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A Social History of Dying
« on: 2007-08-07 04:08:35 » |
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[Homer]"This isn't the worst day of your life. It's the worst day of your life SO FAR!"
[Blunderov] On the subject of obituaries, our local "Deaths" notifications in the smalls have a strict code of euphemism which is apparently cast in stone somewhere. "After a short illness" tends to mean "heart attack". "After a long illness" tends to mean "cancer" or "AIDS". "Died tragically" or "was taken by the Lord" usually means motor car accident.
I've always wondered why people are not more forthright about causes of death. You'd think that this sort of information would be considered vital to the public interest but instead it seems to be considered a matter of deep personal privacy to the extent that gravestones almost never include this information. Must be a stigma thing I suppose.
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A social history of death and dying
07 August 2007, 03:06:18 | vaughan@backspace.org (vaughan)
BBC Radio 4's social history and sociology programme Thinking Allowed recently had a programme on how death and dying customs have changed over time and how obituaries say as much about society as they do about the deceased.
A guest on the show is sociologist Prof Allan Kelehear who discusses his book A Social History of Dying (ISBN 9780521694292) that charts how changes in the physical process of death have meant our social customs have altered to better make sense of new forms of dying.
In ancient times, death was generally quick and sudden, and so little ceremony was needed and people were generally left where they died.
However, as humans became better at avoiding a violent end, death was more often due to disease which was a slower process and so changed the social customs related to the dying process.
Kelehear argues that as we have become better at predicting death, even through the modern times, we've developed ways of preparing for our imminent demise, both socially and psychologically.
The other guest is sociologist Prof Bridget Fowler who has analysed obituaries through the ages to answer the question, 'who have we considered worthy of an obituary?'
As obituary is a type of 'social memory', something we decided to record because we feel other people should know it for the future, it also reflects the cultural assumptions about who and what are important at the current time.
Unsurprisingly, obituaries have typically been concerned with the deaths of the upper classes, but she notes that their style is changing and has become somewhat more democratic and surprisingly frank in some instances.
Link to Thinking Allowed on the sociology of death and dying.
Link to A Social History of Dying on Google Books.
cambridge.org catalogue
A Social History of Dying
...Our experiences of dying have been shaped by ancient ideas about death and social responsibility at the end of life. From Stone Age ideas about dying as an otherworld journey to the contemporary Cosmopolitan Age of dying in nursing homes, Allan Kellehear takes the reader on a two million-year journey of discovery that covers the major challenges we will all face: anticipating, preparing and timing our eventual deaths.
This is a major review of the human and clinical sciences literature about human dying. The historical approach of this book places recent images of cancer dying and medical care in broader historical, medical and global context. Dying is traced from its origins as an otherworld journey to its later development as ‘good death’ or ‘well-managed’ dying in settlement societies. Professor Kellehear argues that most dying today is not well managed. Instead, we are witnessing a rise in shameful forms of dying. It is not cancer, heart disease or medical science that present modern dying with its greatest moral tests but rather poverty, ageing and social exclusion.
Allan Kellehear is Professor of Sociology at the University of Bath, UK...
A Social History of Dying
Allan Kellehear
La Trobe University, Victoria
Paperback (ISBN-13: 9780521694292)
Published January 2007
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Introduction
The study of dying is like gazing into a reflecting pool. The waters there reflect back to us the kinds of people we have become. Behind the fragile and temporary images of our individual selves that appear on its surface exist suggestions of less familiar company – strange tides of history, cultural undertows that sweep in and out of our lives. The ripple of these forces tug and work at our identities, at first to create them, and finally to test them before their eventual dismissal at death. These are influences so subtle, indeed so intimate in our day-to-day lives, that we often barely notice their workings underneath the modern obsession to present ourselves to others as distinct and individual. Yet, dying conduct shows their power over us in sharp relief.
