The Revival of Death

Tony Walter

• Publisher: Routledge
• Year: 2002
• eBook ISBN: 9781134814626
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Talking about death is now fashionable, but how should we talk? Who should we listen to - priests, doctors, cousellors, or ourselves? Has psychology replaced religion in telling us how to die? This provocative book takes a sociological look at the revival of interest in death, focusing on the hospice movement and bereavement counselling. It will be required reading for anyone interested in the sociology of death and caring for the dying, the dead or bereaved.

Part I
Doing it my way

Chapter 1
The dying of death

RATIONALISATION

For millennia, death has disrupted communities and the language of death has been the communal language of religion. In the modern era, however, the human encounter with death has been split—on the one hand into expert medical discourse and associated bureaucratic procedures, and on the other hand into an intensely personal sense of loss. This chapter describes the historical and contemporary development of this split.

From the fifteenth to the seventeenth century, a common artistic image depicted a man or woman going about their daily business but with a skeleton, personifying Death, tugging at their coat tail or tapping them on the shoulder. In the image of death and the maiden, the living embraced the skeleton. Mortal illness could strike anyone, not only in times of plague, with little warning and with death ensuing in a matter of days; death was capricious, determined only by the inscrutable will of the Lord.

This changed with the arrival in the 1680s of the mathematical notion of probability (Hacking 1975; Prior 1989; Prior and Bloor 1992). Though no one could predict exactly when the Grim Reaper would call your name, the new science of statistics made it possible to calculate the chance of your dying in any given year or living to a particular age. In the gaze of the statistician, death takes not individuals but populations and sub-populations. By 1837 in England, all deaths had to be registered, thus making possible the systematic compilation of mortality statistics. The image of Death tugging at the coat of a unique individual is replaced by the life table that enables actuaries to calculate pension premiums and by statistics that enable health care planners to correlate mortality with environment, nutrition, income and so forth.

The Age of Reason shifted death from the frame of religion into the frame of reason, from the frame of sin and fate to the frame of statistical probability. The job of the public official is not to pray over the corpse, but to register, categorise and sanitise it. The rise of medicine and science replaced the basic category moral/immoral with normal/abnormal and healthy/unhealthy, in death as in life—the word normality appearing first in 1759, and normalised in 1834 (Arney and Bergen 1984:21; Canguilhem 1978:151). Exit the good death, enter the normal death. Exit the bad death, enter the abnormal death.

Modern law cannot allow a death not to be rationalised. If there is any doubt about the circumstances or causes of death, the body becomes the property of the pathology lab or the coroner so that a post-mortem can be conducted and a cause determined, often to the considerable distress of relatives who are not able to view, let alone care for, the body (Naylor 1989:238). In post-mortems, scientific examination of the body (often necessitating considerable mutilation) takes precedence over the personal sensibilities of survivors or (in the case of some minority religions) the requirements of religious ritual.

Statistical rationalism has now colonised even the emotions of the dying and their survivors. The basic category in the psychology of grief since the 1950s has been that of normal grief/abnormal grief. Worden, one of the authors most widely recommended on both sides of the Atlantic in the training of bereavement counsellors, makes it clear that ‘normal’ gets its meaning from the discourses of medicine and of statistics:

I am using the word normal in both a clinical and a statistical sense. ‘Clinical’ defines what the clinician calls normal mourning behavior while ‘statistical’ refers to the frequency with which a behavior is found among a randomized bereaved population. The more frequent the behavior, the more it is defined as normal.

(Worden 1991:21)

In the seventeenth century the religious event of Death taking a soul became a medical event; in the twentieth century human emotion has been shifted into that same rational medical realm. Kübler-Ross’s (1970) classification of the emotions of the dying in terms of five universal psychological stages completes the 300-year rationalisation of death. The dying join the living in being judged by those experts in normality whom Foucault has argued are major wielders of power in modern society.

The judges of normality are present everywhere. We are in the society of the teacher-judge, the doctor-judge, the educator-judge, the social worker judge; it is on them the universal reign of the normative is based; and each individual, wherever he may find himself, subjects to it his body, his gestures, his behaviour, his aptitudes, his achievements.

(Foucault 1977:304)

The rationalisation of death is well illustrated in the Consumers’ Association book What To Do When Someone Dies. This tells you nothing about what you should do to prepare the soul for the next life, nothing even about the emotions you may feel, but is entirely about the forms that have to be filled in, the bureaucratic procedures that have to be gone through in order legally to dispose of the body. If you live at the margins of society, you can get through most of life without paperwork, but you cannot get through death without paperwork (Prior 1989).

This much is all too apparent to the survivors. So much so that they willingly move from the medical arena into the arms of a funeral director to help them through the maze of bureaucracy. One book on etiquette describes how the doctor hands you over to the undertaker and: ‘In this way, the person who is perfectly ignorant of the proper procedure is passed on from one authority to another and is guided throughout with valuable information’ (Willoughby 1936). Bureaucratic rationality permeates behind the scenes as well. The American practice of holding the funeral in the funeral parlour began because of the organisational nightmare of transporting coffin and mourners together along the crowded highways of Los Angeles to the often distant cemetery.

