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The last dance encountering death and dying 9th edition pdf

14/10/2021 Client: muhammad11 Deadline: 2 Day

The Last Dance

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The Last Dance tenth edition

Encountering Death and Dying

L Y N N E A N N D e S P E L D E R Cabrillo College

A L B E R T L E E S T R I C K L A N D

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THE LAST DANCE: ENCOUNTERING DEATH AND DYING, TENTH EDITION

Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright © 2015 , 2011, and 2009 by Lynne Ann DeSpelder and Albert Lee Strickland. All rights reserved. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written consent of McGraw-Hill Education, including, but not limited to, in any network or other electronic storage or transmission, or broadcast for distance learning.

Some ancillaries, including electronic and print components, may not be available to customers outside the United States.

This book is printed on acid-free paper.

1 2 3 4 5 6 7 8 9 0 DOC/DOC 1 0 9 8 7 6 5 4

ISBN: 978-0-07-803546-3 MHID: 0-07-803546-5

Senior Vice President, Products & Markets: Kurt L. Strand Vice President, General Manager, Products & Markets: Michael Ryan Vice President, Content Production & Technology Services: Kimberly Meriwether David Senior Brand Manager: Maureen E. Prado Roberts Managing Development Editor: Penina Braffman Marketing Specialist: Alexandra Schultz Director, Content Production: Terri Schiesl Lead Content Project Manager: Jane Mohr Buyer: Nichole Birkenholz Cover Designer: Studio Montage, St. Louis, MO. Cover Images: Edvard Munch, The Dance of Life, 1889–1900. Oil on canvas. 49¼” 3 74¾”. National

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Library of Congress Cataloging-in-Publication Data DeSpelder, Lynne Ann, 1944- The last dance : encountering death and dying / Lynne Ann DeSpelder, Cabrillo College, Albert Lee Strickland.—Tenth edition. pages cm ISBN 978-0-07-803546-3 (alk. paper) 1. Death—Psychological aspects—Textbooks. 2. Death--Social aspects—Textbooks. I. Strickland, Albert Lee. II. Title. BF789.D4D53 2014 155.9’37—dc23 2013041273

The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a website does not indicate an endorsement by the authors or McGraw-Hill Education, and McGraw- Hill Education does not guarantee the accuracy of the information presented at these sites.

www.mhhe.com

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In memory of Coleen DeSpelder

who lived with lightness through the shadows of terminal illness

April 2, 1954—May 17, 2001

and to our parents

Bruce Erwin DeSpelder and

Dorothy Roediger DeSpelder

Luther Leander Strickland and

Bertha Wittenburg Strickland

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Brief Contents

Preface xxi Prologue, by David Gordon 1

CHAPTER 1: Attitudes Toward Death: A Climate of Change 5

CHAPTER 2: Learning About Death: Socialization 49

CHAPTER 3: Perspectives on Death: Historical and Cultural 89

CHAPTER 4: Death Systems: Mortality and Society 139

CHAPTER 5: Health Care: Patients, Staff, and Institutions 175

CHAPTER 6: End-of-Life Issues and Decisions 213

CHAPTER 7: Facing Death: Living with Life-Threatening Illness 259

CHAPTER 8: Last Rites: Funerals and Body Disposition 295

CHAPTER 9: Survivors: Understanding the Experience of Loss 341

CHAPTER 10: Death in the Lives of Children and Adolescents 385

CHAPTER 11: Death in the Lives of Adults 417

CHAPTER 12: Suicide 447

CHAPTER 13: Risks, Perils, and Traumatic Death 489

CHAPTER 14: Beyond Death / After Life 531

CHAPTER 15: The Path Ahead: Personal and Social Choices 569

Epilogue, by David Gordon 599 Notes 601 Credits and Sources 671 Name Index 677 Subject Index 693

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Contents

Preface xxi Prologue, by David Gordon 1

C H A P T E R 1

Attitudes Toward Death: A Climate of Change 5

Expressions of Attitudes Toward Death 6 Mass Media 6

In the News 6 Entertaining Death 8

Language 10 Music 12 Literature 15 Visual Arts 18 Humor 23

Living with Awareness of Death 25 Contemplating Mortality 26 Dimensions of Thanatology 26 Death Anxiety and Fear of Death 27 Terror Management 29

Studying Death and Dying 31 The Rise of Death Education 31 Pioneers in Death Studies 32

Factors Affecting Familiarity with Death 34 Life Expectancy and Mortality Rates 35 Causes of Death 37 Geographic Mobility and Intergenerational Contact 38 Life-Extending Technologies 40 The Internet and the Digital Age 42

Examining Assumptions 43 Death in a Cosmopolitan Society 44 Exploring Your Own Losses and Attitudes 46

Further Readings 415

C H A P T E R 11

Death in the Lives of Adults 417

Death and the College Student 418 The Death of a Friend 420 The Death of a Parent 420 Parental Bereavement 423

Childbearing Losses 424 Miscarriage 426 Induced Abortion 426 Stillbirth 428 Neonatal Death 429 Sudden Infant Death Syndrome 430

Grief for “Unlived” Lives 431

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The Death of an Older Child 432 The Death of an Adult Child 433 Coping with Bereavement as a Couple 434 Social Support in Parental Bereavement 435

Spousal Bereavement 436 Factors Infl uencing Spousal Bereavement 436 Social Support for Bereaved Spouses 439

Aging and the Aged 440 Further Readings 445

C H A P T E R 1 2

Suicide 447

Comprehending Suicide 448 Statistical Issues 449 The Psychological Autopsy 451

Explanatory Theories of Suicide 453 The Social Context of Suicide 453

Degree of Social Integration 453 Degree of Social Regulation 455

Psychological Insights About Suicide 456 Toward an Integrated Understanding of Suicide 457

Some Types of Suicide 459 Suicide as Escape 459 Cry for Help 461 Subintentioned and Chronic Suicide 464

Risk Factors Infl uencing Suicide 464 Culture 466 Personality 467 The Individual Situation 468

Life-Span Perspectives on Suicide 471 Childhood 471 Adolescence and Early Adulthood 472 Middle Adulthood 475 Late Adulthood 476

Contemplating Suicide 476 Suicide Notes 479 Suicide Prevention, Intervention, and Postvention 481

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Prevention 482 Intervention 483 Postvention 484

Helping a Person Who Is in Suicidal Crisis 485 Further Readings 487

C H A P T E R 1 3

Risks, Perils, and Traumatic Death 489

Accidents and Injuries 490 Risk Taking 491 Disasters 494

Reducing the Impact of Disasters 498 Coping with the Aftermath of Disaster 499

Violence 501 Random Violence 503 Serial Killers and Mass Murderers 503 Familicide 505 Steps Toward Reducing Violence 506

War 507 Technological Alienation 508 The Conversion of the Warrior 509 Coping with the Aftermath of War 511 Making War, Making Peace 513

Genocide 516 Terrorism 517

September 11, 2001 519 Rescue, Recovery, and Mourning 521 The Mind of the Terrorist 521

Horrendous Death 523 Emerging Infectious Diseases 524

The Response to AIDS 525 Living with AIDS 527 The Threat of Emerging Diseases 527

Traumatic Death 529 Further Readings 529

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C H A P T E R 14

Beyond Death / After Life 531

Traditional Concepts About Life After Death 532 Jewish Beliefs About Death and Resurrection 534 Classical Greek Concepts of Immortality 536 Christian Beliefs About the Afterlife 538 The Afterlife in Islamic Tradition 542 Death and Immortality in Asian Religions 543

Hindu Teachings About Death and Rebirth 544 The Buddhist Understanding of Death 547 After-Death States in Tibetan Buddhism 550

The Consolations of Religion 551 Secular Concepts of Immortality 552 Near-Death Experiences: At the Threshold of Death 554

NDEs: A Composite Picture 555 Dimensions of Near-Death Experiences 556 Interpreting Near-Death Experiences 558

Death Themes in Dreams and Psychedelic Experiences 562 Beliefs About Death: A Wall or a Door? 565 Further Readings 566

C H A P T E R 1 5

The Path Ahead: Personal and Social Choices 569

Exploring Death and Dying 570 Cultural Competence 572 New Directions in Thanatology 574

Gaining a Global Perspective 576 Bridging Research and Practice 580

Creating Compassionate Cities 581 Living with Death and Dying 584

Humanizing Death and Dying 585 Defi ning the Good Death 587

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Death in the Future 591 Postscript and Farewell 596 Further Readings 597

Epilogue, by David Gordon 599

Notes 601

Credits and Sources 671

Name Index 677

Subject Index 693

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Preface

In The Last Dance: Encountering Death and Dying, we offer a comprehensive and readable introduction to the study of death and dying, one that highlights the main issues and questions. The study of death—or thanatology, from the Greek thanatos, meaning “death”—is concerned with questions rooted at the core of our experience. Thus, the person who sets out to increase his or her knowledge of death and dying is embarking on an exploration that is partly a journey of personal discovery. This is a journey that has both cognitive (intellectual) and affective (emotional) components. Thus, The Last Dance embodies an approach to the study of death and dying that combines the intellectual and the emotional, the social and the psychological, the experi- ential and the scholarly.

The title The Last Dance relates to a book written by Carlos Castaneda about the warriors of the Yaqui Indian tribe in Central America. Because a warrior can die on any day, the warrior makes a dance of power in the face of death. Castaneda says that, to truly live, we must keep death over our left shoulder. In other words, death is part of life and, because we can die at any time, we should be dancing through life.

The painting on the cover, The Dance of Life, by Norwegian artist Edvard Munch, evokes thoughts of the inexorable, compelling cycle of life. It depicts a festival dance on the Asgaardstrand beach on a midsummer night. An indifferent moon sheds light on the water while the dancers dance a roundel, a ring dance. One woman is entering the dance, another is leaving. There is youth, innocent new life, and age.

We are sometimes asked how we came to write a college textbook on death and dying. Lynne says, “It’s as simple as the realization that students hated buying the many books needed for studying all of the topics important to learning about death and dying. And I hated having to assign all those books. One day at the start of a new semester, after getting the usual com- plaints from students, I whined to Al, ‘Why isn’t there just one book that a student could pick up and put under his or her arm that would cover all of these topics?’ Al’s response was, ‘Well, why don’t we write one?’”

So, some years ago, after fi ve years dedicated to research and writing, The Last Dance: Encountering Death and Dying was born. Each subsequent edition refl ects the changes and transformations that have occurred in the fi eld of

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death studies. This book provides a solid grounding in theory and research as well as in methods for applying what is learned to readers’ own circum- stances, both personal and professional. It encourages a constructive process of self-discovery. The Last Dance is not an indoctrination to any particular point of view but, rather, an introduction to diverse points of view. The values of compassion, listening, and tolerance for the views of others are empha- sized. Readers may form their own opinions, but when they do we hope it is only after considering other possibilities in a spirit of open-mindedness. Unbiased investigation leads to choices that might otherwise be neglected or overlooked.

While retaining the popular features of earlier editions, this new edition of The Last Dance refl ects the ongoing evolution of death studies. Although people sometimes think, “What changes about death?” the truth revealed in these pages is that much has changed in recent decades and continues to change in the present. Because of this fact, every chapter has been revised to integrate the latest research, practices, and ideas and to enhance clarity of presentation.

Throughout the text, we give attention to the ways cultural and ethnic viewpoints shape our relationship with death, and there is specifi c discus- sion of the viewpoints and traditions associated with people of African heri- tage, Hispanic heritage, Native American heritage, Jewish heritage, Celtic heritage, Arab heritage, Oceanian heritage, and Asian heritage, including the diverse cultures of Southeast Asia as well as the cultures of India, China, Taiwan, Japan, Korea, and the Philippines. In the pages of The Last Dance, you will also fi nd coverage of

• Ongoing developments in care of the seriously ill and dying, especially as they pertain to hospice and palliative care

• Death through the life course, from infancy through later adulthood, including a new section on death and the college student

• New directions in mortuary services, including personalized funerals, “green burials,” and innovative options for body disposition and memorialization

• A changing health care system and its impact on dying and death • How the Internet is infl uencing our relationship to death, dying, and

bereavement in the digital age • Insights about grief gained through an appreciation of the dual process

and two-track models of coping with bereavement, as well as other models that can aid in understanding bereavement, grief, and mourning, includ- ing discussion of working through grief, maintaining continuing bonds with the deceased, and “telling the story” or narrative approaches to coping with grief

• How achieving the “Care-Full Society” and striving toward the creation of “compassionate cities” could improve and enhance our encounters with death

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In addition, this edition contains new and updated material on physician- assisted suicide, remembrance rituals and linking objects, grief counseling and grief therapy, horrendous death, the placebo effect, familicide, and the death of a companion animal.