This book is an attempt to stand back from these images of ourselves, to take a wide-angle view of the human story of endings, and to identify and describe the major patterns of dying throughout our history. Though all becomes dead eventually, the paths to this eventuality have not all been the same; we have not always died in the same way. This is because human beings do not share a common cultural heritage or physical environment. Idiosyncratic religious beliefs and rituals surrounding the fact of death abound, as any encyclopaedia of human customs will attest. Yet remarkably, intriguingly, much of our personal behaviour before death exhibits itself in only a handful of simple styles.
Each of those styles of dying tell anxious tales about living in particular physical, economic or social environments. Dying conduct throws a harsh, unforgiving light across the moral and political worry-lines that are deeply etched into the face of our human history. Dying behaviour bears all the unmistakable influences of pressures from our living – from animal attacks, property ownership, and the rise of professions, to the challenges of living with ageing, authoritarianism or social alienation.
Dying holds a mirror to these kinds of incidental and institutional origins. In these ways, the experience of dying is the most commonly overlooked measure of our wider history as human beings as we attempt – sometimes successfully, sometimes tragically – to live out a life that is always both inherited from, and intimately tied to other people. The reflecting pool at the end of life reveals the wider context and conditions of our dependency on these others. In good and comforting ways, or simply sorrowful ones, the moral and social quality of our living is truly measured by the pattern of our comings and goings.
WHAT IS DYING?
Biologically speaking, dying only takes a few precious seconds, or occasionally a few minutes. The physical process of dying usually begins in one failing organ of the body and then simply spreads itself, meticulously switching off the lights as it leaves each room of the body. The tissue and then cellular shut-down turns everything to mush, then gases, then dust. And then ‘our’ dust simply joins the wider micro-particle brethren. For you and me this is not the ‘dying’ we observe and experience as people. This is not the ‘dying’ that we see, caress and talk to. This is not the ‘dying’ we live through or live with as survivors or as people with failing health. Neither is this the ‘dying’ of a sentient animal with memories held briefly, or carried long and dearly into whatever world might await (or not) after the biological processes have finally finished with us, forever.
There are other books about dying, about the emotional troubles that people sometimes endure when attempting to come to terms with the promise of their own death; journeys that are highly personal, thoughtful, spiritual. And there are books about dying from a more medical, physical view; books that contain elaborate descriptions of how violently, insidiously or depressingly the body falls apart under the pressures of different disease processes. My book is not a forensic view of dying in these ways.
The dying that I discuss in this book concerns the life we live in that urgent space created by the awareness that death is soon to engulf us. I speak here of dying as a self-conscious anticipation of impending death and the social alterations in one’s lifestyle prompted by ourselves and others that are based upon that awareness. This is the conscious living part of dying rather than the dying we observe as the final collapsing act of a failing biological machine. How is life lived during this time? Why do we live out our dying in what often appear to be set ways? What drives the social and psychological repetition we often see at these times? What is the Zeitgeist – the cultural spirit and values of the times – responsible for these psychological shapes and social actions as they rise to prominence or are eclipsed by other forms down through our history?
In the following pages I will try to reveal incrementally how the nature of dying today is an amalgam of features we have inherited from past tradit- ions – urban, rural and prehistoric – but also the current economic, political and public health pressures exacted by our own time and societies. To describe each historical period I will begin with a chapter that summarises the salient features of its most dominant culture: the economic and cultural character of the time that is responsible for its own patterns of health, illness and death. These broad descriptions will set the scene, as it were, provide a cultural backdrop against which we must understand our dying.
Each second chapter describing this historical period will outline the dominating style of dying typical of the time. I will try to show the moral and cultural features underlying the different styles of dying conduct, the kinds of social audience to which every dying person must relate in some way. I will also describe the tensions and contradictions that push and pull each dying person as they aspire to create or resist the archetypical death of their period.
Each third chapter will discuss the main cultural reasoning, or to put it another way, the social psychology behind the way dying people behaved during this period. Every dying brings its own challenges to which we must respond, just as a stone axe has a handle designed for a handgrip, or as a flute is designed for fingers and lips. Equally, dying people and their audiences have mutual expectations of each other and these are not randomly occurring but instead are determined by their own ‘design’ – the prevalence of certain diseases, the interpersonal requirements of social and economic institutions, the wider but frequently covert moral imperatives and social expectations.
