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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

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

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Gary L. Ebersole (2005)

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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

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 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 later developed by Talcott Parsons. William Graham Sumner wrote widely about such death-related topics as fear of ghosts, mortuary rituals, widowhood, infanticide, war, and even the right to die, but all such references were illustrative of some more general point. In 1956 Herman Feifel chaired a conference on death for the American Psychological Association.

There may well be other precursors, but a bit of history suggests how and when sociology may have staked out its disciplinary claim in a field that had long been cultivated by medicine, theology, ethics, philosophy, law, and psychology.

In May 1967, as part of a new program on "Death Education" at the University of Minnesota, Robert Fulton, a sociologist, arranged perhaps the first interdisciplinary conference on death and dying in the United States. Fulton had just published his ground-breaking book Death and Identity (1965), the purpose of which was to help in "preserving rather than losing . . . personal identity . . ." when facing death. It was a time of broad and diverse interest in the subject. Examples had been popping up in many domains: Jay Lifton's notes on the Hiroshima bombing; Eric Lindemann's report on the psychiatric effects of the disastrous Coconut Grove fire in Boston; Avery Weisman's clinical studies of dying patients; Lloyd Warner's interpretation of the meaning of ceremonial events that honor the dead; Herman Feifel's work on social taboos; Richard Kalish's early essays on teaching; Parsons' emerging theory of the relationship of social action to death, and so on. Fulton, clearly aware of these varying expressions of interest, was prompted to try to interpret the diversity and "get it all together." What Fulton did in Death and Identity (1965) was to piece together some three dozen edited excerpts from the works of a wide range of experts who had written on an equally wide range of death-related topics. He found American society to be essentially death denying.

The Minnesota Conference, 1967. At the Minnesota Conference of 1967, Alber Sullivan of the Minnesota Medical School and Jacques Choron of the New School of Social Research spoke to various medical and philosophical issues; Jeanne Quint from the University of California reported on the role of the nurse in dealing with terminal patients; Eric Lindemann of Harvard Medical School discussed the symptomatology of acute grief; Herman Feifel of the Veterans Administration, famous for his work on taboos, emphasized that death always carries many meanings; and Talcott Parsons from Harvard probed the topic in broad theoretical terms.

It was a heady agenda but there were some strange omissions. Elizabeth Kubler-Ross, then known to be working on the "stages" of dying (On Death and Dying, 1969) was scarcely mentioned, nor was much made of the equally influential work of Barney Glaser and Anselm Strauss (1965), whose book Awareness of Dying had been published two years earlier. The participants in the Minnesota Conference were intrigued by various sociological questions. They wrestled with Karl Mannheim's thought experiment of what society would be like if there were no death (Mannheim 1928, 1959). They wondered what mortality and fertility rates had been historically and how they are related (cf. Riley and Riley 1986). They debated Robert Blauner's thesis (Blauner 1966) that death in all known societies imposes imperatives (a corpse must be looked after, property must be reallocated, vacated roles must be reassigned, the solidarity of the deceased's group must be reaffirmed). They attacked hospital regimens that depersonalized terminal patients, and they challenged the medical profession for treating death as "the enemy" and prolonging life at any cost.

The conference produced extravagant results in anticipating two critical issues: the norms and arrangements for dealing with dying persons were both confused and hazy; and the greater attention paid to caregivers than to dying persons. But the fact that the conference was consistent in insisting that dying always involves at least two persons turned out to be its most important message for the future agenda. Sociological interest in death and dying, of course, did not start with the Minnesota Conference, but what the conference did was to underscore the often overlooked sociological proposition that the dying process is essentially social in nature.