The study of death is unavoidably multidisciplinary. Accordingly, con- tributions from medicine, the humanities, and the social sciences are all found here in their relevant contexts. Throughout the book, principles and concepts are made meaningful by use of examples and anecdotes. Boxed material, photographs, and other illustrative materials expand upon and provide counterpoint to the textual presentation. Specialized terms, when needed, are clearly defi ned. Accompanying this edition is a companion Online Learning Center, www.mhhe.com/despelder10e , designed to pro- mote mastery of the material covered in the text itself. We urge readers to make use of these features.

Chapter-by-Chapter Tour Before you begin using The Last Dance, please join us for a quick tour through the text.

• In Chapter 1, we look at expressions of attitudes toward death in mass media, language, music, literature, and the visual arts. We ask what it means to live with an awareness of death, and we explore death anxiety, or fear of death. We conclude by examining the reasons people tend to be unfamiliar with death in modern, cosmopolitan societies.

• In Chapter 2, we investigate how we learn about death throughout the life course.

• In Chapter 3, we explore historical and cultural factors that shape atti- tudes and practices relative to dying and death.

• Chapter 4 shows how public policy affects our dealings with dying and death by means of a society’s “death systems.” Certifi cation of death, the role of coroners and medical examiners, the functions of autopsies, procedures for legally defi ning and making a determination of death, medicolegal views of homicide and capital punishment, and rules regard- ing organ donation and transplantation are important aspects of the death system. An instructive cross-cultural example describing how Japan has dealt with ethical, moral, and legal questions involving brain death and organ transplantation wraps up this discussion.

• Care of dying persons is the primary focus of Chapter 5. Topics include health care fi nancing; rationing of health resources; the relationship between caregivers and the patient; hospice, palliative care, and home care; elder care; trauma and emergency care; death notifi cation proce- dures; and caregiver stress and compassion fatigue.

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• Chapter 6 deals with a variety of issues and decisions that pertain to the end of life. Some of these issues and decisions become important in the context of diagnosis and treatment—for example, informed con- sent. Others come to the fore when individuals face a more immediate prospect of dying. These include choices about withholding or with- drawing life-sustaining medical treatment, physician-assisted death, and euthanasia, as well as issues involving artifi cial nutrition and hydration. Also discussed is the rule of double effect, which may be invoked when a medical intervention that is intended to relieve suffering leads to death. Some issues regarding the end of life can be dealt with before the crisis of a life-limiting illness—for example, making a will, setting up a living trust, obtaining life insurance, and completing advance directives to express wishes about medical treatment in the event one becomes inca- pacitated.

• Chapter 7, with its focus on how people live with a life-threatening illness, gives attention to the psychological and social meanings associated with such illnesses and offers insight about the ways individuals and families cope with “living-dying,” from the time of initial diagnosis to the fi nal stages of the dying trajectory. Discussion includes treatment options and issues, as well as pain management and complementary therapies. The chapter concludes with sections on the social role of the dying patient and advice about being with someone who is dying.

• The ceremonies and rituals enacted by individuals and social groups after a death form the content of Chapter 8. Death rites and customs create opportunities for expressing grief and integrating loss. This chapter exam- ines the nature and function of last rites, with particular attention to the history of mortuary services in the United States. Information about the options for funeral services and body disposition, as well as a discussion about making meaningful choices, completes the chapter.

• Chapter 9 is devoted to helping readers gain a comprehensive under- standing of bereavement, grief, and mourning. A number of important models of grief are discussed, with the recognition that any notion that “one size fi ts all” is likely to be inadequate. An understanding of the ways people experience and express grief, and of the variables that infl uence grief, demonstrates that there are many ways to cope with grief and to provide support to the bereaved. The concluding section shows that, despite loss, bereavement can present opportunities for growth.

• Employing a life-span perspective, Chapters 10 and 11 deal with death- related issues associated with different stages of life, from early childhood through old age.

• Chapter 10 includes discussion of children with life-threatening illness and discussion of children as survivors of a close death. It provides guide- lines for helping children cope with change and loss.

• Chapter 11 examines losses occurring in adulthood, such as miscarriage, stillbirth, and neonatal death, and the death of a child, a parent, a spouse,

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or a close friend, as well as losses associated with aging. A new section on death in the lives of college students has been added for the tenth edition.

• Chapter 12 offers insights into suicide and its risk factors, including the social and psychological context of suicide and suicidal behavior; life-span perspectives on suicide; psychological autopsies; suicide notes; and suicide prevention, intervention, and postvention. The chapter concludes with advice about helping someone who is in a suicidal crisis.

• Chapter 13 broadens the scope of death-related risks and threats. These include accidents and injuries, disasters, violence, war, genocide, terror- ism, emerging diseases, and other examples of horrendous and traumatic death.

• Questions about human mortality and its meaning are at the forefront in the fi nal two chapters of the book. Chapter 14 describes a variety of both religious and secular viewpoints, as well as accounts of near-death experi- ences, to present a survey of concepts and beliefs concerning immortality and the afterlife. Whether death is viewed as a “wall” or as a “door” can have important consequences for how we live our lives.

• Chapter 15 emphasizes personal and social values that are enhanced by learning about death. Examples of new directions in thanatology include efforts to bridge research and practice, clarify the goals of death educa- tion, gain an international perspective, and create compassionate cities, as well as to improve cultural competence. What does it mean to live with death and dying? Bringing together a host of topics covered in earlier chapters, this fi nal chapter presents food for thought that can stimulate consideration of how a “good death” might be defi ned.

For those who wish to pursue further study of particular topics, a list of recommended readings is provided at the end of each chapter, and cita- tions given in the chapter notes provide guidance to additional sources and references. Thus, while the text serves as an introduction to a broad range of topics in death studies, readers are pointed to resources for investigating top- ics that evoke special interest.

Supplements In addition to the textbook itself, there are a number of instructor and stu- dent resources available.

• The Online Learning Center at www.mhhe.com/despelder10e provides instructors with a Test Bank, Instructor’s Guide, PowerPoint presentations, quizzes, and other premium instructor’s content. This premium content contains numerous fi les ranging from instructor’s resources on the Web to activities an instructor might use such as a questionnaire to examine attitudes and experiences.

• For students, the Online Learning Center, www.mhhe.com/despelder10e , offers a glossary, and each chapter has quizzes, Web activities, chapter objectives, key terms, and fl ashcards.

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Acknowledgments The Last Dance has been reviewed by professors in a broad range of academic disciplines. Their suggestions have helped to make this text an outstand- ing teaching tool. Formal reviews have been provided by Jennifer T. Aberle, Colorado State University; Susan Adams, University of Central Arkansas; Joel R. Ambelang, Concordia University, Wisconsin; Lisa Angermeier, Indi- ana University at Bloomington; Patrick Ashwood, Hawkeye Community College; Thomas Attig, Bowling Green State University; Ronald K. Barrett, Loyola Marymount University, Los Angeles; Michael Beechem, University of West Florida, Pensacola; Laura Billings, Southwestern Illinois College; John B. Bond, University of Manitoba; Tashel Bordere, University of Central Mis- souri; Sandor B. Brent, Wayne State University; Tom Bruce, Sacramento City College; John P. Colatch, Lafayette College, Easton, Pennsylvania; Elizabeth M. Collier, The College of New Jersey; Richard Cording, Sam Houston State University; Charles A. Corr, Southern Illinois University; Gerry R. Cox, Fort Hays State University; Illene N. Cupit, University of Wisconsin, Green Bay; Steven A. Dennis, Utah State University; Kenneth J. Doka, College of New Rochelle; Donald J. Ebel, Minnesota State University; Alishia Ferguson, Uni- versity of Arkansas; Stephen J. Fleming, York University, Toronto; Audrey K. Gordon, Oakton Community College; Judy Green, Walsh University, Ohio; Debra Bence Grow, Pennsylvania State University; John Harvey, Western Illinois University; Russell G. Henke, Towson State University; Lorie Hen- ley, Finger Lakes Community College; David D. Karnos, Eastern Montana College; Linda C. Kinrade, California State University, Hayward; Dennis Klass, Webster University; Anthony Lenzer, University of Hawaii at Manoa; Daniel Leviton, University of Maryland; Paul C. Luken, Arizona State Uni- versity West, Phoenix; J. Davis Mannino, Santa Rosa Junior College; Coleman C. Markham, Barton College, North Carolina; Wendy Martyna, University of California, Santa Cruz; Samuel J. Marwit, University of Missouri; Debbie Mattison, University of Michigan School of Social Work; Marsha McGee, Northeast Louisiana University; Walter L. Moore, Florida State University, Tallahassee; Lachelle Norris, Tennessee Tech University; Tina Olson, Ari- zona State University; Leah Rogne, Minnesota State University; Vincent M. Rolletta, Erie Community College; Cheri Barton Ross, Santa Rosa Junior College; Lee Ross, Frostburg State University, Maryland; Rita S. Santanello, Belleville Area Community College, Illinois; Thomas W. Satre, Sam Houston State University; Edwin S. Shneidman, University of California, Los Angeles; Virginia Slaughter, The University of Queensland; Judith M. Stillion, Western Carolina University; Gordon Thornton, Indiana University of Pennsylvania; Jeffrey S. Turner, Mitchell College; Mary Warner, Northern State University, South Dakota; Hannelore Wass, University of Florida, Gainesville; Jack Bor- den Watson, Stephen F. Austin State University, Nacogdoches, Texas; John B. Williamson, Boston College; C. Ray Wingrove, University of Richmond;

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Robert Wrenn, University of Arizona, Tucson; Joseph M. Yonder, Villa Maria College of Buffalo; Margaret H. Young, Washington State University; and Andrew Scott Ziner, University of North Dakota. In addition to those named, other colleagues and students have generously shared ideas for enhancing and improving the text. We thank all who have offered helpful suggestions about the book through its successive incarnations.

We also thank our collaborators who have helped prepare ancillary instructional materials over the course of various editions of The Last Dance. These include Barbara Jade Sironen, Patrick Vernon Dean, Robert James Baugher, Matt and Kelley Strickland, and Carol Berns, who deserves spe- cial thanks for her work on this edition’s test bank and other resources for instructors , as well as on the Online Learning Center at www.mhhe.com/ despelder10e . In addition, we are grateful to staff members at many muse- ums, libraries, and governmental institutions who have assisted us in our research and in gathering both text and art resources over the years.

Over the course of ten editions of The Last Dance, we have had the plea- sure of working with many talented people who exemplify excellence in publishing. At McGraw-Hill, among the many individuals who helped bring this book to press, we want to particularly thank Mike Sugarman, publisher par excellence; Terri Schiesl, production maven, who at the outset got the ball rolling down the right track; and Erin Guendelsberger, developmental edi- tor, who guided the typescript into production with attention to detail, good cheer, and thorough professionalism. To all whose help was instrumental in bringing this edition of The Last Dance to readers, our heartfelt thanks.

L. A. D. A. L. S.

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Additional McGraw-Hill Resources • Craft your teaching resources to match the way you teach! With McGraw-

Hill Create™, www.create.mcgraw-hill.com , instructors can easily re arrange chapters, combine material from other content sources, and quickly upload personal content such as a course syllabus or teaching notes. Find the content you need in Create by searching through thousands of lead- ing McGraw-Hill textbooks. Arrange your book to fi t your teaching style. Create even allows you to personalize your book’s appearance by selecting the cover and adding your name, school, and course information. Order a Create book and you’ll receive a complimentary print review copy in three to fi ve business days or a complimentary electronic review copy (eComp) via e-mail in minutes. Go to www.create.mcgraw-hill.com today and regis- ter to experience how McGraw-Hill Create™ empowers you to teach your students your way.

• With the CourseSmart eTextbook version of this title, students can save up to 50 percent off the cost of a print book, reduce their impact on the environment, and access powerful Web tools for learning. Faculty can also review and compare the full text online without having to wait for a print desk copy. CourseSmart is an online eTextbook, which means users need to be connected to the Internet in order to access it. Students can also print sections of the book for maximum portability. For further details, contact your sales representative or go to www.coursesmart.com .

