Life's End

Technocratic Dying in an Age of Spiritual Yearning

David Wendell Moller

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9781351843249
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The explicit purpose of this book is to analyze dying and death in the cosmopolitan, modern setting. There is, however, an additional theme that is implicit in the analysis and observations. The portrait of dying, which is provided in the pages of the book, also tells us a great deal about life. It demonstrates that the foundation for the medicalization of death that piercingly shapes the life experience of dying persons and loved ones is a product of the ways of life in the broader culture.

CHAPTER
1

Encountering Mortality: Preliminary Reflections

And now lying and listening in the darkness, he understood his life [1, p. 15].

Herman Broch

Cholera! The thought flashed through Kitty’s mind and then a deathlike feeling came over her; she was seized with terror, she struggled for a moment against the night that seemed agonizingly to run through her veins; she felt horribly ill; and then darkness [2, p. 151].

W. Somerset Maugham

Death is the great instrument and facilitator of life! For it is death above all else which makes life precious and irreplaceable. Within the impossible knowledge that our lives will end lies both terror at the prospects of dying, and an opportunity for resurrection and renewal of life. It is ironic that death, which curdles the human heart with fear and constantly shadows each life with the possibility of extinction, is our unyielding companion throughout life’s journey. For those who love life and yearn for its experiences, life cannot and does not exist independently from death. There can be no escaping the knowledge that life is temporary, and can be lost at any moment. In this regard, one of the most profound and universal challenges of humanity lies in our personal and collective confrontation with mortality. As we are summoned to meet this challenge, which is uniquely at the center of the human experience, it is important to recognize that the struggle for meaningful and fulfilling life must come face-to-face with the realities of suffering, of pain, of sorrow, and of death.

Perhaps the human spirit, with great influence from contemporary values and folkways, can avoid and “conquer” death through pretense and denial. This avoidance, however, is more illusion than productive accomplishment. In truth, we never fully escape the knowledge that we are destined someday to grieve the loss of loved ones as well as die ourselves. It is within this framework of knowing that a serious and successful passage through life must come to terms with death.

The mysteries of mortality are integral to the mysteries of life. The pursuit of self-knowledge and self-acceptance must reconcile the facts of death with the facts of life. It may be ironic that the process of nurturing and caring for life must include preparations for endings of life. The ongoing attempt to avoid the confrontation and encounter with mortality only serves to deepen our fears and heighten our anxieties. In this way, freedom from death in life is only obtained by active engagement with death throughout life. As Sherwin Nuland advises, it is only by frank discussions of the very details of dying can we best deal with those aspects that frighten us the most. It is by knowing the truth and being prepared for it that we rid ourselves of that fear of the terra incognita of death that leads to self-deceptions and disillusions [3, p. XVII].

Today, dying is filled with images of unmitigated suffering and horror. As we have progressed throughout the twentieth century, the styles of everyday life have become increasingly incompatible with facing the burden of mortality. Suffering, dying, and death have lost their presence in modern cultural life, and have been systematically separated from visible and public patterns of social activity. Of course, the confrontation with death remains an inevitable part of human experience. In the modern context, however, encounters with mortality have become increasingly concealed and privatized. Coinciding with this trend toward invisibility and privatization is the vanishing of norms and rituals that once helped to guide individuals through the dying process. In the contemporary milieu, where the cultural devaluation of death has given rise to pervasive patterns of avoidance, the human drama of dying is often sequestered in hospitals and redefined into a clinical and technological matter.

Images of denial have replaced images of familiarity and acceptance. Anxiety about the indignities of hi-tech, medicalized death continues to grow. In this regard, the intersection between the facts of modern life and the facts of modern dying has become increasingly strained and shaped by a gnawing sense of unease and confusion. Consider, for example, how difficult it is to talk openly and comfortably about death. Although very simple to pronounce, dying-death-dead are words which are difficult to say and to hear. When we must talk about mortality, our utterances are usually shrouded in euphemisms such as: “passed away,” “kicked the bucket,” “bought the farm,” and “is with God now.” Medically based euphemisms are also widespread, reflecting both clinical detachment and duplicity: “the patient has expired,” “respirations have ceased,” “the patient is no longer with us,” and “the patient has gone sour.” For many people, even more unsettling than talking openly about death is the actual confrontation with dying. Families are typically overwhelmed with unease and anxiety when witnessing a loved one die. They regularly complain about not knowing what to do or say. They frequently feel impotent and helpless in the face of suffering that seems so alien to the rest of their lives. And individuals, when faced with the diagnosis of life-threatening illness, are often paralyzed with fear upon receiving the news. We can only imagine the terror that grips the heart when a malignancy is discovered, as if the disease itself was an incarnation of evil. As we will see, not only does the encounter with mortality elicit feelings of fear and anxiety, it often results in patients being outraged by and ashamed of what is happening to them.

