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Death

Death

I. Death and BereavementJohn W. Riley, Jr.

BIBLIOGRAPHY

II. The Social Organization of DeathRobert W. Habenstein

BIBLIOGRAPHY

I DEATH AND BEREAVEMENT

Death is a personal event that man cannot describe for himself. As far back as we can tell, man has been both intrigued by death and fearful of it; he has been motivated to seek answers to the mystery and to seek solutions to his anxiety. Every known culture has provided some answer to the meaning of death; for death, like birth or marriage, is universally regarded as a socially significant event, set off by ritual and supported by institutions. It is the final rite de passage.

The social and psychological aspects of death have been studied by anthropologists, sociologists, psychologists, and psychiatrists; and the main outlines of their understandings can be summarized on three levels—cultural, social, and individual. The meanings which have been attached to death in most cultures include beliefs in some kind of existence after death; most peoples—save the nonliterate—have entertained theories of personal salvation; and religion, philosophy, and political ideology have provided some answers to man’s quest for the meaning of death. The relationship between death and the social structure has received little systematic attention from social scientists, although there is much research on the social prescriptions for bereavement, especially as these relate to ritualistic mourning and individual grief. Scattered empirical studies suggest that, for the individual in the contemporary Western world, matters of death are less salient than those of living, although there are clear traces of a latent and underlying ambivalence.

Although between fifty and sixty million people die each year, growing proportions of people in the world live into the later years. Thus, many people have the opportunity to contemplate their death, and unknown but even greater numbers of persons are affected by bereavement. For a phenomenon of such wide and pervasive significance, it is curious that the most recent systematic bibliography on the subject of Western social science literature on death and bereavement (Kalish 1965) does not exceed four hundred entries—many of them recent. In our time death has been largely a taboo topic (e.g., see Feifel 1959; Fulton 1965). But attention is now being directed to various social problems involving man’s relationship to death: the problem of death and bereavement for the aged, dilemmas faced by the practitioners who deal with death, risk taking by both nations and individuals, and the social and moral implications of scientific advance in the control of death.

Death and culture

Death raises two kinds of problems that require cultural definitions and norms: those pertaining to one’s own death, and those pertaining to the obligations imposed upon others by the fact of a death. In no known culture is the individual left to face death completely uninitiated. He is provided with beliefs about “the dead” and about his own probable fate after death. Similarly, all these cultures include norms governing the imperatives imposed by death: a corpse must be looked after; the deceased must be placed in a new status; his vacated roles must be filled and his property disposed of; the solidarity of his group must be reaffirmed; and his bereaved must be re-established and comforted (Blauner 1966).

Death in nonliterate society

Systematic analysis of the records on nonliterate peoples shows various recurrent components in their belief systems (Simmons 1945). Belief in a spirit world inhabited by the dead is practically universal among them. There is no clear theory of “natural” death; they believe that death results from the intervention of an outside agent. The culture typically includes a conception, implicit or explicit, of a relationship between the living and the dead. Death is viewed as a crisis through which the deceased enters upon a new status. Symbols of power, either malevolent or benevolent, are attached to the dead. Among the Navajo, for example, actions of the spirits of the dead are generally perceived as being hostile toward the living; while among the Tikopia, where cohesion and continuity between the two worlds is a central theme, the relationship between quick and dead is believed to be benign. Belief in personal salvation appears rare; and, in contrast to the pervasive concerns of civilized man, primitive man seems to have developed no eschatology of rewards and punishments in the worlds populated by the dead (Bellah 1964).

In respect to bereavement practices, anthropologists report great diversity. The actual bereavement period may extend, as it does for the Cocopa, over a period of years; or, as among the Pueblo, it may be but brief and perfunctory. In some cultures, bereavement begins with illness (which may be tantamount to death); in others, it begins only after the disposal of the corpse. In some cultures, the bereaved are required to idolize and placate the deceased, who is certain “to return”; in others, the deceased is held in such great fear that elaborate rituals are required to prevent his taking up his former role in the community (Krupp & Kligfeld 1962). There is, however, no satisfactory general theory to account for these cultural variations.

Historical perspectives

Within recorded history, answers to problems raised by death are found in religion, philosophy, and, to some extent, in political ideology. The major world religions include varying beliefs in a relationship between man’s life on earth and his ultimate fate after death. Rabbinic Judaism developed a detailed theory of a day of judgment. According to the teachings of Zoroaster, the soul is directed at death to balance its good and evil deeds. In the Islamic scheme, Allah is ready to prepare a happy place for the true believer. Buddhism postulates that nirvana (a final beatitude, oblivion) is attainable through a long succession of reincarnations, each mystically related to the karma (deeds) of preceding lives. Similarly, Hinduism rests upon a complex and philosophical relationship between dharma (civic and religious piety) and moksa (the attainment of salvation). The teachings of both Confucius and Lao-tzu carry an implication of salvation in that man must adapt both to the expectations of his ancestors and to cosmic moral law. The religions of East and West differ fundamentally with regard to death and life after death on only two main points. First, for the East, the route to salvation tends to be either contemplative or mystical; for the West, it tends to be ascetic and active. Second, the East views the ultimate outcome as an undifferentiated and impersonal “oneness” with the universe, while the West sees it as the continuation of the integrity of the personal self.

In the history of Western religion, the emergent Christian conception of salvation gave emphasis to an afterlife in which the individual’s identity continues essentially intact. The Roman Catholic church institutionalized the problem of salvation in the relationship of the individual to the priest; anxiety about death is reduced as the individual experiences sin, repentance, atonement, and release. In contrast, the Calvinist concept of predestination intensified anxiety about death and the afterlife, since it regarded man as powerless to control his fate. Thus new forms of conduct and social organization evolved, as Max Weber (1904–1905, pp. 99–128, 155–183 in 1958 edition) points out, to help the early Protestant deal with this increased anxiety; and, to ensure his salvation, the individual turned to a life that emphasized methodical, rational conduct in work and a disciplined family life. In present-day religious thinking, however, the clear connection between death and salvation has become blurred. Schneider and Dornbusch’s (1958) study of popular religion in America (an analysis of the inspirational writings by Norman Vincent Peale, Joshua Loth Liebman, and others) shows a predominant stress on salvation in this life rather than in the next and small preoccupation—since man is assumed to be essentially good—with spiritual preparation for death.

The most active periods of philosophical concern with death tend to coincide with periods of relative inactivity in formal religious institutions (Choron 1963). In Greece during the fifth and fourth centuries b.c., for example, death was a central theme of philosophical speculation. Plato developed his theories of the interlocking relationship of knowledge and the immortality of the soul—a juxtaposition of ideas destined to play a dramatic role in the history of Christendom. During the second and first centuries b.c. in Rome, the problem of death again became a major focus for philosophy; to the Stoics, for example, preparation for death was considered the only proper end of philosophy.

Although the history of Christian belief in eternal life seems to have largely inhibited widespread philosophical treatments of the problem of death in the West, a notable development took shape toward the end of the nineteenth century in the form of existentialism. Contemporary existentialist theories, often obscure and contradictory, are of special interest because of their emphasis upon death. Jean-Paul Sartre, in one view, echoes several earlier philosophical traditions in his argument that the self is finite, that nonbeing follows death, and that the immortality of the soul is a fiction. Sartre thus ignores and despises “the stranger,” which is death. Martin Heidegger, in another view, wants to “disarm” death by taking it into the consciousness. Hence, the individual’s search for the meaning of existence (Dasein) points to death as the ultimate phenomenon of life (Choron 1963). In still another existentialist view, the question posed by death has been reinterpreted to ask: Can the individual cope with the threat of nothingness by replacing his belief in personal immortality with a belief in social immortality?

Various ideologies throughout history have involved such higher principles as patriotism or work in seeking answers to the meaning of death. The Homeric singers extolled death for warriors, promising that they would not be forgotten. The ideology of the Greek polis offered the individual a kind of immortality if his life was sacrificed for the common good—an element in political ideology that has changed little over the centuries. Man has always been willing to die for the state; in the extreme case, even by his own hand (for example, Durkheim’s conception of altruistic suicide). The stress on death for the state typically gains currency during wartime. War consecrates the meaning of death (Warner 1959), and the similarity between the soldier and the man who perishes “in his calling” foreshadows an important element in the ideology of the monolithic state. According to communist doctrine, the individual can reduce his anxiety about death through work and identification with the party. Thus the Russians, like the Puritans, have incorporated work into their ideology as one answer to the threat of death.

Death and society

Death and the changing patterns of mortality are reflected in the structure of society. With the exception of a number of highly significant and institutionalized practices—war, infanticide, cannibalism, ceremonial human sacrifice, capital punishment—social institutions have evolved to facilitate life and to prevent death. The demographic history of man bears out the generalization that he has been more interested in death control than in birth control. Thus, mortality rates have tended to fall faster than fertility rates. Yet, despite an impressive literature on the means for controlling demographic changes, relatively little attention has been paid to the larger problems inherent in the relationship between death and social structure. Two examples will illustrate the range of developing theoretical concern with such problems, although no general theory is yet at hand.

First, the recent work of Blauner (1966) points to the fact that mortality operates on society as a variable, not as a constant. According to this theory, the higher the mortality, the greater the threat to the social system, a threat which is reflected both in ritualistic mourning practices and in the social prescriptions that are activated when deaths occur. In high mortality societies, social relationships tend to be diffuse and widely dispersed throughout the group (everyone knows everyone else), and, when someone dies, the entire community mourns along with the next of kin and close associates. Similarly, in such societies there tend to be prescriptions that “solve” the social problems created by individual deaths. Thus, elaborate kinship rules provide new families for orphaned children, just as such customs as the levirate and sororate provide new spouses for widows and widowers.

In societies with low mortality rates, however, death poses a greater threat to the personality system. In the West today, for example, the small family tends to socialize its members for interpersonal competence, giving bereavement an especially personal significance. Furthermore, since a person’s significant others are concentrated among his close relatives and friends, bereavement reactions tend to be highly varied and individually therapeutic. The most striking exceptions to this tendency are the highly ritualistic occasions produced by the deaths of heads of state and other prominent figures, such as the funeral of President Kennedy.

Findings of recent studies in the United States and Great Britain support such an individualistic emphasis in bereavement practices. In the United States, the appropriate expressions of grief and the length of the bereavement period, rather than following a widely accepted pattern, are found to vary greatly with the circumstances of the death, the status of the deceased, the status of the bereaved, the nature of their former relationship, and the age and sex of both the bereaved and the deceased (although women are permitted a greater display of sorrow than men, the general prescription is “to be brave”). Bereavement, with few social limitations, is susceptible to individual definition to fit individual needs (Bowman 1959). Similarly, a study of bereavement in Britain concludes that “the majority of the population lack common patterns or ritual to deal with bereavement” (Gorer 1965).

A second theoretical approach, developed by Parsons (1963), calls attention to the changing context of death in American society; it notes that increasing proportions of any birth cohort live to the approximate completion of the life cycle and that death has been largely separated from its long and complex relationship to suffering. Thus, the twin threats of suffering and prematurity have been greatly reduced by medical advances. Death is now more often inevitable than adventitious; as early as the beginning of the twentieth century, Sir William Osier was able to report that few of his dying patients died in agony. Within this context, Parsons argues, new orientations toward death are developing that are less influenced by these traditional anxieties.

Parsons classifies the developing orientations into two types: a “normal” or active orientation (consistent with the high evaluation placed by contemporary society on science and activity) that stresses the moral significance of death as the termination of a completed life cycle of effort and achievement; and a deviant orientation that is essentially regressive and fatalistic. To the extent that this “normal” orientation prevails in American society, the individual is expected to “face up” to death in realistic terms, and his bereaved are expected to do their “grief work” quickly and privately—within the intimate circle of family and close associates. At the same time, the deviant orientation to death is also clearly in evidence, and to this Parsons relegates the denial of the reality of death, which some scholars have regarded as the modal American view (as indicated by such phenomena as the impermeability of caskets, the practice of cosmetic embalming, and the lifelike presentation of the corpse). How widespread each type of orientation actually is becomes an empirical question to which studies have only recently begun to be directed.

Apart from such special theories, the over-all relationships between human death and human society have recently been probed by a few writers (for example, Choron 1963; Hoffman 1964; Sulzberger 1961; Brown 1959) but have not yet received systematic theoretical attention from social scientists. Yet the fact of death raises problems on several levels of social structure (Blauner 1966). Mortality challenges social continuity—and societies are universally characterized by institutions for transmitting the heritage from one generation to the next. Mortality threatens the orderly functioning of society—and social structures are universally characterized by mechanisms for replacing deceased performers of social roles. Mortality weakens the group—and groups have traditionally established means, in the face of death, for reassembly and restoration.

Mannheim (1923–1929) pursues one theoretical approach that begins to deal with such broader issues by asking the disarmingly hypothetical question of what society would be like if there were no death. He points to connections between death and other basic processes: as participants in society die, there are roles to be filled by new participants; moreover, since the accumulated heritage can be only imperfectly transmitted, there is a continual process of transition from generation to generation. Consequently, as new participants are able to take a fresh look at society, social change is facilitated. New approaches and solutions are constantly being developed, and old solutions are discarded and forgotten when they are no longer necessary or effective.

While Mannheim’s provocative essay probes a wide range of social phenomena, a more complete theoretical formulation of the adaptive and selective mechanisms implicit in the relationship of death to society might well be possible. Such widely used social science concepts as those pertaining to political succession, property inheritance, kinship structure, socialization—to list but a few—might be transferable to a more general sociological theory of death.

Death and the individual

The historical shift in bereavement practices from a social to an individual emphasis holds important implications for the individual, who must face not only his own death but also the possible loss of close relatives and associates. Despite the importance of the topic, empirical studies of the individual’s relationship to death have been comparatively few and recent. Great obstacles to research are posed by people’s reluctance to discuss so private a matter, as well as by their underlying ambivalence toward death itself. Nevertheless, attempts are now being made to examine different aspects of the individual’s feelings and attitudes, using a variety of research techniques, from projective tests and physiological response measures to interviews of cross-section samples. Reactions have been obtained from several special segments of the population—children, the aged, the dying, the mentally and the physically ill. Certain characteristics of the individual (sex, age, religiosity, education, health, etc.) have been studied as possible factors affecting attitudes toward death. And, although some of the first findings appear inconclusive or confusing, efforts are underway to explain individual attitudes through their interrelationships with the norms of the culture (Volkart & Michael 1957) and to design new research within a broader conceptual framework.

The image of death

While the empirical studies cannot yet support any over-all formulation of individual attitudes toward death, a few examples will illustrate the many clues and suggestive findings now beginning to emerge. One set of studies focuses on children, indicating, for example, that the child’s conception of death develops in stages. Thus, among very young children, prior to the development of the sense of causality, death is seen as reversible, not final (Nagy 1948). Emotional involvement with death tends to vary with stages in the development of the ego structure and with changing cultural pressures and expectations, so that involvement is greater during early childhood and adolescence than during the preadolescent period (Alexander & Adlerstein 1958). Fear of death in children (as well as in adults) has been related in various studies to such disparate phenomena as separation anxiety, sex guilt, physical restraint, fear of the dark, sibling rivalry, and the castration complex.

Another set of studies emphasizes the importance, for the dying individual, of a secure environment and a return to primordial kinship ties. Most subjects who know they are to die say they prefer to die at home and to be surrounded by families and friends (Fulton 1965; Feifel 1959). Elderly subjects are less apprehensive about death if they live in familiar surroundings and with relatives (or even in homes for the aged) rather than alone. Such indications point to a need for social support that may be out of keeping with present tendencies toward hospitalizing and isolating the dying individual (Glaser & Strauss 1965). And the increasing majority of people do, in fact, die in hospitals (Fulton 1965).

A series of small studies attempting to connect a person’s religion with his attitudes toward death has thus far produced inconclusive findings—in part because of conceptual differences in the attitudes studied and the specialized populations examined. Thus, fear of death is variously reported to increase with religious orientation, or to decline with religious activity. Some studies report that more thought is given to death by the religiously inclined. Other studies show no association whatsoever between religious conviction and attitudes toward death. While there are no satisfactory empirical data at hand to link these apparently conflicting findings, greater consistency will undoubtedly be found as research takes into account the differing definitions of death emphasized by the several religions and the differing needs met by religion in the various sectors of society.

Two other types of research offer preliminary support for Parsons’ argument regarding the development of an active orientation toward death as contrasted with the denial of its reality. In one strand, a few small but cogent studies suggest that many persons fear their own death largely because death eliminates the opportunity to achieve goals important to self-esteem and that death may appear appropriate to the dying under conditions of dignity and personal fulfillment (e.g., Diggory & Rothman 1961). The second type of research deals with people’s concerns with death in comparison with their concerns about the problems of life and studies the modes of their adaptation to death. A cross-section study of the adult population of the United States by Rosalie Goldwater and John W. Riley, Jr. (the results of this study were being analyzed in 1966, but had not yet been published) shows that large majorities report frequent concern with such problems as health (76 per cent) and money matters (74 per cent), in contrast to a minority who say they think often about the uncertainty of their own lives or about the possible death of someone else (32 per cent). That this lack of concern does not reflect a general “denial” of death is indicated by the finding that 85 per cent, in response to a question concerning different ways of adjusting to the uncertainty of life, concur that people should “try to make some plans about death.” Although relatively few adult Americans have executed wills (24 per cent) or made funeral or cemetery arrangements (28 per cent), eight out of ten have purchased life insurance, and half have made a point of talking about death with those closest to them (for a preliminary account of some of these findings, see Riley 1964).

Further analysis shows connections in this study between these views of death and the respondents’ educational attainment and age (analyzed jointly). The higher the education, the less negative the respondent’s image of death, the less his expressed anxiety about death, and the more active his adaptation to death. This suggests that, as the general level of education in the Western world rises, a new orientation toward death may be in the making, however many defense mechanisms may be operative. Furthermore, older people are more likely than their younger counterparts (at any given educational level) to reveal an active orientation to death and to disavow the idea that one should ignore death or avoid making plans. Similarly, other studies note that, among the aged, approaching death seems to provoke less anxiety (Cumming & Henry 1961); whereas among the young (adolescents), there is little structuring of the future and low tolerance for the idea of death (Kastenbaum 1964). Thus, an active adaptation to death seems to become greater as individuals come nearer to completing the life cycle.

Bereavement

Death means to the individual not only his own demise but also the loss of other people who are significant to him. From a psychological standpoint, bereavement—generally held to signify the emotional state and behavior of the survivor following the death of a person who fulfilled dependency needs—is a temporary condition from which the individual is expected to recover. Studies of grief reactions to death have identified such syndromes of associated psychological and physiological symptoms as somatic distress, preoccupation with the image of the deceased, guilt, hostile reactions, and loss of established patterns of conduct (Lindemann 1944). Freud (1915), whose classic work has afforded the theoretical foundation for the psychiatric literature on melancholia, paranoid reactions, and other emotional concomitants of bereavement, argued that recovery from the grief syndrome requires a process of reality testing to demonstrate that the loved object no longer exists; only when this process is complete is the ego free again. Mourning, then, is a psychological task to be performed (Krupp & Kligfeld 1962).

From a sociological standpoint, the bereaved individual may be aided through rituals and the support of family and friends to resume his usual social obligations after the mourning period (Eliot 1932). In this perspective, the task is to re-establish the systems of relationships interrupted by death or to develop new ones. Durkheim originally specified the function of ritual in enabling bereaved persons to cope with death (1912, pp. 445, 448 in 1961 edition): “When someone dies, the family group to which he belongs feels itself lessened and, to react against this loss, it assembles. … The group feels its strength gradually returning to it; it begins to hope and to live again.” Various studies suggest, however, that such social supports often work imperfectly. A large-scale British survey, for example, shows that the help afforded by family gatherings and religious ceremonies is limited to the period of initial shock; for the subsequent period of intense mourning and physiological stress, the bereaved is typically left alone, bereft of attention or affect from the external world (Gorer 1965). Thus societal supports may be ill designed to meet the needs of those who must live through bereavement and come to terms with grief.

The psychological response of the survivor and his need for social support depend upon many factors, and especially upon who has been lost—a child, a parent, a distant friend; in particular, many studies have focused upon the loss of a spouse. The majority of the widowed are older people, for whom the death of a spouse can leave a void that may never be filled, and research has called attention to the associated problems of financial support, changes in housing and daily routine, and social isolation. To be sure, the most extreme sense of desolation occurs with recency of bereavement and tends to decrease over the subsequent years (Kutner et al. 1956). Yet, numerous studies comparing widowed with married persons have consistently shown that the widowed have reduced contacts with their children, intensified feelings of loneliness, higher suicide rates, and higher death rates.

Some current issues

Two specific problems related to the meaning of death are engaging the research efforts of social scientists: the problems of an aging population who are approaching death, and the role conflicts experienced by those who must deal with death (doctors, nurses, ministers, life insurance agents, undertakers). There is increasing concern with the morale and living conditions of the aged. For instance, with death imminent, is disengagement from social relations to be preferred over continued activity (Cumming & Henry 1961)? Should age-homogeneous retirement facilities for the elderly be gradually developed? What are the relative responsibilities of public and private pension plans? Of the family? The solutions to such problems (of which there are many) are being sought by a wide variety of social science researchers.

Role conflicts among those who deal professionally with death are also being increasingly identified and studied. The clergy ponder the distinction between faith and therapy; doctors debate the Hippocratic mandate that life must be preserved at all costs; and nurses are caught between the demands of recuperating and dying patients. Life insurance agents attempt both euphemistic and realistic approaches in their efforts to bring into salience the uncertainty of life; while undertakers, constant reminders of the certainty of death, are berated as “grief therapists” and commercializers of ritual (Mitford 1963; Fulton 1965).

The ambiguity of death is also to be seen in various other fields of scientific advance. Although the law generally holds that death occurs when auscultation can no longer detect a heartbeat, such a definition is frequently made obsolete in routine medical practice. Distinctions are drawn between clinical death (of the organism) and biological death (of the organs), so that the time of death is increasingly a matter for decision, and moral questions arise as to the individual’s “right to die with dignity.” An important issue in the ethics of birth control is also involved—does the intrauterine device cause an abortion and hence a death? Furthermore, while science can neither prove nor disprove the hypothesis of some form of communication between living and dead, recent research in the field of parapsychology, reactivating an old tradition of psychic research (Myers 1903), is demanding attention from reputable scientists. To be sure, the “findings” of such research have not yet earned a place in the framework of modern science, but such efforts cannot be completely ignored. Finally, with the discovery that cells can be kept alive (apparently indefinitely) in a nutrient medium and that such cells can perhaps be reconstituted through the process of genetic transformation, biological immortality itself can no longer be entirely ruled out. Thus science in various ways challenges the social definition of death.

John W. Riley, Jr.

[Directly related is the entryAging. Other relevant material may be found inKinship, article ondescent groups; Life cycle; Llfe tables; Mortality; Ritual.]

BIBLIOGRAPHY

Alexander, Irving E.; and Adlerstein, Arthur M. 1958 Affective Responses to the Concept of Death in a Population of Children and Early Adolescents. Journal of Genetic Psychology 93:167–177.

Bellah, Robert N. 1964 Religious Evolution. American Sociological Review 29:358–374.

Blauner, Robert 1966 Death and Social Structure. Psychiatry 29:378–394.

Bowman, Leroy 1959 The American Funeral: A Study in Guilt, Extravagance, and Sublimity. Washington: Public Affairs Press.

Brown, Norman O. 1959 Life Against Death: The Psychoanalytic Meaning of History. Middletown, Conn.: Wesleyan Univ. Press.

Choron, Jacques 1963 Death and Western Thought. New York: Collier.

Choron, Jacques 1964 Modern Man and Mortality. New York: Macmillan.

Cumming, Elaine; and Henry, William E. 1961 Growing Old: The Process of Disengagement. New York: Basic Books.

Diggory, James C.; and Rothman, Doreen Z. 1961 Values Destroyed by Death. Journal of Abnormal and Social Psychology 63:205–210.

Durkheim, Émile (1912) 1954 The Elementary Forms of the Religious Life. London: Allen & Unwin; New York: Macmillan. → First published as Les formes elementaires de la vie religieuse, le systeme totemique en Australie. A paperback edition was published in 1961 by Collier.

Eliot, Thomas D. 1932 The Bereaved Family. American Academy of Political and Social Science, Annals 160:184–190.

Feifel, Herman (editor) 1959 The Meaning of Death. New York: McGraw-Hill.

Freud, Sigmund (1915) 1959 Thoughts for the Times on War and Death. Volume 4, pages 288–317 in Sigmund Freud, Collected Papers. International Psychoanalytic Library, No. 10. New York: Basic Books; London: Hogarth. → First published as “Zeitgemasses üiber Krieg und Tod.”

Fulton, Robert L. (editor) 1965 Death and Identity. New York: Wiley.

Glaser, Barney; and Strauss, Anselm 1965 Awareness of Dying: A Study of Social Interaction. Chicago: Aldine.

Goody, J. R. 1962 Death, Property and the Ancestors: A Study of the Mortuary Customs of the Lodagaa of West Africa. Stanford Univ. Press.

Gorer, Geoffrey 1965 Death, Grief, and Mourning. New York: Doubleday.

Hertz, Robert (1907–1909) 1960 Death and The Right Hand. Glencoe, III.: Free Press. → First published as “La représentation collective de la mort” in Volume 10 of L’année sociologique and as “La prééminence de la main droite” in Volume 34 of Revue philosophique.

Hocking, William E. 1957 The Meaning of Immortality in Human Experience. New York: Harper.

Hoffman, Frederick J. 1964 The Mortal No: Death and the Modern Imagination. Princeton Univ. Press.

Kalish, Richard A. 1965 Death and Bereavement: A Bibliography. Journal of Human Relations 13:118–141.

Kastenbaum, Robert (editor) 1964 New Thoughts on Old Age. New York: Springer.

Krupp, George R.; and Kligfeld, Bernard 1962 The Bereavement Reaction: A Cross-cultural Evaluation. Journal of Religion and Health 1:222–246.

Kutner, Bernard et al. 1956 Five Hundred Over Sixty: A Community Survey on Aging. New York: Russell Sage Foundation.

Lindemann, Erich 1944 Symptomatology and Management of Acute Grief. American Journal of Psychiatry 101:141–148.

Mannheim, Karl (1923–1929) 1952 Essays on the Sociology of Knowledge. Edited by Paul Kecskemeti. New York: Oxford Univ. Press.

Mitford, Jessica 1963 The American Way of Death. New York: Simon & Schuster.

Myers, Frederick W. H. (1903) 1954 Human Personality and Its Survival of Bodily Death. 2 vols. New York: Longmans.

Nagy, Maria 1948 The Child’s Theories Concerning Death. Journal of Genetic Psychology 73:3–27.

Parsons, Talcott 1963 Death in American Society: A Brief Working Paper. American Behavioral Scientist 6:61–65.

Riley, John W. Jr. 1964 Contemporary Society and the Institution of Life Insurance. Journal of the American Society of Chartered Life Underwriters 18, no. 2:93–103.

Schneider, Louis; and Dornbusch, Sanford M. 1958 Popular Religion: Inspirational Books in America. Univ. of Chicago Press.

Simmons, Leo W. 1945 The Role of the Aged in Primitive Society. New Haven: Yale Univ. Press.

Sulzberger, Cyrus 1961 My Brother Death. New York: Harper.

Volkart, Edmund H.; and Michael, Stanley T. 1957 Bereavement and Mental Health. Pages 281–304 in Alexander H. Leighton et al. (editors), Explorations in Social Psychiatry. New York: Basic Books.

Warner, W. Lloyd 1959 The Living and the Dead: A Study of the Symbolic Life of Americans. New Haven: Yale Univ. Press.

Weber, Max (1904–1905) 1930 The Protestant Ethic and the Spirit of Capitalism. Translated by Talcott Parsons, with a foreword by R. H. Tawney. London: Allen & Unwin; New York: Scribner. → First published in German. The 1930 edition has been reprinted frequently.

II THE SOCIAL ORGANIZATION OF DEATH

The physical extinction of its members, not all at the same time but all eventually, is a contingency that every human group must face. Each death initiates significant responses from those survivors who in some way have personally or vicariously related to the deceased. Inevitably, the collectivities in which the dead person held membership also react. Despite the social (symbolic) ambiguity presented by the dead body, the survivors continue to relate to it for some time with predeath imagery. At the same time, they must attempt to cope with emotions no longer secured within the pre-existing balance of interpersonal relations.

The reciprocal problem for the social group or collectivity remains the reassigning and reassembling of social roles and statuses, optimally in such fashion that not only is the social order in some measure re-established but the survivors affected by the death are re-equipped with images and symbols appropriate for building and sustaining an altered yet viable self-conception. This group problem forms the basis for the treatment of mortuary behavior that follows. No categorical separation is attempted between the personal and organizational dimensions of the subject. The emphasis remains, however, on the latter.

Death as passage

No social group socializes and controls members with a cosmology that categorically holds out death as nothing more than the total eclipse of the person. To the primitive and preliterate, the opposite orientation is more likely. The belief that life is not the end underlies some of the ritual behavior of all peoples. It is perhaps a necessary premise to the development of human culture.

A corollary premise suggests that the death of a society is inconceivable by its members, inasmuch as their belief and symbol systems link man and society reciprocally. Total obliteration of the person would so challenge the grounds for society’s existence that the very idea constitutes, in effect, a sacrilege.

Possibly the most elementary and universal response is found in the conception of death as a transition or journey, as a series of happenings rather than an event complete in itself. The notion of transition implies qualitative changes in time and place. Consequent to death, secular time and location are replaced by sacred time and existence in another world, in which the spirit is either absorbed or exists with some measure of individuality. Recognition cannot help but be given to physical dissolution of the dead body, but the force or entity that gave the body life is held to be only transformed but never extinguished. All great religious systems seemingly build on this principle; its universality directs attention, then, to death as a passage or as stages in the career of some life force that for a time inhabits the body but neither begins nor ends with it.

Channeling of death responses

For the survivors the death of an intimate has its most immediate diate consequence in vaguely or distinctly felt ambiguity and confusion. The intensity of the individual response will be roughly proportionate to the intensity of the interpersonal interaction, vicarious as well as face-to-face, that the survivor enjoyed with the deceased. For these individuals, as well as for the group, the response will in great measure vary with the difficulty of replacing the departed member in an ongoing system of role and status relationships.

The channeling of basic human sentiments is never an automatic process, nor is it possible to guarantee that the collectivity suffering such rupture in its affairs will not react so violently as to threaten all operating institutions. Whatever the rationale or general belief about the nature of death, elaboration into a set of operative prescriptions for behavior proceeds expeditiously in the context of symbolically ritualized ceremonials. The social prescriptions surrounding death do not unequivocally control the responses of individuals and groups to the phenomenon of death. Personal reactions where these prescriptions are embracing, as in preliterate, tribal societies, may seem reflexive. But it would be incorrect to assume that the emotional responses of the survivors must and do coincide exactly with the demands of a socially prescribed mortuary etiquette. Death of an intimate always results in some loss of the bereaved ego— an impoverishment of self—and when the association has been close, whether characterized by positive or negative sentiments, the loss will trigger off emotional responses that can overflow the channels for appropriate mortuary behavior provided by the culture.

The effectiveness of death rituals stems from the fact that, through the medium of a sacred-symbol system, they assist man in defining his relations to himself, his fellow man, and the cosmos. Rites are for the most part performed or engaged in collectively; the representations thus evoked and expressed in ritual carry the authority and sanction of society itself. Mortuary rites characteristically operate to give meaning and sanction to the separation of the dead person from the living, to help effect the transition of the spirit, soul, or life force into an otherworldly realm, and to assist in the incorporation of the spirit of the dead into its new existence.

Ritualization and the drama of funerals

Ritualization of mortuary behavior evokes new or changed self-conceptions, insofar as it serves to move people from moments of personal confusion and ego impoverishment toward a restructuring of identity. Through such ritualization the “work of grief,” as postulated in dynamic psychology, is expedited by the meaningful social interaction of the bereaved survivors. Since this interaction involves role playing, such rearrangement as occurs through the emergence of new or different roles resolves the anomaly of the incumbentless role created by death.

The actual disposal of the dead body is generally handled in a number of ritual-bearing scenes or episodes. Once properly prepared for the funeral, the corpse will receive some form of attention from the survivors. Family and close kin, friends and neighbors, usually have the greatest emotional involvement, although where kin, sib, and clan bonds are strong, more extensive prescriptions for mortuary behavior channel and sanction the emotional and physical behavior of the most closely, as well as the most distantly, related.

Funerals for the dead are matters of dramatic and sacred moment. The manner of disposal of the body, the role of the corpse in the ritual, and the utilitarian care of the dead is highly variable from group to group. Despite preliminary magico-religious prophylactic and propitiatory acts of the survivors, bodies may still be considered so representative of virulence and danger that, as in the case of the Kaingang in South America, they may be abandoned in terror. In like manner, the Navajo and other Indian tribes in the southwestern United States quickly bury the body along with many, if not all, of its earthly effects; the deceased’s dwelling, if he died there, is abandoned and never reused. At another extreme, common among the Malayo-Polynesians, the corpse may for a long period of time be kept on display close at hand, seemingly benign or positive in its influence, or be temporarily sequestered until the remaining burial rites are performed.

Disposal of the dead emphasizes the separation of the physical dead from the society of the living. The role of the specialist, such as the priest, medicine man, shaman, or spiritual intercessor, is crucial at this juncture, since it is through ritualized actions, organized into episodes or scenes, that both the dead and the living are moved on to new points of orientation and to new status positions. The point to be emphasized is that mortuary ceremonials affect the individual’s sense of identity, or self, and provide entry into and departure from the system of roles and status relationships in the society. It is for this reason that funerals have the basic potential for the highest order of social significance. Within the framework of mortuary ceremonies, society-specific patterns of belief and action centering on death and burial arise to express or achieve other purposes, among which are the descent of property, authority, and sexual privilege and the enhancement of a popular aesthetic of beauty in death; or the projection of cults of personality, rationality, or pragmatism. Dramatization of all such purposes—even that of expressing indifference—may achieve a measure of functional autonomy.

Robert W. Habenstein

BIBLIOGRAPHY

Feifel, Herman (editor) 1959 The Meaning of Death. New York: McGraw-Hill.

Freud, Sigmund (1917) 1959 Mourning and Melancholia. Volume 4, pages 152–170 in Sigmund Freud, Collected Papers. International Psycho-analytic Library, No. 10. New York: Basic Books; London: Hogarth.

Fulton, Robert L. (editor) 1965 Death and Identity. New York: Wiley.

Gennep, Arnold van (1908) 1960 The Rites of Passage. London: Routledge; Univ. of Chicago Press. → First published in French. A classic anthropological essay on birth, puberty, marriage, childbirth, and death.

Gluckman, Max (editor) 1962 Essays on the Ritual of Social Relations. Manchester (England) Univ. Press.

Goody, J. R. 1962 Death, Property and the Ancestors: A Study of the Mortuary Customs of the Lodagaa of West Africa. Stanford (Calif.) Univ. Press.

Gorer, Geoffrey 1965 Death, Grief, and Mourning. New York: Doubleday.

Habenstein, Robert W. 1954 The American Funeral Director: A Study in the Sociology of Work. Ph.D. dissertation, Univ. of Chicago.

Habenstein, Robert W.; and Lamers, William M. 1961 Funeral Customs the World Over. Milwaukee, Wis.: Bulfin.

Henry, Jules 1964 Jungle People: A Kaingang Tribe of the Highlands of Brazil. New York: Random House.

Hertz, Robert (1907–1909) 1960 Death and The Right Hand. Glencoe, III.: Free Press. → First published as “La représentation collective de la mort” in Volume 10 of L’année sociologique, and “La prééminence de la main droite” in Volume 34 of Revue philosophique.

Kephart, William M. 1950 Status After Death. American Sociological Review 15:635–643.

Lindemann, Erich 1944 Symptomatology and Management of Acute Grief. American Journal of Psychiatry 101:141–148.

Malinowski, Bronislaw (1916–1941)1948 Magic, Science and Religion, and Other Essays. Glencoe, III.: Free Press. → A paperback edition was published in 1954 by Doubleday.

Radcliffe-Brown, A. R. (1922) 1948 The Andaman Islanders. Glencoe, I11.: Free Press.

Simmons, Leo W. 1945 The Role of the Aged in Primitive Society. New Haven: Yale Univ. Press.

Volkart, Edmund H.; and MICHAEL, STANLEY T. 1957 Bereavement and Mental Health. Pages 281–304 in Alexander H. Leighton et al. (editors), Explorations in Social Psychiatry. New York: Basic Books.

Warner, W. Lloyd 1959 The Living and the Dead: A Study of the Symbolic Life of Americans. New Haven: Yale Univ. Press.

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Death

Death

Accounts of the moments before and after death abound with reports of paranormal phenomena, including apparitions of the dying in distant places and phantom forms seen by the dying and occasionally by others. Such near-death apparitions remain a topic of intense debate in both psychological and parapsychological circles. Those who accept a psychic explanation of near-death experiences assert that the individual's spirit, when near to being freed from its connection to the body, is immersed in two planes of existence and acts in both the material and spiritual worlds. Many reports also exist in which persons who were dead returned to life and remembered their experience of death. They verify an often-told story that in the last moments of earthly existence a panorama of the person's life flashes by.

Near-Death Experiences

A Professor Heiron of Zurich slipped in the Alps on a snow covered crag, slid head first about a mile, and then shot 60 feet through the air, landing on his head and shoulders. He was not killed. Returning to consciousness, he not only testified to having seen a panoramic view of his life but also said he had heard the most delightful music. He interviewed many people who had a similar experiences; the great rapidity of mental action and the absence of terror and pain was narrated by all of them.

Prof. A. Pastore of the Royal Lyceum at Genoa relates his experience in the Annals of Psychic Science of February 1906:

"I have been through a very severe illness. At the crisis, when I had entirely lost consciousness of physical pain, the power of my imagination was increased by an extraordinary degree, and I saw clearly in a most distinct confusion (two words which do not accord, but which, in this case, are the only ones which will express the idea). I saw myself as a little boy, a youth, a man, at various periods of my life; a dream, but a most powerful, intense living dream. In that immense, blue, luminous space my mother met memy mother who had died four years previously. It was an indescribable sensation. Rereading the Phaedo of Plato after that experience, I was better able to under-stand what Socrates meant."

Still more is told by Leslie Grant Scott in Psychic Research (March 1931):

"Dying is really not such a terrifying experience. I speak as one who has died and come back, and who found Death one of the easiest things in lifebut not the returning. That was difficult and full of fear. The will to live had left me and so I died. I had been ill for some time but not seriously so. I was in a rundown condition, aggravated by the tropical climate in which I was then living. I was in bed, a large old fashioned bed, in which I seemed lost. I lay there quietly thinking and feeling more at peace than I had felt for some time. Suddenly my whole life began to unroll before me and I saw the purpose of it. All bitterness was wiped out for I knew the meaning of every event and I saw its place in the pattern. I seemed to view it all impersonally, but yet with intense interest and, although much that was crystal clear to me then has again become somewhat veiled in shadow, I have never forgotten or lost the sense of essential justice and rightness of things."

After telling of the doctor's visit and his attempts at reviving him, Scott continues:

"My consciousness was growing more and more acute. It seemed to have expanded beyond the limits of my physical brain. I was aware of things I had never contacted. My vision was also extended so that I could see what was going on behind my back, in the next room, even in distant places. I wondered if I should close my eyes or leave them open. I thought that it would be less gruesome for those around me if they were closed, and so I tried to shut thembut found that I could not. I no longer had any control over my body. I was dead. Yet I could think, hear and see more widely than ever before. From the next room came great engulfing waves of emotion, the sadness of a childhood companion. My increased sensitiveness made me feel and understand these things with an intensity hitherto unknown to me. The effort to return to my body was accompanied by an almost unimaginable sensation of horror and terror. I had left without the slightest struggle. I returned by an almost superhuman effort of will."

Sometimes, it appears, the return is automatic and against the will of the dying. In the Proceedings of the Society for Psychical Research (SPR) (vol. 8, 1892), F. W. H. Myers published the narrative of a Dr. Wiltse (first printed in the St. Louis Medical and Surgical Journal, November 1889), who, in a state of apparent death, lost all power of thought or knowledge of existence. Half an hour later, his narrative continues,

"I came again into a state of conscious existence and discovered that I was still in the body and I had no longer any interests in common. I looked with astonishment and joy for the first time upon myselfthe me, the real Ego, while the not me closed upon all sides like a sepulchre of clay. With all the interest of a physician I beheld the wonders of my bodily anatomy, intimately interwoven with which even tissue for tissue, was I, the living soul of that dead body. I realised my condition and calmly reasoned thus, I have died, as man terms death, and yet I am as much a man as ever. I am about to get out of the body. I watched the interesting process of the separation of soul and body. By some power, apparently not my own, the Ego was rocked to and fro, laterally as the cradle is rocked, by which process its connection with the tissues of the body was broken up. After a little while the lateral motion ceased, and along the soles of the feet, beginning at the toes, passing rapidly to the heels, I felt and heard, as it seemed, the snapping of innumerable small cords. When this was accomplished I began slowly to retreat from the feet, towards the head, as a rubber cord shortens. I remember reaching the hips and saying to myself: 'Now there is no life below the hips.' I can recall no memory of passing through the abdomen and chest, but recollect distinctly when my whole self was collected in the head, when I reflected thus: 'I am all the head now, and I shall soon be free.' I passed around the brain as if I were hollow, compressing it and its membranes slightly on all sides towards the centre and peeped out between the sutures of the skull, emerging like the flattened edges of a bag of membranes. I recollect distinctly how I appeared to myself something like a jelly-fish as regards colour and form. As I emerged, I saw two ladies sitting at my head. I measured the distance between the head of my cot and the knees of the lady opposite the head and concluded there was room for me to stand, but felt considerable embarrassment as I reflected that I was about to emerge naked before her, but comforted myself with the thought that in all probability she could not see me with her bodily eyes, as I was a spirit. As I emerged from the head I floated up and down and laterally like a soap bubble attached to the bowl of a pipe, until I at last broke loose from the body and fell lightly to the floor, where I slowly rose and expanded to the full stature of a man. I seemed to be translucent, of a bluish cast and perfectly naked. With a painful sense of embarrassment, I fled towards the partially open door to escape the eyes of the two ladies whom I was facing, as well as others whom I knew were about me, but upon reaching the door I found myself clothed, and satisfied upon that point, I turned and faced the company. As I turned, my left elbow came in contact with the arm of one of two gentlemen who were standing in the door. To my surprise, his arm passed through mine without apparent resistance, the severed parts closing again without pain, as air reunites. I looked quickly up at his face to see if he had noticed the contact but he gave me no signonly stood and gazed toward the couch I had just left. I directed my gaze in the direction of his, and saw my own dead body.

"Suddenly I discovered that I was looking at the straight seam down the back of my coat. How is this, I thought, how do I see my back? and I looked again, to reassure myself, down the back of the coat or down the back of my legs to the very heels. I put my hand to my face and felt for my eyes. They are where they should be, I thought. Am I like an owl that I can turn my head half way round? I tried the experiment and failed.

"No! Then it must be that having been out of the body but a few moments I have yet the power to use the eyes of the body, and I turned about and looked back in at the open door where I could see the head of my body in a line with me. I discovered then a small cord, like a spider's web, running from my shoulders back to my body and attaching to it at the base of the neck, in front.

"I was satisfied with the conclusion that by means of that cord, I was using the eyes of my body and turning, walked down the street. a small, densely black cloud appeared in front of me and advanced toward my face. I knew that I was to be stopped. I felt the power to move or to think leaving me. My hands fell powerless at my side, my shoulders and my head dropped forward and I knew no more.

"Without previous thought and without great effort on my part, my eyes opened. I looked at my hands and then at the little white cot upon which I was lying and, realising that I was in the body, in astonishment and disappointment I exclaimed: What in the world has happened to me? Must I die again?"

The clairvoyant description by Spiritualist medium Andrew Jackson Davis of the process of dying in Death and the After Life (1865) is often quoted. He writes:

"Suppose the person is now dying. It is to be a rapid death. The feet first grow cold. The clairvoyant sees right over the head what may be called a magnetic halo, an ethereal emanation, in appearance golden, and throbbing as though conscious. The body is now cold up to the knees and elbows, and the emanation has ascended higher in the air. The legs are cold to the hips and the arms to the shoulders; and the emanation, though it has not risen higher in the room, is more expanded. The death-coldness steals over the breast and around on either side, and the emanation has attained a higher position near the ceiling. The person has ceased to breathe, the pulse is still, and the emanation is elongated and fashioned in the outline of the human form. Beneath it is connected with the brain. The head of the person is internally throbbinga slow, deep throbnot painful, like the beat of the sea. Hence, the thinking faculties are rational, while nearly every part of the person is dead. Owing to the brain's momentum, I have seen a dying person, even at the last feeble pulsebeat, rouse impulsively and rise up in bed to converse with a friend; but the next instant he was gonehis brain being the last to yield up the life principle. The golden emanation, which extends up midway to the ceiling, is connected with the brain by a very fine life-thread. Now the body of the emanation ascends. Then appears something white and shining, like a human head; next, in a very few moments, a faint outline of the face divine; then the fair neck and beautiful shoulders; then, in rapid succession, come all parts of the new body down to the feeta bright shining image, a little smaller than its physical body, but a perfect prototype, or reproduction in all except its disfigurements. The fine life-thread continues attached to the old brain. The next thing is the withdrawal of the electric principle. When this thread "snaps" the spiritual body is free and prepared to accompany its guardians to the Summer Land. Yes, there is a spiritual body; it is sown in dishonor and raised in brightness."

The description is paralleled by the curious case sent by a Dr. Burgers to Richard Hodgson in 1902 and published in the Journal of the SPR (vol. 13, 1908). In it a Mr. G. gives this account of the death of his wife:

"At half-past six I urged our friends, the physician and nurses to take dinner. All but two left the room in obedience to my request.

"Fifteen minutes later I happened to look towards the door, when I saw floating through the doorway three separate and distinct clouds in strata. Each cloud appeared to be about four feet in length, from six to eight inches in width, the lower one about two feet from the ground, the others at intervals of about six inches.

"My first thought was that some of our friends were standing outside the bedroom smoking, and that the smoke from their cigars was being wafted into the room. With this idea I started up to rebuke them, when lo! I discovered there was no one standing by the door, no one in the hall-way, no one in the adjoining rooms. Overcome with astonishment I watched the clouds; and slowly, but surely these clouds approached the bed until they completely enveloped it. Then, gazing through the mist, I beheld standing at the head of my dying wife a woman's figure about three feet in height, transparent, yet like a sheen of brightest gold; a figure so glorious in its appearance that no words can be used fitly to describe it. She was dressed in the Grecian costume, with long loose and flowing sleevesupon her head a brilliant crown. In all its splendour and beauty the figure remained motionless with hands uplifted over my wife, seeming to express a welcome with a quiet glad countenance, with a dignity of calmness and peace. Two figures in white knelt by my wife's bedside, apparently leaning towards her; other figures hovered above the bed, more or less distinct.

"Above my wife, and connected with a cord proceeding from her forehead, over the left eye, there floated in a horizontal position a nude, white figure, apparently her astral body. At times the suspended figure would lie perfectly quiet, at other times it would shrink in size until it was no longer than perhaps eighteen inches, but always was the figure perfect and distinct; a perfect head, a perfect body, perfect arms and perfect legs. When the astral body diminished in size it struggled violently, threw out its arms and legs in an apparent effort to escape. It would struggle until it seemed to exhaust itself, then become calm, increase in size, only to repeat the same performance again and again.

"This vision, or whatever it may be called, I saw continuously during the five hours preceding the death of my wife. Interruptions, as speaking to my friends, closing my eyes, turning away my head, failed to destroy the illusion, for whenever I looked towards that deathbed the spiritual vision was there. All through these five hours I felt a strange feeling of oppression and weight upon my head and limbs; my eyes were heavy as if with sleep, and during this period the sensations were so peculiar and the visions so continuous and vivid that I believed I was insane, and from time to time would say to the physician in charge: 'Doctor, I am going insane.'

"At last the fatal moment arrived; with a gasp, the astral figure struggling, my wife ceased to breathe, she apparently was dead: however, a few seconds later she breathed again, twice, and then all was still. With her last breath and last gasp, as the soul left the body, the cord was severed suddenly and the astral figure vanished. The clouds and the spirit forms disappeared instantly, and, strange to say, all the oppression that weighed upon me was gone; I was myself, cool, calm and deliberate, able to direct, from the moment of death, the disposition of the body, its preparation for a final resting place."

Mr. G. was known to be hostile to Spiritualism, and the physician in attendance appended a statement to the effect that he had known him long enough to affirm that he had no tendency to any form of mental delusion.

Phenomena at Death

Watchers by the deathbed have often claimed to hear rushing sounds and see some kind of curious luminosity. Hyppolite Baraduc attempted to secure a photographic record when his son and wife died. He found that in each case a luminous, cloud-like mass apparently hovered over the bodies and appeared on the photographic plate.

Telekinetic phenomena (see movement ) have been known to occur before death. A Mme. Martillet and a Mme. Claudet, who nursed Alfred de Musset in his last illness, said that as he lay in his armchair they saw by the light of the lamp that he was looking at the bell near the mantelpiece. But he was so feeble that he could not rise. "At the moment," says Martillet, "we were surprised and frightened; the bell-pull that the sick man had not reached, moved, as if by an invisible hand, and my sister and I took each other's hands, saying: 'Did you hear? Did you see? He did not leave his chair.' The servant came, having heard the bell" (Annales des Sciences Psychiques [1899]).

Charles Richet, in a report on the case, inquires,

"Should the singular phenomena mentioned in all ages as accompanying a death or serious event be considered as akin to hauntings? There are legends of clocks stopping, pictures falling, some object noisily breaking, etc., but it is difficult to determine the part played by chance coincidence."

George Micklebury reported in the Daily Graphic (October 4, 1905) a startling instance of clairaudient premonition of impending death that occurred as he was listening to the High Mass in London. He suddenly heard his daughter's distressful voice: "Pray for me, father, I am drowning." Two friends, between whom he was kneeling, heard nothing, but asked him whether he was ill, because he looked so startled. After the mass he took a train to the farm where his daughter was working and found her in bed, alarmed, but safe. She had fallen into the river from a capsized boat and become entangled in weeds. She had lost consciousness before she was rescued. During the moments of unconsciousness, she said, she saw her father at High Mass between two friends, whom she named, and also saw Father Pycke, the celebrant. Then she saw no more.

The vision of traditional family apparitions, death-coaches, banshees, and phantasmal animals often proves to be a true premonition of death. In the Proceedings of the Society for Psychical Research (vol. 10, 1894), Mrs. E. L. Kearney narrates:

"My step-grandfather was lying ill in my father's house. I was coming downstairs when I saw a strange cat coming towards me along the hall. When it saw me it ran behind a green baize door which separated one part of the hall from the other. This door was fastened open, and I went forward quickly to hunt the strange cat (as I thought) away, but to my utter astonishment there was no cat there, or anywhere else in the hall. I at once told my mother (and she told me the other day that she remembers the occurrence). My grandfather died the next day. Taken in connection with the above the following is interesting. My mother told me that the day before he died she saw a cat walk round her father's bed: she also went to hunt it out, but it was not there."

After Death

The question, what happens immediately after death? is more difficult to answer since it is beyond observation and researchers must rely on accounts of after-death communications. They do not even know for certain whether the apparitions of the dead are the result of a voluntary effort or a simple repercussion of strong thought and emotions on the material plane.

Death-compact cases and purposive apparitions, conveying in some form a definite message, suggest conscious action of which the living remain ignorant. Such cases imply that the thoughts and emotional reactions of the dead may greatly depend on the circumstances of their dying. For example, a Private Dowding, who died by shell explosion, said through a medium.

"Something struck, hard, hard, hard against my neck. Shall I ever lose the memory of that hardness? It is the only unpleasant incident that I can remember. I fell, and as I did so, without passing through any apparent interval of unconsciousness, I found myself outside myself. You see, I am telling my story simply; you will find it easier to understand. You will know what a small incident dying is."

"Pelham" (the control of Leonora Piper ), who claimed to have died in a horse-riding accident, described his death as follows: "All was dark to me. Then consciousness returned but in a dim, twilight way as when one wakens before dawn. When I comprehended that I was not dead at all I was very glad." Significance should be attached to the phrase "When I comprehended."

According to numerous communications, many of those who died did not realize that they were dead at all, and finding themselves fully conscious and in a body which, to their perception, was just as material as the earthly one, refused to believe they were in the Beyond. It is still said that these "ghosts" keep performing their former actions in an aimless, automatic way the physician continues to visit his patients, the minister continues preaching. It is usually not until they meet the spirit of someone who died before them that they realize what has happened and begin to learn the conditions of their new existence.

Of the nature of this life, in spite of scores of descriptive accounts, man has only vague notions. William T. Stead, in a message quoted by Estelle Stead in a magazine article "My Father," is reported to have said, "When I think of the ideas that I had of the life I am now living, when I was in the world in which you are, I marvel at the hopeless inadequacy of my dreams. The reality is so much, so very much greater than ever I imagined. It is a new life, the nature of which you cannot understand."

A deceased friend of Richard Hodgson's gave an incoherent communication through Leonora Piper's husband. The control Pelham insisted that they should not go on because the spirit would be confused for some time, having suffered from headaches and neurasthenia while on Earth. Sometimes even the clearest minds give the impression of mental debility if they communicate too soon after death. Pelham said on this, "The words of the wisest persons who have left the material world but a short time ago are incoherent and inexact owing to the severe shock of being disincarnated and their arrival in a new environment where everything is unintelligible."

Public interest in death and claimed after-death communications is regularly stimulated by the loss of so many by unnatural causes during and immediately after wars. The intense interest in communicating with loved ones who have died frequently overrides a more rational approach to death. Many of the learned through the early twentieth century saw the secular approach as leading to an abandonment of belief in the afterlife by the public. However, numerous contemporary studies, such as those of Robert Crookall, who collected and collated hundreds of accounts of out-of-the-body travel experiences, have given a sense of scientific support to belief in survival of death and have contributed some knowledge of after-death consciousness. Whereas astral projection or out-of-body travel can be regarded as a temporary release from the physical body, death is the final release. Through the 1960s Crookall drew attention to many accounts from individuals who nearly died, or who were briefly dead but revived. Their accounts of another sphere of existence may have been colored by their religious background or expectations, but still demand careful consideration. In particular Crookall drew attention to reports of paradise and hell-like conditions in the accounts.

Since World War II a number of specialists in studies of death and dying (thanatology ) have arisen. While most of these studies have been rather mundane, the work of pioneering thanatologist Elisabeth Kübler-Ross has caught the popular imagination. Kübler-Ross is a psychiatrist who has spent many years dealing with dying patients and studying related states of consciousness. Her work since the early 1970s has added a spiritual dimension to the purely physical and medical aspects of death in dealing with terminally ill patients.

Experiences of the clinically dead have been widely reported by Raymond A. Moody, Jr., in his books Life After Life (1975) and Reflections on Life After Life (1977). A similarly conducted study by Kenneth Ring in 1978-79 confirmed many of Moody's observations (see Theta, vol. 7, no. 2, 1979).

A more specialized area of research into death has been the study of claims of reincarnation by psychiatrist Ian Stevenson and several associates at the University of Virginia. In the face of a growing belief in reincarnation by Westerners, a wide variety of attempts to demonstrate its reality have been made including those of hypnotists, such as Arnall Bloxham, who have obtained accounts from hypnotized subjects claiming to remember former earthly lives.

Sources:

Baird, Alexander T. One Hundred Cases for Survival After Death. New York: Bernard Ackerman, 1944.

Barker, Elsa. Letters From A Living Dead Man. London, 1914.

Barrett, Sir William. Death Bed Visions. London, 1926.

Beard, Paul. Survival of Death: For and Against. London, 1966.

