddhist chanting, and other fine points of Buddhist ceremony indicate that even modern Japanese have strong religious sensibilities and expectations when it comes to their funerals—so it behooves even non-religious young funeral workers to acquaint themselves with and follow the expectations of their elders.

As in much of the world today, cremation (7) is the predominant method of bodily disposal in Japan. Unless a particularly long wake or hiatus is maintained between the morgue and the cremation, both the suddenness and absoluteness of cremation can be particularly traumatizing for a minority of families. Just a day or two after their loved one was pronounced dead by the physician, their entire bodily presence is reduced to an urnful of hot ash. In some countries, the ashes are not returned to the family until several days later, allowing some time to “digest” the finality of the death, but in Japan, the hot ashes are returned to the family after a mere two hours while the family have been eating. To illustrate the abruptness of this process, consider the following: before lunch, father appeared to be resting peacefully, but after lunchtime, father’s corpse is reduced to fine powder. The trauma of this sudden transition is intensified if the crematorium does not inform the family that this is their last chance to say good-bye to the corpse, or asks the family themselves to close the doors and/or push the ignition switch on the immolation chamber. Clearly, sensitivity is required at crematoria to soften the psychological impact of the sudden and irreversible transformation of a body into ashes.

Anecdotal references support the idea that large or traditional funerals (item 4) may be more ideal than small ones in reducing grief or supporting the grievers [3,4], and statistical analyses of the data in this survey also suggest that abbreviation of funeral services correlate with higher grief and medical reliance in Japan [2,12]. Our analysis of hundreds of respondents’ comments strongly affirms this. No one regretted that an unexpectedly large number of people attended the funeral that they conducted (other than wishing they had prepared more food or chairs), but dozens regretted not inviting more people than they had, or expressed gratitude that so many people attended and were so supportive. Many mourners also reported later criticism from friends and relations who had not been informed or invited at an early stage. While traditional funerals alone are not sufficient to mitigate prolonged or severe grief, their absence or abbreviation does predict higher funeral dissatisfaction in the long term—with consequences for physical and mental health.

On the other hand, our results also show that high cost (item 9) may be a factor in funeral dissatisfaction; simply spending more money on a more elaborate funeral is not a solution to grief. In Japan, the greatest dissatisfaction was shown with high payments to Buddhist priests or temples who provided little service beyond chanting and bestowing a posthumous Buddhist name on the departed. While several comments simply alluded to unexpectedly high expenses, many others complained about a complete lack of explanation and itemization, in set packages providing no information regarding what payments would cover what purposes, and no options for personalization. So overall, full formal funerals seem distinctly preferred to abbreviated ones, yet at the same time, the funeral profession has a responsibility to explain how each cost is derived, and to maximize the grieving mourners’ choices to customize and personalize their funerals as they and their families (and the deceased?!) would wish. Thus our data are not an argument simply for large funerals, but rather for funerals that meet the needs and desires of the bereaved family. Funeral homes and directors must balance their needs for profit-seeking with their responsibilities to support what their clients want above all.

Finally, our respondents showed great appreciation for many “above-and-beyond-the-call” contributions from their funeral directors: cards, flowers, food, and visits months after the funeral had passed (10). While two responders volunteered that they were “saved” or “restrained from suicide” by their funeral directors, many more of the Japanese bereaved were clearly enheartened and encouraged to know that other people joined in supporting their loss and grief.

Limitations

This survey was conducted in the Japanese language and limited to the country of Japan, so some aspects of these responses may be unique to Japan and not generalizable throughout the world. Of more than 1400 anonymous questionnaires that received complete responses to quantifiable variables, only 20+% volunteered more lengthy responses reflecting personal experiences and feelings, so we cannot project a definitive national average based merely on these 20%.

Unable to access bereaved families otherwise, Kyoto University asked the All-Japan Funeral Cooperation^® to distribute its questionnaires to the bereaved who had used the services of funeral homes in the previous year. While the cover letter made clear that the answers would be untraceable, and the anonymous responses were mailed directly to the university, still the possibility remains that some of the respondents imagined that their answers might affect or be seen by their funeral directors. If so, the responses we received are more likely to be polite or taciturn than critical of their funeral directors.

Despite these possible issues of generalizability and over-politeness or reticence to criticize, these 300 responses do give significant insights into the concerns and memories of those conducting funerals in Japan.

5. Conclusions

Previous research strongly suggested that funeral dissatisfaction can cause or aggravate bereavement grief, but specific factors underlying funeral dissatisfaction remained somewhat unclear. Hundreds of anonymous write-in comments on the all-Japan survey of bereavement grief give a clearer picture of the factors causing or aggravating bereavement grief in Japan. Notable details emerged that had not been widely documented by previous research: the supportive value of funeral size and number of attendants (or regret at failing to invite enough), not only for the surviving relatives and friends, but also for the satisfaction of the departed. The itemization and explanation of funeral costs, offering options of customization to funeral customers, and concern to reduce psychological shock at the cremation, also warrant attention. In addition to emphasizing the importance of proper chances to say good-bye to the departed, respondents underscored the importance of attention to detail in the proper conduct of rituals. Conversely, when funeral directors pay careful attention to detail—listening to their clients’ needs and offering them a range of options; accompanying them with heartfelt understanding support—they may protect the health and productivity of their bereaved clients and in turn reduce national medical and welfare costs.