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I don’t know how much time I have left. I’ve spent my life dispensing salves and purga- tives, potions and incantations—miracles of nature (though I admit that some were pure medicine-show snake oil). Actually, half the time all I offered was just plain com- mon sense. Over the years, every kind of suffering person has made his or her way here. Some had broken limbs or broken bodies . . . or hearts. Often their sorrow was an ailing son or daughter. It was always so hard when they’d lose a child. I never did get used to that. And then there were the young lovers. Obtaining their heart’s desire was so important to them. I had to smile. I always made them sweat and beg for their handful of bark, and for those willful tortures I’ll probably go to hell . . . if there is one. My God, how long has it been since I had those feelings myself? The fever, the lump in the throat, the yearning. I can’t remember. A long time . . . maybe never. Well, there have been other passions for me. There’s my dusty legion of jars. Each one holds its little secret. Barks, roots, soils, leaves, fl owers, mushrooms, bugs—magic dust, every bit of it. There’s my book—my “rudder,” a ship’s pilot would call it. That’s a good name for it. Every salve, every purgative . . . they’re all in there. (Everything, that is, except my stained beard, scraggly hair, and fl owing robes—they’ll have to fi gure those out on their own.) And then there’s my walking stick (always faithful) . . . and the ballerina. And ten thousand mornings, ten thousand afternoons, ten thousand nights. And the stars. Oh, I have had my loves.

It hurts to move. My shelf and jars seem so far away, though I know that, if I tried, I could reach them. But no. It’s enough, and it’s time . . . almost. I hope he makes it back in time. He burst through my door only two days ago. A young man, well spoken. Tears were streaming down his face. He looked so bent and beaten that I could not

P R O L O G U E

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2 p r o l o g u e

refuse him. He told me that his wife had died over a month ago and that he had been inconsolable since.

“Please help me,” he pleaded, “or kill me.” He covered his face with his hands. “Per- haps they’re the same thing. I don’t know anymore.”

I let him cry a while so I could watch him, gauge him. When at last he looked up, with my good hand I motioned him to take a seat. Then, between coughing fi ts, I went to work. “Do you see that toy there?” I said. “The little ballerina . . . yes, that’s it. Pick it up.”

“Pick it up?” “It won’t bite. Pick it up.” (He probably thought it was a trick—that’s what they

expect.) He grasped it carefully with one hand, then wiped his eyes with the other. “That’s better,” I continued. “That’s just a toy to you. You don’t know what meaning to put to it yet. So, I want you to look at that ballerina.”

He was hesitant, but I waited stubbornly until he looked down and fi xed his atten- tion on the little toy dancer. I went on: “I knew a young man once who was very hand- some—always had been. He not only turned every head, he was strong and smart, and his family was wealthy. His main concern each day was which girl he should court that evening. He had planned that, after several seasons of playing at love, he would marry a beautiful girl, have beautiful children, and settle down to spend the money his father had promised him. And he had plans for that money. He had already purchased the land he wanted to live on and was having built there the biggest house in the area. He was going to raise and race horses, I think. One morning, he got on his favorite horse and went for a ride. He whipped that horse into a gallop; it stepped in a hole and threw him. The young man broke his neck and died.” I stared at my guest and waited.

“That’s a tragedy,” he fi nally croaked. “For whom? For those he left behind, perhaps. But was it for him? When he opened

his eyes that morning, he didn’t know he would die that day. He had no intention of dying for another sixty years, if then. None of us does.” The young man looked con- fused. “His mistake was that he forgot that he could die that day.”

“That’s a morbid thought,” he replied, and he looked as though he had just smelled something putrid.

“Is it? A moment ago, you asked me to end your grieving by ending your own life. Suppose I oblige?” I stared at him for a few moments with my most practiced penetrating glare. “Suppose I did agree to kill you. How would you spend your last few minutes?”

He was still a little wary of me but relieved that I seemed to be suggesting a hypo- thetical situation rather than a serious course of action. He considered the possibilities for a while, then straightened in his chair. “Well, I guess I would step outside and take a last, best look at the sky, the clouds, the trees.”

“Suppose you lived that way all the time?” He stared at me, then looked down at his hands, searching them. “That young man I told you about . . . perhaps the tragedy for him was not that he died, but that he failed to use the eventual certainty of his death to make himself live ! Did he woo each of those ladies as though it might be his last romance? Did he build that house as though it might be his last creation? Did he ride that horse as though it would be his last ride? I don’t know; I hope so.” My young guest nodded, but he was still sad. I pointed to the toy ballerina he was holding. “That was given to me by a young lady who understood these things.”

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p r o l o g u e 3

He looked at the fi gure closely. “Is she a dancer?” “Yes, she is, and she is dead.” The young man looked up, once again off balance.

“She has been dead for, oh, a very long time.” After all these years, a tear fell onto my cheek. I let it go. “She was many things. A child, a woman, a cook and a gardener, a friend, lover, daughter. . . . But what she really was—who she was—was a dancer. When she was dying, she gave that doll to me, smiled, and whispered, ‘At the moment of my death, I will take all of my dancing and put it in there, so my dancing can live on.’”

Tears welled in my guest’s eyes. “I can help you,” I said, “but fi rst there is something that you must do.” He became

very attentive. “Go to town, and knock on the door of the fi rst house you come to. Ask the people inside if their family has ever been touched by death. If so, go to the next house. When you fi nd a family that has not been touched by death, bring them to me. Do you understand?” He nodded, and I sighed. “I’m tired now.”

He got up, set the ballerina back on the table, and started for the door. I stopped him. “Young man!” He faced me from the doorway. “Come back as soon as you can.”

David Gordon

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In a Spanish village, neighbors and relatives peer through the doorway upon the deathbed scene of a villager.

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C H A P T E R 1

Attitudes Toward Death:

A Climate of Change

D ead end. Dead on. Dead center. Dead heat. Deadwood. Deadbeat. Dead tired. Dead stop. Deadline. Dead reckoning. Deadlock. Dead ahead.

Look at some of the connotations of the word dead in the English language. Are they

positive or negative? There is no place to go when you get to a dead end, and there are usu-

ally unpleasant consequences when you miss a deadline. In contrast, however, dead reckon-

ing gives us direction to a place where we are going.

This bit of linguistic exploration points up a paradox involved in the study of death and

dying. How is our social world, our culture, set up to deal with death and the dead? Do we,

consciously or unconsciously, relate to death as something to avoid? Or does death capture

our attention as a defi ning moment, worthy of refl ection and deliberate thought?

Of all human experiences, none is more overwhelming in its implications than death.

Yet, we tend to relegate death to the periphery of our lives, as if it can be kept “out of sight,

out of mind.” 1 A fi rst step toward gaining new choices about death is to recognize that avoid-

ing thinking about it estranges us from an integral aspect of human life. As one writer says,

“The moment we begin to be we are old enough to die.” 2

The study of death can “lead us to take seriously our fi nitude, our mortality, as some-

thing that provides signifi cance to our lives.” 3 Formally, thanatology is defi ned as the study of

the facts or events of death and the social and psychological mechanisms for dealing with

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6 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

them. The word is a linguistic heir of Thantatos from Greek mythology, where it is generally understood as a reference to “the personifi cation of death.” A practical defi nition of thanatology includes ethical and moral questions, as well as cultural considerations. It is concerned not only with medicine and philosophy, but also with many other disciplines: history, psychology, sociol- ogy, and comparative religion, to name a few. In a commencement address at Stanford University, Apple founder Steve Jobs said, “Death is very likely the single best invention of life.” He called it “life’s change agent.” 4

Expressions of Attitudes Toward Death Direct, fi rsthand experience with death is rare. Nevertheless, death has a sig- nifi cant place in our social and cultural worlds. This is revealed through the manner in which death is portrayed by the mass media and in the language people use when talking about death, as well as in music, literature, and the visual arts. Notice how these varied expressions reveal thoughts and feelings about death, both individually and culturally.

Mass Media Modern communication technology makes us all survivors of death as

news of disasters, accidents, violence, and war is fl ashed around the world. When situations involve a perceived threat, people turn to the mass media for information. On September 11, 2001, for example, more than two billion people worldwide watched the attacks in real time or watched news reports about the attacks. 5 The Internet not only increases the speed at which news is reported, it also allows us to follow along with updates from international news agencies and comments from blogs giving further details and opinion. 6 What do these secondhand sources tell us about death and dying?

In the News When you read the newspaper or an online news source, what kinds of

encounters with death vie for your attention? You are likely to fi nd an assort- ment of accidents, murders, suicides, and disasters involving sudden, violent deaths. A jetliner crashes, and the news is announced with banner head- lines. You see a story describing how a family perished when trapped inside their burning home, or a story describing how a family’s vacation came to an untimely end due to a fatal collision on the interstate.

Then there are the deaths of the famous, which are likely to be announced on the front pages, followed soon by feature-length obituaries. Prefaced by head- lines, obituaries send a message about the newsworthiness editors attribute to the deaths of famous people. News organizations maintain fi les of pending obituaries for individuals whose deaths are considered newsworthy, and these obituaries are kept updated so they are ready when the occasion demands.

In contrast, the death of the average Joe or Jill is usually made known by a death notice —a brief, standardized statement printed in small type and listed alphabetically in a column of vital statistics “as uniform as a row of tiny

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Expressions of Attitudes Toward Death 7

grave plots.” 7 In some newspapers, obituaries for “ordinary Joes” are given more attention with “egalitarian obits,” which aim to “nail down quickly what it is we’re losing when a particular person dies.” 8 Still, ordinary deaths—the kind most of us will experience—are usually mentioned only in routine fash- ion. The spectacular obscures the ordinary.

Whether routine or extraordinary, our encounters with death in the news media infl uence the way we think about and respond to death. Reports may have less to do with the event than with how that event is perceived. This point is illustrated by Jack Lule in his description of how black activist Huey Newton’s death was reported in newspapers across the country. 9 Newton had a public career spanning two decades, yet most reports focused on the violent nature of Newton’s death while ignoring other aspects of his life.

People look to the media not only for information about events but also for clues about their meaning. This can present problems in determining what is appropriate to report in stories that involve death and survivors’ grief. Media coverage of horrifi c deaths sometimes leads to “revictimization” or “second trauma” after the initial trauma of the event itself. Reporters may seek to capture the experience of a tragedy at the expense of victims or their

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8 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

survivors. The journalistic stance “If it bleeds, it leads” often sets priorities. Do the media help us explore the meaning of death or merely seek to grab our attention with sensational news fl ashes? Robert Fulton and Greg Owen point out that the media may “submerge the human meaning of death while depersonalizing the event further by sandwiching actual reports of loss of life between commercials or other mundane items.” 10 The distinction between public event and private loss sometimes blurs, and the grief experienced by survivors or the disruption of their lives is generally given little attention.

Deaths from cancer and heart disease don’t seem to interest us as much as deaths from plane crashes, roller coaster mishaps, or mountain lion attacks. Bizarre or dramatic exits grab our attention. Although the odds of dying from a heart attack are about 1 in 5, we seem more fascinated by death from bee stings (1 in 62,950), lightning (1 in 81,701), or fi reworks (1 in 479,992). 11

Media experts say that the “reality violence” on TV news really began with coverage of the Vietnam War. 12 As a “living-room” war, replete with daily doses of violent images for more than a decade, it would exert a last- ing infl uence on how news is presented. Viewers were given a succession of violent images: wartime casualties both friend and foe, the execution of a Viet Cong lieutenant by gunshot to the head on a Saigon street, pictures of napalmed children, and images of a burning monk. This is “action news,” and it is a marketable format that fl ourishes with such events as school shoot- ings and the public death of a man on a Los Angeles overpass who, retrieving a shotgun, “blasted half his head away as police and news choppers hovered above.” 13 Allan Kellehear says, “There is no shortage of death reportage in the media . . . however, what passes for death is frequently merely violence.” 14 He adds: “As long as death and loss appear in newspapers and TV programmes in the context of ‘problems’ and ‘tragedies,’ our understanding of these will be coloured by these terms and concepts.” 15

Media analyst George Gerbner observes that depictions of death in the mass media are often embedded in a structure of violence that conveys “a heightened sense of danger, insecurity, and mistrust.” 16 Such depictions refl ect what Gerbner and his colleagues call a “mean world syndrome,” in which the symbolic use of death contributes to an “irrational dread of dying and thus to diminished vitality and self-direction in life.”

According to Gerbner, the effect of violent images in the media is not to cause viewers to become more violent themselves; rather, viewers are likely to perceive the world as a frightening and scary place, a place of murder and mayhem, disease and plague, threats of war, a world populated by psychotic killers, child abductors, terrorists, and threatening animals. This perception of a mean world in which predators of every stripe—and every species— appear forever on the loose and in attack mode creates a sense of anxiety and fear that is out of proportion with reality. 17

Entertaining Death Television’s infl uence on our lives is well established. Programs such as Six

Feet Under, Bones, and CSI may challenge certain taboos surrounding death,

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Expressions of Attitudes Toward Death 9

but this interest in death and dying mainly serves to make the corpse what some commentators call the new “porn star” of popular culture. 18 Seldom do images portrayed in the mass media enhance our understanding of death by dealing with such real-life topics as how people cope with a loved one’s death or confront their own dying.