Carington, W. W. The Foundations of Spiritualism. New York: E. P. Dutton, 1920.

Carrington, Hereward, and J. Meader. Death, Its Causes & Phenomena. London, 1911.

Crookall, Robert. Case-Book of Astral Projection. New Hyde Park, N.Y.: University Books, 1972.

. The Study & Practice of Astral Projection. London, 1960. Reprint, New Hyde Park, N.Y.: University Books, 1966.

Delacour, J. B. [Hanns Kurth]. Glimpses of the Beyond. New York: Delacorte Press, 1974.

Ducasse, C. J. A Critical Examination of the Belief in a Life After Death. Springfield, IL: Thomas, 1961.

Flammarion, Camille. Death and Its Mystery. 3 vols. London: Century, 1921-23.

Guirdham, Arthur. The Cathars & Reincarnation. London, 1970. Reprint, Theosophical Publishing House, 1978.

Knight, David C., ed. The ESP Reader. New York: Grosset & Dunlap, 1969.

Kübler-Ross, Elisabeth. Death; The Final Stage of Growth. Englewood Cliffs, NJ: Prentice-Hall, 1975.

. On Death & Dying. New York: Macmillan, 1970.

. Questions & Answers on Death & Dying. New York: Macmillan, 1974.

Kutscher, M. L., et al., eds. A Comprehensive Bibliography of the Thanatology Literature. New York: Irvington Publications, 1975.

Lodge, Sir Oliver. Raymond, or Life and Death. London, 1917.

Lombroso, Cesare. After DeathWhat? Cambridge, MA: Small Maynard, 1909.

Mead, G. R. S. The Doctrine of the Subtle Body in Western Tradition. London, 1919.

Miller, Albert J., and M. J. Acrí. Death: A Bibliographical Guide. Metuchen, NJ: Scarecrow Press, 1977.

Moody, Raymond A., Jr. Life After Life. Covington, GA: Mockingbird Books, 1975. Reprint, New York: Bantam Books, 1976.

. Reflections on Life After Life. New York: Bantam Books, 1977.

Muldoon, Sylvan, and Hereward Carrington. The Phenomena of Astral Projection. London: Rider, 1951. Reprint, New York: Samuel Weiser, n.d.

Myers, F. W. H. Human Personality & Its Survival of Bodily Death. 2 vols. London: Longmans, Green, 1954.

Osis, Karlis. Deathbed Observations by Physicians and Nurses. New York: Parapsychology Foundation, 1961.

Ring, Kenneth. Life at Death: A Scientific Investigation of the Near-Death Experience. New York: William Morrow, 1980.

Simpson, M. A. Death and Grief: A Critically Annotated Bibliography & Source Book of Thanatology and Terminal Care. New York: Plenum, 1979.

[Stead, William T.] Letters from Julia; or Light from the Borderland: A Series of Messages as to the Life Beyond the Grave Received by Automatic Writing. London, 1897.

Stevenson, Ian. Twenty Cases Suggestive of Reincarnation. New York: American Society for Psychical Research, 1966.

Stokes, Doris. Voices in My Ear. London: Futura, 1980.

Tyrrell, G. N. M. Apparitions. London, 1943. Reprint, New York: Macmillan, 1962.

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Death

DEATH.

The idea of deaththe irreversible end to lifehas preoccupied, fascinated, and struck fear into human beings through the millennia. In the early twenty-first century, artists continue to sing about death, write about death, and depict it in paintings and photographs. Religious leaders are still talking about how to live a meaningful life in the face of death's inevitability. Governments go to war in the name of peace and the defense of the living, causing death on a massive scale. Ethicists and activists argue over the right to die, the right to live, the right to kill. Medical personnel strive to prevent it, are often present at the bedside of the dying, and pronounce when death has occurred. Biologists and physiologists puzzle over when it occurs and how it can be measured. Counselors, therapists, relatives, and dear friends help those who are dying make peace with their death, and help those left behind to live on. Young children wonder what has happened to their loved ones, and families struggle with their grief.

Defining Death

Death is clearly a part of lifeevery day. And yet, the word defies simple definition, because there are so many aspects to death and so many perspectives. A 1913 edition of Webster's Dictionary defined death as "the cessation of all vital phenomena without capability of resuscitation, either in animals or plants." The current Concise Oxford Dictionary defines death both as "dying" (a process) and as "being dead" (a state). As intoned in the Old Testament of the Bible, "All flesh is as grass" (Isaiah 40:68). The body dies but in the religious and philosophical traditions of many observers, the soul or spirit lives on.

The Roman Catholic Church, for example, advances the thought that death is the "complete and final separation of the soul from the body." The church, however, concedes that diagnosing death is a subject for medicine, not the church. In the Zen Buddhist and Shintō religious traditions, mind and body are integrated, and followers have difficulty accepting the brain-death criteria that are now common in Western medical and legal circles. For some Orthodox Jews, Native Americans, Muslims, and fundamentalist Christians, as long as the heart is beatingeven artificiallya person is still alive.

Advances in life-supporting technologies in the 1960s spawned the growth of medical ethics as a distinct field, and a new definition for physiological death was needed. For centuries death was indicated by the absence of a pulse or signs of breathing, but new technologies, including the respirator and heartlung machine, made it possible for physicians to artificially maintain heart and lung function, blurring clear signs of an individual's death. In the United States many states have adopted legislation recognizing brain deaththe loss of brain function, which controls breathing and heartbeatas the certification of death. Canada, Australia, and most of the nations of Europe and Central and South America have broader definitions for death: either loss of all independent lung and heart function, or the permanent, irreversible loss of all brain function.

From a physiological standpoint, somatic deaththe death of the organism as a wholeusually precedes the death of individual organs, cells, and parts of cells. The precise time of somatic death is sometimes difficult to determine because transient states, such as coma, fainting, and trance, can closely resemble the signs of death. Several changes in the body that occur after somatic death are used to determine the time of death and circumstances surrounding it. The cooling of the body, called algor mortis, is mainly influenced by the air temperature of the surrounding environment of the body. The stiffening of the skeletal muscles, called rigor mortis, begins from five to ten hours after death and ends in three or four days. The reddish-blue discoloration that occurs on the underside of the body, called livor mortis, is the result of blood settling in the body cavity. Shortly after death, blood clotting begins, along with autolysis, which is the death of the cells. The decomposition of the body that follows, called putrefaction, is the result of the action of enzymes and bacteria.

Bereavement, Grief, and Mourning

The word bereavement comes from a root word meaning "shorn off" or "torn up." It suggests that one has been deprived or robbed, dispossessed, left in a sad and lonely state. Bereavement is the state of being in which a person has suffered the death of a relative or friend.

Grief refers to the total range of emotions humans feel in response to a loss. The word suggests negative responses, including heartbreak, anguish, distress, guilt, shame, and thoughts of suicide. Grief also encompasses feelings of relief, anger, disgust, and self-pity.

Mourning is the expression of grief over someone's death. It is the process by which people incorporate the experience of loss into their ongoing lives. In mourning, a person searches for answers: How do I carry on in life? How do I survive this? Approaches to mourning are culturally prescribed: Each world culture has certain cultural "rules" for mourning in an appropriate manner. Mourning today is less formal than it was in the past, and so-called modern cultures are less formal in their rituals for mourning than traditional cultures.

Why Must People Die?

A number of answers to this question have been proposed by philosophically oriented biologists such as Sherwin B. Nuland and Basiro Davey and colleagues. The results of tissue cultures indicate that cells are "preprogrammed" by their genetic code to cease the dividing processes after a certain number of divisions have occurred, and then die. A further argument proposes that death is adaptive at the population level, ensuring that individuals do not compete with their offspring for scarce resources and instead channel precious energy into reproduction. Research accounts of the biochemical changes that occur in cells as they age support both these theories and a more straightforward "wear and tear" argument, indicating that death on a biological level can be understood as a combination of a number of factors.

These biological explanations for the occurrence of death focus on the process of aging. The death of younger people, especially one's own child, opens up broader philosophical questions that may be even more difficult to answer: "Why did my baby die, God?" is one of the ways human beings ask this type of question. If God truly is in his heaven and all is right with the world, why do babies die? Human beings have struggled with this type of question through the millennia, and there do not appear to be any definitive, widely accepted answers. Individuals seem to come to grips with such questions in an extraordinarily varied range of ways.

Historical Perspectives

In 1900 the average life expectancy at birth in the United States was 47 years, and this figure increased to a record high of 77.2 years a century later. The gap between female and male life expectancy peaked in 1979 when women outlived men an average of 7.8 years. By 2001 the gap was down to 5.4 years. That year, women lived an average of 79.8 years and men an average of 74.4 years. White males averaged 75.0 years and black males 68.6 years; white females averaged 80.2 years and black females 75.5 years (Arias and Smith).

In 1900 more than half of the deaths involved young people, age fourteen and younger. By 2001, only 1.6 percent of the total reported deaths occur among young people. Heart disease and cancer are the leading causes of death in the early twenty-first century, together accounting for more than half of all deaths in the United States each year. In order, the top fifteen leading causes of death, comprising fully 83.4 percent of all U.S. deaths in 2001, were: heart disease, cancer, stroke, chronic lower respiratory diseases, accidents (unintentional injuries), diabetes, influenza and pneumonia, Alzheimer's disease, kidney disease, septicemia (infection from microorganisms), intentional self-harm (suicide), chronic liver disease and cirrhosis, assault (homicide), hypertension, and pneumonitis (inflammation of the lungs) due to solids and liquids.

In the past century the experience of death has changed from a time when the typical death was rapid and sudden, often caused by acute infectious diseases such as tuberculosis, typhoid fever, syphilis, diphtheria, streptococcal septicemia, and pneumonia, to a time when the typical death is a slow, progressive process. In 1900 microbial diseases, often striking rapidly, accounted for about 40 percent of all deaths; in the early 2000s accounted for only about 3 percent. In sum, in the past century U.S. society has evolved from one in which many children and young people died to a society in which death has become increasingly associated with older-aged people. The U.S. infant mortality rate reached a record low level in 2001: 6.8 deaths per 1,000 live births.

Observers of this phenomenon have proposed a theory of epidemiologic transition, a three-stage model that describes the decline in mortality levels and the accompanying changes in the causes of death that have been experienced in Western populations. The first stage, called the Age of Pestilence and Famine, is characterized by high death rates that vacillate in response to epidemics, famines, and war. Epidemics and famines often go hand in hand, because malnourished people are susceptible to infectious diseases. The second stage, the Age of Receding Pandemics, describes a time in which death rates decline as a result of the improved nutrition, sanitation, and medical advances that go along with socioeconomic development. The third stage, labeled the Age of Degenerative and (Hu)man-Made Diseases, describes the period in which death rates are low (life expectancy at birth exceeds seventy years) and the main causes of death are diseases related to the process of aging. The biggest challenge to this theory comes from the emergence of new diseases (such as AIDS/HIV, Legionnaires' disease, and Lyme disease) and reemergence of old infectious diseases (such as smallpox and malaria) in the latter part of the twentieth century. HIV/AIDS, for example, took the lives of between 1.9 million and 3.6 million people worldwide in 1999.

According to the Population Reference Bureau, life expectancy at birth for the world's population at the turn of the twenty-first century was 67 years69 years for females, 65 years for males. In more developed countries life expectancy averaged 76 years79 years for females, 72 years for males. In less-developed countries, life expectancy averaged 65 years66 years for females, and 63 years for males.

Death throughout Art History

Death, an emotionally wrenching idea, has been both a subject for artists and an incentive for artistic production throughout history. Perhaps as much as, perhaps more than, any other subject, artists have dealt with death, dying, the threat of death, escape from death, thoughts of death, and preparation for death through the centuries.

The importance of death as a concept in ancient Egyptian culture is clearly seen in the creation of the pyramids and other burial artifacts. Ancient art in Greece focused on materialistic representations of life in an ideal state, including the physical perfection of its mythological heroes. This can be interpreted as art affirming life as the Greeks experienced it or desired life to be, and the cultural rejection of the finality of death. Looking at art in the Christian tradition with its focus on the death of its central figure, some art historians have described Christianity as a highly developed death cult; the idea of death, mediated through works of Christian art over the centuries, is ultimately affirming of life. Many artists in the period of the Enlightenment of the eighteenth century were commissioned to work in service to the lay aristocracy and eventually the merchant class. The social hierarchy in this time was reinforced through highly developed techniques in portrait painting. Portraiture, seen as self-constructed identity through painting, constitutes a large segment of traditional Western art. Thus, art during the Enlightenment was closely linked to the idea of personal mortality. Major themes in modern art include the importance of self-expression in the face of the forces of mass conformity and antihumanist ideas. The universal theme of mortality is seen in many modern works, and death remains firmly established as a central theme in contemporary art, though the themes surrounding the concept of death are not as likely to reflect religious, romantic, or metaphysical concerns as they were in earlier historical periods.

No one can predict future directions in artists' responses to death, but it is most likely that humankind will continue to look to these visionaries to both document and inform our thinking. Mourners in Greece during the early fifth century were depicted striking their heads, tearing out their hair, beating their breasts, and scratching their cheeks until they bled. Today, many find solace from the largest ongoing community arts project in the world, the AIDS Memorial Quilt. In both instances, artists helped society commemorate the lives of deceased loved ones, and they supported the living in their efforts to find meaning and the strength to endure their tragic feelings of loss.

The Psychology of Dying

The American psychiatrist Elisabeth Kübler-Ross developed a five-stage model of the psychology of dying and grief. In her book titled On Death and Dying (1969), she proposed that in response to the awareness of their impending death, individuals move through stages of denial, anger, bargaining, depression, and acceptance. Other authorities note that these stages do not occur in any predictable order, and feelings of hope, anguish, and terror may also be included in the range of emotions experienced.

Bereaved families and friends also go through stages from denial to acceptance. Grief can begin before a loved one has died, and this anticipatory grief helps lessen later distress. During the next stage of grief, after the death of the loved one, mourners are likely to cry, have trouble sleeping, and lose their appetite. Some feel alarmed, angry, or wounded by being left behind. After formal services for the deceased are over and conventional forms of social support end, depression and loneliness often occur.

Feelings of guilt are quite common, and in some cases individuals think seriously about taking their own life for somehow failing the loved one. This is especially true in response to the loss of a child. Though people often talk about healthy and unhealthy grief, it is very difficult to measure emotional pain in any precise way or advise how long one's grief should last. Many clinicians believe that those who abandon their grief prematurely are living in denial and make healing more difficult; but, on the other hand, it is also possible to become mired in despair. The death of a loved one, thus, threatens to take all the life out of the person who feels left behind.

Research on attitudes toward death and anxiety about death has been conducted mostly by social scientists around the world. There are more than one thousand published studies in this area, and four broad themes emerge from the findings:

  1. Most people think about death to some extent and report some fear of death, but only a small percentage exhibit a strong preoccupation with death or fear of death.
  2. Women consistently report more fear of death than men, but the difference in levels of fear is typically minor to moderate from study to study.
  3. Fear of death does not increase with age among most people.
  4. When considering their own death, people are more concerned about potential pain, helplessness, dependency, and the well-being of loved ones than with their own demise.

Death Education

The death-related experiences of most Americans and people in other Western and industrialized societies in the early twenty-first century are markedly different from how people experienced death a century ago. At present, death is much more likely to take place in a medical facility under the control of well-trained strangers. In the past, death more commonly was an intimate family event and usually took place at home with family members caring for the dying person. Loved ones were most likely present when the individual passed, and young children witnessed the events surrounding the death. The loved one's body was washed by the family and prepared for burial. A local carpenter or perhaps even family members themselves constructed a coffin, and the body lay in state for viewing by family and friends in the parlor of the home. Children kept vigil with adults and sometimes slept in the room with the body. The body was later carried to the gravesite, which might be on the family's land or at a nearby cemetery. The local minister would be present to read Bible verses and say goodbye, and the coffin would be lowered and the grave covered, perhaps by relatives.

In the early 2000s, death has been sanitized and separated from everyday lives. It is likely to happen in a high-tech, multilayered bureaucratic hospital. The body is soon whisked away from view. It is carefully prepared for viewing and subsequent burial by professionals with an artistic flair, and placed in an elaborate and expensive casket. The body is then carried via a dazzling motor coach to the cemetery for internment in a carefully draped burial plot giving little hint that the loved one will actually end up in the earth.

The choreography of the modern death and burial process has become so elaborate that many people react in frustration and dismay and seek more simple, emotionally connected experiences of death. At the same time, the field of death education has grown as colleges and universities create courses on death and dying. These courses include both formal instruction dealing with dying, death, and grief, plus considerable time invested in talking about the participants' personal experiences with death. These developments can all be interpreted as parts of a movement toward bringing death back into people's lives, as a painful and puzzling event to be explored, experienced, and embraced rather than denied and avoided.

See also Death and Afterlife, Islamic Understanding of ; Heaven and Hell ; Heaven and Hell (Asian Focus) ; Immortality and the Afterlife ; Suicide .

bibliography

Arias, Elizabeth, and Betty L. Smith. "Deaths: Preliminary Data for 2001." National Vital Statistics Reports 51, no. 5 (2003): 1.

Arias, Elizabeth, et al. "Deaths: Final Data for 2001." National Vital Statistics Reports 52, no. 3 (2003): 21.

Carroll, Nöel. Philosophy of Art. London: Routledge, 1999.

Davey, Basiro, Tim Halliday, and Mark Hirst, eds. Human Biology and Health: An Evolutionary Approach. 3rd ed. Buckingham, U.K.: Open University Press, 2001.

DeFrain, John, Linda Ernst, and Jan Nealer. "The Family Counselor and Loss." In Loss during Pregnancy or in the Newborn Period: Principles of Care with Clinical Cases and Analyses, edited by James R. Woods Jr. and Jenifer L. Esposito Woods, 499520. Pitman, N.J.: Jannetti Publications, 1997.

DeSpelder, Lynne Ann, and Albert Lee Strickland. The Last Dance: Encountering Death and Dying. 7th ed. Boston: McGraw-Hill, 2005.

Kastenbaum, Robert. The Psychology of Death. 3rd ed. New York: Springer, 2000.

Kastenbaum, Robert, ed. Macmillan Encyclopedia of Death and Dying. New York: Macmillan Reference, 2003. See especially the entries on "Art History," "Causes of Death," and "Psychology."

Kübler-Ross, Elisabeth. On Death and Dying. London: Macmillan, 1969.

Nuland, Sherwin B. How We Die. London: Chatto and Windus, 1994.

Olshansky, Stuart Jay, and A. B. Ault. "The Fourth Stage of Epidemiologic Transition: The Age of Delayed Degenerative Diseases." Milbank Memorial Fund Quarterly 64 (1986): 355391.

Omran, Abdel R. "The Theory of Epidemiological Transition." Milbank Memorial Fund Quarterly 49 (1971): 509538.

Population Reference Bureau. "Life Expectancy at Birth by World Region, 2001." In 2003 World Population Data Sheet. Washington, D.C.: Population Reference Bureau, 2003.

Seale, Clive. Constructing Death: The Sociology of Dying and Bereavement. Cambridge, U.K.: Cambridge University Press, 1998.

Wollheim, Richard. Painting as an Art. Princeton, N.J.: Princeton University Press, 1987.

Wyatt, R. "Art History." In Encyclopedia of Death and Dying, edited by Glennys Howarth and Oliver Leaman, 3436. London: Routledge, 2001.

John DeFrain

Alyssa DeFrain

Joanne Cacciatore-Garard

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Death and Dying

DEATH AND DYING

Death is the end of life. Dying is the process of approaching death, including the choices and actions involved in that process.

Death has always been a central concern of the law. The many legal issues related to death include laws that determine whether a death has actually occurred, as well as when and how it occurred, and whether or not another individual will be charged for having caused it. With the development of increasingly complex and powerful medical procedures and devices in the middle and late twentieth century, the U.S. legal system has had to establish rules and standards for the removal of life-sustaining medical care. This would include, for example, withdrawing an artificial respirator or a feeding tube from a comatose person, or withholding chemotherapy from a terminally ill cancer patient. Such laws and judicial decisions involve the right of individuals to refuse medical treatment—sometimes called the right to die—as well as the boundaries of that right, particularly in regard to the state's interest in protecting life and the medical profession's right to protect its standards. The issues involved in death and dying have often pitted patients' rights groups against physicians' professional organizations as each vies for control over the decision of how and when people die.

Defining Death in the Law

The law recognizes different forms of death, not all of them meaning the end of physical life. The term civil death is used in some states to describe the circumstance of an individual who has been convicted of a serious crime or sentenced to life imprisonment. Such an individual forfeits his or her civil rights, including the ability to marry, the capacity to own property, and the right to contract. Legal death is a presumption by law that a person has died. It arises following a prolonged absence, generally for a prescribed number of years, during which no one has seen or heard from the person and there is no known reason for the person's disappearance that would be incompatible with a finding that the individual is dead (e.g., the individual had not planned to move to another place). Natural death is death by action of natural causes without the aid or inducement of any intervening instrumentality. Violent death is death caused or accelerated by the application of extreme or excessive force. Brain death, a medical term first used in the late 1960s, is the cessation of all functions of the whole brain. Wrongful death is the end of life through a willful or negligent act.

In the eyes of the law, death is not a continuing event but something that takes place at a precise moment in time. The courts will not wield authority concerning a death. The determination of whether an individual has died, and the way in which this is proved by the person's vital signs, is not a legal decision but rather a medical judgment. The opinion of qualified medical personnel will be taken into consideration by judges when a controversy exists as to whether an individual is still alive or has died.

Legal Death and Missing Persons

There is a legal presumption that an individual is alive until proved dead. In attempting to determine whether a person has died after having been missing for a certain period of time, the law assumes that the person is alive until a reason exists to believe otherwise.

The common-law rule is that where evidence indicates that the absent person was subject to a particular peril, he or she will be legally presumed dead after seven years unless the dis-appearance can be otherwise explained. The seven-year interval may be shortened if the state decides to enact legislation to change it. Some states may permit the dissolution of a marriage or the administration of an estate based on a mysterious disappearance that endures for less than seven years. A majority of states will not make the assumption that a missing person is dead unless it is reasonable to assume that the person would return if still alive.

A special problem emerges in a situation where a person disappears following a threat made on his or her life. Such an individual would have a valid reason for voluntarily leaving and concealing his or her identity. Conversely, however, the person would in fact be dead if the plot succeeded. A court would have to examine carefully the facts of a particular case of this nature.

In some states, the court will not hold that an individual has died without proof that an earnest search was made for him or her. During such a search, public records must be consulted, wherever the person might have resided, for information regarding marriage, death, payment of taxes, or application for government benefits. The investigation must also include questioning of the missing person's friends or relatives as to his or her whereabouts.

Death Certificates

The laws of each state require that the manner in which an individual has died be determined and recorded on a death certificate. Coroners or medical examiners must deal with issues establishing whether someone can be legally blamed for causing the death. Such issues are subsequently determined by criminal law in the event that someone is charged with homicide, and by tort law in the event of a civil suit for wrongful death.

The Nature of Dying

Because of the many advances in modern medicine, the nature of death and dying has changed greatly in the past several centuries. A majority of people in industrial societies such as the United States no longer perish, as they once did, from infectious or parasitic diseases. Instead, life expectancies range above 70 years and the major causes of mortality are illnesses such as cancer and heart disease. Medicine is able to prolong life by many means, including artificial circulatory and respiratory systems, intravenous feeding and hydration, chemotherapy, and antibiotics.

The cultural circumstances of death have changed as well. A study published by the American Lung Association in the late 1990s, indicated that 90 percent of patients who are in intensive care units of hospitals die as a result of surrogates and physicians deciding together to withhold life-sustaining medical care. This rate doubled from earlier in the decade.

Brain Death

In traditional Western medical practice, death was defined as the cessation of the body's circulatory and respiratory (blood pumping and breathing) functions. With the invention of machines that provide artificial circulation and respiration that definition has ceased to be practical and has been modified to include another category of death called brain death. People can now be kept alive using such machines even when their brains have effectively died and are no longer able to control their bodily functions. Moreover, in certain medical procedures, such as open-heart surgery, individuals do not breathe or pump blood on their own. Since it would be wrong to declare as dead all persons whose circulatory or respiratory systems are temporarily maintained by artificial means (a category that includes many patients undergoing surgery), the medical community has determined that an individual may be declared dead if brain death has occurred—that is, if the whole brain has ceased to function, or has entered what is sometimes called a persistent vegetative state. An individual whose brain stem (lower brain) has died is not able to maintain the vegetative functions of life, including respiration, circulation, and swallowing. According to the Uniform Determination of Death Act (§ 1, U.L.A. [1980]), from which most states have developed their brain death statutes, "An individual who has sustained either (1) irreversible cessation of circulatory and respiratory function, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead."

Brain death becomes a crucial issue in part because of the importance of organ transplants. A brain-dead person may have organs—a heart, a liver, and lungs, for example—that could save other people's lives. And for an individual to be an acceptable organ donor, he or she must be dead but still breathing and circulating blood. If a brain-dead person is maintained on artificial respiration until his or her heart fails, then these usable organs would perish. Thus, the medical category of brain death makes it possible to accomplish another goal: saving lives with organ transplants.

The Right to Die: Individual Autonomy and State Interests

The first significant legal case to deal with the issue of termination of life-sustaining medical care was in re quinlan, 70 N.J. 10, 355 A. 2d 647. This 1976 case helped resolve the question of whether a person could be held liable for withdrawing a life-support system even if the patient's condition is irreversible. In 1975, Karen Ann Quinlan inexplainably became comatose and was put on a mechanical respirator. Her parents authorized physicians to use every possible means to revive her, but no treatment improved her condition. Although doctors agreed that the possibility of her recovering consciousness was remote, they would not pronounce her case hopeless. When her parents themselves lost all hope of Quinlan's recovery, they presented the hospital with an authorization for the removal of the respirator and an exemption of the hospital and doctors from responsibility for the result. However, the attending doctor refused to turn off the respirator on the grounds that doing so would violate his professional oath. Quinlan's parents then initiated a lawsuit asking the court to keep the doctors and the hospital from interfering with their decision to remove Quinlan's respirator.

In a unanimous decision, the New Jersey Supreme Court ruled that Quinlan had a constitutional right of privacy that could be safeguarded by her legal guardian; that the private decision of Quinlan's guardian and family should be honored; and that the hospital could be exempted from criminal liability for turning off a respirator if a hospital ethics committee agreed that the chance for recovery is remote. Quinlan was removed from the respirator, and she continued to live in a coma for ten years, nourished through a nasal feeding tube.

In cases following Quinlan, courts have ruled that life-sustaining procedures such as artificial feeding and hydration are the legal equivalent of mechanical respirators and may be removed using the same standards (Gray v. Romeo, 697 F. Supp. 580 [D.R.I. 1988]). Courts have also defined the right to die according to standards other than that of a constitutional right to privacy. The patient's legal right to refuse medical treatment has been grounded as well on the common-law right of bodily integrity, also called bodily self-determination, and on the liberty interest under the due process clause of the fourteenth amendment. These concepts are often collected under the term individual autonomy, or patient autonomy.

Subsequent cases have also defined the limits of the right to die, particularly the state's interest in those limits. The state's interests in

cases concerning the termination of medical care are the preservation of life (including the prevention of suicide), the protection of dependent third parties such as children, and the protection of the standards of the medical profession. The interests of the state may, in some cases, outweigh those of the patient.

In 1990, the U.S. Supreme Court issued its first decision on the right-to-die issue, Cruzan v. Director of Missouri Department of Health, 497 U.S. 261, 110 S. Ct. 2841, 111 L. Ed. 2d 224. Cruzan illustrates the way in which individual and state interests are construed on this issue, but leaves many of the legal questions on the issue still unresolved. Nancy Cruzan was in a persistent vegetative state as a result of severe brain injuries suffered in an automobile accident in 1983. She had no chance of recovery, although with artificial nutrition and hydration could have lived another 30 years. Her parents' attempts to authorize removal of Cruzan's medical support were first approved by a trial court and then denied by the Missouri Supreme Court. Her parents then appealed the case to the U.S. Supreme Court.

The Court held that the guarantee of liberty contained in the Fourteenth Amendment to the Constitution does not prohibit Missouri from insisting that "evidence of the incompetent [patient's] wishes as to the withdrawal of treatment be proved by clear and convincing evidence." The Court left other states free to adopt this "clear-and-convincing evidence" standard but did not compel them to do so. Thus, existing state laws remained the same after the Cruzan decision. Although the Court affirmed that a competent patient has a constitutionally protected freedom to refuse unwanted medical treatment, it emphasized that an incompetent person is unable to make an informed choice to exercise that freedom.

The Court explained that the state has an interest in the preservation of human life and in safeguarding against potential abuses by surrogates and is therefore not required to accept the "substituted judgment" of the patient's family. The Court agreed with the Missouri Supreme Court ruling that statements made by Cruzan to a housemate a year before her accident did not amount to clear-and-convincing proof that she desired to have hydration and nutrition withdrawn. Cruzan had allegedly made statements to the effect that she would not want to live should she face life as a "vegetable." There was no testi mony that she had actually discussed withdrawal of medical treatment, hydration, or nutrition.

After the Court's decision, Cruzan's parents went back to the Missouri probate court with new evidence regarding their daughter's wishes. On December 14, 1990, a Missouri judge ruled that clear evidence of Cruzan's wishes existed, and permitted her parents to authorize withdrawing artificial nutrition and hydration. Cruzan died on December 27, 12 days after feeding tubes were removed.

Advance Directives

A court must consider many factors and standards in right-to-die cases. It must determine, for example, whether a patient is competent or incompetent. A competent patient is deemed by the court to be able to give informed consent or refusal relative to the treatment under consideration, whereas an incompetent patient (e.g., a patient in a coma) lacks the decision-making capacity to do so. According to the principle of individual autonomy, the court must honor the informed consent of competent patients regarding their medical care.

For incompetent patients who cannot make informed decisions regarding their care, an advance directive may provide a means of decision making for the termination of life-supporting treatment. An advance directive is a document, prepared in advance of incompetence, which gives patients some control over their health care after they have lost the ability to make decisions owing to a medical condition. It may consist of detailed instructions about medical treatment, as in a living will; or the appointment of a proxy, or substitute, who will make the difficult choices regarding medical care with the patient's earlier directions in mind. The appointment of a proxy is sometimes called a proxy directive or durable power of attorney. The patient names a proxy decision maker when he or she is competent. In other cases, the physician may appoint a proxy, or the court may appoint a legal guardian who acts on behalf of an incompetent person. Usually, a relative such as a spouse, adult child, or sibling is chosen as a proxy. If an advance directive provides adequate evidence of a patient's wishes, a decision about the termination of life support can often be made without involving a court of law.

For an incompetent patient whose preferences regarding medical care are known from prior oral statements, the patient's proxy may make a substituted judgment—that is, a judgment consistent with what the patient would have chosen for himself. If no preference regarding medical treatment is known, the standard for the proxy's decision is the "best interests of the patient." According to that standard, the proxy's decision should approximate what most reasonable individuals in the same circumstances as the patient would choose. Individual states have statutes governing the requirements for living wills and advance directives.

further readings

Callahan, Daniel. 1990. "Current Trends in Biomedical Ethics in the United States." Bioethics: Issues and Perspectives. Washington, D.C.: Pan American Health Organization.

Cohen-Almagor, Raphael. 2001. The Right to Die With Dignity: An Argument in Ethics, Medicine, and Law. New Brunswick, N.J.: Rutgers Univ. Press.

Council on Ethical and Judicial Affairs, American Medical Association. 1994. Code of Medical Ethics. Chicago: American Medical Association.

Ditto, Peter H., Joseph H. Danks, William D. Smucker, et al. 2001." Advanced Directives as Acts of Communication." Archives of Internal Medicine 161.

Howarth, Glennys, and Oliver Leaman, eds. 2001. Encyclopedia of Death and Dying. New York: Routledge.

Humphry, Derek. 1993. Lawful Exit: The Limits of Freedom for Help in Dying. Junction City, Ore.: Norris Lane Press.

——. 1991. Final Exit. Eugene, Ore.: Hemlock Society.

Monagle, John F., and David C. Thomasma. 1994. Health Care Ethics: Critical Issues. Gaithersburg, Md.: Aspen.

Schneider, Carl E., ed. 2000. Law at the End of Life: The Supreme Court and Assisted Suicide. Ann Arbor: Univ. of Michigan Press.

Urofsky, Melvin. 1994. Letting Go: Death, Dying, and the Law. Norman: Univ. of Oklahoma Press.

cross-references

Euthanasia; Physicians and Surgeons; Power of Attorney.

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Death and Dying

DEATH AND DYING

Dying and death are profound aspects of the human experience. Social science research documents the fact that defining someone as "dying" is a social process. Although critical medical conditions certainly have a physiological basis, disease states are given significance through interpretation (Muller and Koenig). Perceptions that dying has begun and the meanings associated with those perceptions are contingent on a range of such social and cultural factors as the state of biological knowledge, the value of prolonging life or accepting finitude, the relative roles of religion, science, and medicine in creating meaning in everyday life, and personal familiarity with the dying transition. Dying today is shaped by particular notions of therapeutic possibility as well as ideals about approaching the end of life. The distinguishing feature about the process of dying today is that, to some degree, it can be negotiated and controlled depending on the preferences of the dying person, the goals of particular medical specialties, the organizational features of technology-intensive medical settings, and the presence and wishes of family members. It is impossible to think about death today except in language informed by institutionalized medicine.

A century ago, the leading causes of death in the United States were communicable diseases, especially influenza, tuberculosis, and diphtheria, and more than half of deaths occurred among individuals age fourteen or younger. During the twentieth century average life expectancy increased and the chance of dying in childhood was greatly diminished (Quadagno). Since the Second World War, heart disease, cancer, and stroke have become the leading causes of death. In 1995 they accounted for 67 percent of deaths for persons age sixty-five and older. The fact that more people than ever before are dying in advanced age of chronic conditions creates unprecedented challenges for individuals as they confront the dying process of relatives and friends, for the health care delivery system, and for American society as its members struggle to define and implement the idea of a "good death."

Medicalization of dying

In 1900 most Americans died at home, often surrounded by multiple generations of family members. By 1950 approximately half of all deaths occurred in hospitals, nursing homes, or other institutions. By the mid-1990s, 80 percent of Americans died in medical institutions, attended by paid staff. Persons over age sixty-five comprised less than 13 percent of the population, yet they represented 73 percent of all deaths in the United States in the mid-1990s. At the beginning of the twenty-first century, 55 to 60 percent of persons over the age of sixty-five die in the acute-care hospital, though patterns vary considerably across the nation (Institute of Medicine). Those persons fall into two distinct groups. The first includes elderly who were functioning independently until they were struck by a serious illness such as heart attack, stroke, or fractured hip. Most of those patients receive relatively intensive care. The second group includes people who are older, frail and debilitated, have multiple degenerative and chronic conditions, but are not clearly dying. The second group is larger, comprising 70 percent to 80 percent of elderly patients in the hospital. Individuals in that group may require repeated hospitalizations for supportive or intensive care, to stabilize conditions and treat acute problems (Scitovsky and Capron ).

As the place of death has shifted from the home to the hospital, medicine, as a system of knowledge, has become the dominant cultural framework for understanding death, the process of dying, and how to act when death approaches. Health professionals have the assumed responsibility, once held by family and community, for the care of persons at the end of life, and they now widely influence how that care is understood and delivered. Physicians have become the gatekeepers of the dying transition in the United States. They, rather than the dying person or family, define when the dying process has begun. This is most obvious in the hospital intensive care unit (ICU), where the inevitability of death frequently is not acknowledged until the end is very near, and the discontinuation of life-sustaining treatments often signifies the beginning of the dying process. Moreover, in the ICU, medical staff members are able to orchestrate and control the timing of death (Slomka).

A growing elderly population, cultural ambivalence about the social worth of the frail and very old, medical uncertainty about whether or not to prolong frail lives, and rising health care costs contribute to controversy both among health professionals and the wider public about decision-making and responsibility at the end of life. The costs of medical care, and especially the costs of intensive care, are high in the last months of life. Those rising costs have been the source of debates about rationing health care to elderly persons in order to reduce health care costs. For many people both within and outside of medicine, the value of prolonging life by technological means competes with the value of allowing death to occur without medical intervention. That cultural tension has given rise to a vast array of seemingly insoluble dilemmas about the management of dying. A vast literature in bioethics illustrates dilemmas in treatment and care for the dying elderly for which there are competing claims and no distinct solutions. Common dilemmas about technologically prolonging life include the following: whether or not to artificially feed (through a feeding tube) a person who can no longer feed him or herself; whether or not to place a person who has difficulty breathing on a mechanical ventilator; and whether or not to admit a dying person to an intensive care unit.

As more technological and clinical innovations become available, there is more that can be done to postpone death. The technological imperative in medicine to order ever more diagnostic tests, to perform procedures, to intervene with ventilators, medications, and surgery in order to prolong life or stave off death whenever there is an opportunity to do so is the most important variable in contemporary medical practice, influencing much decision-making at the end of life. There are no formulas that health professionals, patients, or families can use to decide between life-extending treatments and care that is not aimed at prolonging life. It is very common for patients, family members, and health professionals to feel obligated to continue aggressive medical treatment even though they do not wish to prolong the dying process.

The largest study ever conducted on the process of dying in the hospital was carried out in five university hospitals across the United States over a four-year period beginning in 1989 (SUPPORT Principal Investigators). In the first two-year phase of the project, 4,300 patients with a median age of sixty-five who were diagnosed with life-threatening illnesses, were enrolled. The SUPPORT investigators concluded that the dying process in the hospital was not satisfactory. For example, only 47 percent of physicians knew when their patients wanted to avoid cardiopulmonary resuscitation (CPR); 38 percent of patients who died spent ten or more days in an ICU preceding death; 46 percent of Do Not Resuscitate (DNR) orders were written within two days of death even though 79 percent of the patients had a DNR order; and for 50 percent of the conscious patients, families reported moderate to severe pain at least half the time in the three days preceding death. Even when a focused effort was made to reduce pain and to respect patient wishes regarding end-of-life care, no overall improvement in care or outcomes was made.

The technological imperative shapes activities and choices in the hospital even though death without high-technology intervention is valued by many in principle. One survey of nurses and physicians revealed that health professionals would not want aggressive life prolonging treatments for themselves, and many would decline aggressive care on the basis of age alone (Gillick, Hesse and Mazzapica). Approximately half of physicians and nurses interviewed in another study stated they had acted contrary to their own values by providing overly aggressive treatment (Solomon et al.).

Philosopher Daniel Callahan has noted that American society, including the institution of medicine, has lost a sense of the normal or natural life span, including the inevitability of decline and death. Callahan and other critics challenge the medical imperative of considering death as an option, one of several available to practitioners and consumers of health care (Callahan). Medicine pays little credence to the biological certainty of death; the tendency instead is to believe that dying results from disease or injury that may yield to advances in technology (McCue). Yet there is a lack of clarity about what constitutes normal aging and decline and what distinguishes them from disease.

Family members are sometimes confronted with the choice of prolonging the life of a person who they consider to have died already as the result of a stroke, a coma, or other serious condition that destroys or masks the personality of the individual. Such social death, when the person can no longer express the same identity as before the health crisis, occurs days, weeks, months, or years before biological death, when the physical organism dies. The discrepancy between social and biological death is one of the most difficult features of contemporary medical decision-making.

The use of hospice programs, in which clinical, social, and spiritual support are given to dying persons and their families without the intention of prolonging life, began in the United States in 1974. Hospice embodies a philosophy, originating with Dr. Cicely Saunders in Great Britain, that pain control, dignity, and the reduction of spiritual and psychological suffering are the most important goals of patient care as death approaches. Hospice care, delivered both in the home and institutional setting, has been growing steadily since the 1980s. Yet in 1995 only about 17 percent of all deaths (all ages) took place in a hospice setting. The notion of palliative care, medical care that seeks to reduce and relieve symptoms of disease during the dying process without attempting to effect a cure or extend life, is gaining support and acceptance among health care practitioners and the public, but the desire to control and conquer end-stage disease still strongly influences most medical thought and action (Institute of Medicine 1997).

Cultural diversity

There is not just one attitude or approach toward dying and death among Americans. Studies in the social science and health literatures on how cultural diversity influences patient, family, and provider responses to end-of-life treatments and decision-making have been appearing slowly but steadily since the mid-1980s. Two themes emerge from this research. First, health workers are trained in particular professional cultures and bring their own experiences to bear on the dying process. Physicians, nurses, social workers, chaplains, and other health care professionals hold different assumptions from one another about how death should be approached as a result of their different types of training, and those sets of assumptions differ from the experiences of patients and families (Koenig). Second, the relationships among ethnic identification, religious practices, ways of dying, and beliefs and priorities about care, autonomy, and communication are complex and cannot be neatly organized along ethnic, class, or professional lines. In assessing cultural variation in patient populations, for example, cultural background is only meaningful when it is interpreted in the context of a particular patient's unique history, family constellation, and socioeconomic status. It cannot be assumed that patients' ethnic origins or religious background will lead them to approach decisions about their death in a culturally specified manner (Koenig and Gates-Williams).

In an increasingly pluralistic society, there is growing diversity among health care workers as well as among patient populations. Especially in urban areas, the cultural background of a health professional is often different from that of a dying patient to whom care is being given. It is impossible and inappropriate to use racial or ethnic background as straightforward predictors of behavior among health professionals or patients. In their study of ethnic difference, dying, and bereavement, Kalish and Reynolds found that although ethnic variation is an important factor in attitudes and expectations about death, "individual differences within ethnic groups are at least as great as, and often much greater than, differences between ethnic groups" (p. 49). The impact of cultural difference on attitudes and practices surrounding death in the United States cannot be denied. The challenge for society is to respect cultural pluralism in the context of an actively interventionist medical system.

Sharon R. Kaufman

See also Bereavement; Hospice; Medicalization of Aging; Mortality; Palliative Care; Refusing and Withdrawing Medical Treatment.

BIBLIOGRAPHY

Callahan, D. The Troubled Dream of Life: Living with Mortality. New York: Simon and Schuster, 1993.

Gillick, M.; Hesse, K.; and Mazzapica, N. "Medical Technology at the End of Life: What Would Physicians and Nurses Want for Themselves?" Archives of Internal Medicine 153 (1993): 25422547.

Institute of Medicine. Approaching Death: Improving Care at the End of Life. Washington, D.C.: National Academy Press, 1997.

Kalish, R. A., and Reynolds, D. K. Death and Ethnicity: A Psychocultural Study. New York: Baywood, 1976.

Koenig, B. "Cultural Diversity in Decision Making about Care at the End of Life." In Approaching Death: Improving Care at the End of Life. Institute of Medicine. Edited by M. Field and C. K. Cassel. Washington, D.C.: National Academy Press, 1997. Appendix E. Pages 363382.

Koenig, B., and Gates-Williams, J. "Understanding Cultural Difference in Caring for Dying Patients." Western Journal of Medicine 163 (1995): 244249.

Mccue, J. D. "The Naturalness of Dying." Journal of the American Medical Association 273 (1995): 10391043.

Muller, J., and Koenig, B. "On the Boundary of Life and Death: The Definition of Dying by Medical Residents." In Biomedicine Examined. Edited by M. Lock and D. Gordon. Boston: Kluwer, 1988. Pages 351374.

Quadagno, J. Aging and the Life Course: An Introduction to Social Gerontology. Boston: McGraw-Hill, 1999.

Scitovsky, A. A., and Capron, A. "Medical Care at the End of Life." An American Review of Public Health 7 (1986): 5975.

Slomka, J. "The Negotiation of Death: Clinical Decision Making at the End of Life." Social Science & Medicine 35 (1992): 251259.

Solomon, M., et al. "Decisions Near the End of Life: Professional Views on Life-Sustaining Treatments." Journal of Public Health 83 (1993): 1423.

SUPPORT Principal Investigators. "A Controlled Trial to Improve Care for Seriously Ill Hospitalized Patients." Journal of the American Medical Association 274 (1995): 15911634.

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Death and Dying

DEATH AND DYING

DEATH AND DYING. In the last 400 years, life expectancies in America have increased, the leading causes of death have changed, and twentieth-century technology has spawned the invention of antibiotics, vaccines, organ transplants, cloning, and genetic engineering. But in seventeenth-century America, death was a terrifying and uncontrollable reality. Half of the original Pilgrims who landed at Plymouth died in the first winter of 1620–1621. Puritan tradition taught that death was a release from the world but juxtaposed this comfort with a fear of God's punishment for earthly sin.

Life in the colonies was made more precarious by infectious diseases, fevers, intestinal worms, spoiled food, and tainted water supplies. One in ten children died before the age of one, and forty percent of children did not reach adulthood. Epidemics (such as diphtheria, influenza, pneumonia, and smallpox), diseases, and accidents were the primary causes of adult deaths, together with frontier Indian wars. Death was so common, and Puritan beliefs so encompassing, that early colonists had no elaborate rituals for the dying or the dead. Funerals were simple; sermons focused on sin and the judgment of God rather than the individual. Bodies were wrapped in cloth (known as winding sheets) or a shroud for burial, and vigils were limited. Wood markers were used to mark graves and listed little more than a person's name. Images on markers were forbidden, and the focus was on preparing the soul to be judged, not on remembrance.

Eighteenth-century America treated death with more elaborate ritual, even though death continued to be a constant, if not more controllable, companion. One in seven children died in childhood, and life expectancies were limited by sweeping epidemics. Urban areas along the coast developed primitive sanitation systems and attracted physicians wishing to set up practice. But the general lack of medical advances (bleeding patients and applying herbal remedies were the mainstays of medical care), limited sanitation practices, poor food preservation, and military casualties during the Revolutionary War limited natural life spans. After the spiritual revivals of the 1730s and 1740s (known as the Great Awakening), colonists viewed death as a spiritual transition rather than a fearful judgment of God. American society embraced European traditions such as tolling the bell to announce deaths and publishing invitations to funerals. Bodies were laid out for vigil, allowing friends and family time to gather. Trinkets such as gloves or rings were offered to funeral participants in memory of the dead. The act of dying and the treatment of death had evolved into a more individualized and elaborate event. Care for the dying and the dead attended to the physical process of death while showing concern for the soul. Bodies were washed and wrapped (using a cloth shroud similar to a nightgown) to preserve them for visitation and were sometimes placed in icehouses or cellars to keep preserved until the funeral could take place. Stonemasons began producing permanent gravestones; the vivid symbols of skulls, the face of Medusa, and urns were carved on stones, as were epitaphs. By the end of the eighteenth century, an aesthetic of simplicity engaged the newly independent United States, and elaborate mourning rituals and funerals fell out of fashion. Death again became a simpler process, now focused on reunion with God and family in heaven. The gentler symbols of cherubs and mourning angels became popular.

The nineteenth century brought a period of expansion and abundance, followed by the Industrial Revolution. Medical advances remained limited until late in the century, and death rates remained high compared with twentieth-century standards. The child death rate remained high, and by 1850, one in sixty-six children died in childhood. Less than ten percent of all adults living in 1860 arrived at adulthood with both parents living and all siblings surviving. At the beginning of the nineteenth century, the average woman gave birth to seven children during her lifetime—a phenomenon that reflected the expectation that children would die from childhood diseases. As medical care, housing, and food preservation improved, birth rates decreased to an average of 3.5 children in 1900. As westward expansion distributed the population throughout the Deep South and the Midwest, Americans experienced a variety of climates and harsh living conditions. Frontier towns such as Detroit and St. Louis had open sewage lanes running through their main streets, and professional medical care was limited in rural areas. Influenza and scarlet fever epidemics plagued the North, and malaria and yellow fever epidemics spread through the South throughout the century, killing thousands at a time. The Civil War (1861–1865) brought the greatest carnage, resulting in an estimated 618,000 deaths by combat, disease, and imprisonment by 1865. This did not include the 472,000 wounded or the numerous civilian deaths caused by disease, malnutrition, and natural causes. It was generally believed in the nineteenth century that diseases were caused by bad air, vapors, and stagnant marshes. Physicians recommended little more for patients than limited bathing, a light diet, and fresh air. Bloodletting and narcotics such as opium powders were used as well, and medicinal concoctions, often laced with lead or mercury, were given as tonics. As a result, the sick often died from the remedies or became invalids. Dying had become such a natural topic of discussion that manuals and books of consolation on preparing the sick for death or coping with loss became popular.

The American middle class emerged in the 1830s, bringing with it a desire to be accepted by the affluent, which required that it follow the appropriate fashions, rituals, and etiquette of genteel society. Many etiquette and household manuals included a section on caring for invalids, laying out the dead, dressing in mourning, preparing a funeral, and decorating the home for mourning. Americans were highly influenced by English and French customs and adapted them to suit American society. Mourning, rather than the dead themselves, became the focus. Once a death had occurred, the body was laid out, washed, and dressed in a shroud or in formal attire. The hair was dressed, and locks were sometimes cut and saved for later use in hair jewelry, hair wreaths, or other memorials. The body was laid out for vigil in a coffin or on a bed in the family home. Concern for the preservation of the body became much more important to Americans, and the process of embalming bodies (removing the bodily fluids and replacing them with preservative chemicals) became common by the time the Civil War began. Wood, metal, and iron coffins were common throughout the nineteenth century, and floral wreaths and arrangements were placed on graves. The funeral industry had begun: cabinetmakers built coffins, liveries arranged or provided hearses and carriages, and professions such as "layers out of the dead" could be found in city directories. (Undertakers were known in England in the 1840s, but the first undertakers in the United States did not establish themselves until the 1870s.) Death was considered a gentle deliverance and was not feared as it had been by the early colonists. Private graveyards gave way to commercially designed cemeteries, where the dead could rest and the living could visit in a pastoral setting. Gravestones evolved into monuments and works of art, rife with symbolism such as weeping willows and hands pointing toward heaven. Epitaphs included more personal information, poems, and phrases such as "at rest" or "going home." Mourning was a feminine responsibility. Women wore black garb trimmed with crape, and veils to hide their faces; they also removed themselves from social activities. Photography brought a peculiar innovation to nineteenth-century death rites. For the first time, Americans could have photos of family members to remember them by. A culture of postmortem photography began in the 1840s and continued through the 1930s. Photos of the dead, of the family in mourning, and of funeral flowers and mementos became an option for mourning memorials.

The twentieth century brought gradual and sweeping changes in the way Americans dealt with death and dying. World War I led to the demise of the visual mourning so important to the Victorians. The emerging garment industry could not keep up with deaths caused by extensive European battles and the mass mourning that ensued. Mourning rituals that demanded special clothing and the mourner's removal from society became archaic luxuries. World War II furthered this trend, as women stepped out of the home and into factories to support the war effort. By 1970, most Americans were not wearing black for funerals and were not using any sign of visual mourning, such as black wreaths, crape, and memorials, in their homes.

The twentieth century also brought great strides in medical care, hygiene, and the extension of life. Vaccines, antibiotics, antiviral drugs, improved water and sewage systems, better food preservation, and food enhancements have allowed Americans to live healthier and longer lives. In 1900 the average life span was 47.5 years; by the end of the century, the average life span had increased to 76.5—a thirty-year increase in 100 years. Cultural focus has shifted to the "cult of youth"; death has become secondary, and for many Americans, the approach to death emphasizes the physical rather than the spiritual. This shift toward a focus on life has taken death outside the home and into hospitals, nursing homes, hospices, assisted living facilities, and funeral homes. This trend began when nursing homes and assisted living facilities were created to provide better medical care for the sick and the elderly. Responsibility for medical care was transferred from the family to corporations and government. Removal of the elderly from the family caused the focus on youth to grow, and the discussion of death and mourning became almost taboo. In the last years of the twentieth century, however, a growing elderly population increased compassion for the dying. Patients' rights, living wills, euthanasia, and assisted suicide have all become important concerns for Americans.

In modern America, bodies are no longer laid out in the home but taken to a morgue and then transferred to a funeral home, which carries out arrangements requested by the family. Family members do not participate in the process of washing and laying out the body, although they may still keep vigil through visitation at a local house of worship or funeral parlor. The funeral industry provides comprehensive services that include transportation and preparation of the body, caskets or cremation, visitation of the body, printing of memorial cards, transportation for the family, and the actual burial and service at the cemetery. Preservation of the body continues to be important in U.S. culture, though cremation is becoming more accepted. Cremation (burning of the body at a high temperature to reduce it to ashes) has been practiced since the Stone Age (circa 3000 b.c.). Cremation was common in pagan societies, but the early Christians associated it with paganism and rejected it. In 1873, crematoriums were reintroduced in Europe and were gaining acceptance by the 1880s. Americans did not openly accept cremation until about 1980, as funeral and burial costs have risen, and cremation remains one of the cheapest methods of disposal. Ashes are disposed of by burial or scattering or are kept in the home. Most Americans still prefer traditional burial, and preparation of the body includes embalming and dressing the corpse in favorite clothing. Unique to this century is the desire to make the body look lifelike by using cosmetics on the face and hands and dressing the hair. The second half of the century has also brought experiments with mummification, cryonics (freezing), and even sending bodies into space to preserve them. Preparation of the body is followed by display and visitation in a funeral home or house of worship, a funeral service, and interment at a cemetery or memorial garden. Persons who have chosen cremation are given a traditional funeral or memorial service after the family has had time to mourn. Visual presentations of mourning are limited to flowers, a memorial card, a hearse, and a procession with cars. Services in the late twentieth century have become very individualized and include favorite music, the display of scrapbooks and pictures, the deceased's favorite objects, or participation by clubs to which the deceased belonged. The funeral has become a celebration and remembrance of life rather than a mourning of death.

Since the late twentieth century, Americans have had many new death-related issues to contend with and choices to make. In the 1990s the leading causes of deaths in America were heart disease, cancer, and stroke. Since 1981, Americans have also had to contend with Acquired Immune Deficiency Syndrome (AIDS), a deadly epidemic that has killed over thirty-six million people worldwide since its discovery. Technology in the twentieth century expanded the frontiers of science and pushed the ethics of medicine to the brink. Organ transplants, chemotherapy, and other medical advances have improved the length and quality of life, and stem cell research, cloning, and genetic engineering are taking Americans into un-known realms of medical options.

BIBLIOGRAPHY

Ariès, Philippe. The Hour of Our Death. New York: Knopf, 1981.

Callahan, Maggie, and Patricia Kelley. Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying. New York: Bantam Doubleday Dell, 1997.

Coffin, Margaret M. Death in Early America: The History and Folklore of Customs and Superstitions of Early Medicine, Funerals, Burial, and Mourning. Nashville, Tenn.: Nelson, 1976.

Curl, James Stevens. The Victorian Celebration of Death. Phoenix Mill, U.K.: Sutton, 2000.

Halttunen, Karen. Confidence Men and Painted Women: A Study of Middle-Class Culture in America, 1830–1870. New Haven, Conn.: Yale University Press, 1982.

Jones, Barbara. Design for Death. Indianapolis, Ind.: Bobbs-Merrill, 1967.

Kübler-Ross, Elisabeth. On Death and Dying. New York: Scribners, 1997.

Mitford, Jessica. The American Way of Death Revisited. New York: Vintage, 2000.

Prothero, Stephen R. Purified by Fire: A History of Cremation in America. Berkeley: University of California Press, 2001.

Reich, Warren T., ed. The Encyclopedia of Bioethics. New York: Macmillan, 1995.

Karen RaeMehaffey

See alsoBioethics ; Cemeteries ; Epidemics and Public Health ; Funerary Traditions .

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Death and Dying

Death and Dying


Death is something that all human beings can expect to experience. But just as there are variations in when life is seen to begin, so too are there variations in when death is seen to occur. In Western cultures, death is assumed to occur when a person irreversibly stops breathing, their heart stops, and there is no evidence of brain activity (Frederick 2001), but this definition is not necessarily held by other cultures.