THE AIM OF THIS BOOK
I wrote this book because scholarship about the social experience of dying has become highly disparate, fragmented and, at times, idiosyncratic. Out of this context I felt a need to write a volume that would address two important purposes. First, reviewing and revising the best of this diverse material around a broad historical storyline can act as a fresh point of departure to launch new debates about the meaning of dying. A broad approach can provide a bold clarity and contrast by shifting our attention from the finer details of small studies to the commonalities inherent across their number. Second, by identifying common themes in our behaviour and motives during this exercise I hope to provide a deeper, but accessible, and more exciting vantage point from which to reflect upon our common fate.
In the past there has been a proliferation of social theory books attempting to speculate about the experience of dying and death. Some of this material does not even attempt to engage with the empirical and policy literature going on in another room of the social sciences. Even if one allows that much social theory enjoys its own company, gaining insights into the human experience of dying from that literature is hard work. The writing is frequently turgid, esoteric and often lethargic towards any evidence of even an ordinary sort found in the numerous studies of dying that have appeared since the 1960s.
On the other hand, the many studies of dying that have been conducted and published in the last forty years are highly limited in their capacity to speak to each other’s findings or even to generalise. Qualitative studies of twenty or thirty dying people in the 1960s and early 1970s made their way into the journal literature, while the same kinds of studies today, now heavily armed with self-conscious methodologies, are made into book-length descriptions. Not much has changed.
The histories of dying, particularly from Western writers, are often quite specialised, commonly covering just decades at a time and usually for highly specific areas of Britain or Europe. There are famous exceptions and these are endlessly cited as representative of our dying ‘traditions’ or ‘past’. Nevertheless, even histories that span over a thousand years, such as the evocative one written by the French historian Philippe Aries, speak neither to the origins nor the diversity of dying in human history.
There is an ever-increasing literature from palliative care about death and dying, as well as textbooks for student readership – both frequently summarising the stereotypes of dying formed from the earlier recycled histories. Some of this work pays far too much attention to ideas about the ‘good death’, with the result that their work underestimates or less appreciably recognises the way professional carers alter the way people die in the most fundamental terms. There is also an over-attention to cancer dying in this literature, a focus that inadvertently masks other major forms of dying today, especially ageing and AIDS dying.
We also see the word ‘tradition’ far too commonly employed to indicate some undifferentiated past with an overemphasis on medieval societies. Yet often the broad features of a longstanding conduct, such as dying, have been determined unimaginably further back in time, and from very different kinds of economy and society. The story of the influences on our present-day dying do not stretch merely to the Middle Ages but to our deeper, primordial links with early humans and their biological and social inheritance with all animals.
Finally, it must be observed that, unlike the study of mortuary rites or bereavement, the experience of dying has been distinctly under-theorised. We have largely invested our efforts in description, and there, on matters mainly to do with body and emotional care. So in this book I have attempted to perform some conceptual mapping and development through a critical review and oversight of the literature. My emphasis has been on the interpersonal, political and cultural life of the dying experience. I have collected and examined the main kinds of research about dying – from the clinical, behavioural, humanities and social sciences – and linked that collective understanding about dying to certain periods of history, culture and epidemiology. I have then linked that periodic, place and public health understanding to particular kinds of social and economic organisation first identified with, but not necessarily confined to, earlier times.
I then outline four representative styles of dying that have emerged from, then dominated, their different periods in history. These descriptions of dying are ideal summations of common, recurring behaviour at the end of life. They have also spawned or sat alongside other important and dissenting patterns of dying that deviate from the archetypical forms, and where these represent important tensions for the main forms, those counter-styles of dying are also discussed. Later I provide arguments about what I believe to be the most important cultural drivers behind all these basic dying styles.