Besides its appearance in movies of the week and on crime and adven- ture series, death is a staple of newscasts (typically, several stories involving death are featured in each broadcast), nature programs (death in the animal kingdom), children’s cartoons (caricatures of death), soap operas (which seem always to have some character dying), sports (with descriptions such as “the ball is dead” and “the other team is killing them”), and religious programs (with theological and anecdotal mention of death). Despite this, the lack of stories depicting realistic themes portraying death, dying, and bereavement has been characterized as “an impoverishment of death sym- bolism” in the media. 19

Turning to programming directed toward children, recall cartoon depic- tions of death. Daffy Duck is pressed to a thin sheet by a steamroller, only to pop up again a moment later. Elmer Fudd aims his shotgun at Bugs Bunny, pulls the trigger, bang! Bugs, unmarked by the rifl e blast, clutches his throat, spins around several times, and mutters, “It’s all getting dark now, Elmer. . . . I’m going. . . .” Bugs falls to the ground, both feet still in the air. As his eyes close, his feet fi nally hit the dirt. But wait! Now Bugs pops up, good as new. Reversible death!

Consider the western, which mutes the reality of death by describing the bad guy as “kicking the bucket”—relegated, no doubt, to Boot Hill at the edge of town, where the deceased “pushes up daisies.” The camera pans from the dying person’s face to a close-up of hands twitching—then all movement ceases as the person’s breathing fades away in perfect harmony with the musi- cal score. Or, more likely, the death is violent: the cowboy gunfi ght at the OK Corral, high noon. The gent with the slower draw is hit, reels, falls, his body convulsing into cold silence.

People who have been present as a person dies describe a very different picture. Many recall the gurgling, gasping sounds as the last breath rattles through the throat; the changes in body color as fl esh tones tinge blue; the feeling of a once warm and fl exible body growing cold and fl accid. Surprised by the reality, they say, “Death is not at all what I thought it would be like; it doesn’t look or sound or feel like anything I see on television or in movies!”

Unrealistic portrayals of violent death fail to show real harm to victims, their pain, or appropriate punishment for perpetrators.

Thrillers featuring extreme violence and what has been called death porn have become a profi table genre for moviemakers. The road to more “blood and gore” in popular fi lms was paved in part by the success of classic “slasher” or “dead teenager” movies, like Nightmare on Elm Street (1984), which included point-of-view shots from the killer’s perspective. In traditional hor- ror fi lms, the audience viewed the action through the eyes of the victim and thus identifi ed with his or her fate. In slasher fi lms, however, viewers are asked

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10 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

to identify with the attacker. (A similar form of identifi cation can be found in violent video games.) The depictions of violence in such movies suggest that residual tendencies from our evolutionary background may attract human beings to “exhibitions of brutality and terror.” 20

When told of his grandfather’s death, one contemporary seven-year-old asked, “Who did it to him?” Death is generally portrayed on television or in movies as coming from outside, often violently, reinforcing the notion that dying is something that happens to us, rather than something we do. Death is an accidental rather than a natural process. As our fi rsthand experiences of death and violence have diminished, representations of death and violence in the media have increased in sensationalism.

Movies engage our psychological faculties in profound and unique ways. 21 In thinking about the fi lms, DVDs, and television programs you’ve watched recently, what are your observations about the ratio of positive and negative images of dying and death?

Language Listen to the language people use when talking about dying or death,

and you are likely to discover that it is often indirect. The words dead and dying tend to be avoided; instead, loved ones “pass away,” embalming is “preparation,” the deceased is “laid to rest,” burial becomes “interment,” the corpse is “remains,” the tombstone is a “monument,” and the undertaker is transformed into a “funeral director.” Such euphemisms—substitutions of indirect or vague words and phrases for ones considered harsh or blunt— tend to suggest a well-choreographed production surrounding the dead. Hannelore Wass, a pioneering death educator, notes that euphemisms substi- tuting for plain-spoken “ D words” turn up even in the language of death and dying experts as terminal care becomes “palliative care,” and dying patients are described as “life threatened.” 22 Death may be described as “a negative patient-care outcome” and an airline crash as an “involuntary conversion of a 727.” 23

When plain talk about death is subverted by substitutions, reality is devalued and depersonalized. For example, description of the horror of death in war is often cloaked by euphemisms—individuals killed in battle

One of the fi rst things we teach to journalism students in the USA is to use “died” instead of “passed away” or “departed this life,” which is how most people can tell the difference between an obituary written by the funeral director and one writ- ten by a newspaper staff member. Even in American English, it seems nearly disre- spectful to go to such lengths to avoid saying the obvious; when my time comes, I hope to have pre-written my own obit, which will say something to the effect that “Old Man Wilcox is dead. He has ceased to be. He has expired and gone to meet his maker. He is a stiff. Bereft of life, he rests in peace. Services will be held on Wednesday; cocktails will be served.”

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Expressions of Attitudes Toward Death 11

are described in terms of “body counts” and civilian deaths are termed “col- lateral damage.” The language people use when talking about death often refl ects a desire to avoid blunt reality. Euphemisms, metaphors, and slang make up a large part of death talk (see Table 1-1 ).

However, the use of euphemism and metaphor does not always imply an impulse to deny the reality of death or avoid talking about it. These linguistic devices are also used to communicate subtler or deeper meanings than those associated with plainer speech. For example, terms like passing or passing on may convey an understanding of death as a spiritual transition, especially among members of some religious and ethnic traditions.

Similarly, sympathy cards provide a way for people to express condo- lences to the bereaved without directly mentioning death. 24 Some cards refer to death metaphorically, as in sentiments like “What is death but a long sleep?” while others apparently deny it in verses like “He is not dead, he is just away.” Images of sunsets and fl owers create an impression of peace, quiet, and perhaps a return to nature. The fact of bereavement, losing a loved one by death, is generally mentioned within the context of memories or the healing process of time. It is interesting to check the greeting-card rack to see if you can fi nd a card that plainly uses the word dead or death. By acknowledging loss in a gentle fashion, sympathy cards are intended to comfort the bereaved.

Croaked No longer with us Kicked the bucket Taking the dirt nap Gone In the great beyond Expired On the other side Succumbed Asleep in Christ Left us Departed Lost Transcended Wasted Bought the farm Checked out With the angels Laid to rest Cashed in Pushing up daisies Crossed over Jordan Called home Perished Was a goner Ate it Bit the dust It was curtains Annihilated Out of his/her misery Liquidated Ended it all Terminated Resting in peace Gave up the ghost Dropped the body Rubbed out That was all she wrote Snuffed Joined the ancestors Bit the grass Subject just fataled Took the last journey Gone west

t a b l e 1-1 Death Talk: Metaphors, Euphemisms, and Slang

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12 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

After someone dies, our conversations about that person usually move from present tense to past tense: “He was fond of music,” “She was a leader in her fi eld.” Using this form of speech, which grammarians term the indicative voice, is a way of acknowledging the reality of death while distancing us from the dead. One way to continue to include the “voice” of the deceased in pres- ent circumstances lies in the use of the subjunctive, which has been described as the mode of “as if,” of what “might be” or “could have been.” It is a “zone of possibility,” rather than certainty. 25 We hear examples of this when people say things like “He would have been proud of you” or “She would have enjoyed this gathering tonight.”

Language usage also tells us something about the intensity and imme- diacy of a person’s encounter with death, as in the form of “danger of death” narratives—stories about close calls with death. In such stories, a shift in tense typically occurs when the narrator reaches the crucial point in his or her story, the point when death seems imminent and unavoidable. Consider the following example: A man who had experienced a frightening incident while driving in a snowstorm began telling his story in the past tense as he described the circumstances. As he came to the point when his car went out of control on an icy curve and began to slide into the opposing lane of traffi c, however, he abruptly switched to the present tense, as if he were reliving the experience of watching an oncoming car heading straight for him and believ- ing in that moment that he was about to die. 26

Word choices can also refl ect changes in how a death event is experi- enced at different times. For example, after a disaster occurs, as the focus of rescue efforts changes, so does the language used to describe the work of emergency personnel and search-and-rescue teams. As hours stretch into days, rescue work becomes recovery work.

Scholars point out that language appears to infl uence many aspects of human thought. In fact, what we normally call “thinking” is a complex set of collaborations between linguistic and nonlinguistic representations and processes. 27 Look again at the words and phrases used in death talk (see Table 1-1 ). Notice how language offers clues about the manner of death and the speaker’s attitude toward the death. Subtle distinctions may refl ect dif- ferent attitudes, sometimes involving cultural frameworks. Consider, for instance, the difference between passed away and passed on. Paying attention to the euphemisms, metaphors, slang, and other linguistic devices people use when talking about death is a way to appreciate the variety and range of atti- tudes toward dying and death.

Music In Music of the Soul, Joy Berger writes, “Nearly every civilization, culture,

and religion exemplifi es the use of music at times of loss and grief.” 28 Pipes and fl utes were referred to by Euripedes in his play Helen as an aid to mourn- ing. Leonard Bernstein’s Symphony no. 3 ( Kaddish ) is based on the Jewish prayer for the dead. Richard Strauss’s Death and Transfi guration depicts the death of an artist. Signifi cant compositions written to commemorate the

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Expressions of Attitudes Toward Death 13

events of September 11, 2001 include John Adam’s On the Transmigration of Souls and Steve Reich’s WTC 9/11. Music scholar Ted Gioia reminds us that the potency and transformational power of music is enhanced by its ability to create a unity of purpose. He notes that the “deep faith in the transfor- mational power of sound is so widespread in traditional cultures that we are perhaps justifi ed in calling it a universal belief.” 29

The dirge (a hymn of grief) is a musical form associated with funeral processions and burials. The jazz funeral of New Orleans is a well-known example of a popular interpretation of the dirge. Beethoven, Schubert, Schumann, Strauss, Brahms, Mahler, and Stravinsky all wrote dirges. Related to dirges are elegies —musical settings for poems commemorat- ing a person’s death—and laments. Elegies are emotional acknowledg- ments that “all things are impermanent, which is itself a profound spiritual understanding.” 30

Laments are an expression of stylized or ritualized leave-taking found in many cultural settings, one example being Scottish clan funerals, where bagpipes are played. Vocally, the typical lament is an expression of mourn- ing called keening, an emotional expression of loss and longing that is remi- niscent of crying. For the ancient Greeks, lamentation was intended to both “praise the deceased and provide emotional release for the bereaved.” 31 An audience, hearing the lament, were “enabled to use the expressions of loss and sorrow as their own, thereby diminishing the opportunity for explosive and spontaneous eruptions of anguish.” 32

Laments may help the bereaved identify their altered social status and seek sympathetic understanding from the community. 33 Italian philosopher Ernesto De Martino traced how the practice of lamentation—in word, ges- ture, and music—moderates the tendency toward collapse or breakdown that threatens persons in moments of extreme crisis, such as the aftermath of the death of a close relative. 34 In this way, laments promote the cultural reinte- gration of the mourner while simultaneously reestablishing bonds of alliance between the living and the dead. In a well-known Greek lament, a mother says that she will take her pain to the goldsmith and have it made into an amulet so that she can wear it forever. 35

The requiem, a musical composition played at a mass for the dead, is related to the elegy. This musical form has attracted composers like Mozart, Berlioz, and Verdi, among others. One section of the Requiem Mass, the Dies Irae (“Day of Wrath”), is a musical symbol for death in works by many compos- ers. In Berlioz’s Symphonie Fantastique (1830), this theme is heard, fi rst follow- ing an ominous tolling of bells and then, as the music reaches its climax, in counterpoint to the frenzied dancing of witches at a sabbat. Berlioz’s Symphonie tells the story of a young musician who, spurned by his beloved, attempts sui- cide with an overdose of opium. In a narcotic coma, he experiences fantastic dreams that include a nightmarish march to the gallows. The Dies Irae is also heard in Camille Saint-Saëns’s Danse Macabre (1874) and Franz Liszt’s Toten- tanz (1849), two of the best-known musical renditions of the Dance of Death (discussed in its historical context in Chapter 3).