Death is a social construction, which means that it is defined by using words, concepts, and ways of thinking available in the culture (Kastenbaum 1998). Because this meaning is socially constructed, death can mean different things to different people, and the meaning can change over time for each person. Marilyn Webb (1997) writes about the cultural mix that is the United States:

American families in fact have widely different views on such crucial issues as the nature of death, necessary rituals, expectations of an afterlife, whether folk medicines or faith healers need to be involved in the medical process, whether or not the patient should even be told of a poor prognosis whether the patient or the family should be the primary decision maker, and who in the family should make decisions. (p. 214–215)

When one looks around the world, one can see evidence of differences in interpretations of death and dying and appropriate behavior in their regard. Death may be seen differently in other cultures, with questions not just about when and how death occurs, but what death is. As an example, persons who would be considered unconscious by Western physicians, would be seen as dead by people living on Vanatinai, a small island near Papua New Guinea, leaving the possibility that they could die over and over (Lepowsky 1985). Clearly, there are social and cultural constraints that act upon beliefs, attitudes, standards, and behavior with regard to death and dying.


Death Systems

Death systems (Kastenbaum 1998) are "the interpersonal, sociophysical and symbolic network, through which an individual's relationship to mortality is mediated by his or her society" (p. 59, emphasis in original). In one sense, we face death as individuals; in another, we face it as a part of a society and a culture. As indicated above, there is no single, consistent, cross-cultural view of death and how we are to respond to it. Death systems help the members of a particular group to know what death is and how to respond. A death system includes cognitive, emotional, and behavioral components and teaches the members of a group how to think, feel, and behave regarding death. Even when social groups share basic beliefs, such as religious beliefs, death systems will differ among groups, as Kathryn Braun and Rhea Nichols (1997) described in their study of four Asian-American cultures, and with groups over time, as Patricia Swift (1989) saw in the evolving death system of Zimbabwe.

Although death systems are most clearly seen in large cultural groups, the family, with its unique shared past, present, and assumed future, also maintains a death system. Its assumptions about who can and should participate in such things as a death watch, who should attend a funeral, what they should wear, and how they should behave are all elements of a family's death system. The family, as an intimate system, acts as a filter for information from the broader culture. Beliefs about what death means, if there is an afterlife and what it is like, may come from the broader culture, but these beliefs are mediated by the family's death system.


Family Relationships and Death

"There is no more emotionally connected system than the family, if for no other reason than because no one can ever truly leave it" (Rosen 1998, p. 17). Families are a collection of individuals, with a unique shared history and unique responsibilities to each other. Indeed, the understanding of family in its most expansive sense, includes all generations: those living, those dead, and those yet to be born (Rosen 1998). We may choose to sever ties by ending contact, or terminating legal responsibilities, but in truth, can never truly sever relationship ties. Family ties may be voluntary or involuntary, wanted or unwanted, central to our thoughts or held to the side, and they often extend beyond death.

For any system to operate, it needs certain functions to take place and roles to be played (Rosen 1998). Each family has its own unique structure, functions, relationships, roles and role responsibilities, and interaction patterns (Rando 1984). Family members often carry out many roles in the family, and the more central these roles are to the family's ongoing operation, the more disruptive is the loss of the person who carried them out.

Families also maintain a certain balance and achieve a predictability in normal day-to-day life (Rosen 1998). This can be challenging without the loss of a family member, because families must deal with normative change that comes from such simple things as normal aging of family members and the evolving character of relationships within the family (Doka 1993). When a crisis like a death occurs, the family is thrown into disorder. The stability that has been established in the family is disrupted and, in order to continue to function, the family must somehow regain some sort of stability and shift the various responsibilities among the remaining family members. Death is what Reuben Hill (1949) referred to as a crisis of dismemberment, an apt term for the loss of a part of the family body. This form of crisis occurs when a family member is lost to the family and his or her various role responsibilities must be shifted to at least one other family member.

The family's ability to adapt to a terminal illness or a death is affected by a variety of factors (Murray 2000): the timing of the illness or the death in the life cycle, the nature of the death itself, and the degree to which the loss is acknowledged— that is, the degree to which it is disenfranchised (Doka 1989), stigmatized, or both. In addition, if families have concurrent stressors, if the person is central to the family's operations, or if there was conflict with the person who is dying or has died, the family will be more vulnerable at this time. Families with a variety of resources within and outside the family as well as openness, flexibility, and cohesiveness are better able to handle the various stressors related to the death (Murray 2000).


The Dying Process—Moving Toward a Death

There is disagreement as to when dying begins. In a sense, dying begins at birth. As Colin Murray Parkes, Pittu Laungani and Bill Young (1997) note, "Life [is] an incurable disease which always ends fatally" (p. 7). Typically, though, dying is considered as starting at a point close to the end of one's life when a life-threatening illness or condition develops. A variety of approaches can be taken: dying can be seen as beginning when the facts are recognized by the physician, when the facts are communicated to the patient, when the patient realizes or accepts the facts, or when nothing more can be done to preserve life (Kastenbaum 1998). Kenneth Doka (1995–96) broke the process of dying into three phases: the acute, the chronic, and the terminal phases of dying, in which the individual initially is given the diagnosis, then lives with the disease and then, finally, succumbs to death.

Like the dying person, the family goes through their own dying process. Families who are faced with the potentiality of the death of a family member generally will follow a pattern of changes, according to Elliott Rosen (1998):

Preparatory phase. In this phase, fear and denial are common. The family may be highly disorganized and the illness is highly disruptive to normal family operation. The family turns inward and is protective of itself and of its members. Anxiety may be higher at this time than at any other point in the dying process.

Living with the disease/condition. This phase can be quite long, and the family may settle into their new roles within the family. Supporters may become comfortable in their caregiving role and adjust to the idea of death. This is an important adjustment, because a great deal of the care for the terminally ill is provided by family members (Mezey, Miller, and Linton-Nelson 1999). Other roles may shift throughout this phase, including those of the terminally ill person. The family may close itself off from others. The family may be less disorganized during this phase, but the reorganization may not be healthy if, for example, the family isolates themselves and refuses offers of help. Anxiety is related to finances, resource availability, and caregiving. As Doka (1998) notes, this phase "is often a period of continued stress, punctuated by points of crisis" (p. 163).

Final acceptance. Usually the shortest phase, death is accepted and family members may say goodbye, although not all family members are equally willing to accept the death. The family is again disorganized and in shock, and roles no longer work as they did in the last phase. The family may become anxious of how others will think of them and view them, which can cause the family to move to extremes, becoming closer or moving further apart.

Throughout this process of moving toward the biological death of the family member, some or all family members may see the dying person to be socially dead (Sudnow 1967). In this, the dying person is seen to be "already dead" with the result that they may then become more and more isolated, as others move on with their lives and visit less and less frequently.

In a model similar to Rosen's, Doka (1993) includes a fourth phase, which he calls recovery, where the family resumes and reorders family roles and expectations. This may take place relatively smoothly, or may be complicated by the reluctance of some family members to give up the roles they held during the illness.


The Family After Death

Froma Walsh and Monica McGoldrick (1991) proposed that in order to successfully adapt to the loss of their family member, the family must do the following:

Recognize the loss as real. Family members must acknowledge the loss as real while each family member shares his or her grief. In order to do this, family members must share emotions and thoughts with each other. Grief is an isolating experience; a sense of acceptance among members would be promoted by displays of tolerance of differences in behavior by family members.

Reorganize and reinvest in the family system. As indicated above, the family system is destabilized by the loss; yet for it to continue to function, order and control must be reclaimed. Family members must reconstruct what family means to them and the roles and related tasks of the person who has died must be reassigned or given up. Family life may seem chaotic at this time and there may be battles over how the family will be reorganized. Differences in grieving may contribute to a feeling of being out-of-synch among family members. To get in-synch, families must reframe, that is, relabel their differences as strengths rather than weaknesses. The family must reinvest itself in normal developmental evolution. Tasks that are carried out as a matter of course in families must again be carried out in the family. This reclaiming of a normal life may be seen by some as abandonment of the deceased loved one. Trying to avoid mention of the deceased may inhibit communication, contributing to a sense of secretiveness in the family. Family members should let each other hold onto the memory until releasing them feels voluntary.

According to Walsh and McGoldrick, open communication is essential to completion of these tasks. This process may be slow, as each family member has strong needs and limited resources after a loss. Family members, who are already more emotional, may not recognize each other's different grief styles as legitimate. Rituals like funerals, religious rites, even family holiday rituals, can be used to facilitate the process of recognition, reorganization, and reinvestment in the family.

See also:Acquired Immunodeficiency Syndrome (AIDS); Chronic Illness; Disabilities; Elders; Euthanasia; Grief, Loss, and Bereavement; Later Life Families; Health and Families; Hospice; Infanticide; Stress; Sudden Infant Death Syndrome (SIDS); Suicide; War/Political Violence; Widowhood


Bibliography

braun, k. l., and nichols, r. (1997). "death and dying infour asian american cultures: a descriptive study." death studies 21:327–360.

doka, k. j., ed. (1989). disenfranchised grief. lexington,ma: lexington books.

doka, k. j. (1993). living with life-threatening illness: aguide for patients, their families and caregivers. new york: lexington books.

doka, k. j. (1995–96). "coping with life-threatening illness: a task model." omega: journal of death and dying 32:111–122.

hill, r. (1949). families under stress; adjustment to thecrises of war separation and reunion. new york: harper.

kastenbaum, r. j. (1998). death, society, and human experience, 6th edition. boston: allyn and bacon.

lepowsky, m. (1985). "gender, aging and dying in an egalitarian society." in aging and its transformations—moving toward death in pacific societies, ed. d. r. counts and d. a. counts. lanham, md: university press of america.

mezey, m.; miller, l. l.; and linton-nelson, l. (1999). "caring for caregivers of frail elders at the end of life." generations 23:44–51.

murray, c. i. (2000). "coping with death, dying, andgrief in families." in families and change: coping with stressful events and transitions, ed. p. c. mckenry and s. j. price. thousand oaks, ca: sage.

parkes, c. m.; laungani, p.; and young, b. (1997). introduction to death and bereavement across cultures, ed. c. m. parkes, p. laungani, and b. young. london: routledge.

rando, t. (1984). grief, dying and death: clinical interventions for caregivers. champaign, il: research press.

rosen, e. j. (1998). families facing death: a guide forhealthcare professionals and volunteers. san francisco: jossey-bass.

sudnow, d. (1967). passing on: the social organization of dying. englewood cliffs, nj: prentice hall.

swift, p. (1989). "support for the dying and bereaved inzimbabwe: traditional and new approaches." journal of social development in africa 4:25–45.

walsh, f., and mcgoldrick, m. (1991). "loss and the family: a systemic perspective." in living beyond loss: death in the family, ed. f. walsh and m. mcgoldrick. new york: norton.

webb, m. (1997). the good death: the new americansearch to reshape the end of life. new york: bantam books.


other resource

frederick, c. j. (2001). "death and dying." microsoft encarta online encyclopedia, 2001. available from http://encarta.msn.com.

kathleen r. gilbert

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Death and Dying

Death and dying

Definition

Death is the end of life, a permanent cessation of all vital functions. Dying refers to the body's preparation for death, which may be very short in the case of accidental death, or can last weeks or months in some patients such as those with cancer.


Description

Risks of surgery

Specific risks vary from surgery to surgery and should be discussed with a physician. All surgeries and every administration of anesthesia have some risks; they are dependent upon many factors including the type of surgery and the medical condition of the patient. The patient should ask the anesthesiologist about any risks that may be associated with the anesthesia. Specific standards are set by the American Society of Anesthesiologists to enhance the safety and quality of anesthesia before surgery, basic methods of monitoring patients during surgery, and the best patient care during recovery.

Overwhelming data compiled in 2001 has confirmed that albumin is an effective marker of general nutrition; low albumin levels can increase the likelihood of post-surgery complications such as pneumonia, infection, and the inability to wean from a ventilator, by as much as 50%. In a national study of 54,000 surgery patients (average age of 61 years old), it was found that only one in five surgical patients were tested for low albumin before their operations.

In a study of 2,989 hospitalized patients admitted for more than one day, risk factors such as cholesterol levels (primarily low levels of high-density lipoprotein, HDL) and low serum albumin were associated with inhospital death, infection, and length of stay. During the study follow-up, 62 (2%) of the patients died, 382 (13%) developed a nosocomial infection, and 257 (9%) developed a surgical site infection.

The National Veterans Affairs Surgical Risk Study was conducted in 44 Veterans Affairs Medical Centers and included 87,078 major noncardiac operations performed under general, spinal, or epidural anesthesia. Patient risk factors predictive of postoperative death included serum albumin level, American Society of Anesthesia class, emergency operation, and 31 additional preoperative variables.

Other factors related to death during surgery are: increasing age, emergency surgery , and general postoperative complications including cardiac, renal, and pulmonary complications. Age-related changes in the immune system play a significant role in the increased risk of infection, decreased ability to fight diseases, and slower wound healing after surgery. An aging body is more susceptible to subsequent infections because of previous illness or surgery and the subsequent weakening of the immune system. The anti-inflammatory medications (e.g., to control conditions such as arthritis) that many older people take are also known to slow wound healing.

One study found that risk of death during coronary artery bypass graft surgery is associated with hospital volume, i.e., the number of surgeries performed. High volume hospitals had a lower mortality rate during surgery. Mortality decreased with increasing volume of surgeries performed (3.6% in low [less than 500 cases], 3% in moderate [500-1,000 cases], and 2% in high [over 1,000 cases] volume hospitals). Thus, the volume of surgeries performed may be an important consideration when selecting a hospital.


Complications of surgery

The most common complications to surgery that can prove fatal are infection, bleeding, and complications of anesthesia.

The Joint Commission's Board of Commissioners reviewed 64 cases related to operative and post-operative complications since the late 1990s. Of the events reviewed, 84% of the complications resulted in patient deaths, while 16% resulted in a serious injury. All of the cases occurred in acute care hospitals; cases directly related to medication errors or to the administration of anesthesia were excluded. Of these complications, 58% occurred during the postoperative procedure period, 23% during intraoperative procedures, 13% during post-anesthesia recovery, and 6% during anesthesia induction.

The following types of procedures were most frequently associated with these reported complications:

  • endoscopy and/or interventional imaging
  • catheter or tube insertion
  • open abdominal surgery
  • head and neck surgery
  • thoracic surgery
  • orthopedic surgery

Of the 64 cases reviewed, 90% occurred in relation to non-emergent (elective or scheduled) procedures. The most frequent complications by type of procedure included the following:

  • Naso-gastric/feeding tube insertion into the trachea or a bronchus.
  • Massive fluid overload from absorption of irrigation fluids during genito-urinary/gynecological procedures.
  • Endoscopic procedures (including non-gastrointestinal procedures) with perforation of adjacent organs. Of all abdominal and thoracic endoscopic surgery, liver lacerations were among the most common complications.
  • Central venous catheter insertion into an artery.
  • Burns from electrocautery used with a flammable prep solution.
  • Open orthopedic procedures associated with acute respiratory failure, including cardiac arrest in the operating room.
  • Imaging-directed percutaneous biopsy or tube placement resulting in liver laceration, peritonitis, or respiratory arrest while temporarily off prescribed oxygen.

Complications associated with misplacement of tubes or catheters usually involved a failure to confirm the position of the tube or catheter, a failure to communicate the results of the confirmation procedure, or misinterpretation of the radiographic image by a non-radiologist.


Preparing for death or incapacitation legally

An advance directive is a way to allow caregivers to know a patient's wishes, should the patient become unable to make a medical decision. The hospital must be told about a patient's advance directive at the time of admission. Description of the type of care for different levels of illness should be in an advance directive. For instance, a patient may wish to have or not to have a certain type of care in the case of terminal or critical illness or unconsciousness. An advance directive will protect the patient's wishes in these matters.

A living will is one type of advance directive and may take effect when a patient has been deemed terminally ill. Terminal illness in general assumes a life span of six months or less. A living will allows a patient to outline treatment options without interference from an outside party.

A durable power of attorney for health care (DPA) is similar to a living will; however, it takes effect any time unconsciousness or inability to make informed medical decisions is present. A family member or friend is stipulated in the DPA to make medical decisions on behalf of the patient.

While both living wills and DPAs are legal in most states, there are some states that do not officially recognize these documents. However, they may still be used to guide families and doctors in treatment wishes.

Do-not-resuscitate (DNR ) orders can be incorporated into an advance directive or by informing hospital staff. Unless instructions for a DNR are in effect, hospital staff will make every effort to help patients whose hearts have stopped or who have stopped breathing. DNR orders are recognized in all states and will be incorporated into a patient's medical chart if requested. Patients who benefit from a DNR order are those who have terminal or other debilitating illnesses. It is recommended that a patient who has not already been considered unable to make sound medical decisions discuss this option with his or her physician.

None of the above documents are complicated. They may be simple statements of desires for medical care options. If they are not completed by an attorney, they should be notarized and a copy should be given to the doctor, as well as to a trusted family member.


Mourning and grieving among cultures

The death of a loved one is a severe trauma, and the grief that follows is a natural and important part of life. No two people grieve exactly the same way, and cultural differences play a significant part in the grieving process. For many, however, the most immediate response is shock, numbness, and disbelief. Physical reactions may include shortness of breath, heart palpitations, sweating, and dizziness. At other times, there may be reactions such as loss of energy, sleeplessness or increase in sleep, changes in appetite, or stomach aches. Susceptibility to common illnesses, nightmares, and dreams about the deceased are not unusual during the grieving period.

Emotional reactions are as individual as physical reactions. A preoccupation with the image of the deceased, feelings of fear, hostility, apathy, emptiness, and even fear of one's own death, may occur. Depression, diminished sex drive, sadness, and anger at the deceased may occur. Bereavement may cause short- or long-term changes in the family unit and other relationships of the bereaved.

It is important for the bereaved to work through their feelings and not avoid their emotions. If emotions and feelings are not discussed with family members, friends, or primary support groups, then a therapist should be consulted to assist with the process.

Various cultures and religions view death in different manners and conduct mourning rituals according to their own traditions. In most cultures, visitors often come to express their condolences to the family and to bid farewell to the deceased. At times, funeral services are private. Various ethnic groups host a gathering after the funeral for those who attended. It is common for these events to become a celebration of the life of the deceased, which also helps the bereaved to begin the mourning process positively. Memories are often exchanged and toasts made in memory of the deceased. Knowing how much a loved one is cherished and remembered by friends and family is a comfort to those who experience the loss. Other methods of condolences include sending flowers to the home or the funeral parlor; sending a mass card, sending a donation to a charity that the family has chosen; or bringing a meal to the family during the weeks after the death.


Resources

books

Beauchamp, Daniel R., Mark B. Evers, Kenneth L. Mattox, Courtney M. Townsend, and David C. Sabiston, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 16th ed. London: W. B. Saunders Co., 2001.

Coberly, Margaret. Sacred Passage: How to Provide Fearless, Compassionate Care for the Dying. Boston: Shambhala Publications, 2002.

Heffner, John E., Ira R. Byock, and Lra Byock, eds. Palliative and End-of-Life Pearls. Philadelphia: Hanley and Belfus, Inc., 2002.

Kubler-Ross, Elisabeth, and David Kessler. Life Lessons: Two Experts on Death and Dying Teach Us About the Mysteries of Life and Living. New York: Scribner, 2000.

Soto, Gary. The Afterlife. Orlando, FL: Harcourt Children's Books, 2003.

Staton, Jana, Roger Shuy, and Ira Byock. A Few Months to Live: Different Paths to Life's End Baltimore, MD: Georgetown University Press, 2001.

Sweitzer, Bobbie Jean, ed. Handbook of Preoperative Assessment and Management. Philadelphia: Lippincott Williams & Wilkins, 2000.


periodicals

Byock, Ira, and Steven H. Miles. "Hospice Benefits and Phase I Cancer Trials." Annals of Internal Medicine 138, no. 4 (February 2003): 335337.

Smykowski, L., and W. Rodriguez. "The Post Anesthesia Care Unit Experience: A Family-centered Approach." Journal of Nursing Care Quality 18, no. 1 (January-March 2003): 515.


organizations

American College of PhysiciansAmerican Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106-1572. Washington Office: 2011 Pennsylvania Avenue NW, Suite 800, Washington, DC 20006-1837. (202) 261-4500 or (800) 338-2746. <http://www.acponline.org>.

Hospice Foundation of America, 2001 S Street, NW, Suite 300, Washington, DC 20009. (800) 854-3402 or (202) 638-5419. Fax: (202) 638-5312. E-mail: [email protected] <www.hospicefoundation.org>.

Inter-Institutional Collaborating Network On End-of-life Care (IICN). (415) 863-3045. <http://www.growthhouse.org>.

National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892. (301) 496-4000. E-mail: [email protected] nih.gov. <http://www.nih.gov/>.

Promoting Excellence in End of Life Care, RWJ Foundation National Program Office, c/o The Practical Ethics Center, The University of Montana, 1000 East Beckwith Avenue, Missoula, MT 59812. (406) 243-6601. Fax: (406) 243-6633. E-mail: [email protected] <http://www.promotingexcellence.org>.

Washington Home Center for Palliative Care Studies (CPCS), 4200 Wisconsin Avenue, NW, 4th Floor, Washington, DC 20016. (202) 895-2625. Fax: (202) 966-5410. E-mail: [email protected] <http://www.medicaring.org>.


other

American College of Physicians. "How to Help During the Final Weeks of Life." ACP Home Care Guide for Advanced Cancer. [cited March 2, 2003]. <http://www.acponline.org/public/h_care/7-final.htm>.

American College of Physicians. "What to Do Before and After the Moment of Death." ACP Home Care Guide. [cited March 2, 2003]. <http://www.acponline.org/public/h_care/8-moment.htm>.

Byock, Ira, M.D. DyingWell.org. [cited March 2, 2003]. <http://www.dyingwell.org/default.htm>.

Kubler-Ross, Elisabeth, and Carol Bilger. On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Family. (Audio Cassette, Abridged edition.) New York: Audio Renaissance, 2000.


Jacqueline N. Martin, M.S. Crystal H. Kaczkowski, M.Sc.

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death

death Reports of the first human heart transplants in 1967 made controversy over the definition of death seem as unprecedented as heart transplantation itself — a radically new issue produced by a radically new technology. But disagreements over the meaning of death long predated the 1960s, and such debates never were simply products of new technical knowledge. From the intense fear in the eighteenth and nineteenth centuries that people were being mistakenly buried alive, to current controversies over brain death, death has long been a contested and changing construct, shaped by scientific discoveries in resuscitation and vivisection, the changing social powers of the medical profession, and changing cultural values. If death means the end of life, defining death implies defining life — a long-contentious issue indeed.

1740–1880

For much of the eighteenth and nineteenth centuries, an intense fear of ‘premature burial’ haunted Western culture, from the tales of Edgar Allen Poe to European laws that imposed long waiting periods before interment. This concern was neither an isolated curiosity nor an outbreak of mass hysteria. Rather, it reflected major changes in the concept of death itself, prompted in large part by new scientific discoveries in resuscitation and experimental vivisection. For example, beginning in the 1740s a series of widely-publicized cases demonstrated that breathing and heartbeats could be restarted after they had stopped. To make sense of such resuscitations, London physician John Fothergill proposed that suspended animation was a curable form of death. Like a machine, life could be turned off and on; reanimation was a form of resurrection. However Fothergill's view was rejected by such vitalists as Scottish medical theorist William Cullen (1710–90). Cullen redefined death, not as the actual cessation of heart and lung functions, but as the loss of the potential for muscle and nerve activity (‘irritability’ and ‘sensibility’). His approach reconciled resuscitation with the belief that death was by definition irreversible. However, it offered no way of diagnosing when this vital potential had been lost, and thus no way of knowing for certain when resuscitation efforts should be ended. Others rejected both these new definitions of death, denying that ‘suspended animation’ was real. They postulated that undetectable levels of heart and lung activity must by definitions have been continuously present in all cases of successful resuscitation.

The mid seventeenth-century discovery that the heart and lungs could be maintained alive in an animal that had been decapitated also challenged concepts of death, by dramatizing the distinction between the death of an organism and the death of its component parts. The guillotine, invented by a doctor to make execution swifter and more humane, also seemed to demonstrate that human heads and bodies could show signs of separate life. Based on such observations, many eighteenth-century medical writers concluded that death was not a single event but a long process taking place at a succession of physiological levels, and that death could not be diagnosed with certainty until the process had concluded with decomposition of body tissues. Such doctors' doubts about their own ability to diagnose or define death played a key role in triggering the cultural concern that people were being buried alive.

However, the specific fear of premature burial was not simply a product of medical uncertainty. To make sure that their bodies would be dead before burial, some people requested that they be cremated or embalmed. Their terror of being buried alive was more than simply a fear of being mistaken for dead. Romantic fascination with the claustrophobia of isolated helpless confinement, anti-Semitic opposition to traditional Jewish rapid interments, and post-Enlightenment doubts about the afterlife helped shape medical uncertainty about death into the specific horror of being buried too soon.

1880–1960

While the fear of premature burial was triggered by the discoveries of eighteenth-century scientists and physicians, late nineteenth-century doctors generally concluded that new technologies, from the stethoscope to X-rays had solved the problem of diagnosing death. These new instruments did not resolve any of the underlying conceptual controversies over the meaning of death, but an unprecedented faith in technology, from the 1880s through the first half of the twentieth century, led both the medical profession and much of the lay public to stop expressing concern over the persisting philosophical uncertainties. The fear of premature burial never disappeared, but it was largely relegated to such marginal organizations as the Association for the Prevention of Premature Burial, an international group of vitalists, anti-vivisectionists, and anti-bacteriologists, united by their opposition to the growing philosophical materialism and social power of twentieth-century medicine. Women also were disproportionately active in this movement. Some opposed the new technological medicine for undermining nineteenth-century women's efforts to integrate moral and physical healing. Others worried that women were particularly at risk of premature burial, because women were believed to be especially susceptible to fainting spells, catatonic fits, and spiritual trances that mimicked death.

Dramatic new discoveries, including recoveries from prolonged hypothermia and successful animal head transplants, continued to complicate the era's concepts of death. The resulting uncertainties were widely debated by scientists and the public. Many physiologists agreed with Boston embryologist Charles Minot that organisms were illusory, and that life and death could be defined only at the cellular level. Alternatively, neurologists like Charles Sherrington redefined the life of an organism as the nerve-mediated capacity to integrate organ and tissue functions. Mass culture, from journalism to science fiction, avidly reported these discoveries and disputes. However, unlike in prior centuries, when such scientific developments sparked public panic, in the first half of the twentieth century they were represented as wonderful marvels of modern science, possibly leading to resurrection or immortality. Also, while physiologists, philosophers, and the public continued to ponder the meaning of death, few of this era's practitioners of clinical medicine joined the discussion.

Since 1960

The brain death debates that began in the late 1960s thus did not constitute an unprecedented change in the meaning of death. But the 1960s did mark two new developments: a revival of interest in the issue on the part of clinicians, and a change from optimism to renewed concern on the part of the public. In the late 1960s, several medical leaders such as Harvard University anesthesiologist Henry K. Beecher proposed that patients be declared dead if their brains had irreversibly lost all functioning, even if their other vital functions were being maintained by mechanical ventilators. At first, ‘brain death’ was explained primarily as a means of defending organ transplantation, and of protecting medicine against the era's renewed social criticism of professional authority. But in the early 1980s, this representation of the issue was dramatically reversed. Brain death now was promoted, not as a defence of medical technology against public criticism, but as a defence of the public against that technology's invasive indignities. Redefining death was understood as logically distinct from euthanasia, but each provided a different way to answer the same clinical question: when should a physician stop treating a patient? Growing public support for a ‘right to die’ and ‘death with dignity’ proved crucial to the rapid adoption in the US of the brain death legislation advocated in the 1981 report of the President's Commission on bioethics. To diagnose brain death, the commission specified that the patient must have suffered permanent loss of all brain functions, both ‘higher-brain’ based activities, such as consciousness, and basic brain stem reflexes, such as gagging and pupil constriction. Great Britain adopted slightly different criteria, promoted by Christopher Pallis, under which the permanent loss of brain stem functions was considered sufficient to diagnose brain death.

Despite the success of brain death legislation, the fear of being treated too long was added to, not substituted for, the fear of being abandoned too soon. Mass culture continued to link brain death with organ-stealing doctors, as in the 1977 book and subsequent motion picture Coma. Orthodox Jews, traditionalist Japanese, and ‘right to life’ supporters are all deeply divided over whether to accept any brain-based definition of death. Some African Americans expressed concern that brain death was being used to take organs prematurely from blacks for transplantation to whites.

On the other hand, many philosophers, such as pioneer bioethicist Robert Veatch, attacked ‘whole brain’ legislation as failing to resolve crucial conceptual ambiguities. They promoted various ‘higher-brain’ alternatives that define human death as the permanent loss of consciousness and personal identity — as in the persistent vegetative state.

Thus, while the whole-brain definition of death has won wide acceptance, death remains a controversial and contingent concept, as it has been for centuries, at the intersection of changes in physiological research, medical practice, social structure, and cultural values.

Martin Pernick

Bibliography

Pernick, M. S. (1988). Back from the grave: recurring controversies over defining and diagnosing death in history. In Death: beyond whole-brain criteria, (ed. R. M. Zaner), pp. 17–74. Kluwer Academic Publishers, Dordrecht and Boston.
Pernick, M. S. (1999). Brain death in a cultural context: the reconstruction of death 1967–1981. pp 3–33 In The definition of death, (ed. S. Younger, R. Arnold, and R. Schapiro). Johns Hopkins University Press, Baltimore.
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1981). Defining Death. US Government Printing Office, Washington, DC.


See also brain death; coma; corpse; euthanasia; funeral practices; life support; organ donation; resurrection; resuscitation; transplantation; vegetative state; zombie.

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Death

Death

Definition

Death is defined as the cessation of all vital functions of the body including the heartbeat, brain activity (including the brain stem), and breathing.

Description

Death comes in many forms, whether it be expected after a diagnosis of terminal illness or an unexpected accident or medical condition.

Terminal illness

When a terminal illness is diagnosed, a person, family, friends, and physicians are all able to prepare for the impending death. A terminally ill individual goes through several levels of emotional acceptance while in the process of dying. First, there is denial and isolation. This is followed by anger and resentment. Thirdly, a person tries to escape the inevitable. With the realization that death is eminent, most people suffer from depression. Lastly, the reality of death is realized and accepted.

Causes and symptoms

The two leading causes of death for both men and women in the United States are heart disease and cancer. Accidental death was a distant third followed by such problems as stroke, chronic lung disorders, pneumonia, suicide, cirrhosis, diabetes mellitus, and murder. The order of these causes of death varies among persons of different age, ethnicity, and gender.

Diagnosis

In an age of organ transplantation, identifying the moment of death may now involve another life. It thereby takes on supreme legal importance. It is largely due to the need for transplant organs that death has been so precisely defined.

The official signs of death include the following:

  • no pupil reaction to light
  • no response of the eyes to caloric (warm or cold) stimulation
  • no jaw reflex (the jaw will react like the knee if hit with a reflex hammer)
  • no gag reflex (touching the back of the throat induces vomiting )
  • no response to pain
  • no breathing
  • a body temperature above 86 °F (30 °C), which eliminates the possibility of resuscitation following cold-water drowning
  • no other cause for the above, such as a head injury
  • no drugs present in the body that could cause apparent death
  • all of the above for 12 hours
  • all of the above for six hours and a flat-line electroencephalogram (brain wave study)
  • no blood circulating to the brain, as demonstrated by angiography

Current ability to resuscitate people who have "died" has produced some remarkable stories. Drowning in cold water (under 50 °F/10 °C) so effectively slows metabolism that some persons have been revived after a half hour under water.

Treatment

Only recently has there been concerted public effort to address the care of the dying in an effort to improve their comfort and lessen their alienation from those still living. Hospice care represents one of the greatest advances made in this direction. There has also been a liberalization of the use of narcotics and other drugs for symptomatic relief and improvement in the quality of life for the dying.

ELISABETH KÜBLER-ROSS (19262004)

A contemporary physician who was a world authority on the subject of death and after-death states. Born in Switzerland on July 8, 1926, she worked as a country doctor before moving to the United States. During World War II she spent weekends at the Kantonspital (Cantonai Hospital) in Zürich, where she volunteered to assist escaped refugees. After the war she visited Majdanek concentration camp, where the horrors of the death chambers stimulated in her a desire to help people facing death and to understand the human impulses of love and destruction. She extended her medical background by becoming a practicing psychiatrist. Her formal work with dying patients began in 1965 when she was a faculty member at the University of Chicago. She also conducted research on basic questions concerning life after death at the Manhattan State Hospital, New York. Her studies of death and dying involved accounts by patients who reported out-of-the-body travel. Her research tends to show that while dying can be painful, death itself is a peaceful condition. Her 1969 text, On Death and Dying, was hailed by her colleagues and also became a popular best-seller.

In 1978 Kübler-Ross helped to found Shanti Nilaya (Final Home of Peace), a healing and growth center in Escondido, California. This was an extension of her well-known "Life-Death and Transition" workshops conducted in various parts of the United States and Canada, involving physicians, nurses, social workers, laypeople, and terminally ill patients. Much of Kübler-Ross's later research was directed toward proving the existence of life after death. Her publication To Live Until We Say Good-bye (1979) was both praised as a "celebration of life" and criticized as "prettifying" the real situation. She also dealt with issues such as AIDS and "near death" experiences. In the mid-1980s, Shanti Nilaya moved from San Diego County, California, to Head Waters, Virginia, where it continues to offer courses and short- and long-term therapeutic sessions.

Living will

One of the most difficult issues surrounding death in the era of technology is that there is now a choice, not of the event itself, but of its timing. When to die, and more often, when to let a loved one die, is coming within people's power to determine. This is both a blessing and a dilemma. Insofar as the decision can be made ahead of time, a living will is an attempt to address this dilemma. By outlining the conditions under which one would rather be allowed to die, a person can contribute significantly to that final decision, even if not competent to do so at the time of actual death. The problem is that there are uncertainties surrounding every severely ill person. Each instance presents a greater or lesser chance of survival. The chance is often greater than zero. The best living will follows an intimate discussion with decision makers covering the many possible scenarios surrounding the end of life. This discussion is difficult, for few people like to contemplate their own demise. However, the benefits of a living will are substantial, both to physicians and to loved ones who are faced with making final decisions. Most states have passed living will laws, honoring instructions on artificial life support that were made while a person was still mentally competent.

Euthanasia

Another issue that has received much attention is assisted suicide (euthanasia). In 1997, the State of Oregon placed the issue on the ballot, amid much consternation and dispute. Perhaps the main reason euthanasia has become front page news is because Dr. Jack Kevorkian, a pathologist from Michigan, is one of its most vocal advocates. The issue highlights the many new problems generated by increasing ability to intervene effectively in the final moments of life and unnaturally prolong the process of dying. The public appearance of euthanasia has also stimulated discussion about more compassionate care of the dying.

Prevention

Autopsy after death is a way to precisely determine a cause of death. The word autopsy is derived from Greek meaning to see with one's own eyes. A pathologist extensively examines a body and submits a detailed report to an attending physician. Although an autopsy can do nothing for an individual after death, it can benefit the family and, in some cases, medical science. Hereditary disorders and disease may be found. This knowledge could be used to prevent illness in other family members. Information culled from an autopsy can be used to further medical research. The link between smoking and lung cancer was confirmed from data gathered through autopsy. Early information about AIDS was also compiled through autopsy reports.

Resources

BOOKS

Finkbeiner, J. Autopsy: A Manual & Atlas. Philadelphia: Saunders, 2001.

Iserson, Kenneth B. Death to Dust: What Happens to DeadBodies? Tucson: Galen Press Ltd, 2001.

Mount, Balfour M. "Care of Dying Patients and Their Families." In Cecil Textbook of Medicine, edited by Lee Goldman, et al., 21st ed. Philadelphia: W.B. Saunders, 2000.

Sheaff, Michael T., and Deborah J. Hopster. Post Mortem Technique Handbook. New York: Springer Verlag, 2001.

PERIODICALS

Roger, V. L., et al. "Time Trends in the Prevalence of Atherosclerosis: A Population-based Autopsy Study." American Journal of Medicine 110, no. 4 (2001): 267-273.

Targonski, P., et al. "Referral to Autopsy: Effect of AtemortemCardiovascular Disease. A Populationbased Study in Olmsted County, Minnesota." Annals of Epidemiology 11, no. 4 (2001): 264-270.

ORGANIZATIONS

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (913) 906-6000. http://www.aafp.org.

American Medical Association. 515 N. State Street, Chicago, IL 60610. (312) 464-5000. http://www.amaassn.org.

American Society of Clinical Pathologists. 2100 West Harrison Street, Chicago, IL 60612. (312) 738-1336. http://www.ascp.org/index.asp.

College of American Pathologists. 325 Waukegan Road, Northfield, IL 60093. (800) 323-4040. http://www.cap.org.

Hospice Foundation of America. 2001 S St. NW Suite 300, Washington, DC 20009. (800) 854-3402. http://www.hospicefoundation.org.

OTHER

American Association of Retired Persons. http://www.aarp.org.

Association for Death Education and Counseling. http://www.adec.org.

Death and Dying Grief Support. http://www.death-dying.com.

National Center for Health Statistics. http://www.cdc.gov/nchs.

KEY TERMS

Angiography X rays of blood vessels filled with a contrast agent.

Caloric testing Flushing warm and cold water into the ear stimulates the labyrinth and causes vertigo and nystagmus if all the nerve pathways are intact.

Electroencephalogram Recording of electrical activity in the brain.

Hospice Systematized care of dying persons.

Living will A legal document detailing a person's wishes during the end of life, to be carried out by designated decision makers.

Stroke Interruption of blood flow to a part of the brain with consequent brain damage, also known as a cerebrovascular accident (CVA).

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Death

Death


Within the popular Western Judeo-Christian tradition, death has usually been understood to be a consequence of original sin. This has, of course, not been a scientifically informed belief. And where theology has been in conversation with science on this point, or when theology is indirectly informed by a growing ecological consciousness, natural death in and of itself is increasingly seen as a natural piece of the creation that God called good.


Western religious perspectives

The growing perspective that death according to natural processes is not necessarily a consequence of sin would cohere with the early Christian tradition, as well as with Eastern Orthodox theology. The second-century Christian theologian Irenaeus, for example, emphasized how the first parents, as described in one of the Genesis accounts, were driven out of paradise so that they would not eat of the tree of life after they had sinned. Their being secured from that temptation by expulsion into a hard life was thus a giftfor who would want to live eternally estranged from God?and presupposes that they were mortal beings. Indeed, death was already part of the natural order designed by God. Eastern Orthodoxy reiterates this anthropology with its emphasis on the incarnation as more a leading of humanity into the next aspect of God's creative work than of rescue from sin and evil; the need for Christ to redeem the creation from the new exigency of sin was, as it were, added to the original agenda of leading the creation into the new age.

Western theology is beginning to adapt this perspective. Christian theologians like Karl Rahner (19041984) and Karl Barth (18861968) at the beginning of the twentieth century already recognized this impulse, and such thought is more advanced in this ecumenical age. Death is not so readily understood as an "evil." It is, rather, a "problem" in Christianity because sin became attached to it. Sin constitutes alienation from God, and thus the experience of death most often is attended by fear, loneliness, and loss. Though biblical scholars still debate the meaning of the apostle Paul's assertions that the wages of sin are death (Rom. 5:12) and that the travails of the creation are attributable to human sin, more and more exegetes are less willing to claim biblical warrant for the dominant Augustinian idea that physical death, along with physical suffering and corruptibility, are consequences of the Fall. Further, an ever more scientifically informed consciousness, one that ever more understands how consciousness itself has evolved from simple matter, is also less inclined to fix material processes, including natural physical death, in dualistic terms of good and evil. Concurrently, such consciousness may recognize that its own knowledge of finitudeand so, an intuited transcendenceis precisely the "problem" that is occasioned by fear of death.

Other religious perspectives are less ambivalent in asserting a spiritual origin to death, and will ascribe death more to God's direct agency than to natural processes. Islamic thought, like some Christian perspectives, links natural death more specifically to the will of God. The Qur'an teaches of death that God determines the span of a person's life: "He creates man and also causes him to die" (Qur'an, XLV:26). How this might cohere with Western religious notions of divine agency, design of creative processes, and so forth, are a ripe field for exploration as the science-theology dialogue begins more to engage Islamic scholars.


Eastern religious perspectives

Hindu tradition, with all its variety, is distinguished by the doctrine of the transmigration of the soul, that is, the passing at death of the soul from one body or being to another. Life and death are aspects of an eternal cycle, as over and against the linear understanding of time embedded in Western science and theology. This process of samsara refers to journeying or passing through a series of incarnational experiences. One's karma accompanies one through these stages, and can be roughly defined as the moral law of cause and effect. Some popular reflection attempts to correlate karmic doctrine with Newtonian physics. The thoughts and actions of the past determine the present state of being, and in turn present choices influence future states. This karmic process characterizes the ever-changing flow of everyday experience, as well as the successive rounds of deaths and rebirths. Each moment conditions the next, and karma impacts the reincarnational flow of being.

An interesting new trajectory might yet be explored with respect to the linking of the spirituality of Hindu self-abnegation and new science. According to Hinduism, underlying the apparent separateness of individual beings is a unitary reality. Just as the ocean is composed of innumerable drops of water, so undifferentiated being manifests itself in human experience as apparently separate selves. The goal of lifelivesis, in the end, to realize the eternal self, or Atman, which by nature defies description. This assuredly difficult task (of the realization of something beyond description) aspires to deliverance from a potentially endless cycle of birth, death, and rebirth. To achieve deliverance, one must act with pure insouciance and detachment, with no attentiveness to cause or effect or reward; "one must act without desire or purpose, independently of the results of the action (Kramer, p. 33)." Thereby the detached self dies to self and into Krishna, becoming a "True Self." The goal of Hindu religion, in other words, is to transcend or leave karma and its cause and effect activity behind, which is perhaps not unlike new science's movement away from Newtonian physics.

The general understanding of death in Buddhism in all its varieties (Zen, Tantric, etc.) is not greatly different from Hindu thought. Generally (there are notable variations in Buddhist thinking) Buddhism understands death as a transition toward either phenomenal rebirth or release from the phenomenal realm into pure nibbana (nirvana). Practicing a life that would ensure the latter, or at least ensure a return to a desirable station after rebirth, requires total moderation of self-will and desire. Death itself involves grieved losses; thus, a certain kind of pastoral care obtains at Buddhist funerals. Even so, death is a phenomenon to be transcended, and so a reality that is not as real or as significant as the transcendent. A Buddhist, in other words, might well question the relevance of an entry about death. Likewise with other Asian religions. Confucianism, the philosophy of Lao Tze, and Daoism, for example, significantly moderate the Buddhist perspective of death, and locate the meaning of life more in practiced simplicity and propitious behavior than in preparing for a hereafter. There are ritually correct ways to conduct life and death, and so human consciousness is at its best simply when it is attentive to the fullness of the present.


Death and ultimate destiny

Finally, the question of whether death is an end is, to be sure, energetically discussed. This, of course, is where religious faiths diverge from final entropy as the last word. Christians believe in a resurrection of the deadthough not necessarily in physicalist termswhich is subject to a coming judgment by God and the possibility of eternal joy (heaven) or despair (hell). Within Judaism, only the most mystical and apocalyptic fundamentalists share any similar concept. In the main, Judaism understands the legacy of a person's life as the moral example left to the next generations. Biophysically there is nothing more. Islamic thought, on another hand, is more detailed with respect to an afterlife and the Qur'an vividly describes the spiritual cum physical states of bliss or torment that await after death. Some of the above, though certainly not all, could cohere with contemporary scientific perspectives. Natural science understands death as the final expenditure of energy, as dissipation into stasis. Yet, that which has decomposed may well be fodder for the recycling of life. Stars turn to dust, stardust has come to mind in human being, human being may become again stuff for stars, and untold other phenomena. Nevertheless, death as a modus unto new, organized, and sentient life is not a theme that natural science readily explores or articulates.


See also Eschatology; Fall; Eternity; Karma; Life After Death; Transmigration

Bibliography

hefner, philip. the human factor: evolution, culture, and religion. minneapolis, minn.: fortress press, 1999.

kramer, kenneth, the sacred art of dying: how world religions understand death. new york: paulist press, 1988.

pannenberg, wolfhart. anthropology in theological perspective, trans. matthew j. o'connell. philadelphia: westminster, 1985.

reynolds, frank e. "death as threat, death as achievement." in death and afterlife: perspectives of world religions, ed. hiroshi obayashi. new york: greenwood press, 1992.

reynolds, frank e., and waugh, earle h., eds. religious encounters with death: insights from the history and anthropology of religions. university park: pennsylvania state university press, 1977.

duane h. larson

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Death and Dying

DEATH AND DYING

DEATH AND DYING. The certainty of death is something we share with our early modern ancestors, but they were more likely than we to die young and to experience throughout their lives a sequence of bereavements. Average life expectancy was shockingly low by modern (Western) standards: barely thirty in the seventeenth century. The averages are brought down by high infant mortality: around a quarter of children died in their first year, and barely half made it to their tenth birthday. For adults, remarriage after the death of a partner was commonplace. Nonetheless, suggestions that early modern people were somehow inured to death, making little emotional investment in young children, have been largely rejected by modern scholarship: there is plenty of evidence for deeply felt grief.

Throughout the period, epidemic disease was a major killer. Early modern Europe witnessed no pandemic on the scale of the "Black Death" of 13481349, but plague was a recurrent visitor, wiping out a quarter of London's population in 1563 and nearly half of Marseilles's in 1720. Plague disappeared from Western Europe in the early eighteenth century, but there was little protection against other virulent diseasestyphoid, dysentery, smallpox, influenza. In urban centers the death rate invariably exceeded the birth rate, and towns relied on immigration to sustain their populations. Periodic harvest failure and famine exacerbated the impact of disease. The 1590s were years of hunger across Europe, as were the 1660s and 1690s (when a third of Finland's population died). The "mortality regime" was punitive and changed little over the course of the early modern period.

RITUAL AND REFORMATION

If death was frequent and unpredictable, it was also highly ritualized. The late medieval church stressed the importance of a good death; pious texts taught the ars moriendi, the "art of dying." On the deathbed Christians felt particularly vulnerable to the wiles of the Devil, who might tempt them to despair and damnation. An elaborate sequence of "last rites"confession, communion, and anointing by a priestoffered some protection, though the moment of death remained fraught with danger, and "sudden death," with no opportunity to make amends for sin, was widely feared. Successful navigation of the deathbed was only the first stage toward eternal life with God in heaven. It was believed that since the ordinary good person could perform only a fraction of the penance due for their sins, the remainder would have to be paid off after their death, in purgatory. Images of fire and torment filled descriptions of purgatory, though it is unclear whether people typically lived in fear of the prospect or stoically accepted it as their lot. In any case, it was possible to ease the pains of souls there and hasten their passage to heaven by performing good works on their behalf, particularly by having masses said for them. A great deal of pre-Reformation religion was driven by a "commemorative impulse": the bequeathing of lands and goods in order to be remembered, and thus prayed for. For some reason, purgatory and intercessory prayer appear to have been a more marked feature of north European than of Mediterranean lands in the century before the Reformation.

The Protestant revolt against medieval Catholicism was from the outset deeply concerned with issues of death. Martin Luther's Ninety-Five Theses of 1517 questioned the pope's authority to issue indulgences (certificates remitting "time" spent in purgatory), and by 1530 Luther, with other reformers, had denounced the doctrine of purgatory itself. Purgatory offended Protestants because they could not find it in Scripture and because it seemed to undermine Christ's sacrifice upon the cross, making human beings active participants in the business of salvation. The doctrine of predestination held that God had from time eternal assigned all people to one of two destinations: heaven or hell. There was no room for a "middle place" and no possibility for the living to change the dead's preordained fate. In territories where the Reformation took hold, institutions (chantries and monasteries) whose purpose had been to intercede for the dead were dissolved, and requiem masses were abolished. Deathbed rituals were radically simplified, and the presence of a clergyman became less necessary. Most Protestant theologians taught, contrary to the medieval theory, that infants dying before baptism could still be admitted to heaven. In Catholic Europe, by contrast, the cult of the "holy souls" in purgatory was emphasized in the Counter-Reformation period.

Yet the dramatic changes of the Reformation were accompanied by underlying continuities. Protestants continued to display a concern with the "good death," and ars moriendi literature remained popular in both Catholic and Protestant societies. (To believers in predestination, appropriate deathbed demeanor might be an indication of "election.") Though Protestants were barred from praying for the dead, the impulse to commemorate them remained strong, finding expression in monuments and epitaphs and in a profusion of printed funeral sermons. The Reformation undoubtedly changed the relationship between the living and the dead, but it did not end it. Most evidence concerns the social elite, but it is at the level of popular belief that continuities were most marked. Though Protestant theologians taught that the souls of the dead could never return (and Catholic theologians imposed strict limitations on it), belief in ghosts was widespread. Indeed, some burial practices may have been concerned not so much with commemorating the dead as with providing protection against them. This was the case with the bodies of those committing suicidethe ultimate "bad death"which were often staked and interred at crossroads.

DEATH AND THE SOCIAL ORDER

Moralists, Catholic and Protestant, presented death as a levelerthe artistic motif of the "Dance of Death" depicted popes, princes, and beggars linked by their common fate. Both before and after the Reformation, however, the delineation of rank was a major concern of funerary rites. This was particularly apparent in the case of royal funerals: the ritual was most elaborate in France, where it involved an eerily lifelike effigy of the deceased monarcha symbolic assertion of the survival of the king's "social body." Extravagant aristocratic funerals, involving vast amounts of black cloth, hundreds of mourners, and lavish distributions of charity sent out messages about the location of power in local communities. The poor were typically carried to the grave with little ceremony. Burial practices, too, reflected social status. In London, Paris, and some other urban centers, pressure on space led to the repositioning of cemeteries in suburban locations away from churchesa process under way throughout the period. But across much of Europe traditional patterns persisted: the elites could expect burial within the church building; the masses had to be content with the churchyard outside, where graves rarely received permanent markers and bones were periodically dug up to be stored in charnel houses. Those who had died "dishonorable" deaths (e.g., by execution) were refused burial in the churchyard and were often interred under the gallows or in other dishonored places. In Calvinist Scotland the authorities forbade church burial as "superstitious," but landowners got around the ban by erecting elaborate "burial aisles" on the side of churches. Early modern Europeans were unequal in death, as in so much else.

See also Medicine ; Plague ; Reformation, Protestant .

BIBLIOGRAPHY

Ariès, Philippe. The Hour of Our Death. Translated by Helen Weaver. London, 1981. Translation of L'homme devant la mort (1977).

Gordon, Bruce, and Peter Marshall, eds. The Place of the Dead: Death and Remembrance in Late Medieval and Early Modern Europe. Cambridge, U.K., 2000.

Koslofsky, Craig M. The Reformation of the Dead: Death and Ritual in Early Modern Germany, 14501700. New York, 2000.

Marshall, Peter. Beliefs and the Dead in Reformation England. Oxford, 2002.

Peter Marshall

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Death and Dying

Death and Dying

BIBLIOGRAPHY

Death is as much a cultural reality as it is a biological one. The only creature known to be aware of its inevitable demise, humans have dealt with their unique insight with considerable creative ritual and belief. Many have argued that religion, philosophy, consumerism, and even civilization itself were all created as antidotes to this terrifying insight (Becker 1973). Mythologist Joseph Campbell (1904-1987) hypothesized that mythmaking began with the first awareness of mortality, forcing early humans to seek purpose, to rationalize the irrational, and to deny deaths finality. Perhaps it should thus be of no surprise that much of what we know of past cultures is based on funerary artifactstheir attempts at death transcendence.

A cultures death system, or death ethos, determines such widely ranging phenomena as a peoples militancy and suicide rate; their preferences for bullfights, gladiator battles, or horror movies; their fears of or hopes for reincarnation and resurrection; their willingness to perform organ transplants or purchase life insurance; their decisions to bury, cremate, or eat their dead; and their attitudes toward capital punishment, abortion, and what constitutes a good death.

Cultures have been classified in terms of their death systems, shedding light on the meanings they give to life. Historian Arnold Toynbee (1889-1975), for example, categorized cultures by whether they are death-accepting or death-denying, hold a hedonistic or pessimistic view toward life, perceive death to be the end of existence or a transition to some personal or collective form of immortality, view corpses as sacred or profane objects, and whether or not the dead are believed to play an active role in the affairs of the living (and whether in a positive or negative way). In the death-defying West, for instance, strategies for salvation have historically featured activism and asceticism, whereas in the East they have often been more contemplative and mystical. In the West, postdeath conceptions typically involve the integrity and continuity of ones personal self; in the East, the ultimate goal is often an undifferentiated and impersonal oneness with the universe.

Changes in social solidarities (i.e., urbanization, religious pluralism), in selfhood (i.e., the shift from collectivist to individualistic identities), and in who dies and why, have historically produced several recognized epochs in the West, each featuring distinctive conceptions of death and funerary ritual. For most of human history, when life was short and death in the midst of life was a literal and not a figurative notion, cultural rituals and social systems were oriented to this fact. People were constantly reminded about times invariable passage and their inevitable mortal fate. Ancient Egyptians would have skeletons brought to their feasts; colonial Americans would daily walk past their church cemeteries, whose tombstones were adorned with skulls and crossbones. Death was tame, according to social historian Philippe Ariès (1914-1984). Deathbeds were community gathering places; public meeting spaces were often adjacent to mass graves whose contents were often partially visible. In early colonial America, realizing that two or three of their children would not survive until age ten, Puritan parents would send their offspring to family and friends as apprentices to avoid excessive attachments with them and the grief their deaths would cause (Stannard 1977).

According to Ariès, the contemporary era in the West features death denials and invisible death, fueling the illusion of immortality with institutions that conceal the dying (over 70 percent of Americans currently die within institutionalized settings) and that make the dead appear lifelike for funerary services. Those most likely to die are the old (nearly eight in ten deaths in the United States are those sixty and older), who are largely disengaged from many of their roles and physically segregated from other age groups in retirement communities and long-term care facilities. Gerontophobia, or fear of aging, has become interwoven with cultural thanatophobia, the fear of death.

So great is the power of an ethos, this construction of meaning thrown up against the terror of death, that social agencies invariably seek to harness its energy as a means of social controland to enhance the social status of their members. For instance, consider religions traditional threats of agonizing hells or bad reincarnations as a means for keeping the living in line. The power and status of the medical establishment increased dramatically during the last century with its growing ability to postpone death. Because of scientific breakthroughs, modern medicine has largely eliminated many traditional causes of premature death, especially infectious disease, and the medical establishment competes with religions traditional control over the dying process. Accordingly, death is shifting from being a moral rite of passage to a technological one. Traditional fears of postmortem judgment are morphing into fears of dying; those most likely to die, the old, fear being institutionalized within nursing homes more than they fear death.

With most premature death now the result of man-made and hence theoretically avoidable causes (e.g., accidents, homicides, and suicides), its occurrence has become increasingly tragic and highly politicized. Political rulers have long enforced their control through death squads, pogroms, war, capital punishment, and campaigns of fear. Disdaining such strategies, modern regimes instead establish legitimacy and citizen loyalty by thwarting (or at least predicting) the death threats of enemies with the countrys military forces, of lethal microbes with health care systems, of violent storms with weather satellites, of possible earthquakes or volcanic eruptions with seismic monitoring stations, and of potential asteroid or meteor collisions with telescope arrays.

Some of the most contentious moral debates in the contemporary United States center on the right to end life (e.g., capital punishment, physician-assisted suicide, and civilian casualties in military campaigns) and precisely where the line between life and death occurs, as in the controversies over abortion and euthanasia.