This growing unease in the face of life-threatening disease stems from the inability of the modern styles of life to establish sanctity, solace, and meaning in death. Our popular culture is filled with illusions of life and beauty eternal. The worldly and physical icons of exciting and dynamic lifestyles, sexy bodies, and materialistic comfort are tied to the development of immortal longings. This environment, which oozes with media-fed images of physical beauty and shiny new products, creates and disseminates the pipe-dream that our earthly bodies will never shrivel with sickness, die, disintegrate, or decompose. Indeed, it is the energy, folkways, and the organization of modern life that conceal the personal, social, and physical realities of death, rendering the human encounter with mortality all the more difficult to ponder. In this way, suffering, dying, and death disappear from everyday life, and the certainty of dying, death, and decomposition of our bodies becomes unfathomable and inapplicable to the self-reflections and cultural experiences of most persons.

Additionally, in a world where we amass and jealously guard our possessions, the tendency is to believe that our lives and relationships can be preserved indefinitely. Despite widespread evidence to the contrary, our cultural conceptions of love and intimacy often promote the fantasy that our relationships will last forever—and are forever exciting and dynamic. In this regard, despite rationally knowing that our relationships are finite, we imagine that our lives will be spared the horror and sorrow of the deaths of those we love. This is part of our reluctance to speak freely and comfortably about such matters and contributes to our inability to productively accompany our loved ones through the ending of their lives. In this way, the prevailing styles of life leave us typically unprepared for and inept at coping with sorrow and devastating loss. They also reinforce our personal and collective need to continually reinvent strategies for denial and avoidance.

La Rochefoucauld may be correct in observing that death and the sun are not to be looked at steadily. Goëthe may also be on target in observing that death is, to a certain extent, an impossibility that becomes a reality. Historically, however, Western society went to great lengths to enable humankind to confront mortality in direct and open ways. Despite variations in form throughout the ages, the community gathered around the deathbed and death was celebrated through solemn and meaningful ceremony. The patterns of traditional death provided for moral guidance and social support, and established death as a public and community affair. The individual dying person was anchored by traditions and cultural expectations that enabled him to prepare for death and to face mortality with dignity. In this context, the individual dying person and those who loved her were successfully escorted through the dying process. The looming terror of death and the grip it has on the human experience was confronted directly and openly, thereby allowing the community to assert a meaningful sense of mastery over the ending of life.

This enduring tradition of dealing with death openly, which the historian Philippe Aries brilliantly chronicles in the Hour of Our Death [4], meant that death was a regular and public part of social and cultural life. For example, for many hundreds of years in traditional Western society, large mass graves were used to bury the dead. Bodies were piled on top each other in enormous holes that could accommodate six hundred to fifteen hundred bodies. Of special interest is the fact that in the cemetery there was always one or perhaps two of these mass graves that were fully open and visible. Additionally, a significant amount of social activity typically occurred in the cemetery—in the presence of the open graves and their decomposing bodies. This may seem surprising and even disgusting to modern persons who are accustomed to the facts of death being banished from their eyesight, but it was a matter of indifference and pervasive acceptance in traditional folkways of life. Of great importance in this ultimate connection between death and life is the fact that death, by being public and noticeable, was seen as being both familiar and normal.

The widespread presence of visible and public icons of death continued, in differing ways and manifestations, until the twentieth century. It is not that the dawning of this century instantaneously transformed the ways of dying, eliminating death as a normal and recognizable part of the life of the community. Rather, it is the metamorphosis and culmination of changes in social, political, and industrial life that transfixed the styles of death. Specifically, the emergence of fear and meaninglessness in modern dying is directly associated with two related processes of historical evolution: the abdication of community to individualism and the emergence of a technological and secular worldview. These changes, while essentially originating in the late eighteenth century, proved to have watershed consequences that dramatically altered not just the ways of life but the ways of death. As we shall see repeatedly, individualism and technological reliance have become central forces in the making of death into a meaningless and monstrous experience.