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14 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

Tragedy and death are common in opera. This art form, which combines drama with music, has been characterized as obsessed with death, or at least a romanticized view of death prevalent in Western culture during the time frame of such classic compositions as Aida, Carmen, La Bohème, Madame But- terfl y, Tosca, and La Traviata. 36

As these examples attest, death themes are heard in both religious and secular compositions. Pink Floyd’s “Time” is a musical reminder of the limits of a life span and how each day’s passing brings us “closer to death.” Eric Clapton’s “Tears in Heaven” was written for his four-year-old son who died from a fall from a high-rise in Manhattan. Tim McGraw’s “Live Like You Were Dying” celebrates life renewed after the death of his father.

The lyrics of Elvis Presley’s early hit “Heartbreak Hotel” reportedly were inspired by a suicide note that contained the phrase “I walk the lonely street.” The branch of heavy metal music known as death metal is partly defi ned by its lyrics, which convey images of homicide, catastrophic destruction, and sui- cide, performed by bands with names like Morbid Angel, Napalm Death, Car- cass, and Entombed. Indeed, death imagery in rock music may have helped break the taboo against public mention of death. Support for this thesis is found in surveys of Top 40 songs. 37 Some authorities have traced the begin- nings of the civil rights movement to a musical event that occurred sixteen years before Rosa Parks refused to yield her seat on a Montgomery, Alabama, bus: Billie Holiday’s singing of “Strange Fruit,” the lyrics of which describe horrifi c imagery of the lynching of African Americans. 38

Music has been recruited to enlist patriotic support for war efforts, as in George M. Cohan’s “Over There” during the First World War. 39 It has also been used to cast doubt on the legitimacy of war. During the Vietnam con- fl ict, listeners heard Country Joe McDonald’s “Fixin’ to Die Rag,” with its well-known refrain, “What are we fi ghting for?”

Mayhem and misery have long been staples of music. Folk ballads describe premonitions of death, deathbed scenes, last wishes of the dying, the sorrow and grief of mourners, and the afterlife. Consider such songs as “Where Have All the Flowers Gone?” (war), “Long Black Veil” (mourning), “Casey Jones” (accidental death), and “John Henry” (occupational hazards).

Themes of suicide are also common, especially in tales of love and death. Some songs, such as “The Ballad of Jesse James,” glorify outlaws and other bad guys. Graeme Thomson observes that “Stagger Lee” is a close relative of “Jesse James,” except “Stag has no great quest for justice to pursue; he is just plain bad. ” 40 This musical genre is also found in Mexican popular culture in the form of narcocorridos, narrative songs or corridos that describe the careers of smugglers and drug lords. 41

In American blues music, themes of loss, separation, tribulation, and death are commonly heard. Disasters have inspired blues lyrics, as with the sinking of the Titanic and the 1927 Mississippi River fl ood. The desire to be remembered after death is voiced in Blind Lemon Jefferson’s “See That My Grave Is Kept Clean.” In “I Feel Like Going Home,” Muddy Waters tells us that death sometimes brings relief. Other examples of blues themes include

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Expressions of Attitudes Toward Death 15

Bessie Smith’s “Nobody Knows You When You’re Down and Out” (economic reversal), T-Bone Walker’s “Call It Stormy Monday” (lost love), John Mayall’s “The Death of J. B. Lenoir” (death of friend in a car accident), and Otis Spann’s “The Blues Never Die” (consolation in loss). In all, the blues express “a deep stoic grief and despair, a dark mood of lamentation, but also a wry and ribald humor.” 42

Sometimes characterized as the fl ip side of the blues, gospel music expresses a wealth of images of loss and grief. Examples include “Oh, Mary Don’t You Weep” (mourning), “Known Only to Him” (facing one’s own death), “When the Saints Go Marching In” (the afterlife), “If I Could Hear My Mother Pray Again” (a parent’s death), and “Precious Memories” (adjust- ment to loss and sustaining bonds with the deceased).

Charles Reagan Wilson identifi es six categories of death in country music: (1) the pervasiveness of death, (2) violent and tragic death, (3) songs of love and death, (4) death and the family, (5) celebrity death, and (6) reli- gious infl uences on death. 43 “Will the Circle Be Unbroken,” a song that can be classifi ed as both gospel and country, describes a mother’s death and a child’s grief in precise imagery. The Appalachian dirge “O, Death” refl ects the memento mori tradition, a reminder of the reality of death. Country songs, as Wilson says, “continue to embody the idea that death should not be segre- gated from the rest of life, but should be dealt with openly as a natural and profound human concern.” 44

In traditional Hawaiian culture, chants known as mele kanikau were used as laments for commemorating a person’s death. 45 Some kanikau were care- fully composed; others were chanted spontaneously during the funeral pro- cession. Imagery of the natural world is called upon to portray the writer’s experience of loss. 46 Memories of shared experiences amid natural surround- ings are mentioned: “My companion in the chill of Manoa” or “My compan- ion in the forest of Makiki.” Such chants fondly recall the things that bind together the deceased and his or her survivors. The message was not “I am bereft without you” but, rather, “These are the things I cherish about you.”

Think about how music provides solace in experiences of loss. As we cope with losses that beset us throughout life, certain songs and musical works bring to mind poignant memories that refresh our grief. 47 Whether Mozart’s Requiem or a Top 40 tune, music can cue the recall of happy moments shared with loved ones whose death has left us bereft. At other times, a lyric or mel- ody sets us refl ecting on our own mortality.

Themes of loss and death are heard in all musical styles (see Table 1-2 ). 48 As you listen to various styles of music, notice the references to dying and death and ask yourself, What messages are being conveyed? What attitudes are being expressed? Whatever your musical taste, you will fi nd a wealth of information about individual and cultural attitudes toward death.

Literature From the epic poetry of Homer’s Iliad and the classic drama of Sophocles’

Oedipus the King and Shakespeare’s King Lear, through modern classics like

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16 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

Leo Tolstoy’s The Death of Ivan Ilych, James Agee’s A Death in the Family, William Faulkner’s As I Lay Dying, and Ernest J. Gaines’s A Lesson Before Dying, death is treated as signifi cant in human experience. 49 Ted Bowman observes that the language of bereavement and grief is enhanced by literary resources that help people give voice to their own stories of loss. 50

Uncertainty about death is often found in poetry of mourning for the dead, which, Jahan Ramazani says, “assumes in the modern period an extra- ordinary diversity and range, incorporating more anger and skepticism, more confl ict and anxiety than ever before.” 51 Earlier in this chapter, we discussed elegies in the context of musical expressions of attitudes toward death. Elegies are also expressed in literature. Note that the elegy is not to be confused with a eulogy (oratory or praise in honor of the deceased) or epitaph (a brief state- ment commemorating the deceased, often inscribed as a memorial on a tomb).

The term elegy refers to a poem or song memorializing the dead. 52 It is usually pensive, refl ective, or plaintive, an expression of suffering or woe. Ele- gies typically describe feelings of sorrow, sadness, mournfulness, melancholy,

Performer Song Theme

Beatles “Eleanor Rigby” Aging and loss Boyz II Men “Say Goodbye to Yesterday” Grief Jackson Browne “For a Dancer” Eulogy Mariah Carey “One Sweet Day” Missing a loved one Johnny Cash “The Man Comes Around” Judgment Day Eric Clapton “Tears in Heaven” Death of young son Joe Diffi e “Almost Home” Father’s death Dion “Abraham, Martin, and John” Assassination Doors “The End” Homicide Bob Dylan “Knockin’ on Heaven’s Door” Last words Grateful Dead “Black Peter” Social support Jimi Hendrix “Mother Earth” Inevitability of death Elton John “Candle in the Wind” Deaths of Marilyn Monroe

and Princess Diana Patty Loveless “How Can I Help You Say

Goodbye” Mother’s death

Dave Matthews “Gravedigger” Anticipation of dying Sinead O’Connor “I Am Stretched on Your

Grave” Mourning

Pink Floyd “Dogs of War” Combat death The Police “Murder by Numbers” Political deaths Elvis Presley “In the Ghetto” Violent death Snoop Dogg “Murder Was the Case” Urban homicide Bruce Springstein “Streets of Philadelphia” AIDS James Taylor “Fire and Rain” Friend’s death Stevie Wonder “My Love Is With You” Death of a child Warren Zevon “My Ride’s Here” Arrival of hearse and death

t a b l e 1-2 Death Themes in Popular Music

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Expressions of Attitudes Toward Death 17

nostalgia, lamentation, or some blending of these qualities. Elegies have been characterized as “a way to say goodbye while celebrating who or what is gone.” 53

Early examples of the genre of elegy in English literature include John Milton’s “Lycidas” (1637) and Thomas Gray’s “Elegy Written in a Country Churchyard” (1750). Examples from American literature include “O Captain, My Captain” (1865), Walt Whitman’s elegy on the death of President Abraham Lincoln, and “For the Union Dead” (1965), Robert Lowell’s elegy based on the story of Colonel Robert Shaw, who led the fi rst all-black brigade during the American Civil War.

Elegies have been written to express a personal sense of grief as well as out of a generalized feeling of loss and metaphysical sadness. Examples include the series of ten poems in Duino Elegies by the German poet Rainer Maria Rilke and poems by Czeslaw Milosz, which lament the cruelties of totalitarian government. Other examples are Wilfred Owen’s poems of moral objection to the pain wrought by industrialized warfare; Allen Ginsberg’s Kaddish after the death of his mother; Seamus Heaney’s memorials to the suffering caused by political violence in Ireland; and the “parental elegies” in the poetry of Sylvia Plath, Anne Sexton, and Adrienne Rich. Poems give us insight into the universality of loss in ways that can be consoling and therapeutic. 54 Edward Hirsch tells us, “Implicit in poetry is the notion that we are deepened by heartbreaks, that we are not so much diminished as enlarged by grief, by our refusal to vanish—to let others vanish—without leaving a verbal record.” 55

In literature, the meaning of death is often explored as it relates to soci- ety as well as the individual. Novels about war depict how individuals and soci- eties search for meaning in shattering experiences of trauma and loss. In All Quiet on the Western Front, a novel set in the time of World War I, Erich Maria Remarque described the pointlessness of modern warfare by telling the story of a youthful combatant who quickly moves from innocence to disillusion- ment. The technological horror of World War II, particularly devastation

John O’Hara’s Appointment in Samarra reminds us that we cannot escape our mor- tality nor the pervasive angst that it arouses. In that story, a servant returns, pro- foundly shaken, from a trip to the market. His master asks what has caused the servant’s terror. The servant replies that when someone in the crowd jostled him, he turned and noticed the Angel of Death beckoning him. The horror-stricken servant then asks his master for a horse so that he might ride to Samarra, some distance away, where the Angel of Death won’t be able to fi nd him. The master agrees, and the servant leaves for Samarra. Later that day, the master goes to the market. He, too, encounters the Angel of Death and asks why the Angel had made that threatening gesture to his servant. Death allegedly replies, “That was not a threatening gesture, simply one of surprise. I didn’t expect to see him here today since I had an appointment to meet him tonight in Samarra.”

Jean Lipman-Blumen, “Our Existential Vulnerability to Toxic Leaders”

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18 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

caused by the atomic bomb, is the focus of John Hersey’s Hiroshima. The surreal aspects of the Vietnam War received attention in books like Michael Herr’s Dispatches and Tim O’Brien’s Going After Cacciato, and similar accounts are being published about the recent wars in Iraq and Afghanistan.

In Holocaust literature, devastating experiences of horror and mass death are dealt with in victims’ diaries, as well as in novels and psychologi- cal studies. 56 Examples include Chaim Kaplan’s Warsaw Diary, Charlotte Delbo’s None of Us Will Return, Elie Wiesel’s Night, and Anne Frank’s Diary of a Young Girl.

Modern literature often explores the meaning of death in situations that are seemingly incomprehensible. The hero tries to come to terms with sudden and violent death in situations that allow no time or place for sur- vivors to express their grief or mourn their dead. 57 Themes may focus on a “landscape of violence.” 58 In “vigilante” stories, for example, such as detec- tive novels and some westerns, the hero sets out to avenge evil but is often corrupted by a self-justifying morality that only perpetuates violence. 59 Finding meaning in death is problematic, as violence reduces persons to the status of things.