Materialism, individualism, secularism, and the distractions of consumer and popular cultures have not eliminated individuals fears of death nor their desires to transcend it. The proportion of Americans believing in an afterlife has generally increased over recent decades, with more than seven in ten confident that their existence does not conclude with death. At a minimum, cultural death systems promise at least symbolic immortality (Lifton 1979), such as being remembered through ones progeny or works of art, or surviving through the preservation of political or natural orders. Thus we witness the proliferation of such projects as halls of fame, the Social Security Administrations online database of deceased Americans, and Forbes magazines annual ranking of top-earning deceased celebrities.

SEE ALSO Euthanasia and Assisted Suicide; Funerals; Suicide

BIBLIOGRAPHY

Ariès, Philippe. 1981. The Hour of Our Death. Trans. Helen Weaver. New York: Knopf.

Becker, Ernest. 1973. The Denial of Death. New York: Free Press.

Campbell, Joseph. 1974. The Mythic Image. Princeton, NJ: Princeton University Press.

Lifton, Robert. 1979. The Broken Connection: On Death and the Continuity of Life. New York: Simon and Schuster.

Stannard, David. 1977. The Puritan Way of Death: A Study in Religion, Culture, and Social Change. New York: Oxford University Press.

Toynbee, Arnold. 1980. Various Ways in Which Human Beings Have Sought to Reconcile Themselves to the Fact of Death. In Death: Current Perspectives, ed. Edwin Shneidman, 11-34. 2nd ed. Palo Alto, CA: Mayfield.

Michael C. Kearl

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Death

157. Death

  1. Ah Puch deity of doom; represented as bloated corpse or skeleton. [Maya Myth.: Leach, 30]
  2. Ankou gaunt driver of spectral cart; collects the dead. [Brittany Folklore: Leach, 62]
  3. Anubis god and guardian of the dead. [Ancient Egyptian Rel.: Parrinder, 10]
  4. Arrow of Azrael angel of deaths way of summoning dead. [Islamic Myth.: Jobes, 129]
  5. As I Lay Dying Bundren family ordeal after Addies death. [Am. Lit.: Faulkner As I Lay Dying ]
  6. asphodel flower bloom growing in Hades. [Gk. Myth.: Kravitz, 37]
  7. Atropos Fate who cuts thread of life. [Gk. and Rom. Myth.: Hall, 302]
  8. Azrael angel of death; separates the soul from the body. [Islamic Myth.: Walsh Classical, 41]
  9. banshee female specter, harbinger of death. [Irish and Welsh Myth.: Walsh Classical, 45]
  10. bell passing bell; rung to indicate demise. [Christian Tradition: Jobes, 198]
  11. black Western color for mourning. [Christian Color Symbolism: Leach, 242; Jobes, 357]
  12. Bodach Glas gray specter; equivalent to Irish banshee. [Scot. Myth.: Walsh Classical, 45]
  13. Bran god whose cauldron restored dead to life. [Welsh Myth.: Jobes, 241]
  14. Bury the Dead six dead soldiers cause a rebellion when they refuse to be buried. [Am. Drama: Haydn & Fuller, 768]
  15. Calvary (Golgotha ) where Christ was crucified. [N.T.: Luke 23:33]
  16. Cer goddess of violent death. [Gk. Myth.: Kravitz, 75]
  17. Charun god of death. [Etruscan Myth.: Jobes, 315]
  18. Conqueror Worm the worm ultimately vanquishes man in grave. [Am. Lit.: Ligeia in Tales of Terror ]
  19. Dance of Death Holbein woodcut, one of many medieval examples of the death motif. [Eur. Culture: Bishop, 363-367]
  20. danse macabre Dance of Death; procession of all on their way to the grave. [Art: Osborne, 299300, 677]
  21. dust and ashes I am become like dust and ashes. [O.T.: Job 30:19]
  22. Endgame blind and chair-bound, Hamm learns that nearly everybody has died; his own parents are dying in separate trash cans. [Anglo-Fr. Drama: Beckett Endgame in Weiss, 143]
  23. Ereshkigal goddess of death; consort of Nergal. [Sumerian and Akkadian Myth.: Parrinder, 93]
  24. extreme unction Roman Catholic sacrament given to a person in danger of dying. [Christianity: RHD, 506]
  25. Gibbs, Emily dying in childbirth, welcomed by the other spirits in the graveyard, she tries to relive her twelfth birthday. [Am. Drama: Thornton Wilder Our Town in Benét, 747]
  26. Grim Reaper name given to personification of death. [Pop. Culture: Misc.]
  27. handful of earth symbol of mortality. [Folklore: Jobes, 486]
  28. horse symbol of agents of destruction. [Christian Tradition: N.T.: Revelation 6; Mercatante, 65]
  29. Ilyitch, Ivan afflicted with cancer, he becomes irritable, visits many doctors, gradually disintegrates, and dies almost friendless. [Russ. Lit.: Tolstoy The Death of Ivan Ilyitch in Magill III, 256]
  30. Kali Hindu goddess to whom Thug sacrificed victims. [Hinduism: Brewer Dictionary, 600]
  31. Krook rag dealer dies spectacularly and horribly of spontaneous combustion. [Br. Lit.: Dickens Bleak House ]
  32. Lenore saintly soul floats on the Stygian river. [Am. Lit.: Lenore in Hart, 468]
  33. Lord of the Flies showing mans consciousness and fear of dying. [Br. Lit.: Lord of the Flies ]
  34. manes spirits of the dead. [Rom. Rel.: Leach, 672]
  35. Mania ancient Roman goddess of the dead. [Rom. Myth.: Zimmerman, 159]
  36. Niflheim dark, cold region to which were sent those who died of disease or old age. [Scand. Myth.: Brewer Dictionary 642]
  37. nightingale identified with mortality. [Animal Symbolism: Mercatante, 163]
  38. On Borrowed Time an old man chases Death up a tree and keeps him there until the old man is ready to die. [Am. Drama: Sobel, 517]
  39. pale horse fourth horse of Apocolypse, ridden by Death personified. [N.T.: Revelation 7:78]
  40. Pardoners Tale, The seeking to slay death, three rioters are told he is under a certain tree; there they find gold and kill each other over it. [Br. Lit.: Chaucer The Pardoners Tale in Canterbury Tales ]
  41. Requiem religious mass (music or spoken) for the dead. [Christianity: Payton, 568]
  42. Rime of the Ancient Mariner, The when Death wins the toss of the dice, the two hundred crew members drop dead. [Br. Poetry: Coleridge The Rime of the Ancient Mariner]
  43. Sacco Benedetto yellow robe worn going to the stake during Inquisition. [Span. Hist.: Brewer Dictionary, 948]
  44. scythe carried by the personification of death, used to cut life short. [Art.: Hall, 276]
  45. skeleton visual representation of death. [Western Folklore: Cirlot, 298]
  46. skull representation of bodys dissolution. [Christian Symbolism: Appleton, 92]
  47. skull and crossbones symbolizing mortality; sign on poison bottles. [World Culture: Brewer Dictionary, 1009]
  48. Styx river which must be crossed to enter Hades. [Gk. Myth.: Howe, 259]
  49. Thanatos (Mors ) god of death; brother of Somnos (sleep). [Gk. Myth.: Gayley, 54]
  50. Thoth record-keeper of the dead. [Egyptian Myth.: Leach, 1109]
  51. Valdemar, M. in hypnotic trance, recounts impressions from other side of death. [Am. Lit.: The Facts in the Case of M. Valdemar in Portable Poe, 268280]
  52. viaticum Eucharist given to one who is dying. [Christianity: Brewer Dictionary, 1128]

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death

death, cessation of all life (metabolic) processes. Death may involve the organism as a whole (somatic death) or may be confined to cells and tissues within the organism. Causes of death in human beings include injury, acute or chronic disease, and neoplasia (cancer). The physiological death of cells that are normally replaced throughout life is called necrobiosis; the death of cells caused by external changes, such as an abnormal lack of blood supply, is called necrosis.

Somatic death is characterized by the discontinuance of cardiac activity and respiration, and eventually leads to the death of all body cells from lack of oxygen, although for approximately six minutes after somatic death—a period referred to as clinical death—a person whose vital organs have not been damaged may be revived. However, achievements of modern biomedical technology have enabled the physician to artificially maintain critical functions for indefinite periods.

Somatic death is followed by a number of irreversible changes that are of legal importance, especially in estimating the time of death. These include rigor mortis, livor mortis (discoloration of the body due to settling of blood), algor mortis (cooling of the body), autolysis (breakdown of tissue by enzymes liberated by that tissue after death), and putrefaction (invasion of the body by organisms from the gastrointestinal tract).

Brain death, which is now a legal condition in most states for declared death, requires that the following be absent for at least 12 hours: behavioral or reflex motor functions above the neck, including pupillary reflexes to testing jaw reflex, gag reflex, response to noxious stimuli, and any spontaneous respiratory movement. Purely spinal reflexes can remain. If the patient has agreed to be an organ donor, the observation period can be shortened to 6 hours.

As a result of recent refinements in organ transplantation (see transplantation, medical) techniques, the need has arisen to more precisely define medical death. The current definition is that of a 1981 U.S. presidential commission, which recommended that death be defined as "irreversible cessation of all functions of the entire brain, including the brain stem," the brain stem being that part of the brain that controls breathing and other basic body functions. Some feel, however, that people in persistent vegetative states, i.e., people who have brain-stem function but have lost higher brain functions (vision, abstract thought, personality), should be considered dead and allowed, through living wills or relatives, to donate organs.

See euthanasia; funeral customs; vital statistics.

See E. Kübler-Ross, On Death and Dying (1969); S. B. Nuland, How We Die (1994).

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Death

112. Death

See also 63. BURIAL ; 99. CORPSES ; 232. KILLING

autophonomania
an obsession with suicide.
cerement, cerements
the cloth or clothing in which the dead are wrapped for burial or other form of funeral.
cinerarium
a place where the cremated remains of the dead are stored. cinerary , adj.
columbarium
a vault where the remains of cremated bodies are kept, usually in one of a number of recesses in a wall.
crematorium, crematory
a place where cremations are done.
epitaph
1. an inscription on a monument, as on a gravestone.
2. a short piece of prose or verse written in honor of a dead person. epitaphial, epitaphian, epitaphic, adj.
euthanasia
the deliberate killing of painfully ill or terminally ill people to put them out of their misery. Also called mercy killing .
ktenology
the science of putting people to death.
moribundity
1. the state or quality of being on the verge of death.
2. close to extinction or stagnant. moribund , adj.
myriologue
an improvised funeral song, composed for the dead and sung by women in modern Greece. myriologist , n. myriologic , myriological, adj.
necrolatry
the worship of the dead.
necrology
1. an announcement of death; obituary.
2. a list of persons who have died within a certain time. Also necrologue . necrologist , n.
necromancy
1. the magie practiced by a witch or sorcerer.
2. a form of divination through communication with the dead; the black art. Also nigromancy . necromancer , necromant, nigromancien, n. necromantie , adj.
necromania
an obsession with death or the dead.
necromimesis
an abnormal condition in which a person believes himself dead.
necrophilia, necrophilism
an abnormal, often sexual attraction toward the dead or a dead body. necrophile , n.
necrophobia
an abnormal fear of death. Also called thanatophobia .
necrosis
the death or decay of body tissue, the result of loss of blood supply or trauma. necrotic , adj.
nerterology
Rare. any learning that pertains to the dead.
ossuarium
a place or receptacle for the bones of the dead. Also called ossuary .
taphophilia, taphephilia
an excessive interest in graves and cemeteries.
thanatoid
resembling death; deathly.
thanatology
the study of death or the dead. Also thanatism. thanatological, adj.
thanatomania
an obsession with death. See also necromania .
thanatophobia
necrophobia.
thanatopsis
a survey of or meditation upon death.
viaticum
the Eucharist given to one about to die; last rites or extreme unction. viatic, viatical, adj.

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Death

Death. The human and religious imagination of the nature and meaning of death has been prolific: virtually everything that can be imagined about death has been imagined. Yet almost universally the major religious traditions did not in origin have any belief that there will be some worthwhile continuing life after death. This is in strong contrast to the popular impression that religions came into being to offer ‘pie in the sky’—i.e. some compensation for the miseries and inequalities of this life. This erroneous view was elevated to a formal theory by such anti-religious theorists as Marx and Freud.

In fact, the early human imagination of death was entirely realistic: since the breath returns to the air and the body to the dust, there is nothing that can survive. Thus in both E. and W., the emphasis originally was on the positive worth of this life, not on some imagined heaven or hell.

The development of beliefs that there may be life beyond death (see AFTERLIFE) came about historically in different ways and with different anthropologies (accounts of human nature) in different religious traditions. In the Judaeo-Christian tradition, the belief developed in the 3rd or 2nd cent. BCE that the ‘friendship with God’ (as Abraham's relationship with God was described) might perhaps be continued by God through death. The imagination of how God might bring that about then varied.

In the E., the sense that death can be contested and, in favourable circumstances (especially with the help of sacrifices), be postponed, led to the belief in Hinduism that a self or soul is reborn many millions of times as it moves toward mokṣa (release). In early Buddhism, it was accepted that there is continuing reappearance, but no self or soul being reborn. In China, the caution of Confucius was widely prevalent: ‘Confucius said, “If we are not yet able to serve humans, how can we serve spiritual beings?” Tzu-lu then said, “Then let me ask you about death.” Confucius said, “If we do not yet know about life, how can we know about death?” ’ But in the Immortality Cult, and even more in the development of Taoism, the quest for immortality was undertaken in the schools of alchemy, sometimes literally, more often in spiritual terms.

On the basis of these understandings of death, different religions have expressed different preferences in the treatment of dead bodies: see CREMATION; FUNERAL RITES. They have also been in agreement to a large extent that excessive grief or mourning is inappropriate. See also AFTERLIFE.

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death

death often (as Death) represented in art and literature as a skeleton or an old man holding a scythe, the personification of the power that destroys life.
death in the pot a biblical phrase, from the story of a famine during which a pottage containing poisonous herbs was made by Elisha's servant for the sons of the prophets; when they cried out, ‘O thou man of God, there is death in the pot’ (2 Kings 5:40), Elisha added meal to the dish, and they were able to eat it safely.
death is the great leveller all people will be equal in death, whatever their material prosperity. The saying is recorded in English from the early 18th century, but the Alexandrian-born Latin poet Claudian (370–c.404) has, ‘omnia mors aequat [death levels all things].’
death knell the tolling of a bell to mark someone's death; in figurative usage, referring to the imminent destruction or failure of something.
death-or-glory brave to the point of foolhardiness (in the British Army, the Death or Glory Boys was a nickname for the 17th Regiment of Lancers, from the regimental badge of a death's head with the words ‘or glory’).
death pays all debts the death of a person cancels out their obligations. The first recorded use is in Shakespeare's Tempest (1611); earlier in 2 Henry IV (1597), Shakespeare has, ‘The end of life cancels all bands [bonds].’
death row especially with reference to the US, a prison block or section for prisoners sentenced to death.
death's head a human skull as an emblem of mortality.
death wish an unconscious desire for one's own death.
till death us do part for as long as each of a couple live, from the marriage service in the Book of Common Prayer.

See also Black Death at black, dance of death, dice with death, a fate worse than death, the kiss of death, nothing is certain but death and taxes.

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death

death / de[unvoicedth]/ • n. the action or fact of dying or being killed; the end of the life of a person or organism. ∎  an instance of a person or an animal dying. ∎  the state of being dead. ∎  the permanent ending of vital processes in a cell or tissue. ∎  (Death) [in sing.] the personification of the power that destroys life, often represented in art and literature as a skeleton or an old man holding a scythe. ∎  [in sing.] fig. the destruction or permanent end of something: the death of hopes. ∎ fig., inf. a damaging or destructive state of affairs. social death. PHRASES: at death's door (esp. in hyperbolic use) so ill that one might die. be the death of (often used hyperbolically or humorously) cause someone's death: you'll be the death of me with your questions. be in at the death be present when a hunted animal is caught and killed. ∎  be present when something fails or comes to an end. catch one's death (of cold) inf. catch a severe cold or chill. do something to death perform or repeat something so frequently that it becomes tediously familiar. a fate worse than death a terrible experience. like death warmed over inf. extremely tired or ill. a matter of life and death see life. put someone to death kill someone, esp. with official sanction. to death used of a particular action or process that results in someone's death: stabbed to death. ∎  used to emphasize the extreme nature of a specific feeling or state of mind: I'm sick to death of you. to the death until dead: a fight to the death.DERIVATIVES: death·like / -ˌlīk/ adj.

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Death and Dying

Death and Dying

How Do We Understand Death?

What Is Grief?

How Do Children Cope with the Death of a Parent or Sibling?

How Do Adults Cope with the Death of a Child?

How Do Rituals Help People Cope with Death?

What Happens After Death?

Resources

A person is dead when he or she stops breathing and the heart and brain permanently stop functioning. A dead person cannot see, hear, taste, touch, or smell and has no awareness or feelings.

KEYWORDS

for searching the Internet and other reference sources

Bereavement

Grlef

Terminal illness

Everyone on this earth shares two experiences: we are born and we die. Someone dies about every 20 seconds. Most of us know someone who has died. But we do not generally like to think about death or talk about death or even acknowledge that we all die. Around the world throughout the ages, death always has been a source of mystery and fear.

How Do We Understand Death?

Our reactions to death often depend on how someone has died and how old they were. The most easily understood are deaths at an old age, when a persons body simply wears out. But others die before their bodies wear out, and sometimes people die with no advance warning. Illness, injuries, natural catastrophes, and violence all can cause early death.

Sometimes people, including children, have to face their own deaths. They may have a terminal illness, a disease or condition that eventually will cause death. Psychologists and physicians who have worked with families in this situation believe that honesty and love from others are very important at this time. People with terminal illness and their families need to understand the effects of the illness and find ways to express their feelings about it. It helps to talk about it, enjoy time together, and help with caregiving.

What Is Grief?

Grief is the wide range of feelings that accompany a death, such as shock, sadness, anger, and confusion. Even when we know ahead of time that someone is going to die, it does not necessarily soften the impact. It still may be difficult to believe that the death has occurred and hard to imagine life without this special person. When the death is sudden and unexpected, the shock of the news may make it hard to come to grips with the reality. Such shock can take a while to fade. Most people need comfort and support while they grieve, either from their personal circle of family and friends or from clergy, therapists, or support groups.

How Do Children Cope with the Death of a Parent or Sibling?

When a sibling or parent dies, everyone in the family suffers. Very young children may not fully understand what has happened and that the death is permanent. Children feel many of the same feelings that adults do when someone dies: shock, sadness, or confusion. Children often personalize a death, asking, Will it happen to me? or Did I cause this to happen to someone else? A death can stir up fears: Will I get cancer too? or Is it safe to drive? A child may wonder how the death will alter his or her life: Will Mom remarry now that Dad has died? or My brother died. Will we have to move?

Adjusting to the terminal illness or death of a loved one is a gradual process, according to Elisabeth Kübler-Ross, author of the landmark On Death and Dying (1969). When normal life (1) is disrupted, people first go through a stage of denial (2), acting as if nothing in their lives has changed. Denial may be followed by anger (3) at the unwanted changes, and by praying or bargaining (4) such as If I never fight with my sister again, Mom wont die. Sadness and depression occur when the loss sinks in (5). Acceptance comes when a loss has been mourned. Acceptance is not a happy feeling, but it does give people the strength to go on with their own lives (6).

Sometimes it is hard for young people to understand their own feelings and reactions to death. Grief can cause people to lose interest in things that they normally enjoy, or they might avoid situations that used to involve the person who died. Reactions like these are normal. Finding someone to talk with (a family member, friend, or trusted adult) usually helps young people understand their feelings and eventually accept the death.

How Do Adults Cope with the Death of a Child?

As with the death of a parent or sibling, the death of a child causes extreme sadness and distress in a family. Whether the death came suddenly or gradually, parents often struggle with guilt that they could not prevent their childs death or even that they outlived their child. Sometimes, after a death, parents might feel the urge to move or change their lives to avoid situations that remind them of their dead child. Most experts say that this is not the best course. As the psychiatrist Elisabeth Kübler-Ross notes, it is usually healthier to face and acknowledge the pain, rather than avoid it.

How Do Rituals Help People Cope with Death?

Funerals, memorial services, and burials are generally held a short time after a death and sometimes on the anniversary of a death. These ceremonies

Mummies Of Ancient Egypt

In ancient Egypt, there were elaborate rituals performed to preserve the body after death. This was done to make sure that the dead person would be connected to gods and spirits in the afterlife.

The first step was embalming, which involved removal of major body organs, drying the body, and wrapping it in linens and spices. The higher the individuals status in society, the more elaborate the ritual. The coffin was painted with a portrait of the person and filled with valuables, such as gems and prized possessions of the deceased, to be used in the afterlife. Cats, which were thought to be sacred, were sometimes mummified and buried with their owners.

An Egyptian mummy dating from about 1000 B.C., that shows the outer decoration of the coffin and wrapped body inside. The Bridgeman Art Library

are often sad and difficult to attend. But they help people to express their feelings, take comfort with others who are grieving, and pay tribute to a persons life. Funerals or other ritualssuch as planting a memorial garden, writing, enjoying the persons interestshelp people stay connected to the person even after the death.

What Happens After Death?

No one knows what happens after death, and people have many different beliefs about it. They might believe that people go to heaven when they die. Some people believe that a persons soul lives on and that the spirit goes somewhere else after death. Still others believe in rebirth or reincarnation, with the soul continuing its life in another person. Some people do not believe in a soul. Even in the face of these unknowns, most people take comfort in the natural cycle of life and death and find meaningful ways to enjoy the memories of people who have died.

See also

Depression

Suicide

Resources

Books

Brown, Laurie Krasny, and Marc Tolon Brown. When Dinosaurs Die: A Guide to Understanding Death. Boston: Little, Brown, 1998. A picture book written for younger children, but thorough and thoughtful enough to appeal to adolescents.

Dower, Laura. I Will Remember You: What To Do When Someone You Love Dies: A Guidebook Through Grief for Teens. New York: Scholastic, 2000. Personal stories from teens who have experienced loss, and handson creative exercises in coping.

Fitzgerald, Helen. The Grieving Teen: A Guide for Teenagers and Their Friends. New York: Simon and Schuster, 2000. A practical guide that answers questions and helps a teenager understand a range of situations involving dying and death.

Gootman, Marilyn. When A Friend Dies: A Book for Teens About Grieving and Healing. Minneapolis: Free Spirit Publishing, 1994. A sensitive guide to help teens cope with the death of a friend. For ages 11 and up.

Kübler-Ross, Elisabeth. On Children and Death: How Children and Their Parents Can and Do Cope with Death. New York: Simon and Schuster, 1997. A compassionate guide for families of dead or dying children.

Kübler-Ross, Elisabeth. On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families. New York: Simon and Schuster, 1997.

Trozzi, Maria, with Kathy Massimini. Talking with Children About Loss: Words, Strategies, and Wisdom to Help Children Cope with Death, Divorce, and Other Difficult Times. New York: Perigree, 1999. For adults, and suitable for older teen readers.

Organization

Nemours Center for Childrens Health Media, A. I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803. This organization is dedicated to issues of childrens health. Their website has articles on coping with death, with valuable links to support organizations. http://www.KidsHealth.org

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death

death Cessation of life. In medicine, death has traditionally been pronounced on cessation of the heartbeat. However, modern resuscitation and life-support techniques have enabled the revival of patients whose hearts have stopped. In a tiny minority of cases, while breathing and heartbeat can be maintained artificially, the potential for life is extinct. In this context, death may be pronounced when it is clear that the brain no longer controls vital functions. The issue is highly controversial.

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death

death (deth) n. absence of vital functions. brain d. permanent functional death of the centres in the brainstem that control breathing, heart rate, and other vital reflexes (including pupillary responses). Many decisions in medicine depend on death being clearly defined and objectively observed. Particular problems arise when a potential organ donor is being kept artificially alive. Legally, two independent medical opinions are required before brain death is agreed and organs can be removed.

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death

death The point at which the processes that maintain an organism alive no longer function. In humans it is diagnosed by permanent cessation of the heartbeat; however, the heart can continue beating after a large part of the brain ceases to function (see brain death). The death of a cell due to external damage or the action of toxic substances is known as necrosis. This must be distinguished from programmed cell death (see apoptosis), which is a normal part of the developmental process.

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death

death OE. dēað = OS. dōð, OHG. tōd (G. tod), ON. dauðr, Goth. dauþus :- Gmc. *dauþuz, f. *dau- (cf. ON. deyja DIE 1) + -TH 1.

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death

death The permanent cessation of living functions within an organ or organism.

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death

deathBeth, breath, death, Jerez, Macbeth, Seth •megadeath • Japheth • shibboleth

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Death

DEATH

DEATH is a fact of life. This statement is at once banal and profound. It is banal insofar as it is common knowledge that all human life is limited in duration; it is profound, however, insofar as serious reflection on the end of life challenges the limits of human language, conceptual thought, symbols, and imagination. In an important sense, the meaning of life is dependent in part on one's understanding of death. That death is a fact of life is also paradoxical, for it suggests a coincidence of oppositesdeath-in-life and life-in-death. How people have imagined death-in-life and life-in-death has shaped their experience of biological death both individually and collectively. Death is paradoxical, as well, in that although every death is an individual experienceonly individuals die, even when they die together in large numbersdeath is also a profoundly social experience.

Death as a biological fact or as a physiological state is uniform across time and space. However, this universal sameness in biological terms should not lull one into the error of assuming that the human sense or experience of death has beenor is alsouniform across space and time. When contemplating death today, people must avoid the anachronism of projecting their contemporary understanding and experience of death back onto others in the past. Similarly, they must also avoid the cultural imperialism of assuming that their understanding and experiences are normative and that those of other cultures should be measured in their terms. This entry on death is concerned with the diverse ways in which death has been imagined and the many different ways it has been experienced in different cultures and different ages. To say this is to recognize that although death is "a given" in one sense, it is culturally and historically constructed in various ways.

The study of beliefs and ritual practices surrounding death has been pursued using a number of different methodological approaches, including ethnographic, sociological, psychological, historical, morphological, and structural to name a few. The best comparative studies of death in the history of religions build upon the large number of available detailed ethnographic descriptions of specific communal beliefs and ritual practices, but move beyond these in a number of ways. Comparative studies in the history of religions are interdisciplinary in nature, integrating the findings of different disciplines in an effort to understand the complex existential meanings of religious beliefs and practices. The classic ethnographic monograph tended to present a historically "flat" and socially undifferentiated picture of the conception of death and the performance of mourning and funerary rites in a given culture. Unfortunately, such "snapshot" studies of different cultures implied that religious beliefs were static over time and uniformly held by all members of a given culture or religious tradition. More recently, the subfield of historical anthropology has reintroduced history into the mix and produced numerous sensitive studies of change in beliefs and practices. Scholars have also paid more attention to the effects of cultural contact, colonialism, and issues of gender, resulting in more complex representations.

In this essay, no attempt will be made to present an exhaustive survey of beliefs and ritual practices related to death. Rather than providing ethnographic detail and careful historical analysis, the entry focuses on selected themes and issues that emerge from a broad survey of cultures and religions, and in so doing offers some general reflections concerning the human imagining and experience of death. In passing, it also touches upon methodological issues involved in the comparative, cross-cultural, and historical study of beliefs and ritual practices surrounding death.

The Concern with Death

Death has been a central concern of religious persons across space and time. The brute fact of death raises pressing questions: Why do people and other living things have to die? What happens to a person after death? Do the dead have a continued existence of some sort? Are they happy? Where do the dead go? Can the dead return to the world of the living? Can the dead communicate with the living? Is death permanent, or is it a temporary or transitional state? These and many other questions have long spurred speculation concerning death and the possibility of an afterlife.

Recognizing that death raised questions for people, numerous nineteenth- and early twentieth-century scholars were led to speculate on the relationship of human ponderings on death to the origins of religion. These theories of the origins of religion were often written in the Enlightenment genre, represented by Rousseau's essay Discourse on the Origin of Social Inequality. Such works of imaginative reconstruction are based on pure speculation, not historical evidence. These reconstructions also are based on the ill-advised belief that modern psychological assumptions are universally applicable. Finally, such accounts are based on logical inferences (often faulty) that are presumed to have been drawn by the earliest human beings. The British anthropologist E. E. Evans-Pritchard dismissively labeled this sort of "a priori speculation, sprinkled with illustrations" the "if I were a horse" fallacy and unworthy of the name historical reconstruction (1965, p. 24). While there is little or no historical evidence to support these imaginative flights, it is salutary to note the broad influence they once had.

Today scholars strive to understand how different conceptualizations of death, the afterlife, and the body, as well as different ritual practices, affect the individual and collective experience of death. The cultural historical constructions of death, the body, the afterlife, and so on also directly affect one's religious valuations of life in this world. In thanatology (the study of death), among other things, it is important to consider the religious anthropology (i.e., the specific understanding of human nature and divine nature and the relationship between them), the understanding of the body, and the operative cosmology of a given culture or religious community. Moreover, one must take into account a given culture's epistemology of death and the afterlife (i.e., how people claim to know things about death and the afterlife). After all, most people would deny that their concepts about death are based on mere speculation. Cultures have established means of obtaining evidence on matters related to death and the afterlife. This evidence is commonly found in the content of dreams, reports from shamans concerning their ecstatic flights through the multiple realms of the universe, or individual accounts of visionary experiences or events witnessed in trance states. Alternatively, the "proof" may be found in the authoritative proclamations of myths or sacred texts.

Death may be accepted as a fact of life by many persons today, but historians of religions have clearly demonstrated that humans have rarely imagined death to have been a natural and inevitable condition from the beginning of time. Throughout the world, a myriad number of myths tell how death came into the world and how humans came to be mortal beings. Death is often claimed to be the result of an accident of some sort or an unfortunate mistake or choice made by a god or an ancestor. It may be the result of an act of forgetfulness, trickery, or theft, or it may have resulted from the breaking of a taboo or perhaps the commission of some major or minor transgression. The Genesis account of the fall, with the consequential changes in the human ontological condition and in the world itself, is only one such myth. It is important to recognize that this myth, like other such stories, continues to exercise power over the collective imagination and lives of millions of people. In yet other religions, the length of human life is imagined to be different in different cosmic ages, with the length usually decreasing as the devolutionary process continues.

Overcoming Death

If death was not always a fact of life, then the possibility suggests itself that death might be overcome in some way. The study of death in the history of religions is, in part, the history of how different cultures and religious communities have sought to deny the finality of the seemingly "given" nature of death. Many religious beliefs and practices aim to overcome death in some way or to restore humans and the world to conditions prior to the introduction of death. Eschatologies, for example, imagine the end of the world as it now exists, including the end of death. Similarly, the so-called cargo cults that emerged in the face of radical cultural disruption and rampant disease in situations of cultural contact are expressions of a desperate anticipation of the destruction of this world and the inauguration of a renewed world.

More generally, scholars have long noted that initiatory rites involve symbols and scenarios of death and rebirth. The performance of an initiatory rite rehearses death followed by a scenario of rebirth of some kind. This death may be imagined in biological terms, or it may be the death (end) of a specific status or ontological condition. In many religions, religious healers gain their powers precisely by having overcome death through an initiatory trial of some sort. Such initiatory trials are often unsought, but they need not be. Many examples of what one might call "dying onto the world" are found in the history of religions, including the elaboration of religious vocations defined over against mundane life in the world. These include, to name only two of the most common types, the renunciation of the world by monks and nuns and individuals going into the mountains, desert, or the bush in order to practice some form of asceticism and to seek visions. In many religions, lay persons or ordinary men and women can also ritually gain a foretaste of death and the afterlife. Altered states of consciousness of various sorts provide access to knowledge of the afterlife in many religions. For Pentacostal Christians, for instance, the psychosomatic experience of the descent of the Holy Ghostthe loss of consciousness, speaking in tongues, the radiant sense of divine infusionis a form of dying onto life as, while at the same time a foretaste of what the Second Coming will bring.

Religious seekers have also proactively pursued various means of achieving immortality, sometimes in human-embodied form and other times by seeking to overcome the human body. The ancient Egyptians exemplify those who imagined the afterlife to be similar to life in this world, with the body surviving death. Thus, the corpse was carefully embalmed in order to preserve its form, while items the deceased would need in the afterlife were also buried with the body.

Practitioners in alchemical traditions around the world have searched for the elixir of immortality. Alchemists provided recipes and proffered various techniques to transform the mortal body into an immortal one. Some religions speak of a spiritual body existing after death. In such traditions, the decomposition or immolation of the physical body is often seen as a form of release into a spiritual existence. Such a belief informs the Ainu bear festival in Northern Japan in which a deity (kamui) visits the world of the living in the form of a bear cub. The cub is nursed and raised by the Ainu; it is also entertained before it is ritually killed, thereby releasing the deity from its temporary physical form and sending it back to the spirit world (Kimura, 1999).

Other traditions, such as yoga in its many forms, have sought to overcome the embodied nature of human existence (i.e., to overcome the body itself, which is identified as the locus of mortality) in order to achieve an immaterial and timeless state of pure consciousness. In Indian religious traditions, biological death is believed to lead to rebirth in another physical form, whereas moksa, release from the karmic cycle of birth-death-rebirth, puts an end to death. Death, then, has been imagined in many different ways, some positing another form of embodied existence and others a disembodied state. Only a few religions, such as the ancient religion represented in the Enuma Elish, viewed death as a real end, with no form of existence following it.

Theories of Death and the Origins of Religion

As noted above, the recognition of the central importance of death in the conceptual worlds of human beings throughout time has occasionally led Western scholars to make some overblown claims concerning death and the origins of culture or civilization. Before returning to a brief consideration of some of the issues related to death that remain central to the study of the history of religions today, it is necessary to review in a cursory manner a few of the most famousand wrongheadedgrand theories of the origins of religion that were based in part on the scholars' imagined human response to death in the misty past.

Edward B. Tylor

The famous nineteenth-century armchair anthropologist Edward B. Tylor no doubt went too far in claiming that death was the reason religion existed. In his highly influential two-volume work Primitive Culture (1871), Tylor argued that the concept of the soul or an animating spirit arose when primitive peoples reflected on death, trance states, visions, and dreams. He asserted that the belief in the existence of the soul was the logical deduction that primitives drew from putting together two separate experiences. First, according to Tylor, the primitives' awareness of the sudden transformation of a vibrant human body into a corpse at the moment of death must have suggested to them that the animating source of life was not to be found in the physical body. At the moment of death, the material body remained, but it was cold, immobile, and lifeless. In dreams and visions, however, people often saw and conversed with dead persons, who thus seemed to continue to "exist" in some form even after their bodily demise. Putting two and two together, this led to the logical deduction that an animating spirit or soul must exist that was invisible, immaterial, and detachable from the physical body.

Tylor believed that this type of primitive reasoning was the basis of the most primitive cultural stage of development, which he labeled "animism." Animism is the belief that both animate and inanimate things, natural phenomena, and the universe itself possess a vital animating power or soul. Like many nineteenth-century theorists, Tylor assumed that all cultures passed through evolutionary stages. The precise enumeration of these stages varied from scholar to scholar, but in general they follow the pattern of evolution from a belief in magic to religion and, ultimately, to the triumph of reason and science. At each stage, it was believed that belief in the earlier form of magic or religion would decline. Moreover, contemporary peoples living in technologically primitive cultures were held to be living fossils, as it were. As such, the study of "primitives" seemed to hold the promise of providing scholars in various disciplines the opportunity to view what the life of their own ancestors must have been like millennia earlier.

Ghosts and ancestral spirits

Herbert Spencer, one of the founders of modern sociology, offered a similar theory in The Principles of Sociology (1885). However, he maintained that the origins of religion were to be found in the belief in ghosts rather than the soul. Significantly, visions of the deadas well as encounters with them in dreamsagain played a central role in Spencer's theory. Because the dead were believed to still be present somehow in the world, Spencer claimed that they came to be propitiated and offered food, drink, and so on by their living relatives and friends. Moreover, the most important and powerful members of society were believed to retain their position and power even after death. Thus, they were treated with special respect and decorum, as they had been while alive. Over time, these ancestors evolved into deities. Thus, according to Spencer, primitive ancestor worship was the basis of all religions. Unfortunately, there is no hard historical evidence for this assertion or for the other universal claims he proffered.

Sigmund Freud

For his part, Sigmund Freud made a stunning series of claims about death, sex, and religion in both his psychological writings and in his works of cultural historical interpretation. The latter include Totem and Taboo (1918), Civilization and Its Discontents (1930), The Future of an Illusion (1928), and Moses and Monotheism (1939). Freud offered a psychological explanation of the paradoxical coincidence of opposites of death-in-life and life-in-death. He argued that eros and thanatos, the drives to reproduce oneself and to annihilate oneself, were both primordial in human nature and deeply intertwined at the unconscious level. Indeed, he claimed that a universal psychological connection existed between sexual activity and death. He found evidence for this assertion not only in the lives of his neurotic patients and ethnographic descriptions of primitive rites, but in such things as a colloquial phrase for male ejaculation, which translates as "the little death." Freud was not an anthropologist, though he used the work of anthropologists, sociologists, and ethnographers in his works of cultural interpretation. Nor was he really interested in cultural diversity. Rather, his interest, like so many others of his age, was only in different psychological-cum -cultural stages of development.

Few anthropologists or historians of religions today would accept Freud's universal claims or offer competing universal claims of their own for that matter. For instance, rather than make a universal assertion about the significance of "the little death," they would note that the male anxiety implicit in this phrase flows from the widely-held (but not universal) archaic belief that the vital fluids and life energy in one's body are finite in quantity and that they are not replenished. For those holding this understanding of the male body, any expenditure of seminal fluids is assumed to deplete the man's life force. Ironically then, the act that leads to the creation of new life ultimately contributes to the male's own physical decline and death.

Menstruation and lactation, to name two prominent female physiological functions, are also highly-charged symbols in many cultures and religions, but Freud paid considerably less attention to them. Had he, he would have found that they, too, are often associated with death-in-life and life-in-death. Freud was equally unaware of the significant impact the differences in the religious anthropologies of diverse people or their different understandings of the human body could have on their experience of sexual activity and death, among other things. Indeed, Freud dismissed native explanations of such things outright, claiming that conscious explanations never got to the real unconscious causal sources of human psychology and behavior.

In Totem and Taboo, Freud again associated death with the origin of religion, society, and civilization. Building upon the now long-discredited hypothesis that the earliest human beings lived in hordes each ruled by a dominant male and the mistaken concept of totemism, Freud produced a gothic tale (or, perhaps, a modern psychological myth) of primordial patricide. In Freud's telling, a single dominant male claimed exclusive sexual rights to all of the women in the horde. The sons produced by this supreme male must have looked up to their father and aspired to be like him, even as they hated and envied him. They no doubt became increasingly frustrated, Freud suggested, as they reached sexual maturity, but were still denied a sexual outlet within the horde. Then, one day the sons collectively hatched a plan to kill their father in order to gain sexual access to the women. After the dastardly deed had been done, "cannibal savages as they were," the sons instinctually devoured their victim in order to incorporate his power. Then, according to Freud, something momentous happened.

The sons' love and admiration of the father, which had been repressed in order to commit the murder, resurfaced as pangs of guilt and psychological ambivalence. These quickly overwhelmed them. On the one hand, they were grieved by their father's death and horrified by their role in it, but on the other they experienced a sense of satisfaction in having replaced the father. Yet Freud claims that in death the father became even stronger than he had been in life through the workings of psychological repression and substitution. In the wake of the murder, the sons forbid themselves sexual access to the local women (this is the origin of the incest taboo and exogenous marriage rules) and forbid the slaying of the father. The latter taboo was expressed through the deflected form of the totem animal or plant, the surrogate for the father, which was normally taboo but which was eaten in a collective ritual meal. In this way, Freud connected the origins of the totemic festival with the primitives' ambivalent psychological response to the death or murder of the father.

The psychological ambivalence felt towards the dead father was, Freud claims, the origin not only of the universal incest taboo and various taboos surrounding death, but also of the totemic meal, social organization, moral restrictions, and even religion itself. Significantly, Freud's narrative and analysis was concerned not only with instincts, but with the ways instincts and primitive desires are affected and controlled by the psychodynamics of family and social organization. For the primitive, the totemic object or animal is a surrogate for the murdered father, while in a more developed stage of culture the figure of God clearly serves this purpose.

Applying the biological theory of Ernst Haeckel that ontogeny recapitulates phylogeny to psychology (i.e., the stages of biological development of an individual from conception through maturity replicate in abbreviated form the evolution of the species), Freud argued that the study of the mental life of children, as well as dreams and neuroses, could shed light on the primitive stage of human development. He believed that the earliest object of sexual desire for every infant boy is incestuous and forbiddenhis mother. Like the grown-up sons in the primal horde, an infant son is jealous of the father's sexual possession of the mother and desires to eliminate him as a rival. Freud posited that the Oedipal complex, as he labeled it, was a universal psychological complex, but one which healthy children in civilized societies could now overcome through submitting to social controls and, thereby, learning to control their instincts and deferring the immediate gratification of their desires.

For Freud, religion was the crucial link between the individual and society. Religious myths and rituals were the collective expressions of the same unconscious desires and psychological processes that produce dreams and neuroses in individuals. Freud famously claimed that religion was a collective neurosis that would eventually be outgrown, although not in the near future. Unlike Spencer and Tylor, though, Freud did not consider primitives to be rational beings; rather, he compared them to neurotics and children. Yet, just as most healthy boys work their way through the psychological conflicts of the Oedipal stage, he believed that cultures, too, evolved psychologically, with reason gradually replacing fantasy.

Modern studies of death

Today few people ascribe to the psychological assumptions underlying these and other theories that connect death to the origin of religion. The search for origins of this sort has been abandoned. Still, scholars have been struck by the patterned ways in which death has been associated with life in many cultures. For instance, scholars have long noted the striking association of death with fertility and/or the regeneration of life in religions around the world. In Versuch über Grabersymbolik der Alten (1859), J. J. Bachofen noted the prominence of symbols of fertility (e.g., eggs) and women on the tombs of ancient Greece and Rome, which he interpreted as indicating a belief in life coming out of death. For his part, Sir George Frazer made the image of the dying-and-rising god a central theme of his influential comparative study, The Golden Bough, which went through multiple editions during the early twentieth century. Other scholars, such as the classicist Jane Harrison, carried the study of the ancient mystery cults further, demonstrating in Themis (1911) how the social order was related to the natural order through these religious rites.

In 1906, Robert Hertz, a student of Emile Durkheim, published a seminal essay on the collective representation of death in Année Sociologique in which he analyzed double or secondary burial practices in Southeast Asia (Hertz, 1960). In the cultures he studied, the first burial period was temporary and dedicated to mourning. After the flesh of the corpse had rotted away, the dry skeletal remains were disinterred and then reburied elsewhere. With this secondary burial, the deceased was integrated into the society of the dead, while the mourners were reintegrated into the society of the living. Hertz also pointed to structural and symbolic parallels between funerary rites and initiation rites and marriages, an insight that numerous other scholars subsequently followed up and detailed in many other societies. More recently, Maurice Bloch and Jonathon Parry have revived interest in the symbolic association of death and fertility in a culturally wide-ranging collection of essays entitled Death and the Regeneration of Life (1982).

One final scholar deserves special mention. In a series of important publications, Philippe Ariès presented an unprecedented survey of the changing attitudes toward and representations of death in Europe over a thousand years from the eleventh through the twentieth centuries. Ariès used an interdisciplinary approach in his quest to trace these changes, working with literary, liturgical, testamentary, epigraphic, and iconographic sources of evidence. Specialists may quibble over specific details and dispute some of Ariès' interpretations, but his work has demonstrated beyond a doubt that the experience of death is subject to change over time within the same culture. On the other hand, scholars have also disclosed the remarkable continuity of some funerary practices over several millennia. Margaret Alexiou's study, The Ritual Lament in Greek Tradition (1974), and more recent anthropological field work (e.g., Danforth, 1982), has demonstrated that the performance of funerary laments and the practice of secondary or double burial continues down to the present in some rural areas, in spite of the dominant presence of Greek Orthodox Christianity.

To his credit, Ariès did not attempt to offer a grand overarching psychological or sociological theory about death. Rather, he sought to organize in a significant way the huge amount of historical evidence he had surveyed and then to trace the changes that occurred over broad sweeps of time. In his magnum opus, Homme devant la mort (1977; English translation, The Hour of Our Death, 1981), Ariès suggested that the history of the Western representations and experiences of death could be organized around variations on four psychological themes: the growing awareness of the individual; the defense of society against untamed nature; belief in an afterlife; and belief in the existence of evil.

Death in Comparative Perspective

Death has rarely been taken as an end as such, a real terminal point. Rather, for most humans throughout time, physiological death has signaled a transitional moment and state, not an absolute end. At death, life as previously lived in this world ends for the deceased, but the memory and imagination of the living open up paths to the past and the future and to other worlds and other modes of existence. A survey of the history of religions clearly shows a widespread affirmation that death creates the potential for new beginnings, for a new stage of the cycle of birth-death-rebirth, or for transitioning to different ends. The transformative possibilities signaled by death are numerous and extremely variable. However these possibilities are imagined, though, humans have rarely been content to "let nature take its course," as it were. Upon closer inspection, even those religious groups that apparently let nature take its course following a death (e.g., when the Parsi Zoroastrians of India exposed the corpse on top of a tower to be consumed by carrion birds, or the Lakota Sioux exposed the corpse on a bier to the elements), will be found to have performed ritualized acts intended to symbolically integrate the deceased into a cosmological world of meaning.

Death almost inevitably moves the living to perform ritual work of some sort in an effort to control what happens posthumously both in the world of the living and in that of the dead. The transformations made possible by death are not automatic, nor are they necessarily without danger. By and large, people have assumed that the desired transitions and transformations after death can be accomplished safely only through proper ritual acts. The performance of such rituals may require specific changes in dress, bodily decoration, voice (e.g., in ritual mourning), diet, daily activities, and so on among the living.

Liminality

Death creates a liminal time and space for the living and for the deceased. For a given period of time, those closely related to the deceased often have specific ritual obligations placed upon them, as well as a number of prohibitions (e.g., they cannot comb or wash their hair, wear colorful clothing, participate in certain activities, eat certain foods, go to certain places). The deceased is often imagined as being in a liminal condition as well, betwixt-and-between the world of the living and the world of the dead. In these cases, the funerary and mourning rites are designed to assist the deceased in his or her journey to the otherworld or to effect the transformation into an ancestor, spirit being, and so on. These rites are often viewed as aiding the dead, but at other times they are also clearly designed to keep the dead from returning to the world of the living or otherwise causing havoc. The liminal status of the newly dead or the dead for whom funerary rites were not performed is often imagined to be potentially dangerous. Such liminal beings haunt the world of the living and may cause illness, death, or other calamities; they may also possess individuals or cause them to go mad. Thus, many posthumous rituals are prophylactic in nature and designed to protect the living from the dead.

The liminal status of the corpse almost always requires that it be prepared or handled in specific ritualized ways. In some societies, the deceased is buried or cremated with objects he or she will need in the other world; in other societies, the dead may be buried in a fetal position, perhaps indicating a belief in rebirth. The care taken with the remains of the dead throughout human history has provided archaeologists with some of their most important evidence about the religious beliefs and practices of diverse peoples.

In many societies, death does not terminate all relationships between the deceased and living relatives. Throughout East Asia, for instance, ancestral cults involve regular ritual interactions often for up to thirty or more years, including prayers, offerings of food, drink, and incense, memorial services, and even dances to entertain the dead during the festival of the dead. In Japan, the corpse is cremated and the ashes buried in a cemetery. The deceased is given a posthumous name, which is inscribed by a Buddhist priest on a wooden tablet that is installed in a domestic Buddhist or Shinto ancestral shrine. After the requisite period of memorial rites has passed, the ancestral tablet is itself burned in a symbolic second cremation. Thereafter, the individual identity of the deceased ends and he or she is incorporated into the anonymous class of ancestors.

Communicating with the dead

Many religions also have ritual techniques for communicating with the dead. In traditional societies, a shaman or medium often serves as a conduit of communication with the dead. The deceased may possess a ritual functionary in order to communicate his or her needs or desires, or the ritual specialist may travel through ecstatic flight to the land of the dead to speak with the dead. In other religions, dreams or visions induced by hallucinogens may provide a means of interacting with the ordinary dead. Many societies have regular festivals to which the dead are invited, such as Obon in Japan or the Days of the Dead in Mexico.

In many mourning rites, mourners converse with the deceased by speaking, singing, or otherwise performing both voices in the dialogue. The desire to maintain some contact with deceased loved ones is widespread, although such contact is carefully controlled and of limited duration. In some societies one finds thatmore than death itselfit is the fear of being forgotten after death that is paramount. One thinks of the ancient Greeks and the cult of heroes in which posthumous fame was more valued than life itself.

Many religions encourage visits to the gravesites of the deceased, where tears are shed, prayers are said, offerings of flowers, food, and incense are made, and communion with the deceased occurs. In many societies, songs associated with the dead are sung to recall the deceased, including an enumeration of the places he or she used to visit or the lands the deceased may have hunted or tilled. The deceased is often ritually mourned or keened at the gravesite, although in societies that practice double or secondary burial, these songs or mourning rites are sometimes offered at the now-empty initial burial site. In some societies, physical objects, songs, or specific places associated with the dead function as souvenirs or memento mori, recalling the deceased to mind. In ancient Japan, people employed objects (e.g., a comb, an item of clothing) called katami (to see the form/shape [of the deceased]) to conjure up an image of the dead (Ebersole, 1989). In the Victorian period, people often carried lockets containing a snippet of hair from a deceased or absent loved one. Victorian women also made elaborate hair weavings or flowers, birds, and other decorative formsby using the hair of dead family membersfor similar purposes. With the emergence of photography, photos of the deceased, including those of dead infants and children carefully posed to appear to be sleeping, became extremely popular. Today many persons find these objects macabre and disturbing, witnessing to a major shift in cultural sensibility surrounding death.

Many religions provide rituals to be performed for the benefit of the dead, as noted earlier. The practice of endowing Christian masses to be performed or the reading of Buddhist sutras for a deceased individual are examples. Sometimes individuals made arrangements for such rites to be performed on their behalf after their death, a clear indication of the belief in the continued existence of the self and personal identity. In other cases, it is the surviving family members who are expected to perform memorial or ancestral rites or to have them performed by religious functionaries. The Hindu pinda rite of offerings of food and drink to one's deceased parents is a prime example of a daily domestic practice.

Preparation for facing death, pacification, and the grieving process

Many religions also developed rites designed to help those facing imminent death to accept this fate. The Catholic rite of last unction is but one example. Such rites are based on the widespread belief that one's state of mind and mental focus at the time of death are critical in determining one's posthumous condition. Those who die in an emotionally agitated state, whether it be of fear, anger, jealousy, or lust, will not find peace in the afterlife and, thus, become potentially dangerous. Many different ritual practices seek to overcome the arbitrary nature of death precisely by controlling the timing and/or manner of death, but also one's mental response to it. By overcoming the survival instinct, one overcomes the fear of death and even death itself. The so-called self-mummified buddhas of Japan are the desiccated remains of Shugendō priests, now enshrined as objects of worship, who took a vow to have themselves buried alive in the mountains. Thousands of people gathered to witness the event, while the priest, breathing through a hollow bamboo tube, continually beat a drum and recited the nembutsu, or the ritual invocation of the Bodhisattva Amida (Amitābha), until death, or release, came (Hori, 1962).

Many religions feature rituals of pacification of the dead, designed to assist the deceased to accept his or her new status and surroundings. A certain ambivalence is evident in many of these rites. On the one hand, surviving loved ones wish for a continued relationship with the deceased; on the other hand, there is some fear or anxiety expressed over the possible return of the dead. The living seek to tightly control their interactions with the dead through ritual means. Although the dead are invoked to be present, the rites also usually include formal send-offs to return the deceased to the land of the dead.

Some scholars have long argued that mourning, funerary, and memorial rites are really for the living and answer to their psychological or social needs. Durkheim, for example, claimed they responded to the need for renewed social solidarity; more recently, psychologists and others insist on the need for individuals to work through the grieving process. (The findings of the history of religions, though, might well lead one to question whether there is a single universal grieving process.) Obviously, religious rituals serve multiple purposes, and need not be mutually exclusive. A brief consideration of the different scholarly interpretations of Japanese Buddhist rites of pacification for aborted fetuses (mizuko kuyō ) will demonstrate this. These rites were newly created in late twentieth-century Japan, where abortion was a common form of birth control. Some have argued that mizuko kuyō rites answer the psychological needs of the parent(s), who experience pangs of guilt after the decision to abort (cf. La Fleur, 1992). Others, such as Helen Hardacre (1997), have argued that entrepreneurial Buddhist priests created the need for such rites through skillful marketing techniques. Significantly, advertisements represented aborted fetuses as haunting spirits in need of pacification rites.

The corpse

Whenever death occurs, a corpse is createdan object at once like a living body and radically different from it. Yet, one finds numerous reports of anomalous cases that deny this truism a universal statusthe Taoist immortal who leaves the physical world, leaving behind only sandals, mysteriously empty tombs or graves, and so on. No matter what the details are, such reports imply that the "death" involved was not an ordinary biological death. In some cases, death is denied by claims that an individual has gone away or into hiding (e.g., the Shīʿah Hidden Imam in Iran), perhaps to return triumphantly at a later time. In ancient Japan, the emperor or empress did not die; rather, as a "living deity," he or she had returned to the High Heavens and there become secluded behind the bank of clouds. In many cases, death restores a person to true form, as in the case of a deity who had temporarily taken on material or human form. In yet other cases, at death the individual is reportedly changed instantly into another now permanent or eternal forma star in the heavens, a rock formation, a springleaving no corpse

When a corpse is present, however, it is usually considered to be polluted, leading to numerous avoidance procedures. In many societies, only designated individuals may touch and prepare the corpse. In India, these ritual functionaries are outcastes; in other societies, they may be close relatives, who take on a polluted state for the duration of the funerary and mourning rites. In modern technologically developed societies, these roles have been assumed by medical professionals and professional morticians.

In a striking number of cultures, though, it is predominately women who perform these ritual duties. Bloch and Parry have provocatively argued that the prominence of women in funerary rites is not, as Frazer and many others believed, so much a part of the symbolic regeneration of life as it is a symbolic elaboration of female sexuality and fertility precisely in order to oppose it to "real" vitality. That is, female sexuality and biological reproduction are equated with death-in-life, which must be overcome. Among other religions Bloch and Parry cite, they suggest that Christianity epitomizes this pattern. They contrast the role the woman Eve played in the Fall in the Garden of Edenwhich led to human sexuality, biological procreation, and deathto that of the Virgin Mary. The asexual conception of Jesus and his subsequent death and resurrection restore the possibility of access to the life eternal of Paradise. The meaning and valuation of physiological death, fertility, and regeneration can be totally transformed by shifts in symbolic and ritual representations, which recontexualize these (Bloch and Parry, 1982).

Whatever the merit of Bloch and Parry's overall thesis, it is clear that the meanings of concepts such as death, fertility, sexuality, and rebirth are not singular, nor are they culturally determined for all time or for all persons within a culture. The meanings for such fundamental categories can be renegotiated over time within the same religious tradition, as Ariès and others have shown. At an individual or subgroup level, they may also be affected by one's class, gender, or occupation among other things. A few admittedly extreme examples allow a more general point about these factors to be made. Take, for instance, Egyptian pharaohs. They no doubt anticipated death and rebirth differently than did their slaves, especially insofar as the afterworld was believed to replicate the social, political, and economic structures found in this world. Similarly, the ruling Mayan and Aztec elites must have understood and experienced the ritual sacrifice of the many human captives offered as tribute differently than did many of the conquered people, who were regularly forced to provide the persons for these bloody sacrifices. Unfortunately, most of the records and representations of these sacrificial deaths come from the elite sectors of the societies. Such evidence must be used carefully, always bearing in mind that the voices of the powerless and the disenfranchised were rarely recorded.