A REVIEW OF SOCIOLOGICAL INQUIRIES

The answer to the second question about related research is more straightforward. A bit of American history shows the range of topics that has received sociological attention. In the 1930s sociological interest in death and dying had focused mainly on the economic plight of the bereaved family (Eliot 1932). In the 1950s attention turned to the high cost of dying and the commercialization of funerals (Bowman 1959). Twenty years later, it shifted to a medley of popular topics of peripheral sociological interest, with many books written on various aspects of death and dying, such as On the Side of Life; On Dying and Denying; After the Flowers Have Gone; Widow; Caretaker of the Dead; Death in the American Experience; Last Rights; Someone You Love is Dying; The Practice of Death; Grief and Mourning; No More Dying; Life After Life; The Way We Die; Death as a Fact of Life; The Immortality Factor; Facing Death; Death and Obscenity; and Living Your Dying. One sociologist termed that burst of literature a "collective bustle," and characterized the "discovery" of death during the 1970s as "the happy death movement" (Lofland 1978). There can be no argument that the topic had become more open. Furthermore, the increasing use of life-sustaining technologies dictated that the circumstances of dying became more controllable and negotiable, even as increasing proportions of all deaths were occurring in the later years.

Little Theoretical Work. Interest in death and dying was varied and diverse during the 1970s and 1980s, and no widely accepted conceptual framework for its study emerged, except that Kathy Charmaz published a seminal book titled The Social Reality of Death in 1980. Sociologists had been critical both of the title and content of Kubler-Ross's widely read book On Death and Dying (1969) but they recognized the appeal of the subject matter (Riley 1968, 1983). In earlier decades death had been typically viewed as a social transition, as a "rite de passage," but new threads running through the literature were emerging. Formal "arrangements" were being negotiated prior to death, dying persons were generally more concerned about their survivors than they were about themselves, dying individuals were able to exercise a significant degree of control over the timing of their deaths, tensions typically existed between the requirements of formal care and the wishes of dying patients, and similar tensions almost always existed between formal and informal caregivers—between hospital bureaucracies and those significant others who were soon to be bereaved (Kalish 1985a, 1985b; Riley 1970, 1983).

Little systematic attention from sociologists, however, had emerged. The Encyclopedia of the Social Sciences (1968) contained but two entries, both on the social meanings of death. Similarly, there are only two indexed references in the 1988 Handbook of Sociology (Smelser 1988): one to poverty resulting from the death of breadwinners, the other to the role of death in popular religion. Sociologists had failed to generate any overarching theory. There have been, however, many attempts. Several kernels illustrate the broad range of these theoretical efforts. Parsons (1963) related the changing meanings of death to basic social values; Mannheim (1928, 1952) used mortality to explain social change; Renee Fox (1980, 1981) found that "life and death were coming to be viewed less as absolute . . . entities. . . and more as different points on a meta-spectrum..a new theodicity"; Dorothy and David Counts (1985) specified the role of death in the various social transformations from preliterate to modern societies; Paul Baker (1990), following Lloyd Warner (1959) and others (e.g. Kearl and Rinaldi 1983) elaborated the long-recognized theory that images of the dead exert profound influences on the living, and Michael Kearl wrote a more general statement in 1989. And more recently, Fulton has published an essay on "Society and the Imperative of Death" (1994) in which he discusses the role of such customs and rituals as the Mardi Gras, the bullfight, the "Dani" of primitive societies, and other symbolic events in which either societal survival or individual salvation is at stake.

One exception to these various theoretical efforts is found in the sustained work of Marshall and collaborators. Starting in 1975 with a seminal article in The American Journal of Sociology, followed by his book Last Chapters (1980), he collaborated with Judith Levy in a review titled "Aging and Dying" (Marshall and Levy 1990). Marshall began his work with an empirical field study of socialization for impending death in a retirement village, followed by a compelling theoretical essay on age and awareness of finitude in developmental gerontology, and has been consistently engaged in such theoretical efforts. His basic postulate is that "awareness of finitude" operates as a trigger that permits socialization to death.