Cadets at the United States Military Academy (West Point) learn about the historical role of poetry in shaping culture, attitudes, and values, with the aim of “dispelling the illusion that prepackaged answers are always there for the taking in a world fl ush with ambiguities.” 60

Visual Arts In the visual arts, death themes are revealed through symbols, signs, and

images. 61 Edvard Munch’s The Dance of Life, which appears on the cover of this text, represents the artist’s summing up of human fate: “Love and death, beginnings and endings, are fused in a roundel that joins private lives and lusts to the larger, inexorable cycle of ongoing generations.” 62

Art is often a vehicle for expressing the impact of personal loss. When Pan Am Flight 103 was brought down by a terrorist bomb, Suse Lowenstein’s son was among those killed. As a sculptor, she found a way to express her own grief and that of other women bereft by the crash by making a series of female nude fi gures that compose an exhibit titled Dark Elegy. In earth tones, the larger-than-life fi gures are shown in the throes of grief (see Figure 1-1 ). Some fi gures look mute. Others are obviously screaming. Some look as though they were eviscerated. Lowenstein expressed the hope that Dark Elegy will be “a reminder that life is fragile and that we can lose that which is most precious to us so easily and have to live with that loss for the remainder of our lives.” 63

Art gives us a window into the customs and beliefs of other ages and places. For example, Charles Willson Peale’s Rachel Weeping (1772 and 1776) depicts a deathbed scene from the American colonial period in which the artist’s wife is shown mourning their dead child. The child’s jaw is wrapped with a fabric strap to keep it closed. Her arms are bound with cord to keep them at her sides. Medicines, all of which have proved ineffective, sit on a

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Expressions of Attitudes Toward Death 19

Figure 1-1 Dark Elegy About the women portrayed in her work Dark Elegy, the artist says, “One by one, they come into my studio, step onto a posing platform, close their eyes, and go back to December 21, 1988, to that horrible moment when they learned that their loved one had died. . . . This is the moment I freeze in time. This is the pose that I shape into sculpture.”

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20 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

bedside table. As the mother gazes heavenward, she holds a handkerchief to wipe away the tears streaming down her face, her grief in marked contrast to the dead child’s peaceful countenance.

Francisco José de Goya’s Self-Portrait with Dr. Arrieta exemplifi es an artistic genre that depicts deathbed scenes and persons in extremis. Completed for the doctor who aided in Goya’s recovery from a life-threatening illness, this painting shows the doctor holding medicine to Goya’s lips while the fi gure of Death is depicted next to people who are thought to be Goya’s priest and his housekeeper. Suicide is another theme dealt with by artists of virtually all eras and cultures. A well-known example is Rembrandt van Rijn’s The Suicide of Lucretia, which portrays Lucretia with a tear in her eye, moments after she has stabbed herself with a dagger.

One of the most arresting expressions of dying and death ever to emerge in the graphic arts occurred in Western Europe during the Middle Ages. Growing out of widespread fears about the spread of plague, the images asso- ciated with the Danse Macabre (Dance of Death) display a concern with the stark features of mortality and fears of sudden, unexpected death. An exam- ple is found in the Bargello National Museum in Florence, where a series of three wax sculptures by Italian artist Gaetano Giulio Zumbo depicts the process of body dissolution from the fresh cadaver to one the worms have completely devoured. The morbid aspects of mortality have also evoked atten- tion by more recent artists, as in Fritz Eichenberg’s woodcuts depicting the fears of our era: annihilation caused by war, environmental catastrophe, and diseases such as AIDS. 64

In some art, we fi nd a whimsical attitude toward death, as in the engrav- ings of Mexican artist José Guadalupe Posada, which contain skeletal fi gures from all walks of life engaged in daily routines, or in American sculptor Rich- ard Shaw’s Walking Skeleton, with the skeleton composed of twigs, bottles, play- ing cards, and similar found objects.

During the nineteenth century, people throughout the United States incorporated both classical and Christian symbols of death to memorial- ize public fi gures as well as family members. 65 Embroidered memorials to the dead were hung in the parlor, the most important room of the house, and elaborate quilts were sewn into designs that celebrated the life of the deceased. Such mourning art provided not only a way to perpetuate memo- ries of a loved one but also a focus for physically coping with grief, an oppor- tunity to actively grieve by doing something.

Similar motives led to the making of a massive quilt to commemorate per- sons who had died from AIDS: The Names Project AIDS Memorial Quilt. 66 In folk art, quilts represent family and community. As the largest ongoing com- munity arts project in America, the AIDS Quilt affi rms the value of creative expression as a means of coping with loss.

The quilt symbolized individuals sharing their grief by sharing their continuing bonds with friends and lovers, and in doing so the survivors became a community of mourners. 67

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Expressions of Attitudes Toward Death 21

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The making of a memorial quilt was among the elaborate personal and social mechanisms for dealing with grief widely practiced during the nineteenth century, as in this example memorializing a granddaughter who died in infancy. This tra- ditional mourning custom was revived recently to commemorate and remember per- sons who died from AIDS; in the example shown here, words and symbols express beloved qualities of Joe’s life. For survivors, the creation of such memorials provides not only a focus for physically working through grief but also a means of perpetual- izing the memory of the loved one.

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22 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

Maxine Junge points out,

Creativity in the face of death offers a spectrum of life-enhancing possibilities. These possibilities can ward off a meaningless conclusion to a life, give meaning and hope to a life lived and to a future in which the dead, through memory, still exist. 68

The urge to memorialize the dead and offer comfort to the bereaved through artistic means is also demonstrated by a variety of homemade con- dolences sent to relatives of military men and women killed in Iraq and Afghanistan. 69 Operation Gold Star Flag, formed by a group of military wives, revived a tradition of fl ag-making that began during World War I, when families with relatives in the military displayed in their windows small fl ags—white fi elds with red borders and in the middle a blue star, which was changed to gold if the serviceman was killed. Other groups, such as Marine Comfort Quilts and Operation Homemade Quilts, fashion quilts with center squares personalized in memory of each casualty.

A woman who had been given one of the Marine Comfort Quilts described how, when she fi nds herself missing her brother, she wraps her- self in the quilt and cries until the wee hours of the morning: “It’s called a ‘comfort quilt,’” she said, “and that’s exactly what it is; it has so much love from so many different people who never even met my brother.” Another woman, a mother whose son was killed by friendly fi re (that is, by his own comrades), said: “Your friends and family are there, but when you receive good deeds from people you don’t even know, it makes you feel like you’re not alone.” 70

Like the AIDS Memorial Quilt, the Vietnam Veterans Memorial Wall in Washington, D.C., designed by architect Maya Lin, is an example of contem- porary mourning art that works to counter the anonymity of lives lost. It has been described as the “iconographic reversal of the Tomb of the Unknowns,” with its “vast polished surface” serving as “the tombstone of the known.” 71 On the wall, names of the dead are listed chronologically by the date of their death, rather than alphabetically, presenting a chronicle that vividly depicts the scale of losses. Mementos left by visitors are collected by the National Park Service, and items have been displayed at the Smithsonian’s National Museum of American History.

Similarly, at Arlington National Cemetery, the graves of veterans killed in Iraq and Afghanistan are decorated with handwritten notes and items that poignantly celebrate personal connection. Before those wars, the expression of grief at Arlington was confi ned to wreaths and fl owers. Now, personnel from the U.S. Army Center for Military History come each week to add to a collection that may one day become an exhibit in a museum devoted to tell- ing the story of war and its cost. About the commemorative function of war museums, Andrew Whitmarsh says:

Memory and commemoration are constructed according to the social, cultural, and political nature, as well as the needs and experiences, of the society and individuals producing them. War museums have often been accused of sanitizing

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Expressions of Attitudes Toward Death 23

or glamorizing war through their depiction of “heroes” and their portrayal of death, The commemorative aspect of war museums directly affects their style of interpretation. 72

In Japan, a shrine honoring the “spirits” of war dead has stirred diplomatic and domestic controversy because of differing interpretations of its signifi - cance and purpose. 73

As Carla Sofka points out, when handled with care and sensitivity, such museums can be healing spaces, honoring the memories and legacies of both victims and survivors. 74

The importance of the arts in a comprehensive understanding of how people cope with loss is expressed in this statement by the International Work Group on Death, Dying, and Bereavement:

The arts and humanities with their images, symbols, and sounds express themes of life, death, and transcendence. They are the language of the soul and can enable people to express and appreciate the universality as well as the particularity of each person’s experience. 75

In the visual arts, these themes and this language are evident in a broad range of works, from those formed out of the particulars of an individual’s unique loss—as in the sculptures of Suse Lowenstein, which depict the grief of a parent following the death of a child—to those that function on a larger scale as sites of memory for losses that are both personal and communal—such as those commemorated by the AIDS Memorial Quilt and the Vietnam Veter- ans Memorial Wall. Whatever the scale, as Sandra Bertman points out, one of the main functions of art is to engage our awareness and “bring us closer to what language cannot reach.” 76

Humor Humor defuses our anxiety about death. It puts fearful possibilities into

manageable perspective. James Thorson says, “We make fun of that which threatens us.” 77 Death-related humor comes in many different forms, from funny epitaphs to so-called black or gallows humor. Incongruity is one of the components of humor. 78 One joke, for example, describes a project manager who leaves a suicide note in the form of a PowerPoint presentation; the joke tells how his colleagues ignore the tragic content of the note while critiqu- ing its presentation. Similarly, on a highway, motorists are taken aback by a gleaming white hearse with the cryptic license plates “Not Yett.” Serious and somber matters can be easier to deal with when there is comedic relief.

There are “intimate connections between death and laughter.” 79 Mary Hall observes that “what is humorous to each of us depends on our particu- lar cultural set, our own experience, and our personal inclination.” 80 Humor often functions as a kind of comment on incongruity or inconsistency rela- tive to social norms or perspectives, as when a young girl wrote a letter to God asking, “Instead of letting people die and having to make new ones, why don’t you just keep the ones You have now?” 81 As Thorson points out, “Taking potshots at the spectre that will destroy us may not in fact do away with the

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24 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

Ultimate Problem, but satire at least makes us feel better in some small way about our common fate. This is the essence of coping.” 82

A joke that is shared gleefully by one group of people may be shocking to others; there are constraints on the kinds of humor that a particular person or group fi nds acceptable. Nevertheless, humor helps us cope with painful situations. Individuals held as prisoners of war during the Vietnam War con- sidered humor so important to coping that they would “risk torture to tell a joke through the walls to another prisoner who needed to be cheered up.” 83 Humor is an important aid in confronting our fears and gaining a sense of mastery over the unknown.

Humor functions in several ways relative to death: First, it raises our consciousness about a taboo subject and gives us a way to talk about it. Sec- ond, it presents an opportunity to rise above sadness, providing a release from pain and promoting a sense of control over a traumatic situation, even if we cannot change it. Third, humor is a great leveler; it treats everyone alike and sends the message that there are no exemptions from the human predicament. Thus, it binds us together and encourages a sense of intimacy, which helps us face what is unknown or distressing. Humor can be a “social glue” that helps us empathize with others. After a death has occurred, humor can comfort survivors as they recall the funny as well as the painful events of a loved one’s life. A sense of humor can moderate the intensity of negative life events.

In place of the conventional sentiment usually engraved on tombstones, a touch of whimsy adorns this memorial to B. P. Roberts at a cemetery in Key West, Florida.

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Living with Awareness of Death 25

In situations involving interactions between patients and health care providers, humor is “one of the great tools of reassurance on the hospital ward.” 84 For people who are seriously ill, humor offers a way to cope with the effects of a shattering diagnosis. It provides another perspective on a pain- ful situation, as in the jest “Halitosis is better than no breath at all.” When things are bad, humor can serve a protective psychological function and help people maintain their equilibrium.

Emergency services personnel and other individuals who encounter death on their jobs use humor to distance themselves from horrifi c death, as well as to rebond as a team rather than feeling isolated in their individ- ual grief after traumatic incidents. A group of doctors at a medical center avoided using the word death when a patient died because of concern that it might alarm other patients. One day, as a medical team was examining a patient, an intern came to the door with information about the death of a patient. Knowing that the word death was taboo and fi nding no ready substi- tute, she announced, “Guess who’s not going to shop at Walmart any more?” This phrase quickly became the standard way for staff members to convey the news of a patient’s death among themselves when in a public setting. For care- givers, humor serves to communicate important messages, promote social relations, diminish discomfort, and manage delicate situations; it has been called the “oil of society.” 85

Living with Awareness of Death It is said that “one of the most important and unique aspects of human expe- rience is the awareness of our own mortality.” 86 Ultimately, one cannot ignore or deny death. “Societies have traditionally taken tremendous care with the shared transformation of life into death because of their responsibility to preserve everyday life’s continuity and stability in the face of death’s many disruptions.” 87 In our time, globalization exposes us to information about deaths far distant from the comfort of our own homes. We are confronted with death seemingly at every turn.

