Skull imagery is usually associated with the Tánis (Hamatsa) ceremony practised by the Heiltsuk and Kwakwakaʼwakw people. Hamatsa is a secret society that is involved ceremonial cannibalism and rituals to return to humanity. Young males are initiated into the community during a four-part ritual in which they are symbolically transformed from flesh-eating cannibals, a state equated with death, into well-behaved members of society. The skull thus symbolizes the rebirth of initiates as they come back from the dead. Skull items are used during the final stages of the ceremony: ritual feeding of the skull, possibly using special ceremonial spoons, precedes a ceremonial meal for the initiates, and the officiating medicine man might wear a skull headdress.