Empirical Research Largely Topical. In contrast to theoretical work, the empirical literature shows that sociological research on death and dying has been, and largely continues to be, essentially topical. Studies range widely, from the taboo on death to funerals and the social "causes" of death (Riley 1983; Marshall and Levy 1990). They include the following examples:

Planning for Death. A national survey conducted in the late 1960s showed that the great majority of Americans (85 percent) are quite realistic and consider it important to "try to make some plans about death," and to talk about it with those closest to them (Riley 1970). In addition, bereavement practices, once highly structured, are becoming increasingly varied and individually therapeutic; dying is feared primarily because it eliminates opportunities for self-fulfillment; and active adaptations to death tend to increase as one approaches the end of the life course (i.e. the making of wills, leaving instructions, negotiating conflicts).

Death and Dying in a Hospital. Among such studies, a detailed account of the "social organization" of death in a public hospital describes rules for dealing with the corpse (the body must be washed, catalogued, and ticketed). Dignity and bureaucratic efficiency are typically found to be at odds (Sudnow 1967). A contrasting account of hospital rules governing disposition of the body in contemporary Ireland is even more sociological in its emphasis (Prior 1989). In another hospital study the "caring issue" has been seen as the main social problem. The selfhood of the dying person is found to be at risk since the hospital is essentially dedicated to efficiency (Kalish 1985b). However, studies suggest that an increasing proportion of deaths may now be occurring at home or under hospice care, which "mediates between the families and formal institutions that constitute the social organization of death and dying" (Marshall and Levy 1990; see also Bass 1985).

The Funeral. The funeral as a social institution has long been of sociological concern (cf. Habenstein 1968). For example, a massive cross-cultural study attests to its worldwide function in marking a major social transition (Habenstein and Lamers 1963; Howarth 1996). Durkheim had emphasized its ceremonial role in facilitating social regrouping. Later sociologists have shown that elaborate and extravagant funeral rites may be more reflective of commercial interests than of human grief or mourning (Parsons and Lidz 1967).

The Bereaved Family. The now classic study (Eliot 1932) of the economic consequences of death on the family stimulated a large literature that documents the general proposition that survivors—particularly significant others—require various types of social supports to "get through" the period of intense personal grief and the more publicly expressed mourning. In today's societies, the time devoted to bereavement activities is generally shorter (Pratt 1981). This is consistent with Parsons's (1963) position that in societies characterized by an "active" orientation, the bereaved are expected to carry out their grief work quickly and privately.

Social Stressors as "Causes" of Death. Sociologists and psychologists have investigated a range of individually experienced "social stressors" as causes of death, such as bereavement and retirement. The hypothesis that a bereaved spouse is at higher risk of death (the "broken heart" syndrome, or "death causes death") has been widely investigated but with no conclusive results. Similarly, retirees in some longitudinal studies have been shown to experience excess mortality, whereas other investigations have reported opposite results. Retirement is a complex process, not a simple or single event, and the mortality impact of retirement is moot.

In an era in which nursing homes play an important role in the lives of many older people, the mortality consequences of relocation have come under critical scrutiny. Several studies have reported that the "warehousing" of the frail elderly results in increased mortality while in other studies feelings of security in the new "home" are shown to enhance a sense of well-being resulting in lower mortality. Similar caveats apply to macro-level studies that attempt to relate such collectively experienced stressors as economic depressions, wars, and technological revolutions to trends in mortality. Advances in mathematical modelling and the increasing availability of large and relevant data sets make this problem an attractive area for continuing sociological research (see Riley 1983 for details and sources).