Threats of environmental destruction, nuclear catastrophe, violence, war, and terrorism have been joined by the specter of emerging pandem- ics. Today’s global population has been described as hibakusha, a Japanese word meaning “explosion affected.” Initially used to describe survivors of the

Clearly, nobody was exempt from the life of life, which dictated that old age, dis- ease, and death were our common lot. Krishnamurti himself had often talked about it, jokingly quoting an Italian saying, “Tutti gli uomini debbeno morire, forse anch’io.” When I asked him what it meant, he translated it, “All men must die, per- haps I, too.”

Michael Krohnen, The Kitchen Chronicles: 1001 Lunches with J. Krishnamurti

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26 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

atomic bombings of Hiroshima and Nagasaki, the term now connotes perva- sive anxiety about the threat of annihilation in our “cosmopolitan era.”

Contemplating Mortality Why is there death? Looking at the big picture, we see that death pro-

motes variety through the evolution of species. The normal human life span is long enough for us to reproduce ourselves and ensure that the lineage of our species continues. Yet it is brief enough to allow for new genetic combi- nations that provide a means of adaptation to changing conditions in the environment. From the perspective of species survival, death makes sense. But this explanation offers little comfort when death touches our own lives. Norman Wirzba observes:

Life as we know it depends on death, needs death, which means that death is not simply the cessation of life but its precondition. . . . Eating involves us in a daily life and death drama in which, beyond all comprehension, some life is sacrifi ced so that other life can thrive. 88

In an article titled “Human Existence as a Waltz of Eros and Thanatos,” the authors suggest that

the proper antidote for death is love, but until the ubiquitous and powerful role of death is accepted, until we learn to “dance with death,” love will continue to be treated as something appropriate only for romance and Sunday School. 89

To remedy this misapprehension and expand our understanding of the rela- tionship between love and death, we need to step out of our fast-paced lives and take time to learn how to “waltz with death” by contemplating the basic questions of human existence.

Dimensions of Thanatology As pioneering Italian thanatologist Francesco Campione points out,

death is not only a topic for refl ection, study, and research; it is also an “exis- tential problem,” which touches every aspect of human existence and every fi eld of knowledge. 90 Existential questions—such as, Who am I? What am I doing here? Where do I fi t in the world?—focus on the meaning of life. Such questions are “concerned with the nature of authenticity and the responsibil- ity of choice,” and they are “discovered via a person’s perception of reality and meaning.” 91

Robert Kastenbaum says that, although the term thanatology is usually defi ned as “the study of death,” it is perhaps better defi ned as “the study of life with death left in.” 92 Thus, as a fi eld of study, thanatology encompasses a variety of disciplines and areas of concern (see Table 1-3 ). Other dimensions and examples can be added to this listing. For instance, religious thanatology has concerns similar to those of philosophical thanatology, but specifi cally as they occur in the context of devotion to a set of beliefs about the nature of ultimate reality (usually involving a deity); issues such as what happens to a person’s soul or spirit after death and the nature of the afterlife are impor- tant within this domain of thanatology.

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Living with Awareness of Death 27

Focus Major Areas of Concern Example Issues

Philosophical and ethical

The meaning of death in human life; questions of values and ethics

“Good” vs. “bad” death; concept of death; suicide and euthanasia

Psychological Mental and emotional effects of death on individuals

Grief; coping with terminal illness; death anxiety

Sociological How groups organize themselves to deal with social needs and problems related to dying and death

Response to disaster; disposal of the dead; socialization of children

Anthropological Role of culture and environment across time and space regarding how individuals and societies relate to death and dying

Funeral rites; memorialization; ancestor worship

Clinical Management of dying and death in medical settings; diagnosis and prognosis; relationships among patients, doctors, nurses, other caregivers

Treatment options; hospice and palliative care; pain and symptom control

Political Governmental actions and policies related to dying and death

Capital punishment; organ transfer rules; conduct of war

Educational Death education; public awareness of death-related issues and concerns

Curricula for instruction in schools; community programs

t a b l e 1-3 Dimensions of Thanatology

Acquiring a core knowledge of thanatology involves becoming familiar with all of these dimensions and their aspects. Together, they constitute what might be called “Thanatology” with a capital T. Professionals who work with the dying or the bereaved need to establish a fi rm foundation in thanatology alongside their expertise in health care or counseling.

Reviewing the scope and mission of death studies, Kastenbaum notes that mainstream thanatology has devoted its efforts to improving the care of people faced with life-threatening illness or bereavement, and it may be time to broaden the focus to include “large-scale death” and “death that occurs through complex and multi-domain processes.” 93 This perspective would include not only the “horrendous deaths” that human beings infl ict on each other in war and other forms of violence but also human-caused activities that threaten or result in the extinction of other species.

Death Anxiety and Fear of Death Our relationship with death has, as Herman Feifel observed, “a shaping

power on thinking and behavior at all points in the life span.” 94 The way in which we anticipate death, Feifel says, governs our “now” in an infl uential

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28 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

manner. This applies not only to people who are terminally ill, combatants in war, or people who fi t other categories we tend to associate with an increased risk of death, such as those who are very old or suicidal. On the contrary, it is true for everyone and “for all seasons.” Death challenges the idea that human life has meaning and purpose. 95

The manner in which individuals respond to this challenge is “inter- twined with the death ethos of the cultures in which they are embedded.” 96 The distinctive stance toward death in a particular culture affects the behav- ior of its members as they go about their daily lives, infl uencing, for example, their willingness to engage in risky behaviors or their likelihood of taking out an insurance policy, as well as their attitudes toward such issues as organ donation, the death penalty, euthanasia, or the possibility of an afterlife. In a variety of ways, our culture helps us “deny, manipulate, distort, or camou- fl age death so that it is a less diffi cult threat with which to cope.” 97 Consider, for example, the effect of a public health discourse that suggests death and misfortune can be avoided if people behave properly—eat the right things, exercise, stop smoking, and so on. 98 The paradox of our attitude toward death is highlighted by the writer Thomas McGuane in his remark that “everyone knows that they are going to die; yet nobody believes it.” 99

Avery Weisman pointed out that realization is critical in our efforts to understand death: “Most people concede that death is inevitable, a fact of nature. But they are not prepared to realize. We postpone, put aside, disavow, and deny its relevance to us.” 100 Individuals and societies must, in fact, both accept and deny death. We must accept death if we wish to maintain a grasp on reality. Yet we must deny it if we are to go about our daily lives with a sense of commitment to a future that is inevitably limited by our mortality. Accord- ing to Talcott Parsons, the characteristic attitude toward death in modern societies is less a matter of outright denial than it is “bringing to bear every possible resource to prolong active and healthful life” and accepting death only when “it is felt to be inevitable.” 101

The largest area of empirical research in thanatology is concerned with the measurement of attitudes toward death, and, more particularly, death anxiety. 102 In posing the question, What do we fear when we fear death? Robert Neimeyer and his colleagues suggest that the term death anxiety may be understood as “a shorthand designation for a cluster of death attitudes characterized by fear, threat, unease, discomfort, and similar negative emo- tional reactions, as well as anxiety in the psychodynamic sense as a kind of diffuse fear that has no clear object.” 103

Generally speaking, the fi ndings from this research indicate that death anxiety tends to be higher among females than among males, higher among blacks than among whites, and higher among youth and middle-aged adults than among older people. People who describe themselves as religious tend to report less death anxiety than those who do not characterize themselves this way. Individuals who report a greater degree of self-actualization and sense of internal control also report less death anxiety than their counter- parts. This summary gives a very broad-brush understanding of the overall

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Living with Awareness of Death 29

picture of death anxiety research. It is important to understand, however, that the responses elicited by such research are “by no means a full represen- tation of one’s awareness of the advancing resoluteness of death or conscious- ness of being-in-the-world.” 104

Despite the accumulated data from numerous studies, there are signifi - cant questions, which Neimeyer summarizes as follows: 105 First, what defi ni- tion of death is implied by the various testing instruments? Second, what are the strengths and limitations of the various instruments that have been used in death anxiety research? Third, based on answers to the fi rst two questions, what are the implications for future research? And, fi nally, reviewing the data gathered up to now, what do we really know?

One conclusion reached by Neimeyer and his colleagues is that “persons who accept both the dying process and the prospect of being dead one day as a natural part of their lives express less intense fear of dying and death.” In short, they are “probably more able than others to see meaning in death by putting it into an overarching context.” 106

Research into death anxiety has been characterized by Kastenbaum as “thanatology’s own assembly line.” 107 Part of the appeal of death anxiety research, he says, lies in the fact that it “allows the researcher (and the read- ers, if they so choose) to enjoy the illusion that death has really been studied.” How data from such research can be applied to practical issues is uncertain. If, for example, it were possible to reliably state that doctors with high death anxiety relate poorly to dying patients, then that fi nding might be applied constructively in health care settings. However, we are mostly unable to ade- quately gauge the effect of death anxiety on real-world issues.

What shall we make of studies showing that women have higher death anxiety scores than men? Does this gender difference mean that women are too anxious about death or that men are not anxious enough? Reviewing the research in this area, Herman Feifel said:

Fear of death is not a unitary or monolithic variable. . . . In the face of personal death, the human mind ostensibly operates simultaneously on various levels of reality, or fi nite provinces of meaning, each of which can be somewhat autonomous. We, therefore, need to be circumspect in accepting at face value the degree of fear of death affi rmed at the conscious level. 108

Terror Management Terror management theory (TMT) states that human behavior is mostly

motivated by an unconscious fear of mortality. In other words, awareness of one’s own death affects the decision making of individuals and groups, a concept known as mortality salience. 109 Because death is always a possibil- ity for us, fear of death is built into human life. 110 To cope with this fear, we erect defenses against death awareness, defenses that are based in denial and include an irrational belief in being “personally special” as well as an irratio- nal belief in “an ultimate rescuer.” 111

Terror management theory suggests that people learn to assuage their fears of death by fi nding meaning in life and value in themselves, this meaning

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30 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

and value being provided by the culture into which people are socialized. 112 “The resulting perception that one is a valuable member of a meaningful uni- verse constitutes self-esteem; and self-esteem is the primary psychological mechanism by which culture serves its death-denying function.” 113 Although cultures differ in their specifi c beliefs, they “share claims that the universe is meaningful and orderly, and that immortality is attainable, be it literally, through concepts of soul and afterlife, or symbolically, through enduring accomplishments and identifi cations.” 114

In an interview days before his death, Ernest Becker, the initiator of ter- ror management studies, addressed “four strands of emphasis” relevant to terror management theory: 115

1. The world is a terrifying place. 2. The basic motivation for human behavior is the need to control our basic

anxiety, to deny the terror of death. 3. Because the terror of death is so overwhelming, we conspire to keep it

unconscious. 4. Our heroic projects aimed at destroying evil have the paradoxical effect

of bringing more evil into the world. . . . We are able to focus on almost any perceived threat, whether of people, political or economic ideology, race, religion, and blow it up psychologically into a life and death strug- gle against ultimate evil. . . . This is the dynamic of spiralizing violence that characterizes so much of human history.

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Studying Death and Dying 31

One of the common reactions to terror management theory is that it couldn’t possibly be correct because people just don’t think about death all that often. 116 However, studies show that “fear of death functions as a moti- vating force whether people are currently focused on this particular issue or not; it is the implicit knowledge of death rather than current focal awareness that is the motivating factor.” 117 In a commentary on the TMT perspective, Robert Kastenbaum points out that we live with sorrow as well as anxiety, and that there are connections between anxiety and sorrow. 118 He says, “Much remains to be learned about the interweaving of sorrow and anxiety through- out human experience.” 119 Summarizing the insights of TMT, Robert Solo- mon says, “Put in the least fl attering way, we might say that my death is a bad thing because it deprives the universe of me.” 120

Studying Death and Dying Take a death and dying course or read a book like this, and someone will probably ask, “Why would you want to take a class about death?” or “Why are you reading about death?” Despite public interest in death-related issues, individuals exhibit varying degrees of avoidance and acceptance when it comes to discussing death openly. A philosophy teacher tells how he was asked to lecture on a subject of his choosing, so he submitted the title “Fac- ing Death.” He reports that his hosts were shocked, forcing him to change to “Immortality: Pros and Cons.” 121 Our relationship with death seems to be in a period of transition.