Sacrificial rites

Modern scholars have with little difficulty reconstructed the symbolic logic informing the ritual taking of human life in Mesoamerican empires. There once again myths and rituals proffer the paradoxical claim that life comes out of death. In order to renew the cosmos and to guarantee fertility and regeneration, blood must be shed at a specific time, at a specific place, and in a specific choreographed manner. This might be in the form of ritual bleedings from the penis of the Mayan king or through human sacrifice at the Aztec New Year and other appropriate moments of transformative potential (cf., Carrasco, 1999).

Such rituals clearly represented the religio-political ideology of the power elites. It should not be uncritically assumed, however, that such ritual performances accurately represented the shared cultural understanding of all people in the empire. At the same time, neither should it be uncritically assumed that the rites were nothing more than a vehicle for ideological obfuscation on the part of the ruling elites. To be sure, in significant ways, human sacrifice was a forced performance, but cases exist in which persons voluntarily went to their own deaths, and as such require an understanding the power such symbolic activitiesdesigned to effect the magic of transforming death into life or even immortalitycan have over individuals and groups. At a minimum, the question here is one of what constitutes a meaningful voluntary death for specific groups.

The history and complex multiple and competing meanings of the Hindu ritual practice of satithe self-immolation of a widow on her husband's funerary pyremay serve as an exemplar of voluntary ritual death. Sati has long captured people's imagination, but only recently have scholars begun to explore its history and the complex, ongoing, and contested representations of its meaning. For instance, Catherine Weinberger-Thomas (Chicago, 1999) sensitively explored how British merchants and later colonial authorities used the ritual as a rationale for taking control of India; how Western scholars have depicted it and why; how fundamentalist Hindu religious and political groups have embraced it; the complex issues of gender; and the at times intense social and familial pressures a widow faces. She also seeks to understand why some young women chose to follow their husbands in death. She discloses the power of the belief that the widow's self-immolation makes two human bodies into one indivisible body, which is ritually transformed into a sacrificial oblation and rice balla pinda. The funeral pyre becomes the mirror image of the marriage bed in which male and female powers were first conjoined, although now this union of opposites is forever. This ritual suicide is also the inverse of the primordial self sacrifice of Purusha, as detailed in gveda X: 40. In the latter, the primordial divine sacrifice leads to the creation of the material world, the caste system, and so on; with the ritual sacrifice of sati, all of these are overcome and the couple escapes the cycle of birth-death-rebirth.

Continued presence of death in life

It is a commonplace to say that religions create worlds of meaning. But they also create meaningful deaths. Death is never far from human experience, no matter how people may try to banish it from sight and mind. It permeates daily life just as it structures the rhythms of collective life. Graveyards, ossuaries, tombs, memorials, and museums bring the presence of death and the dead into human consciousness and landscape. Monumental architectural buildings and structures seek to guarantee and to control the memory of the dead by future generations. The mall of Washington, D.C., for instance, is a public space filled with memorials to the dead designed to evoke a sacred sense of the past and a collective American identity. Today in secular scientific cultures, human genes and DNA have become yet another way of re-imagining the continued presence of the dead in the living.

Religious calendars are punctuated with festivals and observances related to the dead, but so are secular calendars. The citizens of modern nation-states celebrate memorial days of various sorts for their war dead, the victims of genocide, presidents, and kings, but they also celebrate birthdays and beginnings. Even when the dead are feared or are considered polluting and, thus, are segregated and separated spatially from the living, they hover nearby. Ritual avoidances of specific places, foods, words, names, and so on also bring the deadeven in their physical absenceinto the consciousness of the living. The dead live in memory, in dreams, and in physical tokens. In other cases, the dead are physically near to handburied under the cathedral floor, enshrined in part or in whole as holy relics in temples and sanctuaries, or interred under the entranceway to a house. The dead may even be literally incorporated into the living through some form of endocannibalism (e.g., Amazonian natives drinking the cremation ashes of a villager). Scholars have noted the striking similarity to the symbolism (or the reality of the miracle of transubstantiation) of the Christian Eucharist"This is my body; this is my blood."

Death is everpresent, as well, in the privileged myths and stories told again and again in song and poetry, in the arts (painting, sculpture, weaving, mosaics, pottery, etc.), in dance and dramatic performances, in children's play ("Ring around a rosey/pocketful of posies/ashes, ashes, all fall down."), and today on television, in the movies, and in video games. Bringing the ubiquity and the absolute redundancy of death before the mind's eye of the living has often served didactic purposes, moving persons to act in spiritually and morally proper and ascribed ways. The Buddhist ritual contemplation of putrefying corpses, the ritual visualization of the inevitable future of all human bodies, visiting collective ossuaries, and so on have been used to move people to renounce the material body and the world. Graphic pictures of hells and the land of the dead in many religions have similarly served to keep death in the minds of people, just as images of heaven and the afterlife have proffered hope to many.

The ubiquitous presence of death, however, can also make it banal and rob it of any sense of sacrality or meaning. People can become inured to death by the numbing effect of the sheer numbers of the dead in times of plague, war, and, to use a modern term, natural disaster. Death's seemingly relentless redundancy can lead persons to perform horribly immoral acts as death's banality threatens the foundations of society. Akira Kurosawa's film Rashomon, set in Kyoto in an age of terrible civil war and a time of rampaging plague, is an unforgettable portrait of death's power to destroy law and order and to create utter chaos. Sheer desperation, coupled with the drive to survive, can lead humans to depravity as the moral order of the universe collapses. In the European Holocaust, the carrying out of the Nazi policy of extermination of the Jews, gypsies, and others was possible in part because in the camps killing became so banal.

There is also the "death without weeping"the resignation at times of the poorest of the poor to the necessity of death for some if others are to live. The myriad images of a happier life in the future that many religions have proffered must not blind one to the desperate, horrible, and yet rational decision that innumerable mothers have made throughout history to stop feeding one child so that others might live (cf., Scheper-Hughes, 1992). Similarly, in much of the world today and in all countries before the advances of modern medicine, giving birth was an extremely dangerous act. All too often, bringing life into the world meant the death of the mother.

Yet, in the history of religions, few societies have collectively embraced an existential fatalism, which assumes that death is meaningless. Rather, plagues, wars, and natural disasters have often been taken to be cosmological signs of some sort. They have generated eschatological visions on a cosmic scale of the end of the world as we know it and the beginning of a new world. Or they have stimulated calendrical speculation on a cosmic scale, with the positing of ages through which the universe must pass. Examples are legion, ranging from ancient Indian speculation on devolutionary cosmic ages (yugas ) and Buddhist writings on the present time as the Age of Declining Dharma to the elaborate intermeshing calendars of the Aztecs and the Mayans, which inexorably move through their cycles of change and ends and beginnings. In almost all cases, as has been seen in the case with the death of an individual, the end is imagined as a beginning. The end of a cosmic age is a moment of transition and transformation, one marked by death, destruction, and danger. Yet the religious imagination of humans turns this dark timethis descent into chaosinto a prelude to a renewed time and a return to order. Often this denouement is rehearsed in ritual performance and mythic narration.

The need to explain death

Death is both uniform and arbitrary. It is uniform in so far as all persons, regardless of social status, position, and wealth are subject to dying. Death is arbitrary, though, in terms of when it strikes, how it strikes, and often who it strikes. In this sense, death is enigmatic, mysterious, and unnerving. Although death is inevitable, specific deaths need to be explained. In many societies, the corpse or skeletal remains were examined for evidentiary purposes, or other ritual means, such as divination, were employed to determine who or what had caused a death. Today in scientifically developed countries, a special medical practitioner will perform an autopsy for these purposes.

In the past and in many traditional cultures today, ritual autopsies of a different sort were and are performed. In rural Greece, for instance, as in centuries past, old women and female relatives will fondle and closely examine exhumed skeletal bones for signs of the moral condition of the deceased and, thus, his or her posthumous fate (cf. Danforth, 1982). In other societies, the condition of a corpse after death is taken to be a sign of his or her spiritual status. In Buddhist and Christian lore, for example, the corpses of saints do not decay, nor do they emit disgusting odors. Rather, they release aromatic smells. Such extraordinary corpses are, of course, the source of relics in the cults of religions around the world. Such body relics are the repository of healing and saving powers; they are also yet another expression of the belief in life-from-death.

If the timing of death often seems arbitrary, societies and religious communities seek to regularize it temporally by punctuating religious and political calendars with days memorializing the dead. Whether it be the Shīʿah Muslims' annual memorialization and re-enactment of the martyrdom of al Husain, Christians' annual ritual remembrances of the crucifixion of Jesus and his resurrection, the celebration throughout East Asia of the festival of the dead, a ritual time when the spirits of the dead are invited to return to the world of the living and are entertained there, or modern national memorial days for the war dead, calendars are filled with days dedicated to the collective recollection of the dead. Through such collective reflections on death, communal values are reaffirmed. In an important sense, life cannot have meaning until death does.

While death is universal, it is imagined, encountered, and responded to in a myriad number of different ways across space and time. Death in the history of religions is the history of the ever-changing imagination and revaluation of death, as well as of the stylized responses to it. Philippe Aries' magisterial thousand-year history of death in Europe is one notable attempt to interpret and understand the existential meaning of the shifting representations of death over time. Aries' work reminds one that the manner in which death and the afterlife (or, the different possible consequences of death) are imagined and represented informs the lived experience of death both by the dying person and the survivors. Aries describes "the tame death" in medieval Europe when a dying individual accepted his or her coming death and met it at home. Surrounded by loved ones, the dying person said her or his last goodbyes and prepared to face death calmly, for one's state of mind at the time of death helped to determine one's fate.

Many religions have taught ways of preparing for death and facing this inevitability calmly. Holy men of the Agora sect in India meditate on death in the cremation grounds, spread the ashes of the dead over their own bodies, use human skulls as begging bowls, and pursue other practices in order to live with death continually (cf. Parry, 1994). Some Japanese samurai also practiced daily meditation in which they envisioned their deaths in battle. By practicing dying in this way, they sought to prepare themselves to face death unflinchingly (Reynolds and Waugh, 1977). In a myriad number of different ways, humans have sought to control death, even if it could not be conquered. The query "Death where is thy sting?" is an expression of the achievement of this control over death (1 Corinthians 15:55).

One way to gain control over death is to control the timing of one's death or to overcome the arbitrary timing of death by foretelling it. The ability to predict one's own death or to will it to happen at a certain time and place are widely recognized as a sign or a power of a holy person. The Japanese Buddhist poet-monk Saigyō (11181190) wrote a well-known poem (no. 77) included in his collection, Sankashū (Nihon koten bungaku taikei, Vol. 29, p. 32), that reads:

negawaku wa Let me die, I pray, hana no shita nite under the cherry blossoms haru shinan of spring. sono kisaragi no around the full moon mochizuki no koro of the month of Kisaragi.

Kisaragi is the classical Japanese name for the second lunar month. Gotama the Buddha passed away on the fifteenth of this month, so Saigyō's wish was to emulate the Buddha even in death. When Saigyō died on the sixteenth of Kisaragi, many people took this as an auspicious sign. Saigyō's posthumous fame rested in part on this "proof" of his extraordinary spiritual nature. Similar miraculous powers of forecasting one's own death are found in religions around the world.

Conclusion

These general comments on death in the history of religions have done little more than present a brief introduction to the subject. In many ways, conceptions of death are subject to change over time, just as they vary dramatically in different religions. The imagining of death is not an empty exercise; it shapes the individual and communal experience of death and life. That death is a fact of life remains one of the most intractable mysteries that human beings must confront. Human beings past and present have always sought to find meaning in death and, thereby, in life. The history of this search for meaning in the history of religions is both poignant and ennobling.

See Also

Afterlife; Ages of the World; Alchemy; Ancestors; Ashes; Banaras; Birth; Bones; Bushido; Cannibalism; Cargo Cults; Day of the Dead; Descent into the Underworld; Dying and Rising Gods; Easter; Eschatology, overview article; Fall, The; Funeral Rites, overview article; Ghost Dance; Heaven and Hell; Human Sacrifice; Initiation; Life; Otherworld; Pure and Impure Lands; Relics; Rites of Passage; Sacrifice; Sati; Suicide; Tombs; Underworld.

Bibliography

Alexiou, Margaret. The Ritual Lament in Greek Tradition. London, 1974.

Ariès, Philippe. The Hour of Our Death. New York, 1981.

Bachofen, Johann Jakob. Versuch uber Grabersymbolik der Alten, Basel, Germany, 1859.

Bloch, Maurice, and Jonathon Parry, eds. Death and the Regeneration of Life. Cambridge, U.K., 1982.

Carrasco, Davíd. City of Sacrifice: The Aztec Empire and the Role of Violence in Civilization. Boston, 1999.

Danforth, Loring M. The Death Rituals of Rural Greece. Princeton, 1982.

Durkheim Emile. The Elementary Forms of the Religious Life. London, 1915.

Desjarlais, Robert. Sensory Biographies: Lives and Deaths Among Nepal's Yolmo Buddhists. Berkeley, Calif., 2003.

Ebersole, Gary L. Ritual Poetry and the Politics of Death in Early Japan. Princeton, 1989.

Evans-Pritchard, E. E. Theories of Primitive Religion. Oxford, 1965.

Frazer, James. The Golden Bough: A Study in Magic and Religion. London, 1912.

Freud, Sigmund. Totem and Taboo: Resemblances Between the Psychic Lives of Savages and Neurotics. New York, 1918.

Freud, Sigmund. The Future of an Illusion. New York, 1928.

Freud, Sigmund. Civilization and Its Discontents. London, 1930.

Freud, Sigmund. Moses and Monotheism. New York, 1939.

Hardacre, Helen. Marketing the Menacing Fetus in Japan. Berkeley, Calif., 1997.

Harrison, Jane. Themis: A Study of the Social Origins of Greek Religion. Cambridge, U.K., 1911.

Hertz, Robert. "A Contribution to the Study of the Collective Representation of Death." In Death and the Right Hand, trans. Rodney C. Needham. London, 1960.

Hori, Ichiro. "Self-Mummified Buddhas in Japan: An Aspect of the Shugen-dō ('Mountain Asceticism') Sect." History of Religions 1, 2 (1962): 222242.

Kimura, Takeshi. "Bearing the 'Bare Facts' of Ritual: A Critique of Jonathan Z. Smith's Study of the Bear Ceremony Based on a Study of the Ainu Iyomante." Numen 46, no. 1 (1999): 88114.

LaFleur, William R. Liquid Life: Abortion and Buddhism in Japan. Princeton, 1992.

Metcalf, Peter, and Richard Huntington. Celebrations of Death: The Anthropology of Mortuary Ritual. Cambridge, U.K., 1979; 2d ed., 1991.

Nihon koten bungaku taikei, vol. 29. Tokyo, 1958.

Parry, Jonathon. Death in Benares. New York, 1994.

Reynolds, Frank E., and Earle H. Waugh, eds. Religious Encounters with Death: Insights from the History and Anthropology of Religions. University Park, Pa., 1977.

Scheper-Hughes, Nancy. Death Without Weeping: The Violence of Everyday Life in Brazil. Berkeley, Calif., 1992.

Spencer, Herbert. Principles of Sociology. London, 1885.

Stannard, David E. The Puritan Way of Death: A Study of Religion, Culture, and Social Change. Oxford, 1977.

Tylor, Edward B. Primitive Culture. London, 1871.

Weinberger-Thomas, Catherine. Ashes of Immortality: Widow Burning in India. Chicago, 1999.

Gary L. Ebersole (2005)

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Death

DEATH

Although most of the great philosophers have touched on the problem of death, few have dealt with it systematically or in detail. Frequently, as in the case of Benedict (Baruch) de Spinoza, an author's views on the subject are known to us from a single sentence; and at almost all stages in Western history we are likely to discover more about the topic in the writings of men of letters than in those of technical philosophers. Whether this relative reticence on the part of philosophers should be attributed to a general lack of interest or to other causes is a moot point. Arthur Schopenhauer, who was the first of the major philosophers to deal extensively with the subject, declared that death is the muse of philosophy, notwithstanding that the muse is seldom avowed. And the existentialist philosophers from Søren Kierkegaard to the present have more or less consistently endorsed Schopenhauer's contention; Albert Camus's declaration in The Myth of Sisyphus (1942) that suicide is the only genuine philosophical issue is an extreme but notable case in point. On the other hand, most contemporary Anglo-American analytic philosophers probably regard the paucity of materials on death as evidence of the subject's resistance to serious philosophical inquiry. In general, they wish to exclude the subject of death from the area of legitimate philosophical speculation, either as a part of their campaign against metaphysics or on the grounds that the subject can be more adequately dealt with by psychologists and social scientists. The psychologists and social scientists have, in fact, recently given signs of a willingness to explore the question. One such indication was a symposium on the psychology of death at the 1956 American Psychological Association Convention, which resulted in the publication in 1959 of an anthology including contributions from scholars in a wide variety of fields. Unfortunately, as several of the contributors to this volume lamented, the number of experimental studies actually undertaken has been disappointingly small.

The Knowledge of Death

The primary concern of most philosophers who have dealt with the question of death has been to discover ways in which we may mitigate or overcome the fear it tends to inspire. There are, however, several other loosely related problems that have also tended to excite interest or controversy and that it will be advisable to discuss first. How does man learn of death? Is death a natural phenomenon, or does it require explanation in nonnatural terms? What specific psychological or social conditions tend to heighten the awareness and fear of death?

awareness of death

The clearest and simplest answer to the first of these questions was given by Voltaire, who stated: "The human species is the only one which knows it will die, and it knows this through experience" (Dictionnaire philosophique ). Although some persons have questioned whether man is the only animal who knows he will die, arguing that certain of the lower animals appear to show some vague presentiment of approaching extinction, it appears to be unquestioned that man alone has a clear awareness of death and that man alone regards death as a universal and inevitable phenomenon. The interesting question is how man knows he will die. The view that experience alone gives knowledge of death derives support from the ignorance of death displayed by many children and from anthropological data indicating that many primitive peoples refuse even as adults to regard death as necessary or universal. However, a number of twentieth-century philosophers contested this view, especially Max Scheler and Martin Heidegger, who argue that the awareness of death is an immanent, a priori structure of human consciousness. Although neither of these authors offers anything in the nature of scientific evidence for his position, it is not easily refuted; for, if one grants current notions about levels of consciousness, apparent ignorance of death may be interpreted as merely superficial and attributed to some form of repression. Moreover, the imperfect knowledge of death among primitive peoples is a fact that could be used against those who argue that the knowledge of death comes from experience, since the hazards of their lives expose primitive peoples to an earlier and greater experience of death than is common among civilized men. At the very least it must be granted that the knowledge of death depends not only upon experience but also upon a level of mental culture that makes it possible to interpret experience accurately.

Ironically, Sigmund Freud, who more than anybody else has habituated us to think in terms of levels of consciousness and has thereby rendered credible the idea that knowledge of death may exist despite apparent ignorance, stated that the consciousness, not the apparent ignorance, of death is merely superficial, the unconscious being firmly convinced of its immortality. How Freud could reconcile this belief, which dates from the period of World War I, with his later belief in the unconscious death wish is not clear.

death: a natural phenomenon?

Is death a natural phenomenon? Most persons today tend to find this question a bit foolish. It is noteworthy, however, that most primitive peoples attribute death to the agency of gods or demons who are jealous of human achievements. Equally significant is the Christian explanation of death as punishment for the sins of Adam. It should also be observed that if by a "natural" phenomenon one means a fact that can be fully understood and explained by empirical inquiry, death is not a natural phenomenon for Heidegger or Scheler. This reluctance to explain death in terms of natural causes has an interesting parallel in the reluctance to explain life itself naturalistically, and the religious or metaphysical perspectives that give rise to nonnaturalistic interpretations of life tend also to occasion nonnaturalistic interpretations of death.

variations in consciousness of death

Are there great variations in the awareness or fear of death from person to person, from epoch to epoch, from culture to culture? If so, how are these variations to be explained? Surprisingly, very little attention has been given to these questions. The most interesting and almost the only hypothesis on this topic is that of Johan Huizinga and Paul-Louis Landsberg, who, each in his own way, link the consciousness of death to individualism. According to these authors, the consciousness of death has been most acute in periods of social disorganization, when individual choice tends to replace automatic conformity to social values; they point especially to classical society after the disintegration of the city-states; to the early Renaissance, after the breakdown of feudalism; and to the twentieth century. This hypothesis has yet to be fully confirmed or disconfirmed by careful historical and anthropological study. However, it is true that late antiquity, the early Renaissance, and the twentieth century made unusually great contributions to the literature on death.

The Fear of Death

With respect to the fear of death, the great divide is between those who argue that only the hope of personal immortality will ever reconcile men to death and those who argue that the fear of death may be mitigated or overcome even when death is accepted as the ultimate extinction of the individual person. The second group, which is remarkably heterogeneous, may be subdivided according to the techniques recommended for allaying fears.

the epicureans

One of the oldest of the "solutions" to the fear of death was that of Epicurus and his followers. According to Epicurus, the fear of death is based upon the beliefs that death is painful and that the soul may survive to experience pain or torture in an afterlife. Since both of these beliefs are mistaken, it suffices to expose them as such. Although death may be precipitated by painful disease, death itself is a perfectly painless loss of consciousness, no more to be feared than falling asleep. And since the soul is merely a special organization of material atoms, it cannot survive physical destruction. "Death," Epicurus said, "is nothing to us. It does not concern either the living or the dead, since for the former it is not, and the latter are no more" (Letter to Menoeceus ). It is hardly necessary to point out that many persons have questioned Epicurus's conception of the soul and consequently have rejected his views with respect to its immortality. The principal criticism, however, is that the Epicureans have falsely diagnosed the cause of humankind's fear of death. Death terrorizes us, not because we fear it as painful, but because we are unwilling to lose consciousness permanently. The twentieth-century Spanish existentialist philosopher Miguel de Unamuno reports that "as a youth and even as a child, I remained unmoved when shown the most moving pictures of hell, for even then nothing appeared to me quite so horrible as nothingness itself."

the stoics

The later Stoics, especially Seneca, Epictetus, and Marcus Aurelius, offered a more complicated and elusive view of death. Seneca said that to overcome the fear of death we must think of it constantly. The important thing, however, is to think of it in the proper manner, reminding ourselves that we are but parts of nature and must reconcile ourselves to our allotted roles. He recurrently compared life to a banquet from which it is our obligation to retire graciously at the appointed time, or to a role in a play whose limits ought to satisfy us, since they satisfy the author. The fear of death displays a baseness wholly incompatible with the dignity and calm of the true philosopher, who has learned to emancipate himself from finite concerns. Essential to the Stoic outlook was the Platonic view that philosophizing means learning to die; that is, learning to commune with the eternal through the act of philosophic contemplation.

Although much of Stoic thinking on death crept into later Christianity, the contemporary Christians saw in this thinking a sinful element of pride. Death, Augustine said, is a punishment for human sin, and the fear of death cannot be overcome except through divine grace. Others find it highly questionable whether one can reasonably accept the metaphysical underpinnings of the Stoic view, most especially the belief in a providential order of Nature.

spinoza

A third solution is that of Spinoza. He wrote: "A free man thinks of nothing less than of death, and his wisdom is not a meditation upon death but upon life" (Ethics, Prop. LXVII). Since Spinoza did not elaborate, it is possible to argue almost endlessly about the precise import of this famous remark. Most often, however, it is interpreted to mean that men can and should allay the fear of death simply by diverting their attention from it, and some persons have argued that by his nature man tends toperhaps mustfollow this advice. François de La Rochefoucauld, for instance, averred that man can no more look directly at death than he can look directly at the sun. One fundamental criticism of this position comes from the Stoics and the existentialists, both of whom maintain that the fear of death can be allayed only by facing it directly. A second criticism consists in pointing out that the fear of death is frequently an involuntary sentiment that cannot be conquered by a merely conscious decision or a bare act of will. It is not enough to tell people not to think of death; one must explain how they can avoid thinking of it.

death and the good life

This brings us to a fourth view on death, a view that was felicitously put by Leonardo da Vinci. Just as a day well spent brings happy sleep, so, he said, a life well spent brings happy death. Painful preoccupation with death has its source in human misery; the cure is to foster human well-being. A happy man is not seriously pained by the thought of death, nor does he dwell on the subject. This view was held by many Enlightenment thinkers, most notably the Marquis de Condorcet. It also appears to be the view of most pragmatists and of Bertrand Russell.

There are two counterarguments. The first is the theme prevalent in several branches of Christianity concerning the total impossibility of attaining happiness on Earth. The second is the even more familiar and prevalent Christian theme that in order to achieve happiness in this life, one must first conquer the fear of death. Happiness, therefore, is not a cure; it is a consequence of the cure.

death without consolation

In sharp contrast to this last position is that of a long line of nineteenth-century and more recent philosophers, from Schopenhauer to contemporary existentialists. For them human well-being or happiness, at least as traditionally conceived, is totally impossible to achieve; and if the individual is to experience such rewarding values as life does permit, he must uncompromisingly embrace the tragedy of the human condition, clearheadedly acknowledging such evils as death. Like the Stoics, these authors would have us think constantly of death. Unlike the Stoics, however, they do not offer us the consolation of belief in a providential order of nature. From the standpoint of Being or Nature, the death of the individual is totally meaningless or absurd.

For Schopenhauer the finite, empirical self is a manifestation of a cosmic will that has destined man to live out his life in suffering or painful striving. The only remedy is to achieve a state of indifference or pure will-lessnessa state best known in moments of pure aesthetic contemplation but to which the awareness of death substantially contributes.

According to Friedrich Nietzsche, the superior man will not permit death to seek him out in ambush, to strike him down unawares. The superior man will live constantly in the awareness of death, joyfully and proudly assuming death as the natural and proper terminus of life.

Heidegger and Jean-Paul Sartre, like most existentialists, urge us to cultivate the awareness of death chiefly as a means of heightening our sense of life. The knowledge of death gives to life a sense of urgency that it would otherwise lack. The same point has been made by Freud, who compared life without the consciousness of death to a Platonic romance or to a game played without stakes.

Heidegger makes the additional claim, although here Sartre parts company with him, that the awareness of death confers upon man a sense of his own individuality. Dying, he says, is the one thing no one can do for you; each of us must die alone. To shut out the consciousness of death is, therefore, to refuse one's individuality and to live inauthentically.

See also Augustine, St.; Camus, Albert; Epictetus; Epicurus; Euthanasia; Existentialism; Freud, Sigmund; Heidegger, Martin; Immortality; Kierkegaard, Søren Aabye; La Rochefoucauld, Duc François de; Leonardo da Vinci; Life, Meaning and Value of; Marcus Aurelius Antoninus; Nietzsche, Friedrich; Platonism and the Platonic Tradition; Reincarnation; Sartre, Jean-Paul; Scheler, Max; Schopenhauer, Arthur; Seneca, Lucius Annaeus; Spinoza, Benedict (Baruch) de; Stoicism; Unamuno y Jugo, Miguel de; Voltaire, François-Marie Arouet de.

Bibliography

Jacques Choron, Death and Western Thought (New York: Collier, 1963), is a fairly comprehensive review of what Western philosophers have had to say on the subject of death. It is especially recommended for its wealth of quotations. Herman Feifel, ed., The Meaning of Death (New York: McGraw-Hill, 1959), is an anthology containing many contemporary essays by psychologists, sociologists, and workers in allied fields.

Russell's views on death may be found in "The Art of Growing Old," in his Portraits from Memory and Other Essays (London: Allen and Unwin, 1956) and in "What I Believe," in his Why I Am Not a Christian (London: Allen and Unwin, 1957).

Heidegger's views will be found in his Being and Time (New York: Harper, 1962), Part II, Ch. 1; Sartre's in his Being and Nothingness (New York: Philosophical Library, 1956), pp. 531553.

An interesting work by a Roman Catholic existentialist is Paul-Louis Landsberg, Essai sur l'experience de la mort (Paris, 1951).

Freud's views are expressed in "Thoughts for the Times on War and Death," in Standard Edition of the Complete Psychological Works of Sigmund Freud, edited by James Strachey and Anna Freud (London: Hogarth Press, 1957), Vol. XIV, 288317.

Johan Huizinga, The Waning of the Middle Ages (London, 1952), provides the best account of that author's reflections.

For an analysis of primitive attitudes toward death, see Lucien Lévy-Bruhl, Primitive Mentality, translated by Lilian A. Clare (London: Allen and Unwin, 1923).

Robert G. Olson (1967)

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Death

DEATH

In the Bible

The Hebrew word for death is mavet (mawet) (Heb. מָוֶת) from the root mvt (mwt). For the Canaanites, Mwt (Mot) was the god of the underworld. Details of the myth of Mot are found in *Ugaritic literature. Mot fought against *Baal, the god of rain and of fertility; he was victorious and forced Baal to descend to his kingdom in the depths of the earth. But Anath, sister of Baal, avenged her brother and killed Mot. In the end Baal and Mot both returned to life, but at different times. Most commentators interpret this myth as a symbol of the changing seasons: Baal dies at the end of the rainy season, while Mot returns to life; the contrary happens when the rains begin again. In the Bible there are traces of such a myth in the belief that death is a destructive force distinct from God (see *Demons and Demonology) with its own messengers (e.g., war, sickness, plagues, cf. Hos, 13:14; Ps. 91:5–7; Prov. 16:14). In Jeremiah 9:20 it is said, "For Death (mawet) has climbed in through our windows, has entered our fortresses, cutting off children from the streets, young men from the squares." Mawet in this verse (see also Isa. 5:14; Hab. 2:5) may be compared to the Mesopotamian demon Lamashtu, who usually attacks children and pregnant women by climbing over the walls and entering through the windows (cf. Paul in bibl., where the widely held opinion that links this passage with the Baal myth is criticized). In the Bible there are two reasons given for man's death: the first states that God made man from the dust of the earth, and to dust he must return (Gen. 2:7; 3:19; Job 10:9). Genesis 3:22–24 gives a second reason: that of sin. By his expulsion from paradise, man was deprived of access to the tree of life, and thus eternal life was lost to him. The sentence of death passed on man in Genesis 3:19, "By the sweat of your face shall you get bread to eat until you return to the ground. For from it you were taken. For dust you are, and to dust you shall return," is opposed to other biblical passages that speak of the dead who go down into the tomb and enter the region of the dead (Isa. 14:9–12; Ezek. 32:17–32; etc.). Many names are given to this region: *sheʾol, always feminine and without a definite article as is usual in proper nouns, is found in no other language; ʾereẓ ("earth," "underworld"; e.g., i Sam. 28:13; Jonah 2:7; Job 10:21–22), which has the same meaning in Akkadian and Ugaritic; kever (qever, "grave"; Ps. 88:12), whose Akkadian parallel, qabru, is the normal form of designating the world of the dead; ʿafar ("dust"; Isa. 26:6, 19; cf. Gen. 3:19); bor ("pit"; e.g., Isa. 14:15, 38:18; Prov. 28:17; cf. Akk. bûru); shaḥat ("pit"; Ps. 7:16; cf. Akk. šuttu); ʾavadon ("Abaddon"; e.g., Job 28:22); naḥalei beliyyaʿal, "the torrents of Belial" (ii Sam. 22:5,6). This region is in the depths of the earth; it is therefore called "the nether parts of the earth" (Ezek. 31:14); "the depths of the pit" (Lam. 3:55); "the land of darkness" (Job 10:21). Note the common Akkadian expressions for the region of the dead: "house of darkness" and "country of no return." The dead all inhabit this country, even those who were not buried (Gen. 37:35; Isa. 14:19; Ezek. 32:17–32; The Epic of Gilgamesh xii: 153). The dead are also called "*Rephaim" – in Ugaritic as well – but the origin of the word is obscure (Prov. 21:16). After death there is no contact between the dead man and his god (Ps. 30:10; 88:6, 12–13). Besides the idea that all the dead share the same unhappy situation, there is the notion that their fate depends on the attention bestowed on them by the living: whether or not they are properly buried, whether or not food or drink is brought to them (but not in the Bible), and, especially, whether or not their names are remembered. In the Bible great importance is placed on *burial, especially in the family tomb (Gen. 47:29–30; 49:29; 50:25; ii Sam. 21:12–14). On the other hand, not to be buried at all is a serious punishment (cf. i Kings 14:11; et al.; note the Assyro-Babylonian malediction, "May he not be buried in the earth and may his spirit never be reunited with his loved ones."). Among the unfortunate beings in the next world, Akkadian texts name "the man who has no one to recall his name" (cf. ii Sam. 18:18) and "he to whom neither food nor drink is brought"; he is reduced to "drinking fetid waters and eating the food that is thrown out by the living" (cf. The Epic of Gilgamesh xii: 154). Care of the dead is also inspired by self-interest because they can affect the world of the living either for good or for evil and can even foretell the future (i Sam. 28:15–20). In the Babylonian confessions, the spirits of the dead are mentioned along with the gods: "I honored the gods and the spirits of the dead." In the Bible, they were called spirits (lit. "gods"; i Sam. 28:13). The reticence of the Torah on matters concerning the dead is easily understandable. There is nothing about honoring the dead; on the contrary, there are prohibitions about mourning certain persons, and it is forbidden to give them alms (Deut. 26:14) and to consult them. The sacrifices to the dead, forbidden by Deuteronomy 26:14, are linked by Psalm 106:28 to idolatry: "They joined themselves also unto Baal-Peor, and ate the sacrifices of the dead." The custom of bringing meals to the dead did not however disappear, and during the Second Temple period, at least in certain devout circles, it was considered a pious work: "Pour out thy bread on the tomb of the just and do not give it to sinners" (Tob. 4:7). Ben-Sira attacks this belief (Ecclus. 30:18). For the Egyptians, the dead plow, harvest, eat, and drink – in short, do all they did while they were alive (The Book of the Dead, 110). This pessimism about the fate of man expressed in biblical and Mesopotamian texts can be most clearly felt in the words with which Siduri tries to convince Gilgamesh that there is no point in seeking eternal life, for "when the gods created mankind, Death for mankind they set aside, Life in their own hands retaining"; and she goes on advising him to enjoy this world (cf. Pritchard, Texts, 90; see also the parallel passage in Eccles. 9:7–10). The two exceptions to the biblical belief that man descends into she'ol and remains there forever are Enoch (Gen. 5:24) and Elijah (ii Kings 2:11; cf. the fate of the hero of the Mesopotamian flood story Ziusudra/Utnapishtim). Perhaps this belief is the origin of the psalmist's hope that he would not descend to she'ol (Ps. 49:16). In a Ugaritic epic Anat proposes to give Aqhat immortality, but the latter does not believe in it. Similarly in an Akkadian myth it is related how immortality escapes Adapa because he follows the evil counsel of his father, Enki-Ea, and refuses to eat the bread of life and drink the water of life. Enki-Ea had led him to believe that they were the bread and the water of death (cf. Pritchard, Texts, 101–2). An epithet of Marduk in Babylonian texts is muballiṭ mîti, "he who gives life to the dead"; but the meaning of the expression is rather "he who cures the sick" (cf. Ludlul bêl nemêqi 2:47; ii Sam. 9:8; 16:9). In the *Servant of the Lord poems, his sufferings are described as a death. *Resurrection in the true sense of the word is only found in Daniel 12:2, but here too resurrection is a reward and meant only for the people of Israel, while in Isaiah 66:24 punishment of the wicked is eternal, but is not connected with their resurrection. In Ezekiel 37:1–14, the return of Exiles is described as a resurrection from the dead. On the other hand, one should compare this to Genesis 2:19, which states that the body descends to the earth (cf. Ps. 104:29; Job 34:14–15). Whether the spirit of man ultimately goes upward is questioned in the late Book of Ecclesiastes 3:20–21, but 12:7 affirms that "the spirit of man returns to God, who gave it."

In Talmud and Midrash

Though so complex a subject as death was inevitably not dealt with by the rabbis in an unequivocal way, their discussions on the subject incorporate a series of closely interconnected doctrines. Death itself, though imbued with mystery – contact with the corpse, for instance, meant defilement in the highest degree – was thought of as that moment of transformation from life in this world to that of the beyond. In terms of the mishnaic image, "This world is like a corridor before the world to come" (Avot 4:16), death is the passing of the portal separating the two worlds, giving access to a "world which is wholly good" (Kid. 39b).

At death the soul leaves the body with a cry that reverberates from one end of the world to the other (Yoma 20b), to pass into a state of existence, the exact nature of which was a matter of considerable dispute amongst the rabbis (cf. Shab. 152b–153a; Ber. 18b–19a; Maim. Yad, Teshuvah 8:2, and the critical remark by Abraham b. David of Posquières (Rabad); see also *Afterlife, *Body and Soul, *World to Come). Whatever the nature of the world beyond, it was generally accepted that there the dead reap the deserts of the acts they performed while alive, that they were free from Torah and the commandments (Shab. 30b), and that death served as an atoning process (Sif. Num 112). One confession formula before death, particularly prescribed for the criminal about to be executed, is "May my death be an atonement for all my sins" (Sanh. 6:2). The atoning value of death received greater emphasis after the destruction of the Temple, with the abolition of sacrificial atonement, so that complete forgiveness for more serious sins was dependent, despite repentance, the Day of Atonement, and suffering, on the final atoning value of death (cf. the discussion in Urbach, Ḥazal, 380–3).

Death and birth are viewed as parallel processes: just as man is born with a cry, tears, and a sigh, so he dies. He is born with his fist clenched as if to say "the whole world is mine," and he dies with open hands as if to say, "I have inherited nothing from this world" (Eccles. R. 5:14). The rabbis considered that there were 903 forms of death, the most severe way of dying being from asthma, or croup, which is compared to a thorn being torn out of a ball of wool, and the lightest is described as "the kiss of death," specially reserved for the righteous, which is like a hair being removed from milk (Ber. 8a; bb 17a; see *Death, Kiss of). The way in which a person dies, and the day on which he dies, were thought to be significant as good or bad omens for the deceased. Thus, for example, should he die amid laughter, or on the Sabbath eve, it is a good sign, whereas to die amid weeping, or at the close of the Sabbath, is a bad omen (Ket. 103b). To die from a disease of the bowels is considered a good sign (Er. 41b), no doubt because the suffering involved was thought to cleanse a person of his iniquities. Thus it was said that many of the righteous died from bowel illness (Shab. 118b), this being an opportunity for any sins they may have accumulated to be purged before their entrance into the next world (cf., however, what was said above about the "kiss of death"). One description of the death process relates that when the dying man sees the angel of death, who is covered all over with eyes and stands above his pillow with drawn sword, he opens his mouth in fright, whereupon the angel lets fall a drop of gall suspended on the end of his sword. Swallowing this, the person dies, and because of this drop, his corpse gives off a bad odor (Av. Zar. 20b). At the moment of death the righteous man is vouchsafed a vision of the Shekhinah, the Divine Presence (Num. R. 14:22; Zohar, Midrash ha-Ne'elam, Gen. 98a).

Concerning the very necessity of death there was some dispute amongst the rabbis. On the one hand there is the rather extreme view, which did not win general acceptance, that death was the wages of sin: "There is no death without sin" (Shab. 55a), and it is the inevitable fate of man only in that no man is sinless, "… there is not a righteous man upon earth, that … sinneth not" (Eccles. 7:20). Even Moses and Aaron died because they had sinned (Shab. 55b). The few exceptions, the really righteous such as Elijah, were thought not to have died (Lev. R. 27:4; Eccles. R. 3:15), or in other cases to have died only as a consequence of the machinations of the serpent in Eden, who caused Adam to sin and thus bring death to the world (Deut. R. 9:8; Shab. 55a; in the Talmud this view is ascribed to those who maintain that death is not dependent on sin, but the impact of the original passage is unclear; see Urbach, op. cit., 376–7). In this vein it is said that "charity delivers from death, not merely from an unnatural death but from death itself " (Shab. 156b), and that did not the truly righteous request their own death, they would not die (Mid. Shoḥer Tov, Ps. 116).

On the other hand an older view, stemming from the tannaitic period, stresses the inevitability of death, its naturalness as part of the very fabric of the world since creation. Thus when God had completed the creation of the world He saw that "it was very good" (Gen. 1:31), concerning which R. Meir remarked, 'it was very good,' that is death" (Gen. R. 9:5; see Maimonides' comment on this passage in Guide, 3:10). The idea behind R. Meir's enigmatic statement would seem to be that death is an integral part of the natural order, making way for new life and continued creation. The naturalness of death is also explicit in the saying that the angel of death was created on the first day of creation (Tanḥ., Va-Yeshev 4; see also bb 10a, where death is described as the strongest thing in the world). The Mishnah in Avot (4:22) stresses: "Those who are born will of necessity die … for perforce you were created … born … live, and perforce you will die." According to this view sin only hastens death, but does not cause it in the first place. Lack of sin therefore either enables a man to reach his predetermined span of years, thus saving him from an untimely demise, or helps him to live longer than his allotted span (Shab. 156b).

These arguments concerning the inevitability of death or its dependence on sin turn on several factors, among them possible interpretations of the account of Adam's sin in Genesis. According to one view Adam brought death into the world by disobeying God and eating the forbidden fruit. The Children of Israel had an opportunity of overcoming the power of death when they received the Torah at Sinai, but they lost this opportunity when they sinned with the golden calf (Mekh., Ba-Ḥodesh 9; Ex. R. 32:1; cf. also Num. R. 9:45). The way Adam's sin was interpreted amongst the amoraim may have been influenced by apologetic considerations, particularly the need to negate the Pauline doctrine of original sin as an inheritance from Adam to all mankind (Rom. 5:12). Perhaps the view that each man's sin causes his own death is influenced by the need to stress individual responsibility as opposed to the Christian position that in Adam we have all sinned (ibid.).

That both the wicked and the righteous die was explained as follows. The wicked perish so that they should cease angering God, while the righteous die so that they may have rest from their continual struggle against the evil inclination which has no power over them after death (Gen R. 9:5). As noted, the process of dying also may serve the righteous as a means of ridding themselves of their sins (see also Tosef., Yoma 5 [4]:6). Nevertheless, though mortality affects both wicked and righteous alike, the rabbis were sure that the whole quality of their respective lives, on this earth and in the hereafter, differed greatly. For the wicked are considered as if dead while still alive, and the righteous even in death are called "living" (Ber. 18a, b; Tanh., Berakhah 7).

Laws and Customs

Jewish tradition emphasizes respect for the dying and the dead, and deference for the last wishes of a dying man, of adherence to such last wishes: the final requests of Jacob (Gen. 49:29), and Joseph (Gen. 50:25), and the advice of David (i Kings 2:1–9) were all faithfully heeded and observed. The Talmud states that the oral testament of a goses (גּוֹסֵס – the term applied to a dying man) has the same legal force as written and witnessed instructions (Git. 13a; see also *Gift, *Wills). The permission to transgress the Sabbath in order to ease the discomfort of the dying, however slender their chances of recovery, is not affected by the talmudic dictum that "most gosesim die" (Git. 28a). A dying person should not be left alone, and it is a great mitzvah to be present at yeẓi'at neshamah ("departure of the soul"). A candle is usually lit in the presence of the goses to symbolize the flickering of the human soul. A sick person, nearing his end, should be encouraged to confess his sins before God. He is urged: "Confess your sins. Many confessed their sins and did not die, and many who did not confess died; and as a reward, should you confess, you will live." (d 338:1; see also Sanh. 6:2, and Shab. 32a). Should he not know a formula of confession, he should be told to say, "May my death be an atonement" (see Sanh. 6:2). This rite may be performed on a Sabbath and on holy days, but should not take place in front of women and children because it would cause them distress and thus trouble the sick person (Sh. Ar., yd 338:1). One brief confession reads: "I acknowledge unto Thee, O Lord my God, and God of my fathers, that both my cure and my death are in Thy hands. May it be Thy will to send me a perfect healing. Yet if my death be fully determined by Thee, I will in love accept it at Thy hand. O may my death be an atonement for all my sins, iniquities, and transgressions of which I have been guilty against Thee" (Sh. Ar., yd 338:2). The confession should end with the recital of "Hear, O Israel: the Lord is our God, the Lord is One" (Deut. 6:4). The formulas of confession recited on the Day of Atonement are also used (see *Al Ḥet, *Ashamnu, *Confession). Death is presumed to occur when breathing appears to have stopped and when the absences of the peripheral pulse, the heartbeat, and the corneal reflex have been ascertained. Those present recite the blessing Barukh Dayyan ha-Emet ("Blessed be the true Judge"; Bayit Ḥadash, Tur, oḤ 223; see also Ber. 59b). The body must then be left untouched for about eight minutes. During this period, a feather is laid across the lips; those present watch carefully for the slightest sign of movement. When death is finally established, the eyes and mouth are gently closed by the eldest son or the nearest relative. Jacob was assured that Joseph would perform this final filial service (Gen. 46:4). The arms and hands are extended alongside the body, and the lower jaw is closed and bound before rigor mortis sets in. The body is placed on the floor, feet toward the door, and is covered with a sheet. A lighted candle is placed close to the head of the body. In the house of the dead it is customary to turn all the mirrors to the wall, or to cover them. Water standing in the vicinity of the corpse is poured out (Sh. Ar., yd 339:5). The custom may have originated in superstition; but it may also be a method of announcing the death to avoid actually having to articulate the bad news. None of these services discharged for the dead, however, should be performed for a goses (ibid., 339:1). A dead body should not be left alone. It must be guarded constantly, whether on weekdays or the Sabbath, until the funeral, and, in pious circles, the Book of Psalms is continually recited. Various reasons have been advanced to explain the custom of watching the dead, which is apparently very ancient. It may have originated in a desire to keep away evil spirits, or to protect the body from rodents and body snatchers. It became a mark of respect for the dead who must not be left either defenseless or unattended.

[Harry Rabinowicz]

ORIENTAL CUSTOMS

In Tunis and other communities, the custom prevailed of putting a loaf of bread or a nail on the corpse immediately after death took place. In Yemen the mezuzah was removed from the door, and sacred books removed from the room of a dying man who was in great pain. It was believed that their presence weakened the power of the Angel of Death and that their removal would bring a speedier end to the suffering. Sometimes the shofar was sounded. The deceased was dressed in his best clothes (if a woman, in her wedding dress) under the shrouds because "he is going to meet the Messiah." Rose water was sprinkled on him and fragrant leaves put in his clothes. In Salonika the deceased was put in a coffin and his sons formally asked his forgiveness and kissed his hand. If the deceased was a rabbi the whole community did so. The custom of professional women mourners was widespread. Lime was sometimes put on the body to hasten decomposition.

[Reuben Kashani]

bibliography:

ancient times: A. Heidel, The Gilgamesh Epic and Old Testament Parallels (19492), 137–223; H.H. Rowley (ed.), Studies In Old Testament Prophecy (1950), 73–81; idem, The Faith of Israel (1956), 150–76; M.R. Lehman, in: vt, 3 (1953), 361–71; H.L. Ginsberg, ibid., 402–4; J. Blau, ibid., 7 (1957), 98; W. Baumgartner, Zum Alten Testament und seiner Umwelt (1959), 124–46; J. Zandee, Death as an Enemy According to Ancient Egyptian Conceptions (1960); S.N. Kramer, in: Iraq, 22 (1960), 59–68; M. Dahood, in: Biblica. 41 (1960), 176–81; S.M. Paul, ibid., 49 (1968), 373–6; S.E. Lowenstamm, in: em, 4 (1962), 754–63. in talmud and midrash: A. Buechler, Studies in Sin and Atonement (1928); G.F. Moore, Judaism, 3 vols. (1949); S. Schechter, Aspects of Rabbinic Theology (1909); E.E. Urbach, Ḥazal (1969). laws and customs: H. Rabinowicz, A Guide to Life (1964); J.J. Gruenwald, Kol Bo al Avelut (1947); Y.M. Tukaczynski, Gesher ha-Ḥayyim (1947); R. Yaron, Gifts in Contemplation of Death in Jewish and Roman Law (1960).

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Death

Death

In countries all over the world women have been linked with death. Even in societies where their public role has been severely limited, women play a prominent role in rituals associated with death and mourning. They have also been linked to death through their sexuality. These two areas in which women have traditionally been associated with death are not as distinct as they appear. In the funeral rituals of many preindustrial societies, mourning is juxtaposed with sexuality and humor. At Irish wakes dirges for the dead were followed by sexually suggestive games; in Venezuela and rural Greece women may still use language in their laments for the dead that would normally be regarded as crudely sexual; in Borneo and Madagascar women who are otherwise expected to behave modestly, join in obscene behavior with the males as part of the funeral ceremony. In the early twenty-first century, young men and women in urban centers of Africa attend funerals to find a mate. Wedding and death rituals are also symbolically intertwined in countries as far apart as rural China, Romania, and Greece, with the same sad laments being sung for brides as they leave the house of their parents as are performed at funerals.

Sex, through its connection to fertility and renewed life, may be opposed to death, but the two are never far apart. Eros and Thanatos, Love and Death, were regarded by the ancient Greeks as twin deities. Female sexuality, linked as it is to menstruation and birth, has always been mysterious and potentially frightening to men. Menstruating women, like those who have recently given birth, are frequently considered to be polluted and are forbidden to participate in religious ceremonies. The connection between female sexuality and death is also represented in the literature of many countries where mythical female creatures such as the Sirens, Fata Morgana, Circe, the Hindu goddess Kali, and the Maenads lure men to their deaths by their beauty or kill them while in a state of frenzied possession.

DEATH AS A RITE OF PASSAGE

In early twenty-first century European and North American societies, death frequently takes place in a hospital or a nursing home. A person is said to die at the moment when his or her vital signs cease. Often the precise time of death is observed on a screen. The machines are switched off; the patient is pronounced dead at 6.25 p.m. The modern view of death as a discrete event contrasts strongly with beliefs about death in earlier or less technically developed societies where death is widely regarded as a process rather than an event, as a rite of passage, a process fraught with danger and potentially threatening to the community as a whole.

The anthropologist Arnold van Gennep was the first to discuss the rituals of mourning as rites of passage, that is, as activities appropriate to a transitional phase, just as the rites of initiation are appropriate to adolescent boys about to enter manhood. There is a time, in many different societies of the world, when the dead are believed to inhabit neither the world of the living nor the world of the dead. Unless the suitable rituals of burial and mourning are performed, the dead will not, it is believed, successfully separate from the living. They may even cause the living harm. This makes the performance of death rituals one of the most important activities for the living.

Antrhopologists Richard Huntington and Peter Metcalf challenged the universal applicability of van Gennep's theories in their work with the Bara people of Madagascar. The Bara believe that death is associated with order, with the father, and with ancestors. In contrast women are associated with vitality, flesh, and fecundity. The sex-related activities of the funeral nights are a way to keep a balance between the sterility and order of the male and the vitality of the female. The roles of women and men in the funeral preparations differ, with women weeping over the body while men see to the logistics of the ceremony. In Bara society, where death creates sterility and excessive order, only female vitality, represented by sexual intercourse and rebirth, can bring the dead safely to the world of the ancestors.

There has been a great change in the way people view death in modern European and North American societies. Researchers have pointed to hospitalization, medicalization, and secularization as contributing to a change in the rituals surrounding death. Strangely in an age where women have achieved greater freedom and prominence in many fields, their role in the rituals surrounding death has declined.

THE TRADITIONAL PROMINENCE OF WOMEN IN DEATH AND MOURNING RITUALS

Because they have commonly taken care of the dying and prepared the body for burial, engendered life, and are widely believed to have a superior ability to express the pain of grief, women have always played a prominent role in the rites of death. In the ancient world, men and women mourned differently; this is also common in the developing countries of the early twenty-first century. In the ancient Near East, preindustrial Europe, India, and parts of Africa, the archeological record is remarkably consistent. Depictions of funerary rituals on Neolithic pots from Anatolia, on Egyptian tombs, geometric Greek vases, or Etruscan sarcophagi show women standing beside the dead body, their hands raised to their heads, often tearing their loosened hair in what has been recognized as a classical gesture of mourning. Men may also be present in these scenes of mourning, which date back at least to the Bronze Age, but their gestures are more restrained, and they rarely stand beside the dead body.

The sounds that these ancient women mourners made are lost, but contemporary descriptions and anthropological evidence support the view that the women with raised arms were weeping and singing dirges for the dead. Indeed one of the few constants of anthropological observation across the world is that women sing laments. In some cultures men lament too, but women are the chief performers of these wept songs that seem an indispensable part of death rituals in premodern societies. In Europe evidence for the prominent role of women in funeral rites, from the classical Greek and Roman periods to the nineteenth century, can be found in the periodic attempts to restrict their behavior, especially their laments.

In sixth century bce Athens and a number of other Greek city states, laws were passed banning certain behavior and expenditure at funerals. These laws which Plutarch tells us were passed by Solon in an attempt to avoid blood feuding regulated "women's appearance in public, as well as their festivals, and put an end to wild and disorderly behavior … and … abolished the practice of lacerating the flesh at funerals, of reciting set dirges, and of lamenting a person at the funeral of another." Solon's laws may have been especially directed towards the custom of employing professional women mourners to wail at funerals, but the association between women's behavior at funerals and at their own festivals links the issues of sexuality and death. Women both lamented and made bawdy jokes about the dead Adonis at an annual festival celebrated on the rooftops of Athens.

In ancient Rome similar laws were passed to those Solon had introduced at Athens. Professional women mourners had played a central role in Roman funerals, both praising and lamenting the dead. Laws introduced in the Twelve Tables reduced lavish spending on funerals and singled out the behavior of women, forbidding them to scratch their cheeks as they sang laments.

Hired female mourners were the targets of criticism by the early Christian fathers. John Chrysostom described their loud laments as a "disease of females" (Alexiou, 1974:29) and linked their behavior to that of Bacchus's followers. By the fourth century c.e., nuns had replaced professional lament-singers at Christian funerals, especially those of the clergy, but even the nuns could not be trusted to maintain their composure in the face of death, and were criticized for their wild behavior. From the Medieval period to the nineteenth century, the Roman Catholic Church continued to frown on the role of women in funerals, especially their traditional practice of lamenting the dead. By the twentieth century the practice had been stamped out in all but the remotest parts of Europe.

Ireland was one place where laments and funeral games continued well into the twentieth century. Women mourners tore their hair, bared their breasts, and sang dirges, some even drinking the blood of the dead in frenzied displays of grief. It is possible that this crazed behavior and loud wailing may have been a form of subversion, allowing women to talk about taboo subjects like pregnancy and sex among themselves. This situation was not unique: Those who have studied laments in countries as far apart as Venezuela, Finland, and Greece have noted that women use the occasion of the funeral to speak publicly of subjects they would never otherwise raise. The Warao women of Venezuela often criticize members of the tribe in their laments. However harsh or sexually explicit their words are, the laments are believed to tell a truth that the community respects (Briggs 1992:341). In the Peloponnese, Greek women may use the occasion of the funeral to berate the dead and challenge social institutions, and on the Korean island of Cheju, female shamans revive the truth of their violent past by assuming the voice of the dead.

To assume the voice of the dead or to speak to the dead through the medium of lament gave women a potentially dangerous power. Finnish-speaking women from Karelia who used their laments to communicate with the dead were warned not to forget themselves in case they failed to return to the world of the living. As mediums communicating with the spirit world, lament-singers are often considered vulnerable and polluted. In some societies only unmarried and post-menopausal women lament the dead. Powerful for a brief period, women mourners generally resume their inferior status following the funeral.

MODERN MOURNING AND THE MALE FUNERAL

From pagan antiquity to twentieth-century Europe, attempts have been made to control the ways the rituals of mourning are conducted. The distinction between the traditional behavior of men and women at funerals, and the role of women as leading actors in the rites of mourning have undergone a series of changes as social attitudes toward death have changed. Without the framework of a small, unchanging society to order behavior, the larger institutions of state have assumed responsibility for most aspects of life, including the proper conduct of funerals and mourning rituals. With the increasing specialization and expertise of larger urban societies, funerals became an industry; priests became the main actors in the rituals of mourning; undertakers prepared the body for burial; and women were left with a minor part to play. Funerals of the rich and famous remained splendid affairs, with elaborate ceremonies, sumptuous coffins, and special clothing, but women no longer sang laments or used the occasion to make comments about their society. Not only did they have no special role in the rituals of mourning; one could argue that they had abdicated their once prominent position in funerals.

