The last dance encountering death and dying study guide

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.

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

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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.

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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 47

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C H A P T E R 2

Learning About Death: Socialization 49

A Child’s Reasoning 50 A Mature Concept of Death 51 Understanding Death Through the Life Course 53

Infancy and Toddlerhood 57 Early Childhood 58 Middle Childhood or School-Age Period 60 Adolescence 62 Emerging Adulthood 64 Early Adulthood 64 Middle Adulthood 65 Later Adulthood 66 The Evolution of a Mature Concept of Death 66

Agents of Socialization 67 Family 68 School and Peers 69 Mass Media and Children’s Literature 72 Religion 76

Teachable Moments 76 The Death of a Companion Animal 78 The Mature Concept of Death Revisited 81 Further Readings 87

C H A P T E R 3

Perspectives on Death: Historical and Cultural 89

Traditional Cultures 92 Origin of Death 92 Names of the Dead 94 Causes of Death 95 Power of the Dead 97

Western Culture 98 The Deathbed Scene 100 Burial Customs 102

Charnel Houses 102 Memorializing the Dead 104

The Dance of Death 104

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Death Masks 106 Invisible Death? 107

Cultural Viewpoints 108 People of Native American Heritage 108 People of African Heritage 112

The LoDagaa of Northern Ghana 114 Traditions Among African Americans 116

People of Hispanic Heritage 117 Attitudes Toward Death in Mexico 118 Día de los Muertos 118

People of Asian Heritage 122 Paper Offerings 127 Ch’ing ming and O-bon Festivals 128

People of Jewish Heritage 129 People of Celtic Heritage 129 People of Arab Heritage 132 People of Oceanian Heritage 132

Mixed Plate: Cultural Diversity in Hawaii 133 Characteristics of Hawaii’s Peoples 133 Death and Local Identity 134

Death in Contemporary Multicultural Societies 136 Further Readings 137

C H A P T E R 4

Death Systems: Mortality and Society 139

Certifi cation of Death 140 The Coroner and the Medical Examiner 141 Autopsies 144 Assessing Homicide 147 Capital Punishment 150 Defi ning Death 151

Conventional Signs of Death and New Technology 153 Conceptual and Empirical Criteria 155 Four Approaches to the Defi nition and Determination of Death 157

Irreversible Loss of Flow of Vital Fluids 157 Irreversible Loss of the Soul from the Body 157 Irreversible Loss of the Capacity for Bodily Integration 159

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Irreversible Loss of the Capacity for Consciousness or Social Interaction 160

The Uniform Determination of Death Act 162

Organ Transplantation and Organ Donation 165 Medical Ethics: A Cross-Cultural Example 170 The Impact of the Death System 172 Further Readings 173

C H A P T E R 5

Health Care: Patients, Staff, and Institutions 175

Modern Health Care 176 Health Care Financing 178 Rationing Scarce Resources 180

The Caregiver-Patient Relationship 181 Disclosing a Life-Threatening Diagnosis 182 Achieving Clear Communication 183 Providing Total Care 185

Care of the Dying 185 Hospice and Palliative Care 187

The Origins of Hospice and Palliative Care 191 Challenges for Hospice and Palliative Care 192 The Future of Hospice and Palliative Care 195

Home Care 196 Social Support 198

Elder Care 199 Trauma and Emergency Care 201 Death Notifi cation 204 Caregiver Stress and Compassion Fatigue 207 A Changing Health Care System 209 Further Readings 210

C H A P T E R 6

End-of-Life Issues and Decisions 213

Principles of Medical Ethics 214 Informed Consent to Treatment 215

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Principles of Informed Consent 215 Preferences Regarding Informed Consent 217

Choosing Death 221 Withholding or Withdrawing Treatment 225 Physician-Assisted Death 226 The Rule of Double Effect 229 Euthanasia 229 Palliative Care and the Right to Die 230 Nutrition and Hydration 231 Seriously Ill Newborns 232

Advance Directives 233 Using Advance Directives 238 Advance Directives and Emergency Care 240