As my descriptions and arguments unfold, I reject any attempt to associate my history with any of the now discredited concerns with ‘progress’ as a heroic theme in history; or of any suggestion that I am assuming a ‘moral’ superiority of one culture over another, such as is commonly implicit in other histories that involve patterns of linearity. Whatever other shortcomings and imperfections they might display in their arguments or details, all histories are not inevitably flawed and elitist stories. Their continuing and perennial value lies in their practical role as arguments, even methodologies, that act as suggested report cards in an ongoing exploration about who we are and what has driven and continues to drives us as people.
Today, historical sociologies are accessible invitations towards review and debate. Although this style of scholarship sifts the evidence, which is no less important for sociology than history, it is not the evidence for its own sake that is most important, but rather its potential to suggest new or novel views of human experience. Histories can be enjoyable and clear ways to organise our thoughts about how things began and why they might have diversified the way they appeared to have. I recognise, in concert with most of my readers I suspect, that my view is simply one argument, one view, one way of organising the world furniture, however supported by an evidence-based design. Each history, like all social science, is part of an ongoing conversation.
In this context then, sociologist Anthony Giddens (1990) is right to remind us about the discontinuous character of modernity, indeed all history. The historian J.M. Roberts (2002) is right to remind us that all chronology is selective. Biologist Jared Diamond is right to warn us about how linear histories are open to charges of progressivism, elitism, even racism. But another sociologist, Max Weber (1947), also reminds us that we need not take all writing about history and culture too literally.
Historical sociologies, such as the one I present here, can be useful heuristic devices. They can help us explore changes among individuals and societies by building ideal-typologies cobbled together from the ethnographic and historiographic evidence of the day. Though few real-world examples will exactly conform to these ‘types’, most of our experience will more or less approximate them, serving to deepen our understanding of the differences, overlaps and exceptions to these more fixed and literal representations. That is my intention here. With those qualifications declared and warnings acknowledged to the reader, I believe the story of our dying to date has unfolded in the following way.
OVERVIEW
Our human origins, as well as the basic experiences and meanings that we have derived from those origins, cannot be separated from the habits, preferences and experiences of all organic life. To understand the basis of our living and dying experiences we should not draw too sharp a divide between us and other living matter, if only so we do not confuse our inheritance with our subsequent development. The meaning we ascribe to death is undoubtedly our own and unique to our species, but the original challenge and the drive to make sense of death itself may have deeper roots in the developing consciousness of life itself but particularly those expressions from the animal kingdom. To ignore this inheritance is arrogance at best, misleading at worst.
From these still unclear beginnings, much of our human past has been a history of hunter-gathering. We lived in small-scale societies characterised by wandering groups in search of food and safe shelter. Life was frequently short and ended abruptly through accident and misadventure. But these were also people who did not (and current examples do not) see life and death as sharply separate types of existence. Human nature and animal nature, for example, were not viewed as opposites. The otherworld – the world beyond our senses – was an invisible place where people might suddenly find themselves after an unanticipated death. In that world, dying becomes an adventurous but frequently terror-filled journey – an otherworld journey – and the challenge of this life is to anticipate its event so as to be prepared for its inevitable tests.
Settlement cultures arrived more recently. Some 12 000 years ago the first farms and gardens, along with keeping animals, created a pastoral age for many people around the world, alongside a continuing hunter-gatherer presence. Soon after these first farms and villages appeared, the first cities followed. Early farmers and city dwellers were able to live longer and were more likely than their hunter-gatherer peers to see death coming. These were places and times that allowed dying to become a this-world activity as well as an otherworld one.
Preparing for death became the gift and moral imperative that slow dying gave settler society. In farms and rural villages, peasants and early farmers quietly settled their affairs with kin and kith – people aspired to a good death. In the cities, places where strangers were often thrown together for economic, political or military reasons, dying people began to ‘manage’ their dying affairs by involving professional others – people aspired to a well-managed death. In these two parallel ‘traditions’ then, farmers and peasants emphasised preparation for death while urban dwellers made greater efforts to tame the chaos and uncertainty of impending death.
