Death, Grief and Loss in the Context of COVID-19

Panagiotis Pentaris, Panagiotis Pentaris

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000417715
• Edition: 1
• Topic: Scienze sociali
• Subtopic: Morte in sociologia

This book provides detailed analysis of the manifold ways in which COVID-19 has influenced death, dying and bereavement.

Through three parts: Reconsidering Death and Grief in Covid-19; Institutional Care and Covid-19; and the Impact of COVID-19 in Context, the book explores COVID-19 as a reminder of our own and our communities' fragile existence, but also the driving force for discovering new ways of meaning-making, performing rites and rituals, and conceptualising death, grief and life. Contributors include scholars, researchers, policymakers and practitioners, accumulating in a multi-disciplinary, diverse and international set of ideas and perspectives that will help the reader examine closely how Covid-19 has invaded social life and (re)shaped trauma and loss.

It will be of interest to all scholars and students of death studies, biomedicine, and end of life care as well as those working in sociology, social work, medicine, social policy, cultural studies, anthropology, psychology, counselling and nursing more broadly.

Part I

Reconsidering death and grief in Covid-19

1 Familiarity with death

Panagiotis Pentaris and Kate Woodthorpe

Key points

• Pre-Covid-19, death has been concealed from public view, with recent efforts to (re)integrate death into everyday life.
• Covid-19 has triggered a (new) public visibility of death.
• News media has provided wide-ranging coverage of Covid-19 deaths, including inequalities, to the extent that death has entered people’s homes as an everyday subject for discussion.
• These factors have necessitated a political response, and a long-overdue politicisation of death.

Introduction

As this book will attest to, Covid-19 and its associated lockdown measures have changed people’s lives in unprecedented ways. Across the world, governments, societies, families and individuals have been affected by the virus and control measures that have led to huge disruption(s) to everyday life. Seemingly, everyday there have been reports of increased mental health challenges, growth in domestic abuse, concerns over the rationing of health and social care, and the long-term risks attached to prolonged social isolation – especially among the elderly and those at high risk. Within these reports, death, dying and bereavement have received significant coverage. It is almost as if Covid-19 has been a huge and shocking aide-mémoire about the fragility and finality of the mortal human condition. Abruptly reminded that an airborne virus such as Covid-19 ‘can kill’,¹ tales of death and the risk of death have dominated the news for much of 2020, with much talk of ‘premature’ death, and vulnerabilities associated with age, morbidity and physical condition. Access to dying people in hospitals to say goodbye has become headline news, along with whether families are permitted to attend a funeral service, and the legality of their hugging a fellow mourner.

Such public recognition of death and its impact is long overdue. In this chapter, we consider the pre-Covid-19 visibility of death in the public sphere and what the virus has done to raise the social and political profile of death in the public domain. We explore what Covid-19 has thrown up, challenged, or changed in terms of how people in the UK and beyond know and understand death, dying and bereavement, and how these vary between different groups of people. We argue that such a stark reminder about mortality and inequality within the population is much welcome and needed, for socio-economic improvements to be made.

The chapter first introduces the reader to well-established ideas and theories about the presence and concealment of death in modern/late modern society, examining the evolution of ways in which societies and individuals have engaged in conversations about death in public. In the second part of the chapter, we focus on how Covid-19 and associated measures have influenced death, dying and bereavement. Specifically, we start with the argument that Covid-19 has led to a publicly visible (re)institutionalisation of death and concurrent emphasis on death inequalities. This public and ample visibility of death and associated inequalities, we argue, has led to a long-overdue politicisation of death.

The pre-Covid-19 visibility of death

The visibility and concealment of death has been discussed and debated for millennia, first seen in the Socratic period in dialectic inquiries about human nature and the moral concepts of life and death (Derrida, 1995). In probably the most well-known and oft-cited account of death(s) over time, historian Ariès (1975) argued that pre-modernity death had a much greater presence in everyday life, with individuals, families and even whole communities succumbing relatively frequently to infectious disease. Such uncontrollable ‘wild death’ and a corresponding lack of medical care meant that dying usually occurred at home, and the dead remained there, cared for by their family and community, until their (timely) disposal.

With the advent of modern medicine, by the arrival of the 20th century the modern world had sought to – and been able to – control, or ‘tame’, death (Ariès, 1975). Humans became the rulers of life and death (Riley, 1970), mastering and controlling the limits of the human body (Pentaris, 2021) in order to sustain life as long as possible. This greater understanding of causes of death resulted in greater control of illness and with advanced healthcare and medical intervention came the imperative to organise those services as efficiently as possible.