Inheritance: Wills, Probate, and Living Trusts 241 Wills 242

The Formally Executed Will 245 Amending or Revoking a Will 246

Probate 248 The Duties of the Executor or Administrator 248 Laws of Intestate Succession 250

Living Trusts 251

Insurance and Death Benefi ts 253 Considering End-of-Life Issues and Decisions 255 Further Readings 256

C H A P T E R 7

Facing Death: Living with Life-Threatening Illness 259

Personal and Social Meanings of Life-Threatening Illness 261 Coping with Life-Threatening Illness 263

Awareness of Dying 263 Adapting to “Living-Dying” 264 Patterns of Coping 266 Maintaining Coping Potency 269

Treatment Options and Issues 272 Surgery 275 Radiation Therapy 276 Chemotherapy 277 Alternative Therapies 277

The Placebo Effect 280 Unorthodox Treatment 281

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Pain Management 282 The Language of Pain 283 Treating Pain 283

The Dying Trajectory 286 The Social Role of the Dying Patient 289 Being with Someone Who is Dying 292 Further Readings 293

C H A P T E R 8

Last Rites: Funerals and Body Disposition 295

Psychosocial Aspects of Last Rites 298 Announcement of Death 298 Mutual Support 301 Impetus for Coping with Loss 302

Funerals in the United States 303 The Rise of Professional Funeral Services 304 Criticisms of Funeral Practices 306 New and Rediscovered Memorial Choices 309

Selecting Funeral Services 311 Funeral Service Charges 313 Comparing the Costs 314

Professional Services 314 Embalming 315 Caskets 317 Outer Burial Containers 318 Facilities and Vehicles 319 Miscellaneous Charges 319 Direct Cremations and Immediate Burials 319

Funeral and Memorial Societies 321

Body Disposition 321 Burial 324 Cremation 326 Memorialization 328 Laws Regulating Body Disposition 329

New Directions in Funerals and Body Disposition 330 Remembrance Rituals and Linking Objects 333 Making Meaningful Choices 334 Further Readings 339

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C H A P T E R 9

Survivors: Understanding the Experience of Loss 341

Bereavement, Grief, and Mourning 343 Tasks of Mourning 346 Models of Grief 347

Working Through Grief 347 Continuing Bonds with the Deceased 348 Telling the “Story”: Narrative Reconstruction 350 The Dual Process Model of Coping 351 The Two-Track Model of Bereavement 352 Toward an Integrated Model of Grief 353

The Experience of Grief 355 Mental Versus Emotional Responses 355 The Course of Grief 355 The Duration of Grief 358 Complications of Grief 359 The Mortality of Bereavement 362

Variables Infl uencing Grief 364 Survivor’s Model of the World 364

Personality 364 Cultural Context and Social Roles 365 Perceived Relationship with the Deceased 365 Values and Beliefs 367

Coping Patterns and Gender 367 Mode of Death 369

Anticipated Death 370 Sudden Death 371 Suicide 371 Homicide 372 Disaster 372

Multiple Losses and Bereavement Burnout 373 Social Support and Disenfranchised Grief 373 Unfi nished Business 375

Grief Counseling and Grief Therapy 376 Support for the Bereaved 379 Bereavement as an Opportunity for Growth 380 Further Readings 382

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C H A P T E R 1 0

Death in the Lives of Children and Adolescents 385

Experiences with Death 388 Children as Survivors of a Close Death 391

The Bereaved Child’s Experience of Grief 392 The Death of a Parent 393 The Death of a Sibling 395

Children with Life-Threatening Illnesses 399 The Child’s Perception of Serious Illness 400 The Child’s Coping Mechanisms 401 Providing and Organizing Care 402

Pediatric Hospice and Palliative Care 403 Decisions About Medical Treatment 405 Caring for a Seriously Ill Child 406

Support Groups for Children 407 Helping Children Cope with Change and Loss 409

Discussing Death Before a Crisis Occurs 409 Discussions When a Family Member Is Seriously Ill 411 Discussions in the Aftermath of Loss 412

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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1

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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5

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