It is my contention that the struggle to confront mortality has become all the more difficult and precarious because the prevailing ways of life are intrinsically hostile to the relief of suffering and the acceptance of finitude. Dying in the modern context has become perceived as an evil; a cultural evil that is not only feared but is morally and socially injurious. Dying terrorizes not only individual dying persons and their loved ones. It also dramatically undermines the legitimacy of prevailing values around which modern living is organized. The forces of individualism, technology, and materialism, which are so prevalent in daily life, are often dysfunctional when they appear in the dying process. In the modern cultural context, we have lost both our collective and personal ability to support dying persons through the devolution of their bodies and the ending of their lives. The dying experience is consequently filled with an enormous sense of abandonment, isolation, and loneliness. As we shall also see, tenuous connections of family and community in the broader society play a significant role in the modern isolation of dying persons. Of equal or perhaps even greater importance is the cultural tendency to exclude death from the threshold of daily life. As dying has become increasingly invisible and vanquished from the collective cultural experience we have become increasingly inept as a nation, as families, and as individuals to tend to the needs of dying persons. In this way, the process of dying has become disconnected from community, family, ceremony, and purpose. As a result, the modern experience of dying is filled with social isolation and emotional estrangement that becomes a source of suffering for dying persons and for loved ones.

One of the reasons dying individuals seem so profoundly unsettled in the modern era is that their sufferings are pushed out of sight and rendered insignificant in the freneticism of everyday activity. Our busy and demanding lifestyles leave little time for facing the demands and complexities of suffering-relief. Cheerfulness, efficiency of activity, and productivity are some of the prevailing behavioral norms that disconnect suffering from the mainstream parameters of cultural life. Their dominant place in the culture often leaves dying persons and loved ones in a private, turbulent world of avoidance and indifference.

In modern death, not only are dying persons separated from systems of social support, they are often plagued by an overwhelming sense of meaninglessness. Our abilities to face death openly and accompany others into their deaths have been impaired because dying and suffering are the exact opposite of the forces that ignite and organize so much of contemporary culture and social life. Dying has become a source of great worry, and its associated sufferings are exacerbated by the absence of ritual, meaningfulness, and social support. As dying has become more difficult and worrisome during the preceding three decades, the tendency has been to turn to hi-tech intervention as a means of controlling and managing the dying process. Hi-tech medical organization of death is safe and emotionally protective as a means of controlling and regulating death. But, to put it simply, from a humanistic standpoint the technologization of dying has also been an abysmal failure! Despite some moderate success in controlling physical pain, medicalization of dying has precipitated a frightening increase in emotional pain and suffering. In fact, within the milieu of hi-tech dying, the deathbed has become a place where suffering rages. It has also evolved into a place of enormous expense, agonizing conflict and moral choice. Presently, one-half of all Americans die entangled in a web of anxiety provoking tubes and machines. It is this prevailing trend toward never ending procedures and shameless technological attacks upon disease that leaves families emotionally and financially drained. It also leaves patients filled with anxiety while longing for equanimity, relief of suffering, and dignity. Thus the burden of care, once reserved for loved ones in a communal setting, has been transferred to the technical arena of the hospital and is now placed under the jurisdiction of physicians. Trained in a technologically predominate manner, physicians themselves are often the last to accept the idea that good patient care often means summoning the courage not to begin or extend treatment in order to prolong life. In addition, as we will painfully witness in subsequent chapters, physicians frequently do not listen to what patients want, communicate inadequately and with half-truths about bad news, and are oblivious to the profound personal suffering of dying persons. In this framework, the organization and culture of technologically-based medicine are frequently at war with patient wishes, needs, and comfort [5, p. 2457].

This process which seeks to exert technologi...

Table of contents

• Cover
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface
• Acknowledgments
• Précis
• Introduction
• CHAPTER 1 Encountering Mortality: Preliminary Reflections
• CHAPTER 2 Contemplating Death: Human Voices
• CHAPTER 3 The Problem of Meaning: Dying in an Age of Spiritual Longing
• CHAPTER 4 Fear and Denial in the Modern Context
• CHAPTER 5 Technological Medicine, Technocratic Physicians and Human Dying
• CHAPTER 6 Fellowship and Dying: The Problem of Detachment
• CHAPTER 7 Impersonalism, Dying, and Social Organization of the Hospital
• CHAPTER 8 The Stigma of Dying
• CHAPTER 9 Approaching Omega: The Roller Coaster of Dying
• CHAPTER 10 A Concluding Statement: Technicism, Social Isolation, Medicalization, and Remedicalization of Dying
• A Methodological Note
• Index