WOMEN'S SEXUALITY AND DEATH—LA PETITE MORT

In European and North American cultures, Aristotle's view of women as incomplete beings lacking a soul, and as mere vessels for the male seed, has had a pervasive influence on attitudes toward women, encouraging a view of the female as fleshly rather than spiritual. Similarly in the Judeo-Christian tradition, the biblical story of Eve's creation from Adam's rib and her responsibility for the expulsion of humankind from the Garden of Eden both reflected and perpetuated the identification of women with sin and sex.

Christianity contributed to the association of women with sexuality and death through its strong polarization of body and soul, sin and virtue. The early Christian theologians granted women a soul, but an inferior one. Women, being more carnal than men, had to make a greater effort be close to God, denying their sexuality and preferably remaining virgins. Women who failed to live up to the societal expectations of chastity were punished appropriately, by death.

In the Medieval, Renaissance, and Baroque periods, fascination with death encouraged a fondness for the momento mori—a dancing skeleton, or a grinning death's head. Not unsurprisingly these reminders of mortality were often linked to beautiful young women. Sexual intercourse with women was believed, throughout the period, to rob men of their strength. The so-called la petite mort (little death)—a sensation of loss and depression that many men experience during coitus—was blamed on the sexual nature of women.

As the embodiment of the sin of lust, woman also contaminated and destroyed the purity of men. Before the discovery of penicillin, venereal disease provided a more concrete link between women, who were thought to be responsible for the disease, and death. There was even a widespread belief that the vagina was equipped with teeth—the vagina dentata—that could castrate the male.

In nineteenth-century European and North American literature the association of women and death was made explicit in the writings of such authors as Edgar Allen Poe, Thomas Hardy, Fyodor Dostoevsky, Leo Tolstoy and Gustav Flaubert. The adulterous women portrayed in their novels frequently died a grotesque and terrible death. While twentieth-century writers began to question the stereotype of the fallen woman as both death-dealing and death-bound, the association between women's sexuality and death has remained a constant.

Early feminists, particularly Betty Friedan, attacked the stereotypical role of women in European and North American society as a form of death in life (Friedan 1972, p. 16). Women were enjoined to come alive and reject the trap of marriage. In many societies, however, including those of Muslim Africa, the Middle East, and Hindu India, women are still associated with sin, impurity, and, by extension, with death. In the Middle East, women serve as professional mourners because of these socioreligious associations. In India child-brides may die as a result of forced intercourse, and despite laws prohibiting the practice, Hindu widows may cast themselves onto their husbands' funeral pyres in the belief that the sins they committed in a previous incarnation caused the deaths of their spouses. Genital mutilation and the cutting of the hymen with a knife are both still practiced in parts of Africa. Mary Daly reports that among the Bambaras, men fear death from the clitoris of the women who is not first cut.

Perhaps the ultimate association of death with women remains the prevalence of rape as a universal concomitant, often a deliberate weapon, of war. From Troy to Rome, Somalia to Bosnia, Nanking to Vietnam, women have been brutally raped in the context of war, often before being killed. When mass killing is legitimized, it seems the universal associations men make among sex, women, and death find their oldest and ugliest expression.

see also Cannibalism; Funerary Customs, Non-Western; Funerary Customs, Western.

BIBLIOGRAPHY

Alexiou, Margaret. 1974. The Ritual Lament in Greek Tradition. Cambridge: Cambridge University Press.

Ariès, Philippe. 1974. Western Attitudes to Death from the Middle Ages to the Present, trans. Patricia M. Ranum. Baltimore, MD: Johns Hopkins University Press.

Bourke, Angela. 1988. "The Irish Traditional Lament and the Grieving Process." Women's Studies International Forum 11: 287-291.

Caraveli, Anna. 1986. "The Bitter Wounding: The Lament as Social Protest in Rural Greece." In Gender and Power in Rural Greece, ed. Jill Dubisch. Princeton, NJ: Princeton University Press.

Daly, Mary. 1978. Gyn/Ecology: The Metaethics of Radical Feminism. Boston: Beacon.

Friedan, Betty. 1972. The Feminine Mystique. New York: Dell.

Gorer, Geoffrey. 1965. Death, Grief, and Mourning in Contemporary Britain. London: Cresset Press.

Gennep, Arnold van. 1960. The Rites of Passage, ed. Monika B. Vizedom and Gabrielle L. Caffee. Chicago: University of Chicago Press.

Hertz, Robert. 1960. Death and the Right Hand, trans. Rodney and Claudia Needham. Glencoe, IL: Free Press.

Holst-Warhaft, Gail. 1992. Dangerous Voices: Women's Laments and Greek Literature. London and New York: Routledge.

Holst-Warhaft, Gail. 2000. The Cue for Passion: Grief and Its Political Uses. Cambridge, MA: Harvard University Press.

Huntingdon, Richard, and Peter Metcalf. 1979. Celebrations of Death: The Anthropology of Mortuary Ritual. Cambridge, England: Cambridge University Press.

Kim, Seong Nae. 1989. "Lamentations of the Dead: The Historical Imagery of Violence on Cheju Island, South Korea." Journal of Ritual Studies 3(2):252-317.

Seremetakis, Nadia. 1991. The Last Word: Women, Death and Divination in Inner Mani. Chicago: University of Chicago Press.

                                         Gail Holst-Warhaft

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Death

Death

TRIMALCHIO’S TOMB

Sources

TRIMALCHIO’S TOMB

In Petronius’s Satyrica, Trimalchio describes to his dinner guests the tomb he has ordered in his will. His is a particularly ostentatious example and something few Romans would have equaled:

“Tell me my dearest friend,” he said, “will you order my tomb according to my instructions? My earnest request is that you set my little dog below my statue, and put in garlands, perfumes, and all the contests of Petraites, so that through your kindness my life can continue after death. Build it a hundred feet wide at the front, and two hundred feet from front to rear. I’d like fruit trees of all kinds surrounding my ashes, and lots of vines; it’s quite wrong for a man to have an elegant house in life, and not to give thought to our longer place of residence. So before all else I want an inscription with the words ‘This tomb must not pass to an heir. I’ll be careful to stipulate in my will that I come to no harm when dead; I’ll appoint one of my freedmen to mount guard over my tomb, to ensure that people don’t make a beeline to shit against it.

“I want you also to depict ships in full sail, and myself sitting on a dais wearing the toga with a purple stripe and five gold rings, dispensing coins from a wallet to the people at large; you know that I laid on a dinner for them at two denarii a head. If you will, incorporate dining-halls as well, and all the citizens having a good time in them. On my right erect a statue of my Fortunata holding a dove, and leading along her puppy with its jacket on. Put in my boy-favorite, and some big winejars sealed with gypsum to ensure that the wine doesn’t leak out. You can show one of the jars as broken, with a slave weeping over it. Put a sundial in the middle, so that whoever wants to know the time will read my name, whether he wants to or not. Oh yes, and give some thought to whether this inscription strikes you as suitable enough: ‘Here rests Gaius Pompeius Trimalchio of the household of Maecenas.’ He was formally declared Priest of Augustus in his absence. Though he could have claimed membership of every Roman guild, he refused. He was god-fearing, brave and faithful. He grew from small beginnings and left thirty million, without ever hearing a philosopher lecture. Farewell, Trimalchio; and fare well, you who read this.”

Source: Petronius, The Satyrice, translated by P.G. Walsh (New York: Oxford University Press, 1997).

Funeral Rites. When a member of the family died, the family held a funeral that was partly a private and partly a public event. The death of an infant often received little ceremony, other than the private grief of the family. Graves of babies were rarely marked. The nature of funeral proceedings varied depending on the means of the family. No one was buried inside the city walls. Most burials were along roadways. The large size of family tombs created something of a villagelike atmosphere, and the area where such tombs were found became known as a necropolis, literally, a “city of the dead”. Poorer families would have the body taken out of the city, accompanied by the family members who would display their mourning

by dirtying their clothes and faces and leaving their hair uncombed. The monument would reflect what they were able to pay and would express some sentiment about the departed. Often the epitaph included the age of the deceased and whether or not he or she had been married. Wealthier families would have a more-elaborate funeral. A particularly famous man—a politician or general—would lie in state so that the citizens could pass by and pay their respects. A member of the family would deliver a eulogy in the Roman Forum so that as many people as possible could hear. A funeral procession would wind through the city with family, friends, clients, and slaves following the body. Family members would carry the wax death masks of their ancestors as emblems of the glory of the gens. The group would proceed to the family tomb. They would either cremate the body or place it in an ash urn, or sarcophagus. The sarcophagus would then be placed in the tomb. The family would read the person’s will and distribute the wealth according to his or her wishes. Women wrote their own wills, but they had to be approved by their guardians unless the women were Vestal Virgins or independent of another’s control (sui iuris). It was certainly expected that parents would leave their possessions to their children or to family members. Some chose to free slaves or to leave property to their freedmen and freedwomen. In the empire, it became common to name the emperor as an heir, as evidence of one’s esteem.

Sources

Henry C. Boren, Roman Society: A Social, Economic, and Cultural History (Lexington, Mass.: D. C. Heath, 1977).

Jo-Ann Shelton, As the Romans Did: A Sourcebook in Roman Social History (New York: Oxford University Press, 1998).

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Death

DEATH

The American poet Edna St. Vincent Millay once said, "Childhood is the kingdom where no one ever dies." This can be read in two ways: either children never encounter death or they never die. Many Americans rigidly adhere to such mythologies, as childhood death is now a relatively rare event, so that the probability of an infant surviving to age fifteen is close to 99 percent and life expectancy at birth is seventy-nine years. By contrast, in 1900, a couple faced a fifty-fifty chance that one of their three children would die before they grew up.

Because of the strong desire to spare children unnecessary anguish, many adults avoid discussing dying and death with them. "Why take away their innocence?" and "They'll find out soon enough, when they are older," are typical justifications for this. Because of such denial of death, many adults assume that children do not think about death, should not attend funerals, and are not capable of grieving over loss. When a child is unexpectedly thrown into an encounter with death, such as when a pet or grandparent dies, frequently no explanation accompanies the experience, or euphemisms and metaphors (e.g., "Grandma is having a long sleep") are invoked that may promote even more confusion and anxiety for the child. Fortunately, recognition of the importance of learning and educating about dying and death has begun to open up meaningful dialogues and has led to significant research findings.

The Development of a Concept of Death

When one looks and listens carefully, one learns that children are very interested and curious about death. It is one of their first intellectual puzzles that is played out whenever they see a dead bug on the windshield; when they engage in the game of "here" and "not here" in peekaboo; or when they shoot a target dead with the shotgun blast of their finger. Yet, a mature understanding of death, involving a number of components, is accomplished only along with an overall conceptual development about how things in the world work. Most adults and older children understand that death is universal and inevitable; all living things die. Death is irreversible (the dead do not come back), and the body becomes nonfunctional (all functions and activities associated with the physical being cease). The causes of death, ranging from the deterioration of old age, illness, accidents, and homicides, to perhaps extreme psychological distress, are also fairly well known. In contemporary Western societies, it is rare to find widespread belief that magic, bad thoughts, or evil spirits are the sources of death. Finally, a foundation of most Western (and Eastern) belief systems is that some intangible dimension of persons—their soul or spirit—continues beyond the death of their physical bodies, a concept known as noncorporeal continuation.

A classic 1948 study by Maria Nagy of almost 400 Hungarian children aged three to ten revealed that arriving at a mature concept of death requires development through three stages. "Auntie Death," as Nagy was called, learned through interviews and pictures drawn by the children that between the ages of three and five years (Stage 1), children believed that death involved a continuation of life, but at a reduced level of activity and experiences. The dead do not do much, their condition resembles sleep, and they can return to the world of the living. Of greatest concern to the youngest children was the fear of separation, not necessarily the fear of dying or being dead. During Stage 2, identified by Nagy as from five to nine years of age, children progressed to an understanding that death is final and irreversible. Death takes on concrete imagery and a personality, in the guise of skeletons, or the "boogeyman." Such personification leads to another interesting belief of this period: Death can be evaded, if you can only outsmart or outrun that nasty boogeyman! Thus, universality in death is a concept yet to be achieved. Final, the achievements of Stage 3 (age nine and older) reflected the mature components of death.

Although this research was done in the mid-twentieth century, Nagy's findings continue to be applicable. Subsequent research has suggested that children arrive at a mature concept of death at an earlier age than suggested by Nagy, that children do not personify death to the extent that Nagy found, and that modern technology has found its way into their descriptions (death is like a hard drive crash). Furthermore, there is a strong connection between death concepts and overall cognitive development, so that children's understanding of what causes death changes from magical ("I wished he was dead and now he is"), naive ("You die from eating a dirty bug"), and moral ("My Daddy died because I was a bad child") to a more scientific, rational approach ("You die when your body wears out or when you get an incurable disease"). Researchers have also learned that it is too simplistic to view just age as the determining factor with regard to death concepts. Children who have experienced a parent's death, who are dying themselves, or who have witnessed violent, traumatic death will perceive death in an adultlike manner at much earlier ages than children who have not had such experiences.

Children Who Are Dying

As difficult as it is to acknowledge that children think about death, it is even harder for adults to conceive of children dying. The significant accomplishments of modern medicine have certainly made this a relatively rare event. However, there still are many children and families who must cope with the realities of terminal illnesses such as cancer, AIDS, or cystic fibrosis.

In the 1970s and 1980s Myra Bluebond-Langner spent countless hours listening to the stories of dying children and their families. What she learned has offered an important window to the experiences of the dying child, and those of their healthy siblings. According to Bluebond-Langner, children who are dying become very sophisticated about the nature of their illness and hospital procedures. As they enter repetitive cycles of sickness, treatments, and remission, and as they observe children with similar illnesses dying, their self-perceptions gradually change from "I am sick but I will get better" to "I am sick and eventually I will die from this illness." These children know about death at much earlier ages than do healthy children. These children also quickly learn that it causes great pain for their parents and other adults if they bring up the possibility of their dying. In their efforts to protect their elders and to ensure their continued visits and care, many terminally ill children engage in a game of "mutual pretense" wherein everyone knows they are dying but they are reluctant to talk about it in an open and meaningful way.

Bluebond-Langner also found that the well siblings of dying children were in significant need of care and nurturance. As the demands and psychological stress of the illness took its toll on their parents, the healthy siblings were frequently neglected and living in "a house of chronic sorrow." Furthermore, siblings' roles in their families were ambivalent and undefined. "Should I parent my parents?"; "Should I take the place of my dead brother (sister)?"; "Why do I feel both happy and sad that she died?"; "Should I just disappear?"—these were some of the concerns of the siblings.

The knowledge gained from these trying circumstances is important. Children who are dying need open communication, assurances that they will not be abandoned, and a sense of normalcy to the extent to which they are capable. Older children and adolescents also need to feel that they have some control over their situation, and they need to be treated as unique individuals. Many of these concerns are applicable to their well siblings. And, of course, their parents need an incredible amount of social and emotional support as they encounter their ultimate nightmare.

Childhood Grief

Many people encounter death during their childhood. When George Dickinson asked college students to write about their first experiences with death, he found the average age of this first loss to be 7.95 years. Most of these deaths involved the death of a grandparent or a pet.

Grief is an individual affair, no matter if the griever is an adult or a child. Although there are aspects of grief that are common to all people, it is important to recognize that children do not express their sadness over loss in the same manner as do adults. Further, it is necessary to take into consideration the child's developmental concept of death and who has died. A child younger than five, for example, may have a difficult time understanding why grandma is not coming back. Regardless of who it is, death involves not only the loss of a person who was meaningful to the child but also a relationship that would have evolved over time as the child changes into an adolescent and adult. Thus, grieving and understanding the nature of the loss may be a lifelong process for children, especially when they lose a parent.

Children do not typically hold onto their grief over a sustained period as do adolescents and adults. Upon learning the news of a death, they may cry, especially if others around them are doing so, but then return to other activities (e.g., watching television or riding a bicycle). They also may refuse to talk about the person who has died, or show a lack of interest in what is going on around them. Cycling in and out of grief, however, may be a very adaptable way of handling the intense emotions that will overwhelm children. As they have no road map from prior experience, the situations involving death may be especially frightening, especiallyif distressed adults emotionally abandon them. Some children may hide their grief in order to protect their loved ones. Even with a limited concept of death, very young children understand loss when their routines are disrupted and when the person who has died is no longer there. Thus, very young children may play out their grief by insisting on enacting the familiar behavioral patterns they had engaged in with the deceased, such as a daily walk around the street. It also is not unusual for children to regress (as in toilet training), show aggression toward others, have difficulty sleeping, show fear of the dark, or show a lack of interest in activities that formerly were very appealing. In contrast to children, adolescents grieve very deeply and with prolonged intensity. Adolescents appear to find solace with their peers and may reject the well-intended help of adults.

Bereaved children do not necessarily have long-term problems. One of the most important lessons learned from the Child Bereavement Study undertaken by Phyllis Silverman and William Worden of Harvard University is that many children who have lost a parent show positive psychological adjustment a year or two after their loss. These researchers found that it was important for children to maintain the connection to the deceased person through mementos, dreams, or visits to the cemetery. These children also reconstruct their relationship throughout their development, with the aid of their memories and feelings, and in an open environment where it is possible to talk about who was lost.

Helping Children with Death Experiences

When children feel that it is all right to talk about death, they will do so. Frequently their questions occur when there is a "teachable moment," for instance, when the class pet hamster or the relative of a friend has died. This is the time for parents or other adults to be open and honest, and to be aware of the developmental level of the children's understanding. Honesty involves avoiding euphemisms such as "death is like sleep or a long vacation"; clearly stating the facts about death as in "Grandma's body doesn't work anymore and she won't be coming back"; and even admitting ignorance as to what happens after death. Caring adults should also be aware that the questions might be frequently repeated, as the child tries to incorporate the death into his or her understanding of how life works. There also are a number of books that have been written for children about dying and death, and these too may open a dialogue about this topic.

In addition to open and honest discussion, bereaved children need emotional support, as much consistency and continuity with their past lives as possible, opportunities to remain connected to the person who has died, and to not be avoided by the other significant people in their lives. From teachers, other adults, and friends, they need to feel that they are not weird or different from other children. Most importantly, what all children need when it comes to death is to feel that they are on the "same side of the wall, rather than alone on the other side" (Schaeffer 1988, p. 141).

See also:MILESTONES OF DEVELOPMENT

Bibliography

Barrett, Ronald K. "Children and Traumatic Loss." In Kenneth J. Doka ed., Children Mourning, Mourning Children. Washington, DC: Hospice Foundation of America, 1995.

Bluebond-Langner, Myra. "Meanings of Death to Children." InHerman Feifel ed., New Meanings of Death. New York: McGraw-Hill, 1977.

Bluebond-Langner, Myra. "Worlds of Dying Children and Their Well Siblings." Death Studies 13, no. 1 (1988):1-16.

Corr, Charles A. "Children's Understandings of Death." In Kenneth J. Doka ed., Children Mourning, Mourning Children. Washington, DC: Hospice Foundation of America, 1995.

Dickinson, George. "First Childhood Death Experiences." Omega25 (1992):169-182.

Edmondson, Brad. "The Facts of Death." American Demographics 73(April 1997):46-53.

Kastenbaum, Robert J. Death, Society, and Human Experience, 7th edition. Needham Heights, MA: Allyn and Bacon, 2001.

Koocher, Gerald P. "Children, Death, and Cognitive Development." Developmental Psychology 9 (1973):369-375.

Marwit, Samuel J., and Sandra S. Carusa. "Communicated Support Following Loss: Examining the Experiences of Parental Death and Parental Divorce in Adolescence." Death Studies 22 (1998):237-255.

Nagy, Maria H. "The Child's Theories Concerning Death." Journal of Genetic Psychology 73 (1948):3-27.

Schaeffer, Daniel J. Loss, Grief, and Care. Binghamton, NY: Haworth Press, 1988.

Silverman, Phyllis R. Never Too Young to Know: Death in Children'sLives. New York: Oxford University Press, 2000.

Worden, William, and Phyllis R. Silverman. "Parental Death and the Adjustment of School-Age Children."Omega 32 (1996):91-102.

Illene C.Noppe

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Death

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Death

DEATH

As in all religions, death is an event of monumental importance for Buddhism. From one point of view death may appear as a nonissue in Buddhism because the assumption of transmigration guarantees that death is not final. Death nevertheless reminds the Buddhist that human life is the best existence from which to pursue liberation, but it is relatively short; moreover, as an unusual reward of meritorious karma (action), human life cannot be taken for granted as one's next rebirth and may not come again for a long time. Death also reminds the Buddhist that repeated rebirths do not guarantee progress toward realizing nirvĀṆa; in fact each existence in saṂsĀra is difficult to control and so permeated by duḤkha (suffering) in one form or another that it is exceedingly difficult to cease producing karma and escape. Belief in transmigration thus does not remove the sense of insecurity that accompanies death, and for that reason the goal of nirvana is often described as "deathless" (amṛta) because it eliminates all such anxieties. The journey of the prince Siddhārtha outside the palace walls in the biographies of the Buddha similarly show the centrality of death as a religious problem: It is after seeing a corpse that Siddhārtha grows morose and troubled, setting up the next and final encounter with a mendicant who not only shows him the possibility of pursuing a spiritual life, but explains his own motivation as seeking "that most blessed state in which extinction is unknown."

Considering the complexity of the impact death has on Buddhism, it may be helpful to approach the matter in four thematic ways: (1) in doctrine, (2) in praxis, (3) in memorializing the death of the Buddha, and (4) in funerary culture.

Doctrinal death and mythical roots

Philosophical associations with death abound in the various credos that Buddhism has produced over the centuries. In the early tradition, the four nobletruths define humankind's central problem as duḥkha and indicate how it can be overcome. But the tradition also analyzes duḥkha itself as fourfold: birth, aging, disease, and death. Similarly, the last of the twelve "limbs" in the pratĪtyasamutpĀda (dependent origination) formula is "aging and death," indicating the inevitable dissolution of all sentient life. Even the "three characteristics" of all conditioned existence—anitya (impermanence), duḥkha, and anātman (nonsubstantiality)—imply the centrality of death because the deepest resonance of this truth is not the desire for permanent sources of happiness, but a permanent source of our own existence.

Death itself is described in various ways throughout the canon. The Dhammapada and Suttanipāta frame it poetically ("just as ripe fruit falls quickly from the tree" or "like a cow being led to slaughter"), but the later nikāyas and abhidharma literature are more analytical. Here death is explained as the cessation of the continuity of the five skandha (aggregates), the crumbling of the body, and the ending of the āyus (life span) or jīvitendriya (faculty of living). Generally the jīvitendriya is the force that sustains human life through the continuous changes to the five aggregates, and is held to be of predetermined length. This is death in "due time," and it is contrasted with "untimely" death caused by encountering unexpected circumstances, such as being murdered, being eaten by a wild animal, succumbing to illness, and so on. In the TheravĀda commentarial tradition, final moments of consciousness are described in some detail, when past karmic deeds or signs of such "settle" on the individual, and then a vision of one's future destiny occurs, such as the appearance of fire signifying hell, a mother's womb indicating rebirth in the human realm, or pleasure groves and divine palaces for a future in a heavenly realm. Then comes a momentary "death awareness" (cuticitta) followed immediately by "rebirth linking consciousness" (paṭisandhiviññāṇa) signifying the next life. The relationship between these two is said to be one of neither identity nor otherness; likened to an echo it is caused by previous events but not identical to them.

As the skandhas are formed from a collectivity of causes and conditions that are temporary in nature, the skandhas themselves are impermanent, constantly arising and ceasing. Death from the point of view of this "momentariness" doctrine is in fact something that recurs moment after moment. In this and the "end of a lifetime" notions of death, how the karmic identity continues is a key question. The dissolution of the self never means the dissolution of karma.

Some schools speak of four stages of life: birth, the period between birth and death, death, and the period between death and rebirth. According to the AbhidharmakoŚabhĀṢya and Yogācāra literature, one explanation of this process is that in the presence of a life span the jīvitendriya holds onto bodily warmth and consciousness symbiotically and unceasingly until the "due time." At that point all three—life, warmth, and consciousness—abandon the body and death ensues, described as akin to throwing off a piece of wood, whereupon karma forces the three to seek another body. Here it would seem that the physical body is something other than these three animating functions and that only in combination is a finite lifetime produced. Another doctrine posits the antarābhava, an intermediate state between death and the next life wherein one is transformed into an entity called a gandharva, originally a semidivine being associated with fertility and the god Soma in pre-Buddhist Indian myths. Possessing subtle versions of all five aggregates reflective of one's next birth, for most people in this state some perception is possible but willpower is limited to finding an appropriate womb to descend into, and the common view gives the gandharva forty-nine days to accomplish this task. Advanced practitioners known as nonreturners, however, can attain nirvana from this state. This conception was readily accepted into the MahĀyĀna, where it gave rise to a variety of beliefs and practices designed to help the recently deceased alter their destined rebirth.

The gods Yama and MĀra reflect another mythical aspect of the Buddhist concept of death. Son of a gandharva, Yama is depicted in the Ṛg Veda as the first mortal; deciding to remain among the dead, Yama becomes the lord of that realm. In the Atharva Veda he acquires a messenger, Mṛtyu, who later appears in the KĀlacakra as death lurking within the body of sentient beings. Otherwise, King Yama's role is generally restricted to the unseen world of the dead, where he becomes the judge before whom the deceased must stand to receive karmic sentencing to determine their status in the next birth. Yama is thus a negative symbol of saṃsāra itself, and he can be seen holding the six-realm wheel of life in the VajrayĀna, which also includes a deity, Yamāntaka, who represents his defeat. If Buddhists fear Yama in the next world, they fear Māra, also called the "king of death" (Suttanipāta), in this one. From his attempts to dissuade the bodhisattva from attaining enlightenment via the enticement of lust and the fear of attack, Māra symbolizes personal death, the death of Buddhism as a religion, and the evils of destruction and uncontrolled desire. Derived from a verb meaning to die or kill (mṛ), there are various forms of Māra, residing within the aggregates, in the kleśas (defilements), in one of the heavens of the desire-realm (kāmaloka), and so on. Although in one sense Māra is death itself, he is most commonly depicted as a deity who is resentful of the dharma and devoted to hindering the spiritual progress of the practitioner.

Death as a theme of praxis

Meditations on death run throughout the Buddhist tradition. This comes from the fact that the Buddha identified death as the ultimate and therefore most potentially instructive form of duḥkha. Death as a theme in focused ritual or meditation is similarly called the key to the "gate of deathlessness." From very early there have been two famous forms of death-praxis, known as death-mindfulness (maraṇasmṛti) and meditation on pollution (asśubhabhāvanā). These are mentioned in various places in the Pāli canon, but their fullest descriptions are found in the Visuddhimagga by Buddhaghosa.

Mindfulness of death is aimed at fostering existential acceptance of the reality of death and allowing that realization to influence one's life fully. The Buddha was appalled at how common it was for people to go through life as if they were not going to die, and this form of meditation uses eight topics for the practitioner to contemplate:

  1. death as executioner,
  2. death as ruinous of all forms of happiness and success,
  3. death as inevitable for everyone regardless of their power,
  4. death as coming about by an infinite number of causes,
  5. death as close at hand,
  6. death as signless, or coming without warning signs,
  7. death as the end of a life span that is in fact short,
  8. death as a constant in life.

This practice aims at liberating individuals from natural attachments to their own existence, and thus leads to mindfulness of the three marks of existence: anitya, duḥkha, and anātman.

Meditation on pollution is similarly aimed at deepening one's acceptance of the reality of death, but in this practice the point is driven home by actually going to look at decaying human corpses. As described in the Suttanipāta (202–203), when the practitioner sees the corpse, he "sees the body as it (really) is" and thinks, "As is this (body of mine), so is that (corpse); as is that, so is this." Statements like this express one strain in Buddhist thought that regards the body as essentially foul and not the locale of one's identity. But despite one's proximity to corpses in various degrees of decay—a remarkably bold concept considering the contagious nature of pollution in Hinduism—Buddhaghosa tells us that ultimately the meditator comes away from this exercise feeling not angst but joy because now that he has accepted the reality of death, he knows he is on the path to defeat it. In Thailand this meditation is often performed at morgues.

Belief that one's state of mind at the moment of death not only passively reflects but can actively influence what happens after death led to the corresponding belief that the true purpose of all praxis is preparation for that final moment. For example, the Dantabhūmi-sutta points to this final "act of time" (kālakriyā) as something "tamed" or "untamed."

In East Asia, a variation of death-mindfulness is the use of death as an existential kŌan in the Chanschool. This is apparent in the charismatic Chinese teacher Yanshou (904–975), who believed that suicide "reciprocated the kindness of the dharma" if done with the proper state of mind. He saw this as a way to actualize the perfection of giving (dānapāramitā) and thereby attain enlightenment. Yanshou reflects Buddhist ambivalence about suicide, manifesting the principle that one's life is only a tool that can be manipulated or even given away when necessary. Death also shows up prominently in the rhetoric of Japanese Zen during the Tokugawa period (1603–1868). Suzuki Shōsan (1579–1655), for example, was motivated to pursue Zen practice by an obsession with death, and he felt grateful to death for having deepened his practice. The great Rinzai teacher Hakuin Ekaku (1686–1768) is famous for teaching the imperative of an explosive spiritual breakthrough he called the "great death." In a similar vein, Shidō Bunan (1603–1676) wrote:

Die while alive, and be completely dead,

Then do whatever you will, all is good.

About which the modern Zen master Shibayama Zenkei (1894–1974) comments, "The aim of Zen training is to die while alive, that is, to actually become the self of no-mind, and no-form, and then to revive as the True Self of no-mind and no-form" (p. 46). In this form of spiritual death, one's known identity is dissolved, rather abruptly according to Hakuin, yielding a new, more genuine self untainted by discursive, judgmental thinking and totally free to think and act as one pleases.

Memorializing the death of the Buddha

The Mahāparinibbāna-sutta (DN 2:140–142) describes in some detail the circumstances of the Buddha's passing, how he viewed his upcoming death, and how his body was treated afterward. Despite his admonition against attaching value to his corpse—"What is there in seeing this wretched body? Whoever sees dharma, sees me."—the Buddha instructed his attendant Ānanda to give him a funeral like a "king of kings," explained as wrapping the body in five hundred layers of cloth, placing it inside an iron vessel, and then burning it on a funeral pyre. He also authorized the building of one stŪpa at a crossroads to house his remains, extolling the welfare it would bring believers who visited and paid their respects. But even this bow to relic worship was not enough: There was such a clamoring for his śarīra (relics) by the eight kings of the region that all were given portions after the cremation, leading initially to the construction of eight stūpas containing them, with two more later erected that enshrined the bowl used to collect the relics and the ashes from the pyre. The sūtra also promises rebirth in heaven for anyone who makes pilgrimage "with hearts of reverence" to four sites memorializing the Buddha's historical presence—where he was born, achieved enlightenment, delivered his first sermon, and passed away.

The sūtra is probably only canonizing pilgrimage routes that began immediately after the Buddha's death. Stūpa worship increased during the third century b.c.e. under King AŚoka, who is said to have opened up the original ten stūpas and distributed the relics therein among eighty-four thousand new Stūpas built throughout the land. Images of the Buddha also served as public memorials to the founder after his death, though they appear in mass quantities somewhat later. Their similarity to stūpas in this regard can be seen in the fact that both often contain relics, symbols of their animation. Stūpas and images thus became symbols of the corporeal presence of the Buddha and his enlightened followers; at times they evolved into mausoleums of architectural sophistication, as at the great stūpa complex at SĀÑcĪ in central India where the relics of ŚĀriputra and MahĀmaudgalyĀyana are said to be enshrined and where buddha images from Mathurā were brought in. Relics for the consecrations of stūpas and images were exported to other Buddhist nations such as Sri Lanka and China, allowing a physical "presence" of the Buddha in death over an expanded area that could not have taken place while he was alive.

One oddity within the Mahāparinibbāna-sutta is how the narrative deals with the paradox of a buddha dying when he himself professed his ability to continue living until the end of the kalpa. The Tathāgata relates to Ānanda how Māra has repeatedly appeared before him and requested that he relent and die on the spot, but he has consistently found excuses to put him off. This time, however, he has decided to go ahead and let his time run out. Almost akin to a pronouncement of suicide, the sūtra reads, "And now, Ānanda, the Tathāgata has today at Chāpāla's shrine consciously and deliberately rejected the rest of his allotted time" (5:37). Ānanda swiftly responds by beseeching the Buddha three times to remain in the world, living until the end of the kalpa, but each time the Buddha refuses. He then describes no less than sixteen previous occasions when he remarked to Ānanda how much he liked a particular place and could remain there for the duration of the kalpa, hinting that Ānanda should ask him to do so. But each time Ānanda did not understand, and the Buddha now explains that without such an outside request, he is powerless to alter his historical fate. To beseech the Buddha now as he approaches death is too late: "The time for making such a request is past." Ānanda's dim-wittedness is thus made the scapegoat for humankind having to suffer century upon century without a buddha.

Funerary culture

Putting aside the death of the founder, which has unique historical significance, it may be useful in considering the various ways in which the living relate to the dead in Buddhist cultures throughout Asia to divide such expression into the care and treatment of the uncommon dead, the common dead, and the unknown dead. Under the rubric of uncommon dead, would be saints, kings, and lesser religious and political leaders who are typically memorialized in ways that manifest their power and influence. Relations between the common dead and the living is typically dominated by familial concerns regarding how kinfolk can assist the recently deceased in their postmortem "journey," and the flip side of this relationship, which is how the dead can either enhance or disrupt the lives of the living depending on how appropriately such assistance is rendered. The unknown dead appear most commonly in pious efforts to help all beings born in the lower realms of hell and what are usually referred to as hungry ghosts. In all cases, the care and treatment of corpses naturally reflect different attitudes about the expected relationship between the deceased and those left behind.

Two universal principles are often evident in all three categories of funerary culture. First is that in every society in Asia that may be considered traditionally Buddhist, indigenous belief structures regarding the dead that were operative before the assimilation of Buddhism persist and form an integral part of that assimilation. This has resulted in a hybridization of funerary practices under the guise of Buddhist rituals and rhetoric. Within each nation there is considerable diversity in how the dead are treated, and these differences in local culture expose any notion of ethnic homogeneity as political myth. This is particularly true in the care and treatment of the common dead, where the Buddhist input into that amalgam varies widely. There has been easy acceptance of the doctrine of transmigration in Tibet, for example. By contrast, in China deep traditions of family obligations beyond the grave have meant less than full acceptance of the presumption that each rebirth places the individual into a new family wherein the previous family is completely forgotten. It was thus normative in China to use the surname of the Buddha upon taking the tonsure, signifying a public shift of filial affiliation to the saṄgha.

Monks are intimately connected with funerary culture in all Buddhist countries, usually in ways that combine Buddhist and non-Buddhist beliefs about death, and it has been common for monasteries to derive significant revenue from related activities such as cremation, burial, and services for the family. While cremation has been the norm in India since before the birth of Buddhism, this was not so for the rest of Asia, and although there is no scriptural demand for cremation in Buddhism, its adoption on the continent came with the dissemination of Buddhist culture. Thus did the arrival of Buddhism bring cremation as a common approach to the care and treatment of the dead in much of the Buddhist world. But burial has remained the norm in Mongolia, and in Tibet the body is brought to a mountaintop, broken up, and fed to birds. In China cremation appears to have been widespread

only during the Song and Yuan dynasties and the period since the Communist revolution in 1949; here resistance stems from the ancient belief that the dead emerge in the afterlife with a kind of ethereal body that needs to be fully intact to function properly.

The second principle is that when we speak of how the dead are viewed by the living, we should recognize that they are merely one part of another reality wherein are also found a host of supernatural entities such as celestial beings, spirits, fairies, gods of one sort of another, Māra, Yama, future and past buddhas, bodhisattvas, and so forth. This other world is not separate from ours but for the most part is hidden to us. We can glimpse traces of it, however, through unorthodox states of mind experienced in meditative trance, dreams, portents, miraculous manifestations, and occasional encounters with individuals from that realm.

The Mahāparinibbāna-sutta defines four types of uncommon dead by identifying who deserves to be memorialized by means of building sacred stūpas over their graves: buddhas, pratyekabuddhas, śrāvakas, and righteous wheel-turning kings (cakravartin). The sūtra states that these four groups are worthy of memorial stūpas because when a believer looks upon their grave-mound and thinks "This is the stūpa of …," the heart of that person will be made calm and happy, and when that believer dies this personal experience will result in rebirth in a heavenly realm. The sūtra thus canonizes the belief that stūpas built to mark the graves of sacred historical persons will be embodied with the power to transform believing pilgrims who make contact with those stūpas such that their karmic status will be so purified that rebirth in heaven is assured. This is just one example of the fact that belief in the religious power of material expressions of the uncommon dead begins very early in Buddhism. In Mahāyāna countries, cremated remains of eminent monks were often inspected to find relics in the form of jewels or shining bone nuggets, confirming their status as bodhisattvas and prompting burial under stūpas. In China there are numerous stories of the cremated bones of saints found linked in a chain.

Many have pointed to the presence of relics in Stūpas and other funerary paraphernalia as the basis of their power, and indeed relics have played a prominent role in sanctifying not only stūpas, but monasteries, shrines, statues, and so forth. The extreme form of sanctifying the corporeal remains of a saint is to display the mummified body on an altar. This tradition was not uncommon in Mahāyāna countries, reflecting the belief that an "attained" individual leaves behind a "diamond-like" body that remains erect. This view is of a piece with the early belief that buddhas were inevitably marked with thirty-two major and eighty minor physical abnormalities, such as long ears and tongues or webbed hands and feet, stemming from the principle that spiritual achievement brought corporeal manifestations, much like the stigmata in Europe. Numerous mummified monks can still be viewed in China and Japan today, and in 2002 a deceased rin po che (teacher) in Mongolia was discovered in this form. We know that the drinking of lacquer, a poison that ended the saint's life but also stiffened his joints, preceded some of these mummified deaths.

But a tomb does not need a relic to be considered sacred. In Japan, where the relics of famous monks are frequently kept on the altars of monasteries, the uncommon dead typically have multiple tombs with or without something material of the individual interred therein. For example, the fact that the body of Oda Nobunaga (1534–1582), the general who reunited the country after a hundred years of war, was never recovered did not impede the establishment of at least sixteen "empty" burial sites to honor him. While such gravesite mimes are not universal, the stūpa or pagoda, its architectural variant, did become a universal burial marker for the uncommon dead throughout Buddhist Asia. Typically these house relics of the deceased in the form of śarīra, bone fragments remaining after cremation. As with the Buddha, such burial edifices frequently have become both the objects of pilgrimage and centers for monastic communities.

The burial sites of the uncommon dead may also serve as focal points of sectarian identity. When this occurs, other expressions of collective identity, such as larger mausoleums and the pilgrimage routes, typically accompany it. In Japan, this pattern is particularly striking, having led to the custom of interring the common dead at the burial sites of saints, such as KŪkai and Shinran, both founders of their major denominations. The recent dead are thereby thought to be purified by their proximity to the sacred dead, improving their karmic status for achieving rebirth in Tuṣita Heaven or AmitĀbha's Pure Land. Since family members in Japan often want the remains of their loved ones to be kept nearby yet also desire to help them after death, what is left of the body (ashes and bits of bone after cremation, whole bones when the flesh has disappeared after an earth burial) may be divided and two graves created—one at a local cemetery, and another at the site of the saint. The Honganji branch of Shinran's denomination has been selling spots for interment at the grave of Shinran since at least the sixteenth century, a policy that has created both revenue and a deep sense of fealty among the branch's non-clergy members.

It should also be noted that rebirth in the Pure Land of Amitābha has slowly grown into a kind of normative objective of postmortem ritual for most of the Mahāyāna world, from Tibet to Japan, since the seventh century, cutting across a range of schools, beliefs, and sectarian identities. The rhetoric of attaining the Pure Land promises nonbacksliding status and swift progress to buddhahood, yet it also includes the imperative to postpone buddhahood in order to return to saṃsāra to help others attain a similar postmortem peace.

One of the important principles guiding relations between the dead and their deceased kin or intimates is that of merit transfer (parivaṭṭa, pariṇāma), a fundamental theme in funerary rituals devoted to raising the recently deceased to the Pure Land, for example. Adopted from earlier Brahmanic rites for the dead called śraddha that elevated the status of the recently deceased from unstable ghost (preta) to divinity (deva), Buddhism similarly began with tales of ghosts who are incapable of initiating action to improve their situation. In the Theravāda text Petavatthu, the ghost of a deceased person may appear to someone in his or her family requesting that offerings be made to the san ˙ gha with the merit ritually transferred to the ghost. If the ghost is morally capable of appreciating the goodness of the act, he or she can be transformed into a deity, just as in Brahmanism.

In the Mahāyāna, the practice of merit transfer is greatly expanded, but it shares with Theravāda a presumption that the efficacy depends upon the ability of the deceased to perceive religious messages ritually sent to him or her and to appreciate their meaning. It is widely believed in Mahāyāna countries that in the intermediate state one has the potential to refuse the samsaric body offered and, if one can steer clear of distractions, awaken to the truth and proceed directly to nirvana. The so-called Tibetan Book of the Dead is meant to guide the dead when confronted with different choices as to what path to follow in that realm. Kinfolk and close friends gather repeatedly to

chant sūtras and make donations to the saṅgha, producing a store of merit that is ritually transferred to the deceased.

Care of the unknown or nonkin dead typically occurs on an individual basis, such as when a pilgrim dies on the road, but there is also a famous institutional example in the Chinese Ghost Festival. Here Chinese notions of ravenous ghosts and Indian concepts of preta fused into the hungry ghost image—beings in the preta realm that are obsessed with hunger as they try to fill a large belly with a tiny mouth; the hungry ghost can never get enough to feel satisfied. Based on the indigenous Yulanpen jing, a ritual tradition began in the medieval period for a yearly festival to transfer merit to all beings in the preta realm by making donations to the saṅgha. This festival is still practiced throughout East Asia, and is particularly vibrant in Japan.

See also:Abortion; Ancestors; Buddha, Life of the; Cosmology; Ghosts and Spirits; Hells; Mahāparinirvāṇa-sūtra; Merit and Merit-Making; Rebirth; Relics and Relics Cults

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Mark L. Blum

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Death

DEATH

The end of human life is a central concern of Muslim thought and occasions a variety of ritual practices connected to the dying process, burial, and mourning. The most widely held view is that death is the fate prescribed by God for all living things, and that the event itself marks a transition or journey of the soul from worldly existence in the body to bodily resurrection and immortal life in either paradise (janna) or hell (nar and jahannam). In Islamic eschatology, as in rabbinic Judaism, God delegated the power of death to an angel of awesome appearance who separates the soul from the body.

Death (maut) is a dominant theme in the Qur˒an, where it is closely linked with the understanding of life (haya) and belief in God. Thus, "God has possession of the heavens and the earth, he gives life and death" (9:116). Death is an eventuality that all living souls shall "taste" (3:185, 21:35), and precipitates their inevitable return to God (10:56). The Qur˒an even speaks of human existence as being defined by two deaths and two births: nonexistence and entry into worldly life, then death and resurrection in the hereafter (2:28, 22:66). The return to God leads to the final reckoning and immortality for the blessed in paradise and for the damned in hell. Moreover, a special reward is promised those killed on God's "path," who are also said to be alive with God, not dead (3:157, 3:169, 22:58). In Qur˒anic narratives of sacred history, death is depicted as affliction suffered by prophets at the hands of unbelievers (2:61, 3:21), and as a punishment meted out by God to unbelievers (25:35–40). Ethical and juridical passages place a high value on human life (4:29, 5:32, 6:151, 17:31), but call for death as a punishment for those who war against God and Muhammad (5:33). The schools of Muslim jurisprudence later delineated with more precision the kinds of offenses that required capital punishment, as well as mitigating factors (hudud).

Burial and mourning are rites of passage that are codified in fiqh literature. They involve declaration of the shahada by or on behalf of the dying person, and a cleansing of the body (ghusl), followed by enshrouding. Within a few hours of the death, a party of men transport the body to the cemetery, where it is buried facing toward Mecca. Funerary prayers may be performed at the grave site itself, or at a mosque on the way to the cemetery. Jurists prohibit women from participating in funerals, even if the deceased is female. Burial at sea is permitted if landfall is not possible. If the body of the deceased is not recoverable, funerary prayers are still required. Martyrs' bodies remain unwashed and are interred in their bloodstained garments without prescribed prayers, reflecting conditions of combat and a belief that they will immediately gain paradise. In all cases, the bereaved are urged to mourn in dignity for up to three days only, for excessive grieving is an affront to God, the giver of life and death. Grieving may also enhance the suffering of the soul of the deceased. Nonetheless, participation in funerals and visiting cemeteries are endorsed as occasions for cultivating piety and remembering the fate awaiting all creatures.

Ulema and indigenous cultural traditions in the Middle East, Asia, Africa, and recently Europe and the Americas have shaped Muslim beliefs and practices pertaining to death and immortality. A rich and diverse body of eschatological literature developed in medieval Islam that included narratives about the exemplary deaths of prophets and saints, visionary accounts of the torments of the grave, the death angels, and the intermediate condition of the soul between death and resurrection (barzakh), as well as detailed descriptions of the pleasures of paradise and punishments of hell. The major kalam schools defended Islamic doctrines about resurrection and final judgment against the influence of various Christian, Jewish, sectarian, mystical, and philosophical teachings. The deaths of the imams, particularly Husayn, came to hold a dominant place in Twelver Shi ite doctrine and ritual practice. Sufis taught that death obliges seekers to engage in greater self-scrutiny, as the qualities of life after death reflect those of their worldly existence. Other mystics understood pain and death both as the experience of separation from God the Beloved and as metaphors for ecstatic annihilation (fana˒) of the self in him, as exemplified by al-Hallaj (d. 922). To achieve "death before dying," was to attain spiritual union with the divine. A few mystics and philosophers, contrary to orthodox belief, advocated belief in metempsychosis (tanasukh) and denied the reality of personal death, resurrection, judgment, and heaven and hell.

In many Muslim communities, death has been seen as a contagious threat to domestic prosperity caused by the evil eye and malevolent spirits rather than a direct result of God's will. Mourning practices vary widely, but they routinely entail expressions of profound grief, especially by women, and include prayer gatherings and meals for up to a year after the loss of a loved one. Moreover, most Muslims recount visions of the dead in their dreams and believe that the saintly dead, especially the prophet Muhammad and his descendants, have the power to intercede on their behalf both in this world and in the hereafter. Saints' tombs, found in most Muslim communities, have consequently evolved into important pilgrimage and cultural centers. Since the nineteenth century, some Muslim writers have adapted European spiritualism to traditional Islamic understandings of death and the afterlife, while Islamists have revived discourses about the tortures of the grave, the corporal punishments of hell, and the bodily pleasures of paradise to advance their radical political and moral agendas.

See also˓Ibadat ; Jahannam ; Janna ; Pilgrimage: Ziyara .

BIBLIOGRAPHY

Campo, Juan Eduardo. The Other Sides of Paradise: Explorations into the Religious Meanings of Domestic Space in Islam. Columbia: University of South Carolina Press, 1991.

Ghazali, Abu Hamid al-. The Remembrance of Death and theAfterlife (Kitab dhikr al-mawt wa-ma ba˓dahu): Book XL of the Revival of the Religious Sciences (Ihya˒ ˓ulum al-din). Translated by T. J. Winter. Cambridge: Islamic Texts Society, 1995.

O'Shaughnessy, Thomas. Muhammad's Thoughts on Death. Leiden: E. J. Brill, 1969.

Smith, Jane Idleman, and Haddad, Yvonne Yazbeck. TheIslamic Understanding of Death and Resurrection. Albany: State University of New York Press, 1981.

Juan Eduardo Campo

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Death

Death

Beginning in the 1300s, European men and women became increasingly fascinated with death. The waves of bubonic plague and other life-threatening diseases that swept across the continent killed large numbers of people, reminding the survivors that life was fragile. The growing awareness that death might strike at any time led Europeans to develop new funeral customs and methods of preparing for death.


Causes of Death. Bubonic plague was the single greatest killer in Renaissance Europe. The first severe outbreak ravaged the region in the 1340s, killing between one-third and one-half of the population in some areas. The plague reappeared in 1363 and then returned every 10 to 12 years until 1661, with some outbreaks more deadly than others. Diseases such as tuberculosis and syphilis also claimed many lives. Children under age two had an extremely high death rate due to various illnesses. Once children survived their early years, however, they had a reasonable chance of reaching adulthood.

Disease was not the only cause of death in the Renaissance. Men died in accidents while traveling or farming, and many women died in childbirth. Infants and young children were sometimes abandoned or even murdered by parents who could not afford to support them. Child killing, or infanticide, became more common during times of economic hardship. Italian legal records show that twice as many baby girls as boys were abandoned or killed. Parents valued girls less because they earned lower wages than boys and because it cost their families money to supply dowries* when they married.


Attitudes Toward Death. Renaissance Europeans maintained a complete set of views about death. In the 1400s literary works called arsmoriendi ("art of dying"), which told readers how a good Christian should approach death, became popular. The texts stressed that Christians should welcome death, rather than fear it, and that they should view life as preparation for the afterlife.

The ars moriendi emphasized the importance of making a "good death." They advised dying Christians to confess their sins to a priest and to forgive their family and friends, as they gathered around the deathbed, for any wrongs they had done. A good death also involved disposing wisely of possessions, often through donations to charity. Anyone could fall ill suddenly, but accepting and even planning for death was a way of controlling its unpredictability.

People of the Renaissance lived with images of death. The Dutch humanist* Desiderius Erasmus, for example, kept a human skull on his desk as a reminder of the shortness of life. In France, Holland, and other parts of northern Europe, artists developed a variety of grim, fantastic images of death that expressed both fear and fascination. Scenes portraying the "dance of death" featured prancing skeletons, and some tomb sculptures showed the deceased lying on top of a decaying corpse. Such images reinforced the ideas that death triumphs over everyone and that the body is less enduring than the soul.


Funerals and Wills. Funeral rituals developed in two different directions between 1300 and 1600. In some Catholic areas of Europe, funerals became more formal and elaborate. People spent increasing sums on funeral processions, burial outfits, hired mourners, and mourning clothes. In other areas, by contrast, funerals grew simpler and more subdued. Some Renaissance thinkers—drawing on the ideas of ancient philosophers called the Stoics—urged mourners to show self-control and limit their displays of grief. This tendency was strongest in Protestant countries, where preachers advised people to hold simple ceremonies that focused on the afterlife rather than on worldly trappings.

One aspect of the "good death" was arranging to pass one's property on to others. Most Europeans died without leaving a will, the legal document that contains instructions about funeral arrangements and inheritance. In such cases, custom generally called for burial in the local churchyard or cemetery and distribution of property to close relatives. Some people, however, left specific instructions regarding their deaths. From the thousands of wills that survive it appears that, over the course of the Renaissance, people left increasing sums of money to pay for tombs or church services dedicated to their memory.

(See alsoHospitals and Asylums; Religious Thought; Sickness and Disease. )

* dowry

money or property that a woman brings to her marriage

* humanist

Renaissance expert in the humanities (the languages, literature, history, and speech and writing techniques of ancient Greece and Rome)

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Death

DEATH


Death haunts American literature. Upon even a cursory sampling of works by Nathaniel Hawthorne, Herman Melville, Edgar Allan Poe, Harriet Beecher Stowe, Walt Whitman, or any of the other major writers of the nineteenth century, readers will trip over coffins, bump up against ghosts, hear voices from beyond the grave, and witness the shock of people buried alive, though these writers did not have a monopoly on the corpse and its afterlife. Popular works from the period, ranging from sentimental literature to sensational novels and from religious fiction to African American slave narratives, also fed a compulsive cultural imagination obsessed with death. With the carnage associated with places like Fredericksburg, Cold Harbor, and other Civil War battlefields, the American public was confronted by the dead and the dying on an unprecedented scale. But even before the eruption of hostilities between North and South, death was firmly lodged in the nation's literature, its psychological hold expressive of troubling political and social dynamics.

How is one to understand this morbid fascination with death? While the nation's fratricidal conflict killed more white Americans than any previous conflict, the body count in American literature both precedes and extends beyond the anxieties and mourning associated with the war years of 1861 through 1865. Even as one guards against reducing the obsession with death to a specific historical conflict, one must likewise prevent the tremendous literary energy lavished on death scenes and corpses from being simply abstracted and explained as some universal fascination with the inevitable. One must examine the ideological factors that gave death such resonance in American culture in the nineteenth century. Such factors are at once political, gendered, and national in nature and can be grouped into three general lines of inquiry: death as an anxious expression about the decay of the American Republic, the corpse as a specifically female body that resounds with uncertainties about the status of women in an era of public reform, and the afterlife as an eerie commentary on citizenship and freedom.

DEATH AND POLITICAL DECAY

Sucked into the whirlpool at the end of Moby-Dick; or, The Whale (1851) by Herman Melville (1819–1891), the whaling ship vanishes with all its crew save one sailor named Ishmael. An elaborate metaphor for the ship of state, the Pequod sinks, carrying with it a diverse crew that, like the United States, had been united around a single quest—to hunt the white whale. Only one object bubbles to the surface, escaping the vortex: a coffin carved by a reformed cannibal named Queequeg. Ishmael clings to this coffin even as he abandons the memory of Queequeg, his loving companion. The friendship between the two men represents the best impulses of democracy, including equality and a heart-felt commitment to others. The political significance of their homosocial bond is heightened early in the novel with Ishmael's famous comparison that "Queequeg was George Washington cannibalistically developed" (p. 847). But by the novel's final page the comparison becomes an empty one as Ishmael floats on the husk intended for his friend's dead body. So, too, in an era of sectional division over slavery, the national promise encapsulated by the mythic Washington seems hollowed out, devoid of true meaning.

Ishmael's forgetting Queequeg typifies the malady of the post-Revolutionary generation that struggled to preserve the traditions and ideals of its forefathers. What would happen to democratic ideals and republican virtue now that the heroes of 1776 had faded into memory and as that memory itself faded? The deaths of Thomas Jefferson and John Adams, each on the Fourth of July 1826, poignantly staged the crisis confronting the citizens who inherited a nation from their political fathers. Would the nation die along with those men? The intense divisions over issues such as tariffs, territorial expansion, and most crucially, slavery seemed to indicate that the ship of state was indeed headed for dangerous waters and that this new country would not long outlast its dead founders.

For these reasons the body count of founding fathers must have been alarming for many nineteenth-century readers. As he wrote about the glories of national history, James Fenimore Cooper (1789–1851) found himself forced to confront the fact that the past was dead, never more to return. Although his romance of the American Revolution, The Spy: A Tale of Neutral Ground (1821), ends with a strengthened union as families from North and South unite in marriage, the final pages of this novel also witness the death of Harvey Birch, the patriot who worked selflessly for the American cause. He dies alone, deprived of human companionship, his national ardor a fragile relic of an almost forgotten past. When the novel was reissued in 1849 as the sectional crisis over slavery intensified, Cooper wondered aloud in his introduction whether the story of Washington could still exercise the mythic force to keep the nation intact. It seemed that the dead might really be dead, unable to offer the post-Revolutionary generation any advice about how to safeguard the political life of the new nation.