In the present modern period, a time I choose to call the Cosmopolitan Age, people live in a more global social and economic set of arrangements. Old social divisions and ranks characteristic of past societies such as location, gender, religion, ethnicity or social class blur into each other. The advances in public health and medical care in the last hundred years have sent life expectancy soaring in the rich industrial countries of the world. However, globalisation processes in communication and human movement have meant that ‘new’ or revived infections of recent modernity, such as HIV or tuberculosis, go where the sexual and poverty action is, and as always, that action is everywhere. Such globalising mixture of wealth and poverty, long and short life expectancies, confuses the popular expectations of rich and poor nations about what they hold to be true about their life and death prospects by overturning our past understandings about risk (Beck 1992).
Dying in this Cosmopolitan period increasingly produces deaths that are neither good nor well-managed for anyone. People’s attempt to prepare for death (as they did in farming communities for millennia) or to tame death through medical or other forms of professional care (as they did in cities for millennia) is frequently thwarted, distorted or simply denied.
Dying has recently become a rather shameful affair – negatively labelled by others, inherently shaming for or resisted by their human targets. The social and moral challenge for everyone caught up in these modern battles over identity at the end of life suddenly, but unsurprisingly, becomes the problem of timing death. How can we avoid the shameful slip into spoiled forms of identity when only yesterday we stood proudly shoulder to shoulder with the main herd of fellow life travellers? How can we delay or transcend such slippage so as to disguise oneself as a ‘normal other’ while we think of ways to rehabilitate or dispense with our new, spoilt selves? In each scenario ‘the last dance’, as DeSpelder & Strickland (2005) poetically describe dying, is becoming an increasingly privileged waltz for the few as less dancers get invited to the final ball at the end of life.
Dying – now far, far away from its otherworld origins – has become a set of this-world trials and tests. Dying continues its reversal from the otherworld as secularisation dims our sights there or permits only the most vague descriptions of those places. Increasingly, the slow deterioration of ageing, and the slow dimming of consciousness experienced as we age, brings a new and urgent question about dying as living. Every day, more people now ask if dying has become ‘living’ in name only. This is increasingly the kind of question people are asking the world over and the ethnographic, historical and sociological record of our dying throughout human history reveals the cultural source, if not the public health structures, behind this modern anxiety.
We can only begin to formulate a way through these new worries and social problems by standing back, taking a wide-angle view of the origins as well as the present institutional architecture, and ask: what can be done? To begin to formulate a personal answer to that question we must embark on our journey of assessment and reflection by first following the history and society trail outlined in the coming pages
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Blunderov
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"We think in generalities, we live in details"
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Re:A Social History of Dying
« Reply #1 on: 2007-10-28 13:07:03 » |
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[Blunderov]"Philosophising is learning to die."~Montaigne, Essays
Perhaps one might add to this and say instead "learning to die well"?
http://science.howstuffworks.com/worst-way-to-die.htm
Is there a worst way to die?
by Josh Clark
Inside This Article
1. Is there a worst way to die? 2. Thanatology and Ernest Becker 3. Lots More Information 4. See all Life Science articles
Anna Gosline's recent article in New Scientist, entitled "How Does It Feel To Die?" got our hearts pumping here at HowStuffWorks. Gosline interviewed experts to find out what it's like to drown, fall from a tall building and ride the electric chair, among other terrible ways to die. This got us to thinking: Is there a worst way to die?
Courtesy Keystone/Getty Images
Immolation is one of the most painful ways to die -- which makes this Buddhist monk's protest of the Vietnam War by publicly burning himself to death all the more significant.
As it turns out, determining which mode of death is the worst way to go is subjective. There are impromptu polls on sites around the Internet (burning has a high ranking). But there's no consensus among professionals like physicians or funeral directors about which method is the least desirable way to exit this mortal coil. A person's fears may factor into his own personal worst way to die. The thought of falling to one's death from a tall building, for example, would probably scare the daylights out of someone who is afraid of heights, but wouldn't qualify as the worst death for someone else.