A more efficient ‘funeral’ is held at the funeral home: the casket bathed in light, the family around it, the eulogy spoken, the casket lowered into the darkness, tears shed, and the family departing. Once in the basement, caskets can be stacked and driven, singly or in multiples, out to the appropriate cemeteries according to the work schedules of those cemeteries. Deaths and the accompanying cemetery work, formerly unpredictable, can now be brought under rational control.

(Kamerman 1988:80)

In the UK where cremation is the norm, the scheduling of funerals to fit into a time slot available at the crematorium rather than for the convenience of mourners is another example of bureaucratic rationalisation. The rapid expansion of cremation in the mid-twentieth century was largely driven by local authorities as a way of solving their financial and administrative problems (Jupp 1993), so the actual layout of British crematoria is determined neither by the requirements of religious ritual nor by a careful study of the needs of mourners, but by ease of operation and by Department of the Environment guidelines. In some other countries, however, such as

Finland and to some extent the USA, cremation developed not for reasons of rationality but to enable families to place remains in a family grave when there was no room left in the grave for a farther body.

In France, the rationalisation of cemeteries goes back to the Revolution (McManners 1981); in Britain it began in earnest in 1843 with Chadwick’s report and Loudon’s influential treatise on cemetery management, both of which recommended that the chaos of burial in the rapidly expanding industrial towns be solved by constructing out-of-town cemeteries with rational layouts, clear numbering of graves, no re-use of graves, and (in Chadwick’s report) only one grave per person (Prior 1989: ch. 5). With ownership of the new cemeteries in the hands not of the church but of municipalities and private companies, the corpse could be cared for in the efficient hands of Reason rather than in the ritual hands of Religion.

MEDICALISATION

At the late eighteenth-century deathbed the doctor took control from the dying man or woman and from the priest. Previously, doctors had seen their role as predicting the timing of death so that the dying person could organise their last hours. But then the doctor remained until the moment of death, administering opium to relieve the pain and sometimes keeping knowledge of imminent death from the patient in order to relieve suffering. Thomas Sheridan, writing in the 1760s, observed this shift and didn’t like it: ‘Very few now die. Physicians take care to conceal people’s danger from them. So they are carried off, properly speaking, without dying; that is to say, without being sensible of it’ (Porter 1989:89).

Death ceased to be a spiritual passage, and became a natural process overseen by doctors. ‘We have seen death turn from God’s call into a ‘natural’ event and later into a “force of nature”…. Death had paled from a metaphorical figure, and killer diseases had taken its place’ (Philippe Ariès, quoted in Arney and Bergen 1984:31). This deconstruction of death into discrete, identifiable diseases is seen by Bauman (1992) as the hallmark of death in the modern era. The human being is no longer shadowed by a single skeleton personifying Death, but by any number of germs and diseases which attack medically identifiable organs of the body.

In medical practice, these vulnerable organs have a double relationship to the corpse. It is not only that the corpse is explained by the presence of one or more failed organs, but also that in medical training the organs are identified by means of the corpse. The role of the anatomy class, in which pairs of students learn anatomy through dissecting a corpse, has been revealed in the past two decades by some of the most intriguing of sociological and historical research. Whereas in life all the doctor can witness are symptoms, under the scalpel death reveals to the student’s gaze what the body is really made of. In this medical gaze, the human body becomes objectified, no longer a person but a constellation of objects to be subjected to medical scrutiny (Foucault 1973). The patient’s own experience of his or her body is inferior to the objective knowledge of the doctor. Richardson (1989) has shown the extreme lengths to which unscrupulous characters (who dug up fresh corpses and even murdered unsuspecting victims) and, after 1834, even the state (which made available the bodies of paupers) would go in order to meet the insatiable demand of the anatomy schools for corpses in good condition. Though voluntary donation now meets the demand, the anatomy class remains a key part of medical training, even if it is a process that some students find distressing (Coombs and Powers 1976; Hafferty 1991). Not only are dead and dying bodies medicalised, but dead bodies enable the medicalisation of living bodies.

Death is medicalised in other ways too. The deathbed itself has moved from home to hospital, where two-thirds of Britons now draw their last breath. Cases of serious stroke and heart attacks are rushed to hospital; those with a lingering illness may spend most of their time at home, but are likely to be transferred to hospital for their last days.

Once the body has been buried or burned, medicalisation is extended to the survivors. Lindemann (1944) wrote about the ‘symptomatology and management’ of grief, and Engel suggested that grief is comparable to a disease and should become ‘a legitimate and proper subject for study by medical scientists’ (1961:20). These two widely quoted articles reflect what was in any case happening: psychiatrists were, from the 1950s, laying successful claim to be the experts on grief, while the bereaved themselves were more likely to go and see a doctor than a priest or social worker.