When in 1823 Cooper brought forth Natty Bumppo, his most famous hero, in the first in the series of novels that would be called the Leatherstocking Tales, Washington died yet another death in ways that deepened the gloom over the possibilities of interracial democracy. Much as Melville pairs Queequeg and Ishmael in a politically and erotically charged union, Cooper's white scout and his Indian chief, Chingachgook, commit themselves to a deeply felt companionship in The Pioneers; or, The Sources of the Susquehanna: A Descriptive Tale (1823). Wearing around his neck a silver medallion emblazoned with an image of Washington, Chingachgook symbolically recognizes the national paternal authority that in Cooper's world makes equality among men possible. Often given as part of treaty ceremonies between the federal government and Indian tribes, this medallion is brought into view by Chingachgook only "on great and solemn occasions" (p. 406), most notably his own death. As the flames of a wildfire swirl around his body, Chingachgook dies unadorned save for this icon of national promise. Washington's symbolic body becomes fuel for the fire. Although the chief's stoic resolve to his own fate participates in a voluntaristic logic that represented Native Americans as acceding to their own disappearance, The Pioneers also communicates a darker lesson in which fatherly law seems ready to perish as well.

Yet not all writers expressed loss or remorse over the death of America's paternal ancestors. In The Scarlet Letter (1850) and The House of the Seven Gables (1851), both by Nathaniel Hawthorne (1804–1864), men and women express a different sort of longing: if only the dead would die and stay dead. In "The Custom-House," his introduction to The Scarlet Letter, Hawthorne feels oppressed by the burden of the past, weighted down by the memory that his Puritan ancestors were "conspicuous in the martyrdom of the witches" (p. 126) that has made seventeenth-century Salem so notorious. Moreover, Hawthorne confesses to feeling judged by his stern progenitors for being nothing more than an "idler" and a "writer of story-books" (p. 127). It is thus not without some satisfaction that the strangulating influence of such forefathers is put to death when the novelist turns his attention to the Salem of his day. In The House of the Seven Gables the harsh Puritan strain remains ascendant, now embodied in the person of Judge Pyncheon, who uses the law's authority to harass his poorer relations. But in a scene dripping with sarcasm, Hawthorne's narrator badgers the judge, asking him repeatedly why he does not move, lest he miss a political meeting at which he is to be the guest of honor. The answer is that the judge is a corpse, having choked on his own blood. A hereditary gag reflex is the cause; the dead come back to kill the descendents who most resemble them. While disastrous for the judge, the murderous claims of the past are good news to the Pyncheon cousins, who have been suffering from both the judge's schemes and the psychological burden of family history.

For the citizens represented by the crew on Melville's ship of state, Cooper's frontier scouts, and Hawthorne's shopkeepers, death occasioned a sense of grieving as the bereaved often felt cut off from the political traditions that had secured the health and vitality of the nation. At the same time, however, death provided hints of liberation, suggesting that the post-Revolutionary generation could be freed from conventions and practices that had persisted since America's founding. Like Ralph Waldo Emerson (1803–1882) in his essay Nature (1836), antebellum citizens could ask irreverently, "Why should we grope among the dry bones of the past?" (p. 7).

THE BEAUTIFUL CORPSE

Tragic as the deaths of the founding fathers may have been, no death in the nineteenth century was as traumatic as the passing of Evangeline in the antislavery novel Uncle Tom's Cabin; or, Life among the Lowly (1852) by Harriet Beecher Stowe (1811–1896). Tens of thousands of readers were deeply moved by the death of this sainted child, and many even shed real tears as they watched little Eva waste away, imparting with her dying gasp millennial lessons about love, goodness, and perfect equality. Her death represents the height of American sentimentalism, a deeply emotional style that has been vilified for falsifying social reality even as it has been acclaimed for its affective power in changing attitudes and reorienting sensibilities. Certainly there is something troubling about a novel in which the death of a pampered slave owner's daughter threatens to overshadow—and sentimentalize—the historical actuality of racial bondage in the United States. Almost as certainly, however, the sentimental plea of Uncle Tom's Cabin caused many northern readers to feel personally and passionately about an issue—the abolition of slavery—that to many had no doubt seemed remote and distant. While it is difficult to settle this debate definitively, it is undeniable that the death of little Eva carries a political charge. On her deathbed this sinless child provides a glimpse of heaven on earth, a utopian world of pure equality based on love. As her slaveholding father comments, such a "little child is your only true democrat" (p. 211).

Eva's death fits within a larger cultural framework that idealized women and girls as the spiritual communicants of a pure social order. It was precisely their supposed proximity to death that allowed female trance mediums and clairvoyants to regale audiences with mystical pronouncements about abolition, women's rights, and eternal peace. Like Stowe's Eva, these women seemed barely embodied, hovering close to death, cultivating an aura of heavenly disconnection in which their near transcendence of earthly trappings left them free to glimpse vaster political truths that so surely eluded a world marred by slavery and other forms of injustice. Because they communicated with departed beings from the "other side," spiritualized women, such as those who practiced spirit rapping, gained access to public venues—lecture halls, abolitionist meetings, and reform conventions—previously denied to them. In addition to Stowe, prominent women activists and early feminists such as Amy Post showed an interest in the political reformist possibilities emerging mystically from the afterlife. Death, it seemed, promised a liberation unavailable in an earthly sphere contaminated by slavery and the subjugation of women. Once within a trance and insensible to the commotion of the terrestrial world, the female medium inhabited a shadowy and sentimental realm whose glorious freedom she shared with audiences at public séances. Women's participation in the public sphere of nineteenth-century America was thus organized around a contradiction: women can take part in public life only by approximating death. Uncle Tom's Cabin illustrates this contradiction perfectly as slaveholders and slaves alike are moved to follow Eva's living example of brotherly—and sisterly—love only once the girl dies. The power of sentimentalism to move and affect readers, in turn, pivots on the morbid faith that problems in this world could best be solved by attending to otherworldly voices channeled through girls and young women.

In 1846 Edgar Allan Poe (1809–1849) wrote that "the death . . . of a beautiful woman is, unquestionably, the most poetical topic in the world" (p. 19). Poe's remark suggests the particular resonance attached to women in a culture that sentimentalized death and dying. Hawthorne's Miles Coverdale, the narrator of The Blithedale Romance (1852), no doubt models the attitude of many men who viewed this spiritual fad with a combination of distrust, contempt, and fear. Based on Hawthorne's own experiences at Brook Farm, a mid-century utopian experiment that included supporters of women's rights, abolitionists, and spiritualists, The Blithedale Romance is an erotically charged novel of voyeurism and betrayal that lavishes attention on women's bodies. Mediums, reformers, and frauds flit in and out of the novel, appearing on public stages and making appeals to the afterlife in order to ground their pronouncements in a mystical authority. While the young clairvoyant Priscilla certainly attracts her share of male interest, nobody is more subject to the public eye than Zenobia, a striking woman renowned for her intellect, reformist zeal, and literary talent. But Zenobia never garners so much attention as when she is a corpse.

In a scene rife with overtones of necrophilia, the men of the community drag her dead body from a river, puncturing the corpse with a hooked pole and grappling with her arms in an attempt to make a body affected by rigor mortis appear docile and penitent. Zenobia preeminently is a public woman (since the novel was first published her portrait has drawn comparisons to Margaret Fuller) who pays the ultimate price for disregarding social strictures that relegate women to private spheres. As Hawthorne implies in several instances, when Zenobia is alive, Coverdale is threatened by his own erotic desire for her. Is it possible that he really feels attracted to an unruly woman who does not know her place? But death allows him to sidestep this uncomfortable question without forcing him to give up his desire. Her dead body makes no feminist protests and is powerless to evade the invasive gaze of men like Coverdale, except that Hawthorne adds an ironic wrinkle to his narrator's morbid satisfaction: Zenobia's corpse itself remains recalcitrant, refusing to abide by notions of feminine propriety. Having retrieved the body from the river, the men of Blithedale determine that its posture is inappropriate, bearing an attitude of "immitigable defiance" (p. 837). But because rigor mortis has set in, they are powerless to alter her body's posture; in the most graphic way, the dead woman cannot be bent to their will.

Death, when conjoined with femininity, is the picture of acquiescence. Yet the corpse also houses uncontrolled and rebellious indications that not all bodies abide by earthly restraints.

FREEDOM AND DEATH

In other words, death implies a passport to freedom. Patrick Henry's famous challenge to British colonial authority—"Give me liberty or give me death"—is critically reworked in African American slave narratives, poetry, and fiction to stake a defiant posture against American slavery. Indeed the climax to the first African American novel, Clotel; or, The President's Daughter (1853) by William Wells Brown (c. 1814–1884), comes in a chapter titled "Death Is Freedom." How exactly does death liberate? In the case of Brown's heroine, a quadroon slave who can trace her bloodline back to Thomas Jefferson, suicide frees her from the institutional proscriptions that make her body the property of another. Pursued by slave catchers and with nowhere to turn, Clotel takes her own life by jumping into the rushing waters of the Potomac that flow by the nation's capitol. An abolitionist verse by Grace Greenwood (1823–1904), absorbed by Brown into his novel, memorializes the event with bitter irony: "To freedom she leaped, through drowning and death—/ Hurrah for country! hurrah!" (p. 222). Clotel's status as a slave woman's daughter is meaningless in the culturally lifeless vacuum that death provides. Her suicide radically divorces her from legal and racial contexts that legitimate bondage. Clotel finds peace in an eternal, final freedom that exists apart from the sociohistorical currents that give meaning to everyday life. Death radically abstracts her from history; indeed American freedom recognizes only an abstract identity.

Although perhaps extreme in its gothic sensationalism, Clotel's leap readily tallies with scenes of suicide, infanticide, and murderous longing in African American writing and abolitionist poetry and fiction. Morbid fantasies exerted an almost phantasmic hold upon antebellum audiences, especially after 1856, when the slave Margaret Garner killed her two-year-old daughter rather than see her fall into the clutches of slave catchers. But even before this much-publicized tragedy, deathly tropes were common to mid-century African American writing, including slave narratives by William Wells Brown and Lunsford Lane as well as Hannah Crafts's The Bondwoman's Narrative, an African American novel written in the 1850s but lost to readers until its discovery at the beginning of the twenty-first century. In Narrative of the Life and Adventures of Henry Bibb, an American Slave (1849), for instance, Henry Bibb (1815–1854) finds solace in imagining his wife's death. Because he has been unable to rescue her from southern bondage, he prefers to think of his wife as no longer among the living, freeing him—but not her—from the painful attachments that threaten his sense of liberty. Her death would leave him free; the fantasy of her death permits him to construct, in self-negating terms, an identity that, like Clotel liberated by the cessation of being, neither suffers nor enjoys any earthly entanglements. But whereas Clotel takes her own life, Bibb sacrifices the memory of his wife, thereby escaping the fatal implications of American freedom.

In order for death to secure liberty, it must produce a political identity that is both steeped in the isolation of abstraction and unswerving in its forgetting of all cultural contexts, including one's family, friends, and past. Freedom demands social death. Clotel, Bibb, and the other heroes and heroines of antislavery literature, who ponder suicide and see liberty as residing only in the afterlife, construe freedom as befitting only a lifeless political subject, a figuratively bloodless person who knows neither memory nor embodiment. Frederick Douglass (1818–1895), the great antislavery orator and black leader, was not immune to this deathly political rhetoric either. His Narrative of the Life of Frederick Douglass, an American Slave (1845) invokes Patrick Henry's morbid trope, but by the time of his second autobiography, My Bondage and My Freedom (1855), Douglass had come to see the need of moving beyond absolute political formulas based on an extreme all-or-nothing logic. Quoting Henry's dictum of "liberty or death," Douglass implies in this later work that this expression is "incomparably more sublime" when "practically asserted by men accustomed to the lash and chain—men whose sensibilities must have become more or less deadened by their bondage" (p. 312). Because Douglass's claim to freedom never forgets the institutional history of its own origin, never outstrips whips or fetters, his political identity exceeds standard American formulas linking death and liberty. In effect Douglass's freedom is practical and worldly, not abstract and eternal. Consequently Douglass moves beyond death to think about an experience of citizenship rooted in life and memory, no matter how traumatic or pained.

See alsoThe Blithedale Romance;Cincinnati; Civil War; Clotel;Gothic Fiction; The House of the Seven Gables;Leatherstocking Tales; Moby-Dick;Mourning; Slave Narratives; Slavery; Uncle Tom's Cabin

BIBLIOGRAPHY

Primary Works

Bibb, Henry. Narrative of the Life and Adventures ofHenry Bibb, an American Slave. 1849. In Slave Narratives, edited by William L. Andrews and Henry Louis Gates Jr., pp. 425–566. New York: Library of America, 2000.

Brown, William Wells. Clotel; or, The President's Daughter:A Narrative of Slave Life in the United States. 1853. New York: Citadel Press, 1969.

Brown, William Wells. Narrative of William W. Brown, aFugitive Slave. 1847. In Slave Narratives, edited by William L. Andrews and Henry Louis Gates Jr., pp. 369–423. New York: Library of America, 2000.

Cooper, James Fenimore. The Pioneers; or, The Sources of theSusquehanna: A Descriptive Tale. 1823. In The Leatherstocking Tales, vol. 1, edited by Blake Nevius, pp. 1–465. New York: Library of America, 1985.

Cooper, James Fenimore. The Spy: A Tale of Neutral Ground. 1821. New York: AMS Press, 2002.

Crafts, Hannah. The Bondwoman's Narrative. c. 1850s. Edited by Henry Louis Gates Jr. New York: Warner Books, 2002.

Douglass, Frederick. My Bondage and My Freedom. 1855. In Autobiographies, edited by Henry Louis Gates Jr., pp. 103–452. New York: Library of America, 1994.

Douglass, Frederick. Narrative of the Life of FrederickDouglass, an American Slave. 1845. In Autobiographies, edited by Henry Louis Gates Jr., pp. 1–102. New York: Library of America, 1994.

Emerson, Ralph Waldo. Nature. 1836. In Essays andLectures, edited by Joel Porte, pp. 9–49. New York: Library of America, 1983.

Hawthorne, Nathaniel. The Blithedale Romance. 1852. In Novels, edited by Millicent Bell, pp. 629–848. New York: Library of America, 1983.

Hawthorne, Nathaniel. The House of the Seven Gables. 1851. In Novels, edited by Millicent Bell, pp. 347–627. New York: Library of America, 1983.

Hawthorne, Nathaniel. The Scarlet Letter. 1850. In Novels, edited by Millicent Bell, pp. 115–345. New York: Library of America, 1983.

Lane, Lunsford. The Narrative of Lunsford Lane, Formerly of Raleigh, N.C. 1842. In Five Slave Narratives: A Compendium, edited by William Loren Katz. New York: Arno Press, 1968.

Melville, Herman. Moby-Dick; or, The Whale. 1851. In Redburn, His First Voyage; White-Jacket; or, The World in a Man-of-War; Moby-Dick; or, The Whale, edited by G. Thomas Tanselle, pp. 771–1408. New York: Library of America, 1983.

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Andrews, William L. To Tell a Free Story: The First Century of Afro-American Autobiography, 1760–1865. Urbana: University of Illinois Press, 1986.

Bercovitch, Sacan. The Office of the Scarlet Letter. Baltimore: Johns Hopkins University Press, 1991.

Gates, Henry Louis, Jr., and Hollis Robbins. In Search ofHannah Crafts: Critical Essays on the Bondwoman's Narrative. New York: Basic Books, 2004.

Goddu, Teresa. Gothic America: Narrative, History, and Nation. New York: Columbia University Press, 1997.

Laderman, Gary. The Sacred Remains: American Attitudes toward Death, 1799–1883. New Haven, Conn.: Yale University Press, 1996.

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Sundquist, Eric J. To Wake the Nations: Race in the Making of American Literature. Cambridge, Mass: Harvard University Press, 1993.

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Weisenburger, Steven. Modern Medea: A Family Story ofSlavery and Child-Murder from the Old South. New York: Hill and Wang, 1998.

Russ Castronovo

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Death

DEATH

David G. Troyansky

Death is a phenomenon both universal and profoundly personal. Its history takes many forms. It may be written in terms of a familiar presence in people's lives, a series of catastrophes resulting from epidemics and wars, a challenge to be overcome by science and medicine, a private event giving meaning to life, and an occasion for religious or secular ritual. It is about humanity at its most vulnerable and life at its most meaningful—and meaningless. Approaches range from historical demography and family history to the history of disease, religion, and the state. Histories of death tell tales of horror, medical triumph, continuity and discontinuity of religious belief, and shifts in the relationships between individuals, families, and communities.

In the last three decades of the twentieth century, social historians and historical demographers contributed mightily to the body of knowledge on certain aspects of the history of death. Much of the quantitative work, illustrating a remarkable demographic triumph over mortality, is summarized in Jean-Pierre Bardet and Jacques Dupâquier's three-volume Histoire des populations de l'Europe (1997–1999), from which some of the demographic data in this essay is drawn. The field of the history of death, however, has been dominated by two French historians whose writings of the 1970s and early 1980s combined social and cultural history and remain the only European-wide overviews from the late Middle Ages to the contemporary era. The better-known work remains that of Philippe Ariès, but perhaps more influential among specialists, both in terms of argument and method, is the scholarship of Michel Vovelle. Ariès told a story of growing individualism and large-scale sociocultural change. Vovelle identified changes in mentalities associated fundamentally with secularization. Historians working in the 1980s and 1990s have developed variations on those themes. This essay addresses those fundamental works as well as the themes raised by a generation of social-historical scholarship. It first provides an overview of demographic knowledge of death since the Renaissance.

DEMOGRAPHY

The most notable demographic feature in the long history of death from the Renaissance to the twenty-first century is the reduction in mortality rates and the increase in life expectancy from birth. Death rates in sixteenth-century cities fluctuated around 35 to 46 per thousand, exceeding 100 in periods of epidemic disease. In 1996 the rate for most European countries was between 8 and 11 per thousand. The timing of the mortality change varied from place to place, but the most dramatic improvements occurred from 1880 to 2000. Some reduction in mortality was seen beginning in the eighteenth century, but even then rates of death fluctuated in a range that was reminiscent of medieval conditions; and in the contemporary period, for reasons that have to do with politics and warfare, it would be fair to say that Europe's history has been played out against a background of death.

Beginning in the 1340s the Black Death decimated the European population. Even a century later, Europe was without one third of its preplague population, having fallen from 73.5 million inhabitants in 1340 to 50 million in 1450. Plague mortality in England ranged from 35 to 40 percent. Its 1310 population of 6 million was not seen again until 1760. Cities were devastated. Hamburg lost 35 percent of its master bakers and 76 percent of its town councillors in the summer of 1350. Florence lost 60 percent of its population, Siena 50 percent. The population of Paris fell from 213,000 in 1328 to 100,000 in 1420–1423, that of Toulouse from 45,000 in 1335 to 19,000 in 1405. People fled the cities, but large areas of the countryside were touched as well. Upper Provence saw a 60 percent decline in numbers of households from 1344 to 1471; eastern Normandy lost 69 percent of its households from 1347 to the middle of the fifteenth century; and Navarre lost 70 percent from the 1340s to the 1420s. Most villages in some territories of the Holy Roman Empire were deserted.

Population decline was actually multicausal, with increased mortality documented even before the arrival of the Black Death, but plague was terrifying, as it hit rich and poor, young and old. Historians disagree about the cultural impact of the Black Death. Some describe a religious turn, others document a release in sensuality, but the next wave of plague in the 1360s seems to have led to a morbid literary and visual culture. Fear led to assault on those considered "other," especially Jews. Survivors saw an increase in per capita wealth and a weakening of feudalism in western Europe. Some historians describe the plague as putting an end to a demographic and economic deadlock and forcing the renewal of intellectual and spiritual life.

Recovery began in the period 1420–1450 and was even more dramatic after 1500; but until the eighteenth century, plague was endemic in Europe, and it joined famine and warfare as a major cause of death. Several outbreaks decimated local populations and terrorized survivors. The 1651 plague in Barcelona was particularly well documented. Nonetheless, Europeans had learned a lesson from the Black Death and limited population growth to a generally manageable level. They lived in greater equilibrium with the environment than they had done in the late Middle Ages.

Such equilibrium did not rule out great demographic shocks. Early modern Europe was characterized by broad fluctuations in mortality due especially to epidemic disease. Mortality rates (per thousand) in England in the mid-sixteenth century provide a good example (Table 1). In the eighteenth century, fluctuations were less dramatic, and gradual improvement was evident in the nineteenth (Table 2). Famines still occurred in the early modern period (and as late as the 1840s in Ireland, and even later in Russia), but they tended to be local and often prompted by war. There was not a year without war in Europe from 1453 to 1730. The Wars of Religion of the sixteenth century and the Thirty Years' War (1618–1648) were particularly deadly, but even then more people died of disease than of battle wounds. Movement of troops across Europe spread disease with alarming speed and destroyed crops and homes. An army of fewer than ten thousand could cause more than a million deaths by plague.

Population growth stagnated during the various crises of the seventeenth century but then continued in a significant way after 1720. From 1400 to 1800 the European population tripled, from 60 to 180 million inhabitants. Indicative of that progress is the emergence of scientific thinking about mortality and life expectancy in the late seventeenth and eighteenth centuries. John Graunt and Edmund Halley in the seventeenth century and Nicolaas Struyck, Willem Kersseboom, and Antoine Deparcieux in the eighteenth were among the founders of the modern demographic study of mortality; their work gave the lie to the early modern truism, appearing in many testaments, that the moment of death is completely unpredictable.

Before the demographic transition, or Vital Revolution, as some historians describe it, life expectancy at birth ranged from 25 to 35 years. It was higher in northern and western Europe than southern and eastern Europe. Until the eighteenth century, 40 to 50 percent of children did not reach the age of 5. Rates of survival varied geographically. In the 1750s life expectancy at birth was 28.7 in France, 38.3 in Sweden; the difference was narrower at age 10: 44.2 in France, 46.7 in Sweden. "National" figures, however, are misleading, as regional variation was striking. Within France, among those born between 1690 and 1719, 61 percent of children in the southeast failed to reach age 10, while the figure was only 46 percent in the southwest. Mary Dobson (1997) finds great mortality differences among southeastern English parishes separated only by ten miles and by elevations of four and five hundred feet. Even as late as the 1870s, infant mortality ranged from 72 per thousand in a rural area of Norway to 449 per thousand in the most deadly districts of urban Bavaria.

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During the demographic transition, the greatest shift in death rates concerned infants and children. The farming out of babies to wetnurses often had disastrous consequences. Among infants kept by their mothers, mortality was lower for those who were breast-fed than those who were fed by bottle, but the choice of method sometimes depended upon the mother's work environment or upon regional and cultural patterns that are still poorly understood. In the nineteenth century, central and northern German mothers tended to nurse, while Bavarians often had recourse to the bottle. Religion was one of the factors at work, and higher infant mortality rates were often found among southern European Catholic populations than among their northern European Protestant counterparts. Some historical demographers explain such divergences by positing a Catholic resignation about death and a more active Protestant, particularly Calvinist, pattern. But it would be hazardous to argue for such a simple explanation.

FROM A JOURNAL OF THE PLAGUE YEAR

And as I have written above, God took our little girl the day after her mother's death. She was like an angel, with a doll's face, comely, cheerful, pacific, and quiet, who made everyone who knew her fall in love with her. And afterwards, within fifteen days, God took our older boy, who already worked and was a good sailor and who was to be my support when I grew older, but this was not up to me but to God who chose to take them all. God knows why He does what He does, He knows what is best for us. His will be done. Thus in less than a month there died my wife, our two older sons, and our little daughter. And I remained with four-year-old Gabrielo, who of them all had the most difficult character. And after all this was over I went with the boy in the midst of the great flight from the plague to Sarrià to the house of my mother-in-law. I kept quarantine there for almost two months, first in a hut and then in the house, and would not have returned so soon had it not been for the siege of Barcelona by the Castilian soldiers, which began in early August 1651.

James S. Amelang, ed. and trans. A Journal of the Plague Year: The Diary of the Barcelona Tanner Miquel Parets, 1651. New York, 1991, p. 71.

Differential mortality rates resulting from social inequality were greater in cities than in the countryside. They would be dramatic in the era of industrialization, but they were already visible in the early modern period. Table 3 illustrates life expectancy at birth and at age thirty in Geneva according to the social status of the father.

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Industrialization in the nineteenth century made cities even more dangerous, particularly for the laboring classes. Insalubrious living conditions, inadequate nutrition, and dangerous workplaces, combined with unprecedented concentrations of people, increased mortality rates for a generation or two. Among the Danish working classes in the period 1820–1849, mortality rates in Copenhagen were 230 per thousand, in provincial cities 160 per thousand, in rural regions 138 per thousand. But eventually municipal authorities, often with the collaboration of the medical profession, addressed problems of drinking water and sewage.


DISEASE

Historians have debated the causes of the demographic transition, from general improvement in health resulting from greater nutrition and resistance to infectious diseases to medicine and public health measures. Quarantining populations worked effectively in responding to plague. Environmental factors and more effective provisioning may have caused the early decline in mortality in the period 1750–1790. Greater decline occurred from 1790 to the 1830s and 1840s, when the smallpox vaccine, discovered by the English physician Edward Jenner in 1798, had an important impact. There followed a period of stagnation until the 1870s and 1880s, with dramatic changes coming from Louis Pasteur's research into infectious disease in the 1880s. Still, different parts of Europe were on different schedules. Western and central Europe saw progress in the early part of the century, southern Europe registered change by the middle of the century, and eastern Europe entered the transition around the end of the nineteenth century.

For Europe as a whole, 1895–1905 represented a great turning point in infant mortality. But causes of death still varied geographically. Southern Europe had many deaths from diarrhea and gastroenteritis. In industrialized England tuberculosis was the more pressing problem. Historians have offered both ecological and climatic explanations and socioeconomic ones for the timing of the mortality change. Lower temperatures seem to have encouraged lower mortality. The turn of the century saw a combination of better climatic conditions and improvement in public and private hygiene.

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Causes of death shifted from infectious diseases to cardiovascular illness and cancer. The nineteenth century as a whole saw an epidemiological and sanitary transition. Plague was gone, smallpox was greatly reduced, and public health measures eventually dealt with epidemics of cholera, typhoid, measles, scarlet fever, diphtheria, whooping cough, and gastroenteritis. Cholera coming from Asia reached central and eastern Europe in late 1830 and early 1831. It continued west to Poland, Germany, Scandinavia, and Great Britain, reaching Belgium and France in early 1832 and southern Europe by 1833. More pandemics hit in 1848, 1865, and 1883. Intervention by public health officials protected cities by the late nineteenth century. The great exception was the cholera epidemic of 1892 in Hamburg, the destructiveness of which, killing almost ten thousand in about six weeks, was a result of the failure of the municipality to filter the city's water. As presented in Richard Evans's massive study (1987), it was a classic example of resistance by the business class to medical intervention. Cholera affected young and old more than adults. It was a shock to European opinion, as Europeans imagined they no longer had to fear epidemic disease. The quick progress of the disease and its high rates of mortality were terrifying, and the experience of 1892 indicated the importance of clean water and effective sewer systems.

A major triumph for medicine was the defeat of smallpox, a disease of childhood that was painful to behold. Mandatory vaccination had its impact, yet as one disease was conquered, another seemed to take its place. Tuberculosis, the most deadly epidemic disease in the nineteenth century, became endemic, with cases doubling in cities in the first half of the century. Curiously, the disease took on a fashionable image in the European upper and middle classes, who portrayed its victims, slowly wasting away, as romantic sufferers. The reality was greater incidence among the working classes and the poor, who lived in crowded conditions and suffered from poor nutrition. Suburbanization and improved nutrition probably helped reduce the incidence of the disease at the end of the nineteenth century.

THE TWENTIETH CENTURY: MASS DEATH AND A NEW VITAL REVOLUTION

The twentieth century began and ended with significant reductions in mortality. It might be said to constitute a second Vital Revolution, but the twentieth century also witnessed the death of 80 million Europeans as a result of war, deportation, famine, and extermination. World War I had at least 8 million victims, with another 2 million succumbing to the influenza epidemic of 1918–1919. World War II saw 43 million deaths in Europe and the Soviet Union, including 30 million civilians. The Soviet Union lost 26.6 million, 7.5 million of whom were soldiers. Poland lost 320,000 soldiers but 5.5 million civilians, including 2.8 million Jews. Germany lost 4.7 million people. The bloodletting was unprecedented, but declining mortality accelerated after the war. Progress was continuous in western Europe. In the east mortality rates actually went up after the collapse of communism.

Death took on a different meaning with the genocides of World War II. The ghettos, to which many Jews were confined, were already places of very high morbidity and mortality rates; then the Nazis moved to mass shootings and mass extermination by gas. Some 60 percent of Europe's Jews were killed. One third of the Roma (Gypsy) population was killed. The Eastern Front saw racial war, as 3.3 of 5.7 million Russians imprisoned by the Germans died in captivity. Central and Eastern Europe were more touched than the West. Poland lost 15 percent of its population. Whereas World War I had killed young men, World War II killed men and women of all ages.

Mass death—the influenza epidemic of 1918–1919, the Soviet famine of 1933, and, of course, the world wars—has been one of the major characteristics of the twentieth century. It was an essential part of the political processes of the era. The idea of the two world wars' constituting Europe's second Thirty Years' War brings to mind the way in which the events of 1618–1648 represented a major crisis in European history. The resolution of that war saw the achievement of stability and rationality. The resolution of the conflicts of 1914–1945, even if it took the rest of the century and a cold war, also represented the achievement of a kind of stability and, in the history of death, an unprecedented turn.

Mortality had declined in Europe since the eighteenth century, and the process accelerated in parts of Europe in the 1880s. The two postwar periods saw even greater progress, especially the antibiotic revolution after World War II. The most common age for dying was displaced. Death had always clustered in childhood and youth and then been fairly evenly distributed across the life course. By the second half of the twentieth century, it clustered in advanced age, and thus the image of death was transformed.

Life expectancies around 1900 still varied greatly from one part of Europe to another. Over the course of the twentieth century, they increased by 50 and even 100 percent, and by the end converged, for most of Europe, around ages in the late 70s and early 80s. Death rates were cut in half. Infant mortality fell from 190 per thousand in 1900 to 9 per thousand in 1996. Causes of death also changed. Respiratory infections were defeated by medicine, gastrointestinal ailments by public health measures, climatic change, and better nutrition. Tuberculosis had been a major killer of young people; it was surpassed after 1960 by violent death in traffic accidents. The emergence of AIDS proved that infectious disease was not thoroughly defeated.

It is clear that the medical triumph over death has left inequalities. Women's life expectancy continues to increase faster than men's. The female advantage, having disappeared completely for a time in some nineteenth-century cities, was 3 years in 1910, 5.1 years in 1960, and 8 years in 1995. Socioeconomic inequalities before death were noticeable in early modern cities but increased with industrialization. The spread of health insurance and public health measures reduced such inequality, but continued differences in standards of living, dietary habits, exercise, and the use of tobacco are among the factors encouraging inequality. Regional inequalities have evolved. At the start of the twentieth century, northwestern Europeans were used to living longer than southeastern Europeans, for the north and west had begun the sanitary transition relatively early. That distinction was reduced by 1960, but soon the major difference occurred between east and west, as life expectancy continued to increase in the west but stagnated in the east.

SOCIAL AND CULTURAL HISTORIES OF DEATH

The history of death requires measures of mortality, but numbers alone do not tell us how people faced death. The historical literature on death has examined a huge variety of sources and addressed a wide range of questions, from cultural representations and social attitudes to ritual, ceremony, and bedside practices. Ritual tends to resist change, but even traditional patterns undergo significant modifications over time and reveal social and cultural transformations.

Ariès's work on the history of death came after his influential history of childhood and before his project on the history of private life, and it shared a major concern of those works: an emphasis on individualism and its relationship to families and communities. He observed that contemporary European society, greatly influenced by developments in the United States, had increasingly serious problems dealing with death but could learn much from historical experience. He borrowed the English author Geoffrey Gorer's notion of the "pornography of death"—the idea that death replaced sex as the great taboo subject—and looked for the various ways premodern people seemed to face death more successfully. Of course, they had more experience with death, but for Ariès changes in mortality were not as important as changes in culture. In four essays (1974) that appeared before his magnum opus with individualism as his great theme, he laid out the argument that medieval and some fortunate modern people saw death as "tamed," something to be approached with equanimity and in public and to be managed comfortably by the dying individual surrounded by others. He used cultural representations of the deaths of knights and monks, along with an assortment of literary characters, to paint a picture of death as an event provoking little anxiety. Death then became less tame, and Ariès claimed that a new religiosity, beginning in the High Middle Ages but developing significantly in the era of the Reformation, encouraged a new focus on "one's own death."

Death, as Ariès saw it, came to be governed by religious concerns, by the struggle between God and the Devil, by a shift from a cultural focus on Final Judgment and the end of time to concern for the individual soul and its separation from the body. The cultural fascination with death prompted a widespread literature of the ars moriendi (art of dying). Guides for dying well proliferated in the sixteenth and seventeenth centuries and indicated a new sense of individual fear and responsibility. Out of that individualism emerged a concern for the death of loved ones, what Ariès called "thy death." It included an eroticization of death as early as the Renaissance, but it developed more fully and in a more secular fashion in the eighteenth and nineteenth centuries, especially in the culture of romanticism and a Victorian cult of death. A subsequent rejection of that cult followed, according to Ariès, and developed into a profound discomfort around reminders of mortality, the "forbidden death" that he thought marked the second half of the twentieth century.

Ariès's larger work employed the same basic argument as the four essays on death. Yet whereas the essays proceeded with elegant simplicity, the book amassed a weight of evidence demanding a more complicated structure. Archaeological sources, artistic, literary, religious, and philosophical representations, scientific and medical treatises, and sheer interpretive daring made The Hour of Our Death the benchmark against which subsequent works would be measured. Ariès's sometimes naive use of a limited sample of high cultural sources led him to propose cultural changes more dramatic than those subsequent scholars could identify, but his ideas have continued to appear in the scholarly literature.

Have people died comfortably or anxiously? Have they died alone or in public? Have they spent long periods of time in preparation for death? Have they been accompanied by religious or medical authorities? Have they been buried with great pomp or simplicity? Has the body been treated individually or buried in mass graves, the bones dug up and placed in ossuaries? All such questions sprang from the pages of his book, and his answers have served as hypotheses for subsequent historians of death.

BETWEEN RENAISSANCE AND ENLIGHTENMENT

The question of pomp versus simplicity and the related issue of secularization lay at the heart of Michel Vovelle's investigations into the history of death. His first major work (1973) was essentially a study of testaments in Provence in the seventeenth and eighteenth centuries. It took secularization or, as he put it, de-Christianization as its major theme and proposed a transition from a time of baroque piety to one of Enlightenment simplicity and secularism. It also represented a major methodological contribution to modern historiography, for it brought a "serial" method from social and economic history to the study of culture. Vovelle understood that Enlightenment thinkers doubted the received wisdom of religion and found medical and public health issues in the realm of death, but he wondered how far down in French and European society new ideas, beliefs, and practices might be found. The serial study of testaments permitted such analysis. The testament is a document that expresses religious faith and property concerns. Clauses invoking the Virgin Mary or the various saints went into decline, and religious bequests gave way to more secular directives, making the testament a more profane document in a world in which property took precedence over matters of the soul. By employing large numbers of wills that represented a broad area of Provence and a socially diverse population, Vovelle could trace the spread of new mentalities and social practices across space and time.

Vovelle had used archival traces of preparation for death to explore popular beliefs and practices, but his study of wills was limited to one part of southern France and one period, from the end of the Catholic Reformation to the end of the Old Regime. A literature developed concerning other times and places. Pierre Chaunu (1978) demonstrated a somewhat earlier cultural shift in Paris, Bernard Vogler (1978) explored differences between Catholics and Protestants in Alsace, and Jacques Chiffoleau (1980) discovered significant changes in the uses of wills in Papal territories in southern France in the late Middle Ages. Chiffoleau identified the creation of the culture of death that Vovelle saw unraveling. In other words, he wrote of the Christianization of death, describing residents of Avignon who, cut off from traditional village solidarities and family lineages, forged new ways of dealing with death. Against a background of developing trade and urban growth, people of Avignon spent their wealth on "flamboyant" funerals and religious bequests, the cultural practices that Ariès had called "one's own death." The most ambitious work on testaments was undertaken by Samuel Cohn, who in one book (1988) traced them over the course of six hundred years (1205–1800) in the city of Siena, finding dramatic changes in attitudes and practices, and in another (1992) compared testamentary practices in six Italian cities from the twelfth century to the fifteenth. In the Siena study, Cohn found late medieval testators dividing their wealth among pious causes, practicing a selfless religious devotion in preparation for death, until the second wave of plague in the fourteenth century, when they concentrated their donations and made long-term demands of their heirs. The dying were using their wealth to make a lasting impact on earth. Late Renaissance donations turned secular and familial, and subsequent Counter-Reformation and Enlightenment-era trends corresponded with some of Vovelle's findings. Vovelle's use of serial sources was also taken up by his own students, including Bernard Cousin (1983), who studied votice paintings of life-threatening events.

FROM THE WILL OF A SIXTEENTH-CENTURY SPANISH NOBLEMAN

I, Don Martin Cortés, Marquis of the Valley of Guaxaca, residing in this city of Madrid, beset by infirmities and lacking in health, but unaffected in my intellect, fearing that since death is a certainty but its hour an uncertainty, I might be taken while I am unprepared in those things that are necessary for salvation, and wishing to make perfectly clear to my wife and children how they are to inherit my belongings, so that there will be no discord or quarreling among them, do hereby order and execute this my last will and testament in the following manner.


Quoted in Eire, p. 19.

Critics of Vovelle, including Ariès, argued that he may have mistaken privatization of religious belief and practice for full-blown de-Christianization. Vovelle supplemented his work on long-term change with a study of de-Christianization in the French Revolution. He demonstrated the importance of sudden death and political death, and other scholars have followed that path. In his own synthetic study of death since the late Middle Ages, Vovelle offered a picture that was somewhat more complicated and more careful than that of Ariès, but, unlike the latter, it never had great impact on the broader public, perhaps because it never appeared in English translation. Both synthetic works told a story of secularization and individualism, but subsequent scholarship recognized no simple transition from medieval to modern attitudes.

The study of testaments was one approach to the topic of religion and death. Historians have also looked at the twists and turns of religious ritual, the idea of death as a rite of passage, and the ways in which Europeans faced death, disposed of the dead, and mourned. Some of those practices had to do with religious doctrine. Even during times when much evidence indicates change in religious attitudes, traditional religious practices provided solace.

Most Europeans for most of the period approached death with an arsenal of Christian ideas, beginning with the notion that death was the consequence of original sin. They learned to expect a separation between body and soul, to prepare for an individual judgment, and to hope for Final Judgment at the end of time. Catholics were encouraged to see the time before death as a trial, and the last rites, including prayer, anointing with oil, the administering of Communion (the viaticum), and the commendation of the soul, were essential parts of the process. Multiple editions of the Ars moriendi warned against the five temptations of the dying: unbelief, despair, impatience, spiritual pride, and excessive attachment to things of this world. Illustrations show competition between terrifying devils and an inspiring Christ. The passage from life to death involved changing patterns of emotional and financial investment by family and ritual behavior by community. Sharon Strocchia's study (1992) of Renaissance Florence described a double agenda for the death ritual, which recognized the honor of individuals and families, distinguishing them from others, and the need to reaffirm the community's sense of order. The funeral was the setting for demonstrating an individual's or family's power and status; the funeral procession demonstrated and legitimated the city's social hierarchy. Their increasing flamboyance revealed competition among old and new elites. On the other hand, the requiem was designed to bring people together. It affirmed communal and spiritual ties, as friends, neighbors, coworkers, kin, and public officials joined together in commemorating the dead.

The flamboyance of Renaissance funerals had social and political functions, but the culture of death evolved in religious contexts. Charitable bequests, processions, masses, and prayers eased the journey of the soul in Catholic Europe, as the actions of the living were thought to shorten the stay in purgatory and encourage the passage to heaven. Carlos Eire's book on sixteenth-century Madrid (1995) is the most detailed study of the testament, of ways of approaching death, and of cultural models for dying. Eire described how, when someone was thought to be dying, the notary and priest would be called for, kin and neighbors would arrive to help the dying person, and members of religious confraternities would attend. All those participants would help the dying person in the final battle. The testament itself narrates a process of identification before God and one's neighbors, supplication, meditations on death and judgment, profession of faith, deliverance into God's hands, and then instructions concerning the disposing of the body, the saving of the soul, and the dividing up of the estate. In sixteenth-century Madrid one was buried in a parish church, a monastery chapel, or occasionally a cloister. Clergy to be buried wore their religious garb, but so did many in the laity. The Franciscan habit was the most popular item of clothing for the dead laity in Madrid. Some even wore two habits and called explicitly for the advocacy of Francis. Early in the century the vast majority of testators provided detailed instructions for the funeral. Later many left the planning to their executors. A similar evolution had occurred a century earlier in Valladolid, and it might be interpreted as an increased codification of ritual by status rather than a loss of interest. The funeral procession began with the clergy; the coffin followed, with family, friends, and acquaintances next, and the poor and orphans, who were paid for their trouble, taking up the rear. Processions became more elaborate over the century; in the second half large numbers of mendicant friars joined the cortege, and participation by confraternities grew. Demands for masses in perpetuity (literally forever) increased as well. Eire concludes that people of Madrid pawned their earthly wealth to shorten their stay in purgatory.

Eire also presented two elite models of Catholic death: Philip II (1527–1598) and Teresa of Ávila (1515–1582). Philip, who built the Escorial as his place of death and as a gathering place for religious relics, taught a lesson in how to die. His was a slow, painful death, one that demonstrated publicly that even a king could not escape mortality; it affirmed also the centrality of the sacred in public life in Catholic Spain. The saintly paradigm was even more important than the royal one, and Saint Teresa of Ávila became the great exemplar of Counter-Reformation death. As a mystic she combined ecstasy and death. Her body after death was said to have become smooth as that of a child and to emit a healing fragrance. The buried body was associated with miracles. After nine months it was dug up and described as uncorrupted. But it was then cut up and parceled out for relics and the continued working of miracles. As the example of Saint Teresa suggests, Catholic approaches to death had grown more intense during a time when the Church was being challenged by Protestantism.

PROTESTANT DEATH

Protestantism rejected the Catholic emphasis on the last hours—the outcome had already been decided—but important elements of the "good death" carried over. Preparations mattered, and the behavior of the dying might indicate where the soul was headed, but confession, absolution, and extreme unction disappeared. The Protestant on his or her deathbed played an active role, offering good advice to family and demonstrating acceptance of the inevitable. The good death survived as a familial event for the bereaved. The Protestant Reformation, by eliminating purgatory, whose existence Martin Luther denied in 1530, focused attention on the faith of the dying individual and the grace of God, and Protestant thinkers claimed that the passage to heaven was immediate. It called into question and indeed placed limits on efforts by the living to intercede. Prayers for the dead would be of no use.

Such a dramatic change in doctrine had major repercussions for the ways in which people behaved when in mourning. As described in Craig Koslofsky's study (2000) of early modern Germany, a separation was made between the living and the dead both in terms of the decline of purgatory and the relegation of cemeteries to less populated areas. That process had to do with interpretation of doctrine but also the practical problems of residing in growing cities. The rejection of Catholic tradition, which Luther described as trickery, did not automatically result in the elaboration of a Protestant model. Radical Reformers buried their dead with utter simplicity, but Lutherans developed a new ritual that eventually included communal processions, funeral hymns, and honorable burial in a communal cemetery rather than a churchyard. Funeral sermons became the central element by 1550. Religious and secular authorities valued the use of ceremony to reinforce social hierarchies. Burial at night, reserved for criminals, suicides, or dishonorable people, or any burial without the participation of pastor and community was seen as irreligious. The possibility of denying Christian burial meant an emphasis on the individual's relationship to the living rather than to the dead. The sermon was the occasion to use the dead to honor the living.

The Lutheran model did not hold for all Protestants. Lutherans and Calvinists battled over matters of ritual, and by the late seventeenth century Lutheran nobles opted for nocturnal interment, which now was seen as honorable, and by candle-lit processions. Pietism and the preference for private devotion provided a context in which non-noble people also participated in nocturnal burial, which remained a common way of dealing with death throughout the eighteenth century. When daylight funerals once again became common in Germany, they retained a private, familial nature.

David Cressy (1997) has demonstrated that in England men and women maintained long-standing death rituals long after the Reformation. Traditional ways of dealing with the dead, such as sprinkling with holy water, wakes, the ringing of bells, and elaborate processions, continued in some parts of Protestant England into the seventeenth century; but vestiges of Catholic practice began to be seen as heathen superstition, and memories of purgatory may have survived in the form of belief in ghosts. Elaborate ceremony certainly continued, as the wealthy dressed and coffined their dead in more ostentatious fashion, but it may have been a necessary substitute for the older actions on behalf of the soul. What had previously been done for the dead had obviously functioned effectively for the grieving. The proliferation of individual graves provided new sites for such activities. Inscriptions had more to do with earthly memory than with old beliefs in resurrection. The era of the Protestant Reformation saw a separation of life-course ritual from participation by the entire community, an assertion of privacy. Ralph Houlbrooke's study (1998) of early modern English death demonstrated that family and neighbors replaced clergymen at the deathbed and, as ritual support diminished, had more to do. Some traditional practices, including of course rites and gestures associated with belief in purgatory, were strongly reaffirmed in Catholic Europe, but even there elites gradually moved away from a public culture of death. The poor were no longer invited. In the seventeenth and eighteenth centuries, communal care for the dead in some places even began to give way to the professional services of undertakers, although their dominance would not come until the nineteenth century.

ENLIGHTENMENT

Seventeenth-century thought played on fears of damnation, but belief in hell fell into decline among significant numbers of Catholics as well as Protestants. In the eighteenth century, Enlightenment thinkers sought a non-Christian way of dying and ridiculed their fellows who opted at the last minute for a Christian exit. Stories circulated of the deaths of philosophes, the French Enlightenment thinkers and writers; Voltaire's managing to die (in 1778) "in the Catholic religion" but not of it and not as a Christian represented an Enlightenment triumph. Form and dignity mattered; serenity and the metaphor of sleep replaced the agony of the religious death; in response to the question of whether he recognized the divinity of Jesus Christ, Voltaire said, "Let me die in peace." Belief in a non-Christian Supreme Being, the emergence of a protoromantic cult of melancholy, the development of more secular funerary sculpture, and public health concerns about overcrowded urban cemeteries led to new ways of thinking about death. The pilgrimage to the tomb was itself an important activity even as faith in reunion after death was shaken. A late-eighteenth-century cult of death encompassed deists, agnostics, and Christians.

Posterity, an earthly form of immortality, replaced heaven in much Enlightenment thought. Practical contributions to society and expressions of public virtue would yield a post-Christian form of immortality. Serving the nation or even humanity became the new ideal. Late Enlightenment and French Revolutionary funereal architecture, with its neoclassical plans and structures, embodied a secular and often nationalized way of death. The draped urn, the willow, the broken column, and the veiled mourner were all part of the neoclassical vocabulary of death. Secular ceremonies honoring revolutionary martyrs replaced Christian practices in the 1790s; hymns, processions, and eulogies emphasized civic virtue rather than Christian spirituality. The citizen's political death provided a new model for a republican public.

THE NINETEENTH CENTURY

Secularization was hardly complete. High cultural sources indicate a Romantic turn that involved a good deal of spirituality. Sentiment and sorrow replaced the serenity of the previous period. New levels of attention were devoted to grief and to mourning rituals. Romantic burial grounds and a literature evoking them provided an alternative to the neoclassicism of the eighteenth century. The afterlife made a comeback, but the new emphasis was on a heaven where loving families would reconstitute themselves. Religious and secular beliefs and ritual combined in the nineteenth century. Alternative cults of the dead proliferated; their creators included the liberals Victor Cousin and Charles-Bernard Renouvier and the socialists Charles Fourier and Pierre Leroux. Less political but equally mainstream was the spiritism of Allan Kardec and Camille Flammarion, encouraging communication between the living and the dead. Spiritism, like the occult more generally in Europe, was largely a middle-class phenomenon, a response to the decline of formal religious practice and an expression of enthusiastic hopes for science.

A focus on the legacy of the Enlightenment, on declining church attendance, and on movements toward separation of church and state may lead one to disregard the survival of religious practices for the majority, particularly when marking life-course events. In Victorian England, a continuity can be detected until the 1870s in the Evangelical style of dealing with death, which perpetuated the notion of the good death but added great intensity in the expression of grief. But there was already a good deal of secular influence. Throughout Europe the doctor played a more important role at the bedside. His administration of opiates eased the passage. The doctor's bedside presence in nineteenth-century votive paintings demonstrates his intervention in even the most devout Catholic contexts. Large suburban cemeteries took the burial ceremony away from the churchyard and into secular space. The cemeteries came to resemble cities of their own, with streets, alleys, and addresses. Burials increasingly fell into the hands of commercial enterprises.

When twentieth-century Europeans looked back at the nineteenth century, they criticized what they took to be elaborate Victorian rituals of death. They assumed that what appeared to be excessive mourning by Queen Victoria for Prince Albert was considered normal by her contemporaries. Scholarship of the 1990s calls that assumption into question. Victoria was, in fact, criticized for excessive mourning; her own subjects saw her as depressed. But formal mourning practices, rules, and schedules certainly were important in Victorian society. In France widows mourned for a year and six weeks in Paris, two years in the provinces; men mourned six months in Paris, a year in the provinces. Fashionable widows spent the first months in the black woolen dress, hood, and veil of high mourning, the next stage in black silk, and the last in alternate colors. In high society mourners wrote on black-bordered paper, widows continuing the practice until remarriage or death.

THE TWENTIETH CENTURY

Nineteenth-century formality was already giving way before World War I, but the mass slaughter that ensued transformed the setting if not the content of the cult of death. The difficulty of finding bodies and, once found, of transporting them raised practical problems. Bereavement in some ways became more difficult, and recovery from a loved one's death was seemingly more challenging. Such developments occurred across Europe, and in every country monuments sprang up quickly. Monuments to the war dead placed local contributions within a national narrative, and the key to their success was the listing of names. Whereas previously war memorials had honored rulers and officers, now they were democratized. Veterans' groups were often heavily involved, thus taking some responsibilities out of the hands of families. Sometimes local sculptors crafted original monuments, but most towns and villages opted for mass-produced works which they ordered out of catalogs. In some cases the meaning of memorials was contrary to the received wisdom. Among a few small pacifist monuments that stand in rural France, one shows a schoolboy in Gentioux with raised fist and the inscription, "Cursed be war." But most monuments of that era represent the soldier or an allegorical female embodying the nation.

World War II called for further commemoration of mass death, but the working out of memory and the design of monuments were in some ways more difficult. Death in the Holocaust, in particular, was long described as unrepresentable. Yet as survivors reached old age at the end of the century, efforts were made to collect their stories, to encourage them to speak, and to create monuments and memorials not only in Europe but in countries all over the world. Commemorating the deaths of those who fought in colonial and postcolonial wars involving Europeans also took some time. In France, the Algerian War of Independence (1954–1962) began to be memorialized in a serious way that recognized French defeat and Algerian victory only in the 1990s.

After World War II, European countries moved against the death penalty. The Nuremburg tribunals in the war's immediate aftermath resulted in the executions of Nazi war criminals. But 1948 saw the adoption of the Universal Declaration of Human Rights, which proclaimed a right to life. Although the declaration did not explicitly call for the outlawing of the death penalty, it served as the basis for a series of international covenants. The death penalty was abolished in Italy in 1948, in West Germany in 1949, in Britain in 1965, and in France in 1981. In 1989 the European Parliament adopted a Declaration of Fundamental Rights and Freedoms, which announced the abolition of the death penalty.

The post–World War II period also saw the transformation of the cultures of death in the most traditional regions of rural Europe. In Brittany Catholic ceremony and Breton folklore coexisted with modern individualism. Until the 1960s traditional notions of purgatory predominated, mourning was still a communal experience, and supernatural connections between the living and the dead were central to people's worldviews. But by the end of the century, even Brittany participated in the more general "denial of death."

In the twentieth century people chose alternative methods to the traditional disposal of the body by burial. By the latter part of the century, 72 percent of English people in 1998 opted for cremation. For some religious and ethnic minorities that choice was more difficult to make, as it raised the question of assimilation. Some immigrant communities also engaged in reflection on the meaning of being buried in Europe rather than in their countries of origin. Generations born in Europe questioned their elders' attachments.

SUICIDE AND EUTHANASIA

Suicide and euthanasia, specialized themes in the history of death, offer perspectives on the processes of secularization and medicalization. In English the word for suicide did not exist until the seventeenth century. Until then the act was called self-murder, and those who committed it were assumed to be criminals, madmen, and sinners. Suicide was an affront both to God and to the social order. Suicides were tried posthumously, their property was forfeited, and their bodies, denied Christian burial, were buried away from the community. In England suicides were buried facedown with wooden stakes driven through them so as to prevent their ghosts from wandering. The incidence of suicide is difficult to measure, but it has elicited scholarly interest during the Renaissance and serious investigation during the Enlightenment. The Renaissance saw the revival of classical cases of elite suicide. Taking one's own life could be construed as an act of freedom. Literary representations of suicide proliferated in the period 1580–1620, notably in the 1600 example of Hamlet. Seventeenth-century thinkers tried to repress the practice, but the numbers seem to have been fairly constant. By the late seventeenth century, as officials and the public grew more sympathetic, attitudes toward suicide had begun to change; evidence suggests that in England after 1750 suicide was seen not as diabolical but as the result of mental illness. Coroners' juries increasingly refused to punish severely; where they did convict, they undervalued self-murderers' goods. Among Enlightenment thinkers, the right to commit the act was supported by those favoring individual liberty, but the fact of suicide was seen as an attack on social solidarity. Although the French Revolution decriminalized the act and Romantic suicide in the wake of Goethe's Sorrows of Young Werther (1774) gave it some cachet, Enlightenment ambivalence toward it continued. Self-sacrifice for political reasons might be seen as an ideal or, alternatively, as an act of cowardice. In the first half of the nineteenth century, suicide became less a philosophical subject than a social scientific one. The practice, of course, continued, but by the second half of the twentieth century attempted suicides were seen as calls for medical help, not acts requiring legal responses.

Euthanasia represents a related phenomenon. It originally meant a gentle death, such as that which may be the desire of suicides seeking to end unendurable pain. Since the work of the English philosopher Francis Bacon in the seventeenth century, the assumption has been that euthanasia, as the alleviation of the suffering of the dying, must be administered only by a doctor, although doctors have ethical obligations not to end life. Beliefs about euthanasia began to change in the 1890s, when Adolf Jost wrote of voluntary euthanasia (a right to die) and the idea of negative human worth. In 1920 Karl Binding, a professor of jurisprudence, and Alfred Hoche, a professor of psychiatry, developed the idea of "life unworthy of life." What began as a discussion of psychiatric reform in line with cost-effectiveness ended up as a program for the killing of the mentally and physically handicapped. Euthanasia came to be seen as a eugenic method for "improving" the population and eliminating those deemed unworthy of life. The early euthanasia program in Nazi Germany focused on the young. In 1940–1941 70,273 people were killed, many in gas chambers. Some of the killers would soon use the same methods on the Jews of Europe.

Postwar opinion recoiled at the crimes of the Nazis. Yet as long life became the norm in subsequent generations, and the incidence of degenerative diseases in old age increased, doctors and patients returned to the issue of mercy killing. Questions of the withholding of medical care that would prolong the lives of the terminally ill accompanied debates over medical coverage in the world of the welfare state. Rationing of medical care and notions about the overconsumption of medicines were on the public agenda in the turn to neoliberalism in the 1980s and 1990s.

CONCLUSION

The contributions of social history have challenged the understanding of changes and continuities in the experience of death. It is not always easy to pinpoint the relationship between physical and cultural change. For example, nineteenth-century grief, particularly over the death of children, may have contributed to greater attention to measures designed to reduce mortality levels; but shifts in mortality levels affected attitudes toward death and mourning practices in turn.