Awareness of the type of death and fear of the unknown can also make one kind of death more grisly than another. Dying in a plane crash is one example: The time between the airplane beginning its rapid descent and the moment of impact is more than long enough to generate terror. What's worse, depending on the circumstances, the passengers may remain conscious during the entire process. The plane is literally -- and unstoppably -- carrying its passengers to their probable deaths, and of this they are all totally aware.
With most forms of death, unconsciousness meets the victim before the grim reaper does, thus releasing the dying person from the fear that grips him. But the moments before death can be fraught with fear and pain.
A physician we interviewed recounts the story of a laborer in Africa who worked around vats of sulfuric acid -- one of the most caustic forms of acid. The man fell in one day. He quickly leapt out, but was covered in sulfuric acid, which immediately began to burn him chemically. In a panic and excruciating pain, the man ran outside. By the time his coworkers caught up to him, the man had essentially dissolved.
The acid burned the man to death, searing through skin, cauterizing blood vessels, and eating through organs until he died. The pain would be unbearable, and the circumstances irreversible. This is unquestionably a really bad way to die.
But what is it about stories like this? Why is it that on some primal level we feel the urge to imagine the man running madly about as his tissue fell away from his bones? Why do articles like Gosline's become so popular? In other words, why do we think about death? Read on to find out about an entire field of study dedicated to exploring death.
Thanatology and Ernest Becker
Death looms around us all, but for the most part, people try to avoid thinking about it. The success of antiaging skin care products and the hospital's increased role as supporter of life beyond the time after quality of life diminishes both attest to this. But while people in most cultures may avoid thinking about death, others find it a fascinating study. An entire school of thought is dedicated to the study of death and dying -- along with its processes, like grief. This field is called thanatology.
Courtesy Vintage Images/Getty Images
A man confronting his own mortality?
Thanatologists believe that humans have compartmentalized death in a quest to trick ourselves into believing that we will not die. Unfortunately, by failing to confront our own mortality -- or even the mortality of those around us -- we will be ambushed when death inevitably comes knocking. What's worse, we will fail to live our lives in the best manner possible: It is the person who has accepted his own mortality who will live life to the fullest, say thanatologists.
Those who study death -- physicians, funeral directors and psychologists alike -- point out that before the early part of the last century, death was a very visible part of life in Western culture. When a person died, he most likely died at home. His corpse was often laid on a sofa or in a bed in the living room ironically enough, and meals were taken around it. Family members slept near the body of their deceased beloved. They had professional photographers take photos of the family gathered around the body, which was sometimes propped up with the eyes open to make the dead still appear to be alive.
This process often took place over the course of days before the person was buried. Both adults and children were exposed to the body. In this way, a child became socialized with death, and was arguably more ready to face his own mortality than the children of today.
So why is death so hard for many people to confront? Fear of the unknown is certainly one reason, but there is also another, more sublime aspect that is based on modern medicine.
A century ago, a person with cancer would die. A person with access to today's medical technology has a much better chance to live. In this manner, some have come to see medicine as a way to cheat death, and rather than confront the fact that they will die one day, they look instead to medicine to save them from their inevitable fates.
This is what the psychologist Ernest Becker considered a distraction. Becker won the Pulitzer Prize in 1974 for his book, "Denial of Death." It was Becker's opinion that culture at large served to distract all of us from our impending deaths. It's as if we are all on the same roller coaster, chugging slowly up toward the tallest hill. At the crest is death, and every one of us will eventually make it to that crest. Culture in this metaphor is a set of giant televisions on each side of the coaster tracks, which some people choose to watch rather than look up toward the top of the hill and consider what's beyond the hill.
But although some allow themselves to be distracted, we are all unconsciously fully aware of our finite time here on Earth. In Becker's opinion, this causes feelings of anxiety and woe and is expressed through aggressive acts like invasions and wars.
Becker's field of study -- referred to as the psychology of death -- does suggest a worst way to die. Since culture has the potential to distract us from confronting death, it can lead us to waste our lives. The worst type of death, according to Becker's theory, would be one that followed an insignificant life.
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