It is quite staggering what has been achieved in such a short space of time, with high levels of control and the ability to sustain life leading to massive improvements in longevity. Infant mortality rates are low, with aims to get them lower (Office for National Statistics, 2020a); people are living longer with cancer (50% live for 10 years or more), doubling in the last 40 years (Cancer Research UK, n.d.) and around the world people are living longer and in better health (World Health Organization, 2020a). These long lives have created a whole host of challenges for healthcare systems and economies that need to support their ageing population. They have also, we argue, resulted in a collapse in familiarity with death, dying and bereavement. Death no longer occurs as a matter of course throughout individual’s lives. Now, people – in western post-industrial countries at least – can easily reach middle adulthood before they experience and encounter a ‘close’ death. Correspondingly, death any time before adulthood is regarded as ‘out of time’, with Public Health England (PHE) (2018a) identifying death before 75 years as ‘premature’.

Such unfamiliarity with death has been further exacerbated by the institutions that have been established to efficiently manage the end of life, removing dying and the dead from ‘everyday’ domestic settings. In the UK, three in every four people will die in an institutional setting, be it a hospital, care home or hospice (Public Health England, 2018b). After death, unless there is coroners involvement, typically deceased people are immediately handed over to funeral directors, who sanitise and store their body until the day of their disposal. Dying and the aftermath of death thus takes place behind closed doors.

Thus, everyday encounters with people who are dying or bereaved have declined, and so too has a corresponding recognition in the public sphere that death happens. Death is something that has become mastered and hidden from public view; it has become domesticated, taking place behind closed doors (see Stanley and Wise, 2011). This privatisation of death and its impact, pre-Covid-19, has long been of concern for sociologists (see Howarth, 2006 for a good overview): 70 years ago, in his famous essay on The Pornography of Death, sociologist Gorer (1955) opined that the growing concealment of everyday death in the 20th century had left people with a sensationalised version of death in the public domain – versions there were embellished and characterised principally to appeal to media consumers and voyeurs. Fast forward three decades and the 1990s saw a resurgence of sociological interest in the status and visibility of death in modern societies (see for example Mellor and Shilling, 1993). UK sociologist Walter was one of the most prolific contributors to literature during this period and argued – in contrast to anthropologists who were arguing that death as ‘taboo’, and psychologists who were arguing that death was ‘denied’ in modern societies – death was being hidden from public view (Walter, 1991). Such concealment was underpinned by, and contributed to, its routinisation and institutionalisation (James and Field, 1992).

As a result of growing concerns about this process of institutionalisation and a lack of public scrutiny (see Lawton, 1998), by the mid 1990s there were signs of a burgeoning ‘revival’ of death in the public domain, with dying people being asked to discuss death (more) openly, on the prerequisite that professionals, family and friends would do so similarly (Walter, 1994). Since then, in recent years there has been a growing interest in news coverage of death (see Hanusch, 2010) and moves towards ‘de-institutionalising’ death through a death positive movement (Lofland, 2019; Leland and Yalkin, 2018), which has seen the establishment of death cafes and death doulas to promote dying at home and ‘naturalise’ the end of life (Rawlings et al., 2019). Efforts such as these have attempted to (re)integrate death into everyday life. A (re)conceptualisation of death through a lens of spiritual transcendence has, Lee (2008) has argued, further enabled greater ‘death talk’ in the public domain. Such efforts to assimilate death and life have not been without critique, however, with shortcomings identified in how this increase in ‘death talk’ overlooks temporal and cultural contexts. For example, Cheng et al. (2019) have argued that death remains taboo (that is, unspoken) among people of Chinese origin living in the UK, to the extent that it can interfere with end-of-life decisions.² Elsewhere, Paul (2019) has critiqued contemporary theorisation of death for neglecting children. Indeed, it could be argued that for children death has remained embedded in their everyday worlds throughout the 20th and 21st centuries, with research showing that in children’s literature death is a relatively common topic and has been since the 1600s (Gibson and Zaidman, 1991). Similarly, the ‘ordinariness’ of death has been reflected in children’s animated films since the early 1900s (Pentaris, 2019).

So, what has happened to the visibility of death in 2020 with the Covid-19 pandemic? In the second half of this chapter, and focusing on the UK specifically, we propose that Covid-19 has resulted in a publicly visible (re)institutionalisation of death, and a 21st-century revival of death talk in the public domain. This revival has included a radical shift towards public recognition of inequalities associated with death and a (much needed) political reply. In other words, death has become politicised.

The visibility of death in the face of the pandemic

The arrival of Covid-19 in 2020 marks a turning point for the public visibility of death in the 21st century. Pre Covid-19, efforts to de-institutionalise and to (re)locate dying away from institutions (see above) were predicated on a small but crucial number of factors: free choice, freedom of movement and known disease trajectories that could be managed flexibly in both acute care settings and communities. Come 2020, what no one was expecting was the potential impact of a novel virus on how end of life would be managed and resulting ‘death talk’. The early Spring of 2020 saw the introduction of hyper-vigilance/surveillance of individuals at the end of their life amid concerns of infection control, virus t...