Along with death’s rationalisation and medicalisation went its masculinisation, for rationalist and medical discourses have, until very recently, been largely the preserve of men. It is significant that those in the 1960s who first challenged the appropriateness of these discourses for describing the dying person’s experience and who began instead to pay close attention to what the dying themselves had to say, have been in large measure women—notably Cicely Saunders and Elisabeth Kübler-Ross.

SECULARISATION¹

If medicalisation forms one side of the dying of death, the other side is secularisation. Although the oldest forms of some world religions, such as early Judaism, have not been concerned with the problem of death, it has been central to later religions, notably Buddhism and Christianity (Bowker 1991). Christianity has historically been a defence against death, offering a place in heaven for the righteous and defining death as a spiritual passage. This was a particular feature of the late Middle Ages, with fear of going to the wrong place becoming a major cause for devotion, art, prayer, and the increasing power of the church. Theologically, the Reformation rejected such trading on fear (though there have subsequently been hell-fire preachers enough who have traded in a very similar line). The paid-for prayers of the church were denounced as ineffective; all that mattered now was the faith of the person while alive and the grace of God. If the dying person was a believer, there was no need for a priest at their bedside—leaving an empty chair ready to be filled some two centuries later by the doctor. In the decades immediately after the Reformation, funerals were spartan affairs, as any prayers over the body could be interpreted as popish and even lead to the arrest of mourners. John Knox’s Genevan Service Book of 1556 simply stated that

the corps is reuerently brought to the graue, accompagnied with the congregation withe owte any further ceremonies, which beyng buriede the minister goethe to the church, if it be not farre off, and maketh some comfortable exhortation to the people, touching deathe and resurrection.

(quoted in Rowell 1974:82)

The Scottish Book of Common Order of 1564, said much the same, adding after the words concerning the minister ‘if he be present and required’.

Just as the Reformed deathbed left a space to be filled later by the doctor, so the Reformed funeral left a space to be filled later by the undertaker—who first appeared in London in the 1680s. If Protestantism allowed dying to become medicalised, it allowed the funeral to become commercialised. Even before that, in the seventeenth century, mourners filled the gap left by Reformed religion with feasting, so that the funeral became more a social than a religious ritual (Gittings 1984).

Philippe Ariès’ (1981) magisterial survey of Western attitudes to death is written from a largely French perspective and therefore underplays the effect of the Reformation compared with English historians such as Gittings or Americans such as Stannard (1977).² But Ariès does highlight another feature of secularisation, namely what he terms the shift from my death to thy death. In the high Middle Ages people were concerned with what would happen to their souls, but in the Renaissance the concern was more what would happen after death to their reputation on earth. The Renaissance man hoped that the art, architecture and literature produced or patronised by him would survive and so guarantee immortality. By the nineteenth century, however, people became concerned less with what would happen to their soul or name when they died than with how they would manage when their loved ones died. Thy death came to be feared as much as my death, bereavement as much as my own demise. In the romantic age of the holy Victorian family in which identity was increasingly found within the private family, the question became: how will I cope when death tears my family apart? ‘One person is absent, and the whole world is empty’ (Ariès 1981:472).

This in turn undermined religious narratives. At the deathbed, the survivors’ grief eclipsed any concern with the spiritual destination of the departing soul; the hope of an afterlife was not union with God but reunion with the beloved—still the major form of afterlife belief in Britain today (Walter 1990: ch. 21). Paradoxically it was the First World War, hell on earth, that finally killed off hell below— no field chaplain could even so much as hint that the brave lad he was burying might be going to the wrong place, and thereafter hell disappeared off the agenda in all but the most conservative of churches. And without hell, death lost any spiritual risk, and became a medical and psychological affair.³

All these changes are expressed in the final resting place of the earthly remains (Davies 1990:31f). In early Christianity, believers were buried in mass graves awaiting the resurrection, with only the richest and holiest resting in individual tombs near the high altar. The Renaissance created the individual tomb that celebrated the earthly works of the male and the fertility and maternal qualities of the female. By the nineteenth century, these individual tombs began to express the grief of the survivor as well as, or instead of, the achievements of the deceased; the patriarch’s tomb was adorned by his weeping spouse, symbolised by a drooping nude or less daringly by a weeping willow. By the late twentieth century it is becoming fashionable in some circles to scatter cremation ashes in a special place known only to close family. Communal resurrection has thus given way via the family tomb to private memories—a process not only of secularisation, but also of ever growing individualism and privacy.

INDIVIDUALISM

In societies where identity is bound up largely with the group, what is feared is the demise of the group. But the more individualistic a culture, the more my own personal demise becomes problematic: ‘In death, we fear we will lose our “I”, our “me-ness”. And the stronger this idea of “I”, the more distinct is the feeling of a separation from life and a fear of death’ (Levine 1988:14). This Achilles’ heel of individualism has been ...

Table of contents

• Cover Page
• The Revival of Death
• Title Page
• Copyright Page
• Acknowledgements
• Introduction
• Part I: Doing it my Way
• Part II: Keeping on Listening
• Glossary
• Notes
• Bibliography