The history of death is about the present as much as it is about the past. It permits us to address painful issues at a distance. Yet clearly those issues are not in fact all that distant. Some historians seem to be looking for a better way of dying and dealing with uncertainty. In that spirit, the German historian Arthur Imhof (1996) turned from historical demography to the kinds of cultural and religious questions raised by Ariès. He asked why life had become so difficult despite a dramatic medical triumph over death, and devised a chart that illustrated the history of life expectancy as a decline from hope of heavenly immortality to knowledge of earthly mortality. Like Ariès, he claimed that as Europeans have conquered death, they have lost the ability to deal with it. For example, the response to the death of Diana, Princess of Wales, on 31 August 1997 prompted studies of the hunt for new ways of mourning. In that case, mass mourning became a media event and vice versa, as multicultural mourners, in the role of both participants and spectators, explored new ceremonies and rituals. Death was far from hidden, and the ways in which media death might influence ordinary Europeans' approach to dying remained to be seen.

See also other articles in this section.

BIBLIOGRAPHY

Anderson, Olive. Suicide in Victorian and Edwardian England. Oxford and New York, 1987.

Ariès, Philippe. The Hour of Our Death. Translated by Helen Weaver. New York, 1981.

Ariès, Philippe. Images of Man and Death. Translated by Janet Lloyd. Cambridge, Mass., 1985.

Ariès, Philippe. Western Attitudes toward Death: From the Middle Ages to the Present. Translated by Patricia M. Ranum. Baltimore, 1974.

Badone, Ellen. The Appointed Hour: Death, Worldview, and Social Change in Brittany. Berkeley, Calif., 1989.

Bardet, Jean-Pierre, Patrice Bourdelais, Pierre Guillaume, et al. Peurs et terreurs face à la contagion: Choléra, tuberculose, syphilis: XIXe–XXe siècles. Paris, 1988.

Bardet, Jean-Pierre, and Jacques Dupâquier, eds. Histoire des populations de l'Europe. 3 vols. Paris, 1997–1999.

Burleigh, Michael. Death and Deliverance: "Euthanasia" in Germany, c. 1900–1945. Cambridge, U.K., and New York, 1994.

Chaunu, Pierre. La mort à Paris: XVIe, XVIIe, et XVIIIe siècles. Paris, 1978.

Chiffoleau, Jacques. La comptabilité de l'au-delà: Les hommes, la mort et la religion dans la région d'Avignon à la fin du Moyen Âge (vers 1320–vers 1480). Rome and Paris, 1980.

Cohn, Samuel K., Jr. The Cult of Remembrance and the Black Death: Six Renaissance Cities in Central Italy. Baltimore, 1992.

Cohn, Samuel K., Jr. Death and Property in Siena, 1205–1800: Strategies for the Afterlife. Baltimore, 1988.

Cousin, Bernard. Le miracle et le quotidien: Les ex-voto provençaux, images d'une société. Aix-en-Provence, 1983.

Cressy, David. Birth, Marriage, and Death: Ritual, Religion, and the Life-Cycle in Tudor and Stuart England. Oxford, 1997.

Dobson, Mary J. Contours of Death and Disease in Early Modern England. Cambridge, U.K., and New York, 1997.

Eire, Carlos M. N. From Madrid to Purgatory: The Art and Craft of Dying in Sixteenth-Century Spain. Cambridge, U.K., and New York, 1995.

Etlin, Richard A. The Architecture of Death: The Transformation of the Cemetery in Eighteenth-Century Paris. Cambridge, Mass., 1984.

Evans, Richard J. Death in Hamburg: Society and Politics in the Cholera Years, 1830–1910. Oxford and New York, 1987.

Gillis, John R., ed. Commemorations: The Politics of National Identity. Princeton, N.J., 1994.

Houlbrooke, Ralph. Death, Religion, and the Family in England, 1480–1750. Oxford and New York, 1998.

Imhof, Arthur E. Lost Worlds: How Our European Ancestors Coped with Everyday Life and Why Life Is So Hard Today. Translated by Thomas Robisheaux. Charlottesville, Va., 1996.

Jalland, Pat. Death in the Victorian Family. Oxford and New York, 1996.

Jupp, Peter C., and Clare Gittings, eds. Death in England: An Illustrated History. New Brunswick, N.J., 2000.

Jupp, Peter C., and Glennys Howarth, eds. The Changing Face of Death: Historical Accounts of Death and Disposal. New York, 1997.

Kear, Adrian, and Deborah Lynn Steinberg, eds. Mourning Diana: Nation, Culture, and the Performance of Grief. London and New York, 1999.

Koslofsky, Craig M. The Reformation of the Dead: Death and Ritual in Early Modern Germany, 1450–1700. New York, 2000.

Kselman, Thomas A. Death and the Afterlife in Modern France. Princeton, N.J., 1993.

Lebrun, François. Les hommes et la mort en Anjou aux 17e et 18e siècles: Essai de démographie et de psychologie historiques. Paris, 1971.

MacDonald, Michael, and Terence R. Murphy. Sleepless Souls: Suicide in Early Modern England. Oxford and New York, 1990.

McDannell, Colleen, and Bernhard Lang. Heaven: A History. New Haven, Conn., and London, 1988.

McManners, John. Death and the Enlightenment: Changing Attitudes to Death among Christians and Unbelievers in Eighteenth-Century France. Oxford and New York, 1981.

Minois, Georges. History of Suicide: Voluntary Death in Western Culture. Translated by Lydia G. Cochrane. Baltimore, 1999.

Schofield, Roger, David Reher, and Alain Bideau, eds. The Decline of Mortality in Europe. Oxford and New York, 1991.

Strocchia, Sharon T. Death and Ritual in Renaissance Florence. Baltimore, 1992.

Vogler, Bernard, ed. Les testaments strasbourgeois au XVIIIe siècle: Textes et documents de M. M. Mager, M. Pierron et B. Spor. Strasburg, France, 1978.

Vovelle, Michel. La mort et l'Occident: De 1300 à nos jours. Paris, 1983.

Vovelle, Michel. Piété baroque et déchristianisation en Provence au XVIIIe siècle: Les attitudes devant la mort d'après les clauses des testaments. Paris, 1973.

Walker, D. P. The Decline of Hell: Seventeenth-Century Discussions of Eternal Torment. Chicago, 1964.

Whaley, Joachim, ed. Mirrors of Mortality: Studies in the Social History of Death. New York, 1982.

Woods, Robert, and Nicola Shelton. An Atlas of Victorian Mortality. Liverpool, U.K., 1997.

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Death and Dying

Death and Dying

Definition

Death is the end of life, a permanent cessation of all vital functions. Dying refers to the body's preparation for death, which may be very short in the case of accidental death, or can last weeks or months in some cancer patients.

Description

Quality and method of death differs between cultures, circumstances and degrees of preparation. For many years, the terminally ill did not have choices in their manner of death, often enduring excruciating pain before the inevitable end of life. In recent years changes have been made to allow for a better quality for end of life, such as hospice care and preparatory actions by the patient.

It is important to recognize the differences in the ways people grieve. Each culture socializes a person in a certain way to deal with death. Death affects a person cognitively, behaviorally and socially. The death and grieving attitudes of a person affect the subjects of death, dying, bereavement, suicide and euthanasia. While a person may be able to verbalize feelings about death, internal contradictory feelings of anxiousness are common. Each person handles the subject individually, and seeking appropriate assistance will help the person to come to terms with the event in his or her own time and way.

Hospice care

A diagnosis of terminal illness is a sad and traumatic circumstance. Hospice care provides quality, caring services for both the patient and his or her loved ones. Most communities have a variety of hospice providers. A physician or hospital patient services can assist with provider names. The yellow pages of the phone book, or referral services from United Way, the local council on aging, Visiting Nurse Association or the American Cancer Society are other information sources.

While the patient should be the one to choose hospice care, it is always appropriate to discuss all care options. Hospice staffers are sensitive to concerns of both patient and family members and assist in the planning process as requested. Most physicians are aware of the services provided by hospice and will cooperate fully.

The hospice program will work closely with the physician to optimize the patient's care. The patient will sign consent and insurance forms, which are similar to those signed for hospital admission. There is also a form that states the patient's understanding that hospice care is aimed at pain relief and symptom control (palliative), rather than curative. Should a patient's condition improve and hospice services are no longer necessary, or the patient is in remission, services can be discontinued and the patient may return to regular care options. There is no obligation to remain with hospice care if it is not necessary. Should the patient need readmission to the program, medical insurance and Medicare may allow additional funding for this purpose.

Once hospice services are approved, the provider will perform a needs assessment, then assist in locating the equipment necessary for the patient's care. Quite often, the earlier needs are minimal, increasing as the illness becomes more serious. The purpose of hospice care is to make the home environment a comfortable haven for the patient.

The hospice team prepares a plan of care that is tailored to the patient. This will address the amount of care necessary to maintain the patient's comfort and well-being. The staff visits the home regularly and provides instruction on patient care, as well as answers medical questions and supports the caregivers.

As the illness progresses, care becomes more difficult. Hospice plans provide staff around the clock to consult by phone or to make visits if deemed appropriate. Respite care is also available for exhausted caregivers, so that the home can remain functional.

Hospice patients are cared for by a team of doctors, nurses, counselors, social workers, clergy, and volunteers, among others. Each provides assistance based on area of expertise. Additionally, hospices provide supplies, equipment, medications and other services related to the terminal illness. Hospice does not hasten nor does it delay the death process. However, hospices do provide specialized care that eases some of the anxiety and worry that accompany oncoming death.

The management of pain is very often an issue in terminal illness. The mission of hospice is to address all types of pain, not only the physical. Support is available to assist the patient in achieving the highest quality of life possible under individual circumstance. This may include physical and occupational therapists to keep the patient as self-sufficient and mobile as possible. Music therapy, art therapy, massage and diet counseling are available. The latest medications and devices for relief from pain and other symptoms is available. Also, counselors, some of whom are clergy members, assist both the patient and the family as needed/requested. However, hospice programs are not affiliated with religious groups and do not expect participants to adhere to any particular belief system.

The goal of the hospice program is to keep the patient both as pain free and alert as possible. Constant communication with the patient and caregivers assist in the high success rate of the hospice program. After the loved one's death, hospice programs provide both individual and group support for caregivers for at least one year, longer if necessary.

Preparing for death legally

An advance directive is a way to allow caregivers to know a patient's wishes, should the patient become unable to make a medical decision. People who are admitted to hospitals must be told about advance directives at the time of admission. Description of the type of care for different levels of illness should be in an advance directive. For instance, a patient may wish to have or not to have a certain type of care in the case of terminal or critical illness or unconsciousness. An advance directive will protect the patient's wishes in these matters.

A living will is one type of advance directive and may take effect when a patient has been deemed terminally ill. Terminal illness in general assumes a life span of six months or less. A living will allows a patient to outline treatment options without interference from an outside party.

A durable power of attorney for health care (DPA) is similar to a living will; however, it takes effect any time unconsciousness or inability to make informed medical decisions is present. A family member or friend is stipulated in the DPA to make medical decisions on behalf of the patient.

While both living wills and DPAs are legal in most states, there are some that do not officially recognize these documents. However, they may still be used to guide families and doctors in treatment wishes.

Do-not-resuscitate (DNR) orders can be incorporated into an advance directive or by informing hospital staff. Unless instructions for a DNR are in effect, hospital staff will make every effort to help patients whose hearts have stopped or who have stopped breathing. DNR orders are recognized in all states and will be incorporated into a patient's medical chart if requested. Patients who benefit from a DNR order are those who have terminal or other debilitating illnesses. It is recommended that this be discussed with a physician by a patient who has not already been considered unable to make sound medical decisions.

None of the above documents are complicated. They may be simple statements of desires for medical care options. If they are not completed by an attorney, they should be notarized and a copy should be given to the doctor, as well as a trusted family member.

Viewpoints

In the Hague, Netherlands, euthanasia was legalized in April 2001 and the country became the first in the world to allow doctors to end the lives of patients with painful, terminal illnesses. The Dutch Senate voted 46-28 in favor of the law, which took effect in the summer of 2001.

Prior to the vote, Health Minister Els Borst assured the legislators that euthanasia would not be abused by doctors because of the strict supervision that would accompany the measure. The practice has been discreetly practiced in the Netherland for decades, and preliminary guidelines were established by the country's Parliament in 1993.

In the United States, Oregon has permitted doctors to perform assisted suicides since 1996.

Mourning and grieving among cultures

The death of a loved one is a severe trauma, and the grief that follows is a natural and important part of life. No two people grieve exactly the same way, and cultural differences play a significant part in the grieving process. For many, however, the most immediate response is shock, numbness and disbelief. Physical reactions may include shortness of breath, heart palpitations, sweating and dizziness. At other times, there may be reactions such as loss of energy, sleeplessness or increase in sleep, changes in appetite, or stomach aches. Susceptibility to common illnesses, nightmares, and dreams about the deceased are not unusual during the grieving period.

Emotional reactions are as individual as physical reactions. A preoccupation with the image of the deceased, feelings of fear, hostility, apathy, and emptiness, even fear of one's own death, may occur. Depression, diminished sex drive and anger at the deceased, as well as extreme sadness may occur. Bereavement may cause short- or long-term changes in the family unit and other relationships of the bereaved.

It is important for the bereaved to work through their feelings and not avoid emotions. If this does not occur through family, friends, or primary support group methods, then a therapist should be consulted to assist with the process.

Various cultures and religions view death in different manners and conduct mourning rituals according to their own traditions. In the Christian faith, bodies of deceased are normally on view at a funeral parlor for one or more days before the actual funeral service. Specific hours are given for visitation or viewing.

Visitors come to express their condolences to the family and to bid farewell to the deceased. At times, funeral services are private. Various ethnic groups host a gathering after the funeral for those who attended. If it is held at the family's home, very often relatives and others will bring food and drink. Others choose to hold this event at a restaurant or some other public venue. It is common for these events to become a celebration of the life of the deceased, which also helps the bereaved to begin the mourning process positively. Memories are often exchanged and toasts made in memory of the deceased. Knowing how much a loved one is cherished and remembered by friends and family is a comfort to those who suffer the loss. Other methods of condolences include sending flowers to the home or the funeral parlor; sending a mass card (for Catholics); sending a donation to a charity that the family has chosen; bringing a meal to the family during the weeks after the death.

In the Jewish culture, bodies are buried as soon after death as possible, even as early as sundown of the day after death. For the Jewish population, this marks a sign of respect to the deceased. A seven-day period of morning follows, which is called Shiva or sitting Shiva. Friends and community visit the family and often bring food, so that the family does not have to worry about meals. Normal activities are suspended for the family of the deceased at this time, so that the bereaved can focus fully on their grief, thus enabling them to reenter life a bit easier after the period of mourning. The first meal that is served after return from the cemetery is called seudat havrach, prepared by friends and neighbors. Eggs and other round objects are traditionally served. These are objects that are symbolic of life, hope and the full circle of life, which ends in death. Flowers are not traditional; however, donations to charities chosen by the family are acceptable in memory of the deceased.

In the Muslim faith, everyone accompanies the funeral procession to the gravesite. The permitted mourning period for a deceased Muslim is three days, except for a widow, who is permitted to mourn her spouse for four months and 10 days. Traditionally, people leave the gravesite after offering condolences and offering assistance. However, some families do hold gatherings at home. Friends and neighbors bring food and drink to alleviate the family from the worry of providing refreshments. Flowers are often sent after the funeral to the family's home.

Buddhists normally hold a funeral within a week after the death. Flowers or a donation to a charity in the deceased's name are appropriate signs of respect. Caskets are often open, and guests are expected to view the deceased and bow slightly toward it. Friends are invited to call at the deceased's home after the funeral service but not before. The funeral service itself is usually held within 24 hours after the death. Then the body is kept at home until the traditional cremation ceremony. Flowers are acceptable from visitors and are placed at the feet of the deceased. Fruit is also a customary gift to bring to the family.

Professional implications

The primary concern of health care workers in most cases is preserving the life and health of an individual. Severely ill patients may be given nutrition and fluids intravenously or have their breathing supported by a ventilator. In cases in which the heart stops, CPR (cardiopulmonary resuscitation) is performed. In the case of terminally ill and dying patients, the role of health care professionals is to provide palliative care, ensure that proper arrangements are made for the person after death, and address the concerns of family members.

Physical signs

The causes of death vary greatly. Injuries, illness and more violent deaths occur routinely. However, as the time of death grows near for the dying, certain signs are common as their bodies begin to shut down. The time variable is as much as a few days and as little as a few hours. There is no particular order of events and not everyone experiences all of them. Support and caring by those surrounding the dying person are essential to make the passing as comfortable and with as little stress as possible.

The health care professional should keep the patient comfortable. Eggshell mattresses or foam cushions can prevent bedsores, as can changing the patient's position in bed. Sheets should be changed at least twice a week. Helping the patient with mouth care often makes him or her feel better.

There will be less interest in eating and drinking. Refusal of food indicates a readiness to die. Fluid intake may be reduced to only as much as will keep the mouth from feeling dry. At this time it is important for caretakers to offer food, drink, and medications, but they should not be forced. Pain may not be an issue when the end is near, so the patient may not feel the need for the medication.

The patient will begin to sleep more and begin to detach from his or her surroundings. The caregiver should not interfere, except to make the patient as comfortable as possible. The caregiver's presence is the most important factor.

Mental confusion may occur as less oxygen reaches the brain. Loss of hearing and vision may occur. The patient may complain of strange dreams. The caregiver should gently remind the patient of the day and time, who is present, and where the patient is at the moment. This should be done in a conversational manner. The caregiver should speak louder than normal if that is necessary, but not draw attention to the patient's loss of senses.

The room should be kept at the light and temperature that the patient requests. All conversations should be carried on as if the patient were aware. Hearing is the last of the senses to leave entirely, even in the case of stroke victims who sometimes appear completely unaware. However, many patients are able to speak even just a few minutes before death and are reassured by loving words.

Secretions may collect at the back of the throat. This may cause a gurgling sound as the patient breathes and possibly tries to cough up mucus. A cool mist humidifier in the room may help. If not, it may be advisable to turn the patient on his or her side, propped up with pillows, so that secretions can drain out of the mouth. The caregiver can cleanse the mouth with glycerin-dipped swabs, mineral oil, or cool water.

Near the end, there may be periods of non-breathing or irregular breathing. As death comes nearer, breathing may resume regularity but become shallow and mechanical. The patient may become agitated, try to get out of bed, hallucinate or pull at the bed linens. The caregiver should calmly reassure the patient and try to prevent the patient from falling if an attempt is made to get out of bed. A massage or soothing music may help.

As circulation slows down, the patient may lose the ability to realize his or her body temperature. The arms will become cool and begin to turn a bluish color. The underside of the body may darken. The caretaker should provide additional blankets or remove them as necessary. The patient should be kept as comfortable as possible.

Loss of control of the bladder and bowel may occur at the time of death. Breathing and heartbeat will stop. The jaw may sag open slightly as it relaxes. The eyelids may close partially, but the eyes will be fixed.

After a patient dies, health care staff allow family members time to grieve with the body before starting post-mortem procedures.

Resources

BOOKS

Aminoff, Michael J. "Nervous System." In Current Medical Diagnosis and Treatment. Edited by Lawrence M. Tierney, Jr., et. al. Stamford, CT: Appleton and Lange, 1996, p. 954.

Bennett, J. Claude, and Fred Plum, eds. Cecil Textbook of Medicine. Philadelphia: W.B. Saunders, 1996.

OTHER

American College of Physicians. "How to help during the final weeks of life." ACP Home Care Guide for Advanced Cancer. 2001. 〈http://www.acponline.org/public/h_care/7-final.htm〉.

American College of Physicians. "What to do before and after the moment of death." ACP Home Care Guide. 2001. 〈http://www.acponline.org/public/h_care/8-moment.htm〉.

Partnership for Caring. "Talking about your choices." 2001. 〈http://216.36.240.148/Advance/talking_choices_content.html〉.

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Death and Dying

Death and dying

Definition

Death is the end of life, a permanent cessation of all vital functions. Dying refers to the body's preparation for death, which may be very short in the case of accidental death, or can last weeks or months in some cancer patients.

Description

Quality and method of death differs between cultures, circumstances and degrees of preparation. For many years, the terminally ill did not have choices in their manner of death, often enduring excruciating pain before the inevitable end of life. In recent years changes have been made to allow for a better quality for end of life, such as hospice care and preparatory actions by the patient.

It is important to recognize the differences in the ways people grieve. Each culture socializes a person in a certain way to deal with death. Death affects a person cognitively, behaviorally and socially. The death and grieving attitudes of a person affect the

Top causes of death for people over 65
(Illustration by GGS Information Services. Cengage Learning, Gale.)
  1. Heart disease
  2. Cancer
  3. Cerebrovascular disease (stroke)
  4. COPD
  5. Pneumonia
  6. Diabetes
  7. Accidents
  8. Septicemia
  9. Nephritis
  10. Alzheimer's disease

subjects of death, dying, bereavement, suicide and euthanasia . While a person may be able to verbalize feelings about death, internal contradictory feelings of anxiousness are common. Each person handles the subject individually, and seeking appropriate assistance will help the person to come to terms with the event in his or her own time and way.

Hospice care

A diagnosis of terminal illness is a sad and traumatic circumstance. Hospice care provides quality, caring services for both the patient and his or her loved ones. Most communities have a variety of hospice providers. A physician or hospital patient services can assist with provider names. The yellow pages of the phone book, or referral services from United Way, the local council on aging, Visiting Nurse Association or the American Cancer Society are other information sources.

While the patient should be the one to choose hospice care, it is always appropriate to discuss all care options. Hospice staffers are sensitive to concerns of both patient and family members and assist in the planning process as requested. Most physicians are aware of the services provided by hospice and will cooperate fully.

The hospice program will work closely with the physician to optimize the patient's care. The patient will sign consent and insurance forms, which are similar to those signed for hospital admission. There is also a form that states the patient's understanding that hospice care is aimed at pain relief and symptom control (palliative), rather than curative. Should a patient's condition improve and hospice services are no longer necessary, or the patient is in remission, services can be discontinued and the patient may return to regular care options. There is no obligation to remain with hospice care if it is not necessary. Should the patient need readmission to the program, medical insurance and Medicare may allow additional funding for this purpose.

Once hospice services are approved, the provider will perform a needs assessment, then assist in locating the equipment necessary for the patient's care. Quite often, the earlier needs are minimal, increasing as the illness becomes more serious. The purpose of hospice care is to make the home environment a comfortable haven for the patient.

The hospice team prepares a plan of care that is tailored to the patient. This will address the amount of care necessary to maintain the patient's comfort and well-being. The staff visits the home regularly and provides instruction on patient care, as well as answers medical questions and supports the caregivers.

As the illness progresses, care becomes more difficult. Hospice plans provide staff around the clock to consult by phone or to make visits if deemed appropriate. Respite care is also available for exhausted caregivers, so that the home can remain functional.

Hospice patients are cared for by a team of doctors, nurses, counselors, social workers, clergy, and volunteers, among others. Each provides assistance based on area of expertise. Additionally, hospices provide supplies, equipment, medications and other services related to the terminal illness. Hospice does not hasten nor does it delay the death process. However, hospices do provide specialized care that eases some of the anxiety and worry that accompany oncoming death.

The management of pain is very often an issue in terminal illness. The mission of hospice is to address all types of pain, not only the physical. Support is available to assist the patient in achieving the highest quality of life possible under individual circumstance. This may include physical and occupational therapists to keep the patient as self-sufficient and mobile as possible. Music therapy, art therapy, massage and diet counseling are available. The latest medications and devices for relief from pain and other symptoms is available. Also, counselors, some of whom are clergy members, assist both the patient and the family as needed/requested. However, hospice programs are not affiliated with religious groups and do not expect participants to adhere to any particular belief system.

The goal of the hospice program is to keep the patient both as pain free and alert as possible. Constant communication with the patient and caregivers assist in the high success rate of the hospice program. After the loved one's death, hospice programs provide both individual and group support for caregivers for at least one year, longer if necessary.

Preparing for death legally

An advance directive is a way to allow caregivers to know a patient's wishes, should the patient become unable to make a medical decision. People who are admitted to hospitals must be told about advance directives at the time of admission. Description of the type of care for different levels of illness should be in an advance directive. For instance, a patient may wish to have or not to have a certain type of care in the case of terminal or critical illness or unconsciousness. An advance directive will protect the patient's wishes in these matters.

A living will is one type of advance directive and may take effect when a patient has been deemed terminally ill. Terminal illness in general assumes a life span of six months or less. A living will allows a patient to outline treatment options without interference from an outside party.

A durable power of attorney for health care (DPA) is similar to a living will; however, it takes effect any time unconsciousness or inability to make informed medical decisions is present. A family member or friend is stipulated in the DPA to make medical decisions on behalf of the patient.

While both living wills and DPAs are legal in most states, there are some that do not officially recognize these documents. However, they may still be used to guide families and doctors in treatment wishes.

Do-not-resuscitate (DNR ) orders can be incorporated into an advance directive or by informing hospital staff. Unless instructions for a DNR are in effect, hospital staff will make every effort to help patients whose hearts have stopped or who have stopped breathing. DNR orders are recognized in all states and will be incorporated into a patient's medical chart if requested. Patients who benefit from a DNR order are those who have terminal or other debilitating illnesses. It is recommended that this be discussed with a physician by a patient who has not already been considered unable to make sound medical decisions.

None of the above documents are complicated. They may be simple statements of desires for medical care options. If they are not completed by an attorney, they should be notarized and a copy should be given to the doctor, as well as a trusted family member.

Viewpoints

In the Hague, Netherlands, euthanasia was legalized in April 2001 and the country became the first in the world to allow doctors to end the lives of patients with painful, terminal illnesses. The Dutch Senate voted 46–28 in favor of the law, which took effect in the summer of 2001.

Prior to the vote, Health Minister Els Borst assured the legislators that euthanasia would not be abused by doctors because of the strict supervision that would accompany the measure. The practice has been discreetly practiced in the Netherland for decades, and preliminary guidelines were established by the country's Parliament in 1993.

In the United States, Oregon has permitted doctors to perform assisted suicides since 1996.

Mourning and grieving among cultures

The death of a loved one is a severe trauma, and the grief that follows is a natural and important part of life. No two people grieve exactly the same way, and cultural differences play a significant part in the grieving process. For many, however, the most immediate response is shock, numbness and disbelief. Physical reactions may include shortness of breath, heart palpitations, sweating and dizziness . At other times, there may be reactions such as loss of energy, sleeplessness or increase in sleep, changes in appetite, or stomach aches. Susceptibility to common illnesses, nightmares, and dreams about the deceased are not unusual during the grieving period.

Emotional reactions are as individual as physical reactions. A preoccupation with the image of the deceased, feelings of fear, hostility, apathy, and emptiness, even fear of one's own death, may occur. Depression , diminished sex drive and anger at the deceased, as well as extreme sadness may occur. Bereavement may cause short- or long-term changes in the family unit and other relationships of the bereaved.

It is important for the bereaved to work through their feelings and not avoid emotions. If this does not occur through family, friends, or primary support group methods, then a therapist should be consulted to assist with the process.

Various cultures and religions view death in different manners and conduct mourning rituals according to their own traditions. In the Christian faith, bodies of deceased are normally on view at a funeral parlor for one or more days before the actual funeral service. Specific hours are given for visitation or viewing.

Visitors come to express their condolences to the family and to bid farewell to the deceased. At times, funeral services are private. Various ethnic groups host a gathering after the funeral for those who attended. If it is held at the family's home, very often relatives and others will bring food and drink. Others choose to hold this event at a restaurant or some other public venue. It is common for these events to become a celebration of the life of the deceased, which also helps the bereaved to begin the mourning process positively. Memories are often exchanged and toasts made in memory of the deceased. Knowing how much a loved one is cherished and remembered by friends and family is a comfort to those who suffer the loss. Other methods of condolences include sending flowers to the home or the funeral parlor; sending a mass card (for Catholics); sending a donation to a charity that the family has chosen; or bringing a meal to the family during the weeks after the death.

In the Jewish culture, bodies are buried as soon after death as possible, even as early as sundown of the day after death. For the Jewish population, this marks a sign of respect to the deceased. A seven-day period of morning follows, which is called Shiva or sitting Shiva. Friends and community visit the family and often bring food, so that the family does not have to worry about meals. Normal activities are suspended for the family of the deceased at this time, so that the bereaved can focus fully on their grief, thus enabling them to re-enter life a bit easier after the period of mourning. The first meal that is served after return from the cemetery is called seudat havrach, prepared by friends and neighbors. Eggs and other round objects are traditionally served. These are objects that are symbolic of life, hope and the full circle of life, which ends in death. Flowers are not traditional; however, donations to charities chosen by the family are acceptable in memory of the deceased.

In the Muslim faith, everyone accompanies the funeral procession to the gravesite. The permitted mourning period for a deceased Muslim is three days, except for a widow, who is permitted to mourn her spouse for four months and 10 days. Traditionally, people leave the gravesite after offering condolences and offering assistance. However, some families do hold gatherings at home. Friends and neighbors bring food and drink to alleviate the family from the worry of providing refreshments. Flowers are often sent after the funeral to the family's home.

Buddhists normally hold a funeral within a week after the death. Flowers or a donation to a charity in the deceased's name are appropriate signs of respect. Caskets are often open, and guests are expected to view the deceased and bow slightly toward it. Friends are invited to call at the deceased's home after the funeral service but not before. The funeral service itself is usually held within 24 hours after the death. Then the body is kept at home until the traditional cremation ceremony. Flowers are acceptable from visitors and are placed at the feet of the deceased. Fruit is also a customary gift to bring to the family.

Caregiver concerns

The primary concern of health care workers in most cases is preserving the life and health of an individual. Severely ill patients may be given nutrition and fluids intravenously or have their breathing supported by a ventilator. In cases in which the heart stops, CPR (cardiopulmonary resuscitation ) is performed. In the case of terminally ill and dying patients, the role of health care professionals is to provide palliative care, ensure that proper arrangements are made for the person after death, and address the concerns of family members.

Physical signs

The causes of death vary greatly. Injuries, illness and more violent deaths occur routinely. However, as the time of death grows near for the dying, certain signs are common as their bodies begin to shut down. The time variable is as much as a few days and as little as a few hours. There is no particular order of events and not everyone experiences all of them. Support and caring by those surrounding the dying person are essential to make the passing as comfortable and with as little stress as possible.

The health care professional should keep the patient comfortable. Eggshell mattresses or foam cushions can prevent bedsores, as can changing the patient's position in bed. Sheets should be changed at least twice a week. Helping the patient with mouth care often makes him or her feel better.

There will be less interest in eating and drinking. Refusal of food indicates a readiness to die. Fluid intake may be reduced to only as much as will keep the mouth from feeling dry. At this time it is important for caretakers to offer food, drink, and medications, but they should not be forced. Pain may not be an issue when the end is near, so the patient may not feel the need for the medication.

The patient will begin to sleep more and begin to detach from his or her surroundings. The caregiver should not interfere, except to make the patient as comfortable as possible. The caregiver's presence is the most important factor.

Mental confusion may occur as less oxygen reaches the brain. Loss of hearing and vision may occur. The patient may complain of strange dreams. The caregiver should gently remind the patient of the day and time, who is present, and where the patient is at the moment. This should be done in a conversational manner. The caregiver should speak louder than normal if that is necessary, but not draw attention to the patient's loss of senses.

The room should be kept at the light and temperature that the patient requests. All conversations should be carried on as if the patient were aware. Hearing is the last of the senses to leave entirely, even in the case of stroke victims who sometimes appear completely unaware. However, many patients are able to speak even just a few minutes before death and are reassured by loving words.

Secretions may collect at the back of the throat. This may cause a gurgling sound as the patient breathes and possibly tries to cough up mucus. A cool mist humidifier in the room may help. If not, it may be advisable to turn the patient on his or her side, propped up with pillows, so that secretions can drain out of the mouth. The caregiver can cleanse the mouth with glycerin-dipped swabs, mineral oil, or cool water.

Near the end, there may be periods of non-breathing or irregular breathing. As death comes nearer, breathing may resume regularity but become shallow and mechanical. The patient may become agitated, try to get out of bed, hallucinate or pull at the bed linens. The caregiver should calmly reassure the patient and try to prevent the patient from falling if an attempt is made to get out of bed. A massage or soothing music may help.

As circulation slows down, the patient may lose the ability to realize his or her body temperature. The arms will become cool and begin to turn a bluish color. The underside of the body may darken. The caretaker should provide additional blankets or remove them as necessary. The patient should be kept as comfortable as possible.

Loss of control of the bladder and bowel may occur at the time of death. Breathing and heartbeat will stop. The jaw may sag open slightly as it relaxes. The eyelids may close partially, but the eyes will be fixed.

After a patient dies, health care staff allow family members time to grieve with the body before starting post-mortem procedures.

Resources

BOOKS

Aminoff, Michael J. “Nervous System.” In Current Medical Diagnosis and Treatment. Edited by Lawrence M. Tierney, Jr., et. al. Stamford, CT: Appleton and Lange, 1996, p. 954.

Bennett, J. Claude, and Fred Plum, eds. Cecil Textbook of Medicine. Philadelphia: W.B. Saunders, 1996.

OTHER

American College of Physicians. “How to help during the final weeks of life.” ACP Home Care Guide for Advanced Cancer. 2001. http://www.acponline.org/public/h_care/7-final.htm.

American College of Physicians. “What to do before and after the moment of death.” ACP Home Care Guide. 2001. http://www.acponline.org/public/h_care/8moment.htm.

Partnership for Caring. “Talking about your choices.” 2001. http://216.36.240.148/Advance/talking_choices_content.html.

Jacqueline N. Martin M.S.

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"Death and Dying." The Gale Encyclopedia of Senior Health: A Guide for Seniors and Their Caregivers. . Encyclopedia.com. 12 Dec. 2018 <https://www.encyclopedia.com>.

"Death and Dying." The Gale Encyclopedia of Senior Health: A Guide for Seniors and Their Caregivers. . Encyclopedia.com. (December 12, 2018). https://www.encyclopedia.com/caregiving/encyclopedias-almanacs-transcripts-and-maps/death-and-dying

"Death and Dying." The Gale Encyclopedia of Senior Health: A Guide for Seniors and Their Caregivers. . Retrieved December 12, 2018 from Encyclopedia.com: https://www.encyclopedia.com/caregiving/encyclopedias-almanacs-transcripts-and-maps/death-and-dying

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Notes:
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Death and Dying

Death and Dying

Definition
Description
Preparing for death or incapacitation legally
Mourning and grieving among cultures

Definition

Death is the end of life, a permanent cessation of all vital functions. Dying refers to the body’s preparation for death, which may be very short in the case of accidental death, or can last weeks or months in some patients such as those suffering from cancer.

Description

Risks of surgery

Specific risks vary from surgery to surgery and should be discussed with a physician. All surgeries and every administration of anesthesia have some risks; they are dependent upon many factors including the type of surgery and the medical condition of the patient. The patient should ask the anesthesiologist about any risks that may be associated with the anesthesia. Specific standards are set by the American Society of Anesthesiologists to enhance the safety and quality of anesthesia before surgery, basic methods of monitoring patients during surgery, and the best patient care during recovery.

Overwhelming data compiled in 2001 has confirmed that albumin is an effective marker of general nutrition; low albumin levels can increase the likelihood of post-surgery complications such as pneumonia, infection, and the inability to wean from a ventilator, by as much as 50%. In a national study of 54,000 surgery patients (average age of 61 years old), it was found that only one in five surgical patients were tested for low albumin before their operations.

In a study of 2,989 hospitalized patients admitted for more than one day, risk factors such as cholesterol levels (primarily low levels of high-density lipoprotein, HDL) and low serum albumin were associated with in-hospital death, infection, and length of stay. During the study follow-up, 62 (2%) of the patients died, 382 (13%) developed a nosocomial infection, and 257 (9%) developed a surgical site infection.

The National Veterans Affairs Surgical Risk Study was conducted in 44 Veterans Affairs Medical Centers and included 87,078 major noncardiac operations performed under general, spinal, or epidural anesthesia. Patient risk factors predictive of postoperative death included serum albumin level, American Society of Anesthesia class, emergency operation, and 31 additional preoperative variables.

Other factors related to death during surgery are: increasing age, emergency surgery, and general postoperative complications including cardiac, renal, and pulmonary complications. Age-related changes in the immune system play a significant role in the increased risk of infection, decreased ability to fight diseases, and slower wound healing after surgery. An aging body is more susceptible to subsequent infections because of previous illness or surgery and the subsequent weakening of the immune system. The anti-inflammatory medications (e.g., to control conditions such as arthritis) that many older people take are also known to slow wound hea

One study found that risk of death during coronary artery bypass graft surgery is associated with hospital volume, i.e., the number of surgeries performed. High volume hospitals had a lower mortality rate during surgery. Mortality decreased with increasing volume of surgeries performed (3.6% in low [less than 500 cases], 3% in moderate [500-1,000 cases], and 2% in high [over 1,000 cases] volume hospitals). Thus, the volume of surgeries performed may be an important consideration when selecting a hospital.

Complications of surgery

The most common complications to surgery that can prove fatal are infection, bleeding, and complications of anesthesia.

KEY TERMS

Anesthesia— Loss of sensation and usually of consciousness without loss of vital functions artificially produced by the administration of one or more agents that block the passage of pain impulses along nerve pathways to the brain.

Anesthesiologist— A physician specializing in administering anesthesia.

Electrocautery— The use of a low-voltage electrified probe used to remove tissue through cauterization (burning).

Endoscopic— Of, relating to, or performed by means of an endoscope or endoscopy.

Euthanasia— To bring about the death of another person who has an incurable disease or condition.

High-density lipoprotein— A cholesterol-poor, protein-rich lipoprotein of blood plasma correlated with reduced risk of atherosclerosis.

Nosocomial— Originating or taking place in a hospital.

Percutaneous— Effected or performed through the skin.

Serum albumin— A crystallizable albumin or mixture of albumins that normally constitutes more than half of the protein in blood serum and serves to maintain the osmotic pressure of the blood.

The Joint Commission’s Board of Commissioners reviewed 64 cases related to operative and post-operative complications since the late 1990s. Of the events reviewed, 84% of the complications resulted in patient deaths, while 16% resulted in a serious injury. All of the cases occurred in acute care hospitals; cases directly related to medication errors or to the administration of anesthesia were excluded. Of these complications, 58% occurred during the postoperative procedure period, 23% during intra-operative procedures, 13% during post-anesthesia recovery, and 6% during anesthesia induction.

The following types of procedures were most frequently associated with these reported complications:

  • endoscopy and/or interventional imaging
  • catheter or tube insertion
  • open abdominal surgery
  • head and neck surgery
  • thoracic surgery
  • orthopedic surgery

Of the 64 cases reviewed, 90% occurred in relation to non-emergent (elective or scheduled) procedures. The most frequent complications by type of procedure included the following:

  • Naso-gastric/feeding tube insertion into the trachea or a bronchus.
  • Massive fluid overload from absorption of irrigation fluids during genito-urinary/gynecological procedures.
  • Endoscopic procedures (including non-gastrointestinal procedures) with perforation of adjacent organs. Of all abdominal and thoracic endoscopic surgery, liver lacerations were among the most common complications.
  • Central venous catheter insertion into an artery.
  • Burns from electrocautery used with a flammable prep solution.
  • Open orthopedic procedures associated with acute respiratory failure, including cardiac arrest in the operating room.
  • Imaging-directed percutaneous biopsy or tube placement resulting in liver laceration, peritonitis, or respiratory arrest while temporarily off prescribed oxygen.

Complications associated with misplacement of tubes or catheters usually involved a failure to confirm the position of the tube or catheter, a failure to communicate the results of the confirmation procedure, or misinterpretation of the radiographic image by a non-radiologist.

Preparing for death or incapacitation legally

An advance directive is a way to allow caregivers to know a patient’s wishes, should the patient become unable to make a medical decision. The hospital must be told about a patient’s advance directive at the time of admission. Description of the type of care for different levels of illness should be in an advance directive. For instance, a patient may wish to have or not to have a certain type of care in the case of terminal or critical illness or unconsciousness. An advance directive will protect the patient’s wishes in these matters.

A living will is one type of advance directive and may take effect when a patient has been deemed terminally ill. Terminal illness in general assumes a life span of six months or less. A living will allows a patient to outline treatment options without interference from an outside party.

A durable power of attorney for health care (DPA) is similar to a living will; however, it takes effect any time unconsciousness or inability to make informed medical decisions is present. A family member or friend is stipulated in the DPA to make medical decisions on behalf of the patient.

While both living wills and DPAs are legal in most states, there are some states that do not officially recognize these documents. However, they may still be used to guide families and doctors in treatment wishes.

Do-not-resuscitate (DNR) orders can be incorporated into an advance directive or by informing hospital staff. Unless instructions for a DNR are in effect, hospital staff will make every effort to help patients whose hearts have stopped or who have stopped breathing. DNR orders are recognized in all states and will be incorporated into a patient’s medical chart if requested. Patients who benefit from a DNR order are those who have terminal or other debilitating illnesses. It is recommended that a patient who has not already been considered unable to make sound medical decisions discuss this option with his or her physician.

None of the above documents are complicated. They may be simple statements of desires for medical care options. If they are not completed by an attorney, they should be notarized and a copy should be given to the doctor, as well as to a trusted family member.

Mourning and grieving among cultures

The death of a loved one is a severe trauma, and the grief that follows is a natural and important part of life. No two people grieve exactly the same way, and cultural differences play a significant part in the grieving process. For many, however, the most immediate response is shock, numbness, and disbelief. Physical reactions may include shortness of breath, heart palpitations, sweating, and dizziness. At other times, there may be reactions such as loss of energy, sleeplessness or increase in sleep, changes in appetite, or stomach aches. Susceptibility to common illnesses, nightmares, and dreams about the deceased are not unusual during the grieving period.

Emotional reactions are as individual as physical reactions. A preoccupation with the image of the deceased, feelings of fear, hostility, apathy, emptiness, and even fear of one’s own death, may occur. Depression, diminished sex drive, sadness, and anger at the deceased may occur. Bereavement may cause short- or long-term changes in the family unit and other relationships of the bereaved.

It is important for the bereaved to work through their feelings and not avoid their emotions. If emotions and feelings are not discussed with family members, friends, or primary support groups, then a therapist should be consulted to assist with the process.

Various cultures and religions view death in dif-ferent manners and conduct mourning rituals according to their own traditions. In most cultures, visitors often come to express their condolences to the familyand to bid farewell to the deceased. At times, funeral services are private. Various ethnic groups host a gathering after the funeral for those who attended. It is common for these events to become a celebration of the life of the deceased, which also helps the bereaved to begin the mourning process positively. Memories are often exchanged and toasts made in memory of the deceased. Knowing how much a loved one is cherished and remembered by friends and family is a comfort to those who experience the loss. Other methods of condolences include sending flowers to the home or the funeral parlor; sending a mass card, sending a donation to a charity that the family has chosen; or bringing a meal to the family during the weeks after the death.

Resources

BOOKS

Beauchamp, Daniel R., Mark B. Evers, Kenneth L. Mattox, Courtney M. Townsend, and David C. Sabiston, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 16th ed. London: W. B. Saunders Co., 2001.

Coberly, Margaret. Sacred Passage: How to Provide Fearless, Compassionate Care for the Dying. Boston: Shambhala Publications, 2002.

Heffner, John E., Ira R. Byock, and Lra Byock, eds. Palliative and End-of-Life Pearls. Philadelphia: Hanley and Belfus, Inc., 2002.

Kubler-Ross, Elisabeth, and David Kessler. Life Lessons: Two Experts on Death and Dying Teach Us About the Mysteries of Life and Living. New York: Scribner, 2000.

Soto, Gary. The Afterlife. Orlando, FL: Harcourt Children’s Books, 2003.

Staton, Jana, Roger Shuy, and Ira Byock. A Few Months to Live: Different Paths to Life’s End Baltimore, MD: Georgetown University Press, 2001.

Sweitzer, Bobbie Jean, ed. Handbook of Preoperative Assessment and Management. Philadelphia: Lippincott Williams & Wilkins, 2000.

PERIODICALS

Byock, Ira, and Steven H. Miles. “Hospice Benefits and Phase I Cancer Trials.” Annals of Internal Medicine 138, no. 4 (February 2003): 335–337.

Smykowski, L., and W. Rodriguez. “The Post Anesthesia Care Unit Experience: A Family-centered Approach.” Journal of Nursing Care Quality 18, no. 1 (January-March 2003): 5–15.

ORGANIZATIONS

American College of Physicians—American Society of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106-1572. Washington Office: 2011 Pennsylvania Avenue NW, Suite 800, Washington, DC 20006-1837. (202) 261-4500 or (800) 338-2746. http://www.acponline.org.

Hospice Foundation of America, 2001 “S” Street, NW, Suite 300, Washington, DC 20009. (800) 854-3402 or (202) 638-5419. Fax: (202) 638-5312. Email: [email protected] foundation.org. www.hospicefoundation.org.

Inter-Institutional Collaborating Network on End-of-Life Care (IICN). (415) 863-3045. http://www.growthhouse.org.

National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892. (301) 496-4000. Email: [email protected] http://www.nih.gov/.

Promoting Excellence in End of Life Care, RWJ Foundation National Program Office, c/o The Practical Ethics Center, The University of Montana, 1000 East Beckwith Avenue, Missoula, MT 59812. (406) 243-6601. Fax: (406) 243-6633. Email: [email protected] http://www.promotingexcellence.org.

Washington Home Center for Palliative Care Studies(CPCS), 4200 Wisconsin Avenue, NW, 4th Floor, Washington, DC 20016. (202) 895-2625. Fax: (202) 966-5410. Email: [email protected] http://www.medicaring.org.

OTHER

American College of Physicians. “How to Help During the Final Weeks of Life.” ACP Home Care Guide for Advanced Cancer. [cited March 2, 2003]. http://www.acponline.org/public/h_care/7-final.htm.

American College of Physicians. “What to Do Before and After the Moment of Death.” ACP Home Care Guide. [cited March 2, 2003]. http://www.acponline.org/public/h_care/8-moment.htm.

Byock, Ira, M.D. DyingWell.org. [cited March 2, 2003]. http://www.dyingwell.org/default.htm.

Kubler-Ross, Elisabeth, and Carol Bilger. On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Family. (Audio Cassette, Abridged edition.) New York: Audio Renaissance, 2000.

Jacqueline N. Martin, M.S.

Crystal H. Kaczkowski, M.Sc.

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Death and Dying

Death and Dying

Death is an event that demands explanation. Every human society has recognized the importance of orienting its members to the phenomenon of death, the process of dying, and death's aftermath. So powerful is the event of death, with its demand for interpretation, that it may well have been one of the first causes of religion and philosophy in primitive people.


Ancient Views on Death and Dying

The Hindu religion views life as connected not with concrete personal, historical existence as such, but rather with the concept of being, which is contrasted with both life and death. Life and death are a form of existence, which is not real in the sense that being is real. Therefore, death is not the loss of being as such, but merely the end of the illusion of life as existence in time.

For the Buddhist, the self exists as a sheer moment of becoming in history. Life and death as a process of time and history are fictions that prod the self to discover the liberation of the self from reflection and feeling alike. Death is not an enemy in Buddhist theology; instead it is a goal, which produces a liberation from the cravings and sensations of life.

In ancient Greek philosophy we see a quite different answer to the question of death. Here there is a concern for immortality as a specific object of philosophical reality. Whereas Jews find continuity in the purpose of history as a dialogue with God, Hindus in the Atman as the reality of being, and Buddhists in the contentless moment of not knowing, Greek philosophers seek continuity in knowledge as the eternal reality. Death has been dissolved of its power to destroy the self; because all of life itself in its bodily form is only of passing significance, death, too, is viewed only as a passing away of that which is unnecessary to the true personality of the soul. "True philosophers," Socrates suggested, "make dying their profession."

A common assumption among the Hindu, Buddhist, and Greek concepts of death is a fundamental dualism with regard to the reality of the "otherworldly" and the unreality of this present temporal existence. The individual dying in such a culture, whether an ancient, preindustrial one or a contemporary one, is thus equipped with a religious or philosophical system that transcends death and that can offer experiential training in altered states of consciousness, including symbolic confrontations with death. The approach to death may even be accompanied by the nourishing context of extended family, clan, or tribe, and may even include specific guidance through the successive stages of dying.

A Judeo-Christian theology of death stands in stark contrast to the dualism of the Greek, Hindu, and Buddhist theology of life and death. A theology of death within Judaism builds on foundations that are unique to the beginnings of Israel as a historical community, set within the temporal bounds of a created world. For Hebrews, death comes from the hand of God and has no power of its own. Death does not have an arbitrary power to break the continuity of life, because life is related to the continuity of God's purpose in history. The Hebrew understanding of the meaning of death lies with the affirmation that death marks an absolute end of personal existence on earth. Continuity consists, therefore, not in a theory of personal immortality that extends the individual's life beyond death, but instead in the assurance of a future in which there is continuing conversation and relation between God and his people.

There is no concept of an immortal soul in Hebrew anthropology as presented in the Old Testament. The critical issue in the doctrine of the immortality of the soul is the continuity of the self through the dissolution of the body in death. In the biblical view, this continuity resides in the continued power of God, who created the human person in his own image and likeness and who upholds that person in a relation that guarantees life, even in the face of being mortal by nature. In the Christian tradition, continuity of life beyond death in terms of the essential unity of body and soul is strongly supported by the biblical teaching on the nature of the resurrection of the body as well as the soul to eternal life.

There is a close affinity between the Christian and the Jewish perspectives on death. There also remains, however, a fundamental difference. The Christian tradition, building on the foundations of ancient Israel's belief in God as the creator and sustainer of life, answers the question of death through its testimony to the death and resurrection of Jesus Christ.


Contemporary Views on Death and Dying

The typical Western view of death has become more pragmatic and dissociated from religious or philosophical worldviews. Aging and dying are seen not as integral parts of the life process but as reminders of our limited ability to control nature, despite technological and scientific achievements in this regard. The educated Westerner tends to regard belief in consciousness after death as a manifestation of primitive fears and relics of religion. Nietzsche even went so far as to say that fear of death is a "European disease," and attributed it largely to the influence of Christianity. Ernest Becker, in his classic work The Denial of Death (1974), argued that an attempt to deny human mortality leads to neurotic patterns of behavior, while accepting the reality of our mortality through faith in a transcendent source leads to faith and mental health.

Death is becoming more difficult to define. Advances in medical science in the last half of the twentieth century have made the moment of death more ambiguous. The empirical sciences explain death in terms of mechanistic and organic processes, with loss of brain function taken as a sign of clinical death. To provide the dying with the maximum benefits of scientific medical research and technology, they are usually institutionalized under the assumption that the vital processes of life are essentially organic and physical. In our contemporary Western society, while the costs of dying and burying the dead have increased dramatically, there is also a denial of the reality of death and a tendency to separate the moment of death from life.

Having compartmentalized death so that we no longer live in continuity with the dead, our contemporary culture is nonetheless preoccupied with an awareness of death such as never before (Bregman 1992). Anecdotal accounts of "near death" experiences give many reason to believe in the possibility of life after death. Persons lying unconscious in wrecked cars or on operating tables awaken and report seeing and hearing events from a perspective that suggests an "out of body" experience. Some report moving through a tunnel toward a bright light, which includes appearances of figures representing persons who have died or supernatural beings. While these experiences are sometimes said to defy scientific explanation, they also fall short of providing evidence for the existence of life beyond death, for they are not "after death" accounts but "near death" experiences.

An encouraging sign of the development of a human ecology of death and dying is the modern hospice movement. The hospice movement, with a focus on caring for dying persons, had its beginning in the founding of St. Christopher's Hospice in London. Dr. Cicely Saunders, founder and director, traces the antecedents of the modern hospice back to medieval hospices, but more recently to Mother Mary Aidenhead, who used the concept of the hospice when she founded the Irish Sisters of Charity in the middle of the nineteenth century. Dr. Saunders's work at St. Christopher's began in 1967, and since that time the hospice movement has developed in England and has spread to the United States. At the center of the hospice community is the concept of a body coexisting with a belief. The body is the dying patient, and the belief is that the patient is something more than a body. The hospice community embraces patient, family, and close friends, not only during the final days and weeks of the patient's life but also long after death, offering consolation and support during the time of bereavement.

The universality of the human experience of death is finally an individual experience that has not changed from the beginning of human history. Philosophers seek to comprehend it with wisdom, poets inspire us to face it with courage, priests clothe it with sacred ritual, psychologists offer inner healing, and religion weaves the fabric from which we shape our shroud. In the Bible, the tormented Job cries out in his agony, "If mortals die, will they live again?" ( Job 14:14). Jesus, the crucified messiah, promises, "I am the resurrection and the life. . . . I am the first and the last, and the living one. I was dead, and see, I am alive forever and ever. . . ." ( John 11:25; Revelation 1:18).


See alsoAfterlife; Body; Deathof God; Ethics; Near Death Experiences; Ritesof Passage; Spirit.

Bibliography

Anderson, Ray S. On Being Human: Essays in TheologicalAnthropology. 1982.

Anderson, Ray S. "On Being Human: The Spiritual Saga of a Creaturely Soul." In Whatever Happened tothe Soul? Scientific and Theological Portraits of HumanNature, edited by Warren S. Brown, Nancy Murphy, and H. Newton Malony. 1998.

Anderson, Ray S. Theology, Death and Dying. 1986.

Becker, Ernest. The Denial of Death. 1974.

Bregman, Lucy. Death in the Midst of Life: Perspectives onDeath from Christianity and Depth Psychology. 1992.

Carse, James P. Death and Existence: A Conceptual Historyof Human Mortality. 1970.

Choron, Jacques. Death and Western Thought. 1963.

Corr, Charles A., Clyde M. Nabe, and Donna M. Corr, eds. Death and Dying, Life and Living, 2nd ed. 1997.

Dumont, Richard G., and Dennis C. Foss. The American Way of Death: Acceptance or Denial? 1972.

Foos-Graber, Anya. Deathing: An Intelligent Alternativefor the Final Moments of Life. 1984.

Grof, Stanislav, and Christina Grof. Beyond Death: TheGates of Consciousness. 1980.

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Mills, Listen O., ed. Perspectives on Death. 1979.

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Shneidman, Edwin, ed. Death: Current Perspectives. 1976.

Stoddard, Sandol. The Hospice Movement: A Better Wayof Caring for the Dying. 1978.

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Wass, Hannelore, Felix M. Berardo, and Robert A. Neimeyer, ed. Dying: Facing the Facts, 3rd ed. 1995.

Wolf, Richard. The Last Enemy. 1974.

Ray S. Anderson

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Death and Dying

DEATH AND DYING

This essay asks three questions about death and dying: 1) Why should an entry on such phenomena, which are clearly of interdisciplinary interest, appear in an encyclopedia of sociology? 2) What related topics have been studied by sociology? 3) What issues are currently pending that call for sociological attention?

DEATH AND DYING AS A FIELD OF SOCIOLOGICAL INQUIRY

The answer to the first question is not readily found in the history of sociological thought, although Victor Marshall once bemoaned the fact that Georg Simmel in 1908 had identified but had not pursued the topic as suitable for sociological inquiry, and a half century later the topic was thought to be a neglected area for sociology (Faunce and Fulton 1958). On other hand, Fulton reminds us that "sociological interest in death is coexistent with the history of sociology" (Fulton and Bendiksen 1994; Fulton and Owen 1988). Both Marshall and Fulton are correct in that the "interest" has typically been peripheral. Herbert Spencer had noted that social progress depended on the separation of the world of the living from the world of the dead, but that was hardly his central theory. Emile Durkheim's Suicide depends on an elaborate theory of "anomie," not on any theory of death. Max Weber deals with the fact of death in that it interrupts the pursuit of one's calling—a basic observation la