Ambivalent attitudes toward death are evident when one educator applauds the study of death as the “last of the old taboos to fall,” while another contends that death is “not a fi t subject for the curriculum.” In response to this state of affairs, Patrick Dean observes that, if death educa- tion is criticized by some as a “bastard child of the curriculum, hidden in the closet,” then those who value death education can be grateful to such critics because they are creating opportunities for highlighting the importance of death education as preparation for living. 122 In fact, Dean says, death educa- tion could appropriately be renamed “life and loss education,” because “only through awareness of our lifelong losses and appreciation of our mortality are we free to be in the present, to live fully.”

The Rise of Death Education Informal death education occurs in the context of “teachable moments”

that arise out of events in daily life. Such an event may be the death of a gerbil in an elementary school classroom, or it may be an event experienced widely, such as a school shooting, a terrorist attack, a devastating tsunami or hurri- cane, or the sudden death of a celebrity.

The fi rst formal course in death education at an American university was initiated by Robert Fulton at the University of Minnesota in the spring of 1963. 123 The fi rst conference on death education was held at Hamline Uni- versity in Minnesota in 1970. From these beginnings, death education has

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32 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

embraced a wide range of issues and topics, from nuts-and-bolts issues such as selecting mortuary services or probating an estate to philosophical and ethical matters such as the defi nition of death and speculation about what happens after death.

Because death education addresses both objective facts and subjec- tive concerns, it receives broad academic support, with courses offered in a variety of disciplines. 124 In most courses, mastery of facts is enhanced by personal narratives that describe the myriad ways human beings encounter and cope with death. 125 The arts and humanities serve to balance scientifi c and technical perspectives. Images, symbols, and sounds express themes of life, death, and transcendence that allow for many ways of knowing and learning.

In the broad picture, death education includes training for physicians, nurses, allied health personnel, funeral directors, and other profession- als whose duties involve contact with dying and bereaved individuals. This includes police offi cers, fi refi ghters, and emergency medical technicians (EMTs). As witnesses to human tragedy in the line of duty, they are called upon to comfort victims and survivors. The stoic image of the police offi cer, EMT, or fi refi ghter who “keeps it all in” instead of expressing natural emo- tions is challenged by the recognition that such a strategy may be physically and psychologically harmful.

Pioneers in Death Studies The establishment of death studies in modern times can be traced to

explorations of death by Freud and others of the psychoanalytic school and to anthropological accounts of death customs in far-fl ung societies. Dis- course about death and dying during the 1940s and 1950s is highlighted by, for example, Sylvia Anthony’s studies of children (1940), Erich Lindemann’s analysis of acute grief among survivors of a nightclub fi re (1944), and Geoffrey Gorer’s essay “The Pornography of Death” (1955; reprinted 1963). 126 Edgar Jackson wrote about grief for both lay and scholarly readerships in publica- tions such as Understanding Grief: Its Roots, Dynamics, and Treatment (1957) and You and Your Grief (1961). The 1950s may have been the threshhold of a new era in which death and dying were “rediscovered.” The question became “What does death mean to you?” 127

The modern scientifi c approach to the study of death, or thanatology, is usually traced to a symposium organized by Herman Feifel at a 1956 meeting in Chicago of the American Psychological Association. 128 This symposium resulted in a book, edited by Feifel: The Meaning of Death (1959). This land- mark book brought together experts from different disciplines whose essays encompassed theoretical approaches, cultural studies, and clinical insights. Death was shown to be an important topic for public and scholarly consid- eration. Given the prevailing resistance at that time to discussing death, this was no easy feat. About his early efforts in death studies, Feifel recalled that he was emphatically told that “the one thing you never do is to discuss death with a patient.” 129

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Studying Death and Dying 33

The same message was communicated to Elisabeth Kübler-Ross, whose book On Death and Dying (1969) “caught the public’s imagination” by “offer- ing a vision of a natural death unburdened by technology.” 130 Hospice pio- neer Cicely Saunders had addressed similar issues in her earlier work, Care of the Dying (1959). Barney G. Glaser and Anselm L. Strauss applied the tools of sociological analysis to conduct studies focusing on the way awareness of dying affected patients, hospital staff, and family members and on how the “timing” of death occurred in hospital settings. These studies, published as Awareness of Dying (1965) and Time for Dying (1968), showed that caregivers were reluctant to discuss death and avoided telling patients they were dying. Jeanne Quint Benoliel, who collaborated with Glaser and Strauss, published The Nurse and the Dying Patient (1967), which called for systematic death edu- cation for nurses.

The 1960s were a fruitful period for death studies. John Hinton’s Dying (1967) shed light on contemporary practices and suggested how care of the dying could be improved. In “Death in American Society” (1963), sociologist Talcott Parsons looked at the impact of technological advances in health and medicine on dying. Philosopher Jacques Choron traced the history of ideas and attitudes about death and investigated the fear of death and its meaning for human beings in Death and Western Thought (1963) and Death and Modern Man (1964). Robert Fulton gathered a group of scholars and practitioners to address both theoretical and practical issues in his compila- tion, Death and Identity (1965). During the same era, literary works such as C. S. Lewis’s A Grief Observed (1961) brought attention to issues involving bereavement and mourning.

The progress of death studies during the 1960s continued into the 1970s with works like Avery D. Weisman’s On Dying and Denying: A Psychiatric Study of Terminality (1972), which astutely combined research skills and clinical expe- rience with dying patients, and Ernest Becker’s The Denial of Death (1973), which drew upon a broad range of psychological and theological insights in order to better understand the “terror” of death in human life. Richard Kalish and David K. Reynolds initiated multicultural studies in Death and Ethnicity: A Psychocultural Study (1976). The early 1970s also witnessed the blossoming of the fi rst peer-reviewed journal in the fi eld of death studies, Omega: Journal of Death and Dying, which had begun its life as a newsletter in 1966 with an article in the fi rst issue by Weisman titled “Birth of the Death- People.” 131 This was a decade of collaboration and connection, as individuals recognized a mutual interest manifested in organizations like The Founda- tion of Thanatology, Ars Moriendi (a forerunner of the International Work Group on Death, Dying, and Bereavement, or IWG) and the Forum for Death Education and Counseling (now known as the Association for Death Educa- tion and Counseling, or ADEC). 132

In the decades since these pioneering contributions, Omega has been joined by other scholarly journals, including Death Studies; Journal of Personal and Interpersonal Loss; Illness, Crisis, and Loss; and Mortality (an international journal published in the United Kingdom), and textbooks in thanatology

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34 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

have come on the scene. 133 Meanwhile, books written for a general read- ership, such as Mitch Albom’s Tuesdays with Morrie and Joan Didion’s The Year of Magical Thinking, have become bestsellers, and information about death and dying is now widely available on the Internet. In 1971, the Psychol- ogy Today questionnaire “You and Death” garnered a response from read- ers that exceeded the response to a previous sex questionnaire. A recent study of responses to the questionnaire concluded that “interest in death as a topic was not a passing fad but continues to be a topic of interest across the United States.” 134

The publication of several encyclopedic works covering death studies (including at least one on the Internet) is another sign of the maturing of the fi eld. 135 Clearly, the seeds planted a few decades ago by pioneers have ripened into a thriving interest in dying, death, and bereavement that is evident in both the academic setting and the larger public arena. 136

Tracing the emergence of thanatology, Luciana Fonseca and Ines Testoni write: “Thanatology theory took shape as death studies and research, whereas thanatology practice manifests primarily as formal death education, end-of- life care, and bereavement counseling.” 137 Hannelore Wass observes that thanatology can help individuals and societies transcend self-interest in favor of concern for others. 138 Death studies “is about love, care, and compas- sion . . . about helping and healing.”

Factors Affecting Familiarity with Death The past hundred years have seen dramatic change in the size, shape, and distribution of the American population—that is, its demographics. These changes—the most notable of which involve increased life expectancy and lower mortality rates—signifi cantly affect our expectations about death. In the past, a typical household would include parents, uncles, aunts, and aged grandparents, as well as children of varying ages. Such extended families, with several generations living together under the same roof, are rare today. One consequence is that most of us have fewer opportunities to experience our relatives’ deaths fi rsthand.

Consider how experiences with dying and death have changed. 139 During the late 1800s and early 1900s, individuals typically died at home, often sur- rounded by an extended family that spanned several generations. As death drew near, relatives and friends gathered to maintain a vigil at the bedside. Afterward, they washed the body and prepared it for burial. A home-built coffi n was placed in the parlor of the house, where friends and relatives participated in a wake and shared in mourning the deceased. Death was a domestic experience.

In close-knit communities, a death bell tolled the age of the deceased, giving notifi cation of the death so that others in the community could join in the rites and ceremonies marking the deceased’s passing (see Figure 1-2 ). Children were included in activities surrounding the dead, staying with adults and sometimes sleeping in the same room as the corpse. Later, in a

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Factors Affecting Familiarity with Death 35

family plot at the homeplace or a nearby churchyard cemetery, the coffi n was lowered into the grave, and those closest to the deceased shoveled dirt over the coffi n to fi ll in the grave. Throughout this process, from caring for the dying person through burial, death remained within the realm of the family.

If you were a person living in those times who was suddenly transported to the present, you would likely experience culture shock as you walked into the “slumber room” of a typical mortuary. There, in place of a simple wooden coffi n, you view an elaborate casket. The corpse shows the mortician’s skill in cosmetic restoration. At the funeral, you watch as relatives and friends eulogize the deceased. Ah, that’s familiar, you say—but where is the dear departed? Off to the side a bit, the casket remains closed, death tastefully concealed. At the graveside, as the service concludes, you are amazed to see mourners leaving while the casket lies yet unburied; the cemetery crew will complete the actual burial. You may be most impressed by the fact that the deceased’s family and friends are spectators rather than participants. The tasks of preparing the dead for burial and managing the rites of passage are carried out by hired professionals.

Our familiarity with death has also been powerfully infl uenced by sophis- ticated medical technologies, which have affected both the place where death most often occurs and the manner in which most people die. In contrast to earlier generations, who typically had major roles in the care of their dying and dead, we usually rely on professionals—from the cardiologist to the coro- ner to the cremator—to act as our go-betweens. The net result is that, for most of us, death is unfamiliar.

Life Expectancy and Mortality Rates Since 1900, average life expectancy in the United States has increased

from forty-seven to nearly seventy-nine years (see Figure 1-3 ). 140 Japan, at eighty-three years, has the longest life expectancy of countries worldwide. 141 These fi gures refl ect what demographers call “cohort life expectancy,” mean- ing the average number of years a specifi ed group of infants would live if they were to experience throughout their lives the age-specifi c death rates pre- vailing in their birth year. Thus, for 2011, life expectancy at birth for the U.S. population as a whole was 78.7 years. When this overall U.S. cohort is

You can feel the silence pass over the community as all activity is stopped and the number of rings is counted. One, two, three—it must be the Myer’s baby that has the fever. No, it’s still tolling—four, fi ve, six. There is another pause at twenty—could that be Molly Shields? Her baby is due at any time now—no, it’s still tolling. Will it never stop? Thirty-eight, thirty-nine, another pause—who? It couldn’t be Ben; he was here just yesterday; said he was feeling fi t as a fi ddle—no, it’s starting again. Seventy, seventy-one, seventy-two. Silence. You listen, but there is no sound—only silence. Isaac Tipton. He has been ailing for two weeks now. It must be Isaac.

Figure 1-2 Tolling the Bell

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36 c h a p t e r 1 Attitudes Toward Death: A Climate of Change

broken out into population groups, however, we fi nd that Hispanic females have the longest life expectancy (83.7 years), followed by non-Hispanic white females (81.1 years), Hispanic males (78.9 years), non-Hispanic black females (77.8 years), non-Hispanic white males (76.4 years), and non-Hispanic black males (71.6 years). 142 In addition to differences between birth cohorts, it should be recognized that such fi gures represent statistical life expectancies. The actual life span lived out by any particular individual may well be signifi - cantly shorter or longer than the average for his or her cohort.

Although there are certainly localized and regional variations, wide- spread human longevity is quite recent, occurring in the last century or so. As one writer said, “Despite what the fashion magazines tell you, 40 isn’t the new 30. Seventy is.” 143 Today, we tend to assume that a newborn child will live into his or her seventh or eighth decade, perhaps longer. This was not the case in 1900. Over half of the deaths in 1900 occurred among children age fourteen and younger; now, fewer than 2 percent of deaths occur among this age group. 144 This fact infl uences how we think (or don’t think) about death.

Another way to appreciate the changing impact of death is to examine death rates (which are typically stated as the number of individuals dying per 1000 population in a given year). In 1900, the death rate in America was about 17 per 1000; today, it is about 7.4 per 1000, a record low (see Figure 1-4 ). 145

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