Self-Motivated Death. Durkheim's studies of suicide spawned a wide, diverse, and sometimes confusing research literature. In most such studies social integration is the operative concept. If the theoretical relationship is believed to be unambiguous, the empirical relationship is far from tidy. The literature is vast and well beyond the reach of this review. Apart from suicide, it is a sociological truism that individuals are often socially motivated to influence the time of their own deaths. It has long been noted, for example, that both Thomas Jefferson and John Adams delayed their dying in order to participate in Independence Day celebrations. Several empirical studies have explored this so-called "anniversary effect" in which social events of significance are preceded by lower-than-expected mortality (Phillips and Feldman 1973). Such studies rest on Durkheim's insight that if some people are so detached from society that they commit suicide, others may be so attached that they postpone their deaths in order to participate in social events of great significance (Phillips and Smith 1990). An example of the mortality impact of personal and local events is seen in studies of the "birthday dip." One year-long study, in a test area, coded all obituaries for birthdates. The results were striking. Fewer than 10 percent of the deaths occurred during the three months prior to the birth date, whereas nearly half were reported during the following three months. Along similar lines, several sociological investigations have explored the proposition that some people die socially before they die biologically. These studies center on the notion of "levels of awareness" of death (Glaser and Strauss 1965). When both the dying person and his or her significant others are cognizant of death as a soon-to-beexperienced event, the ensuing "open" awareness may enable them to negotiate various aspects of the final phase of life. Other research on "dying trajectories" involves certainties and uncertainties as to the time of death (Glaser and Strauss 1968).

"The Right to Die." As a final and critical example in this review of disparate empirical work, a basic and far-reaching question is being asked: Does the individual, in a society deeply committed to the preservation of life, have a "right" to die? This has become one of the most profound, complex, and pressing issues of our time (Glick 1992). It involves the "rights" and wishes of the dying person, the "rights" and responsibilities of his or her survivors, the "rights" and obligations of attending physicians, and the "rights" and constraints of the law. The human side of such issues is producing a tidal wave of expressions of public interest in television documentaries, opinion surveys, editorials, pamphleteering, and radio talk shows. The issue of euthanasia is openly debated in leading medical journals, an unthinkable topic only a few years ago. Hospital rules, in which do not resuscitate (DNR) orders were written on blackboards then quickly erased, are being changed. Certain aspects of the issue have reached the Supreme Court. A major book has proposed the rationing of medical resources (Callahan 1987). Radical movements have sprung up that advocate active euthanasia and offer recipes for self-deliverance. Final Exit, the Hemlock Society's handbook, was an instant best-seller (Humphry 1991). The costs of the last days of life have been dramatized, sometimes spoofed as a myth (Alliance for Aging Research 1996), and sometimes reported with great care (Congressional Research Service). Jack Kevorkian, often referred to as "Dr. Death," has become both hero and despised public enemy. In short, the problems and dilemmas inherent in the "management" of death have captured both popular and scientific attention (see various issues of the Hastings Center Reports). In both instances doctors and lawyers play ambiguous but critical roles. It is, however, the "negotiation" that is of sociological interest. Norms designed to reduce the perplexities in wrenching decisions or to reassure the decision makers (including dying persons) are generally lacking (Wetle 1994). The need for relevant norms governing "the dying process" has been noted earlier (Riley and Riley 1986), and the main considerations have been specified (Logue 1989). The U. S. Office of Technology Assessment (1987) and the Hastings Center (1987) have issued medical and ethical guidelines, respectively, on the use of life-sustaining procedures. Many years ago sociologists developed research models for studying the social aspects of heroic operations and the treatment of nonsalvageable terminal patients (Fox and Swazey 1974; Crane 1975). Yet models necessary to the formation of norms capable of handling the "rights" and wishes of the various parties to the process of dying are still clearly needed. Furthermore, the conceptual problem of distinguishing between the two actors in the dying process, which the Minnesota Conference had emphasized, has not been resolved.

CURRENT ISSUES

With roots in these diverse studies, a set of three issue-laden topics cry out for more research and understanding: 1) dying individuals want a clearer voice in how their last days are to be treated; 2) policy questions are being raised that call attention to potential conflicts between the rights of individuals and the imperatives of society; and 3) programs and campaigns designed to reduce the difficulties of dying are demanding wide social action. These issues can be grouped under three shorthand labels: the living will; assisted suicide; and the quality of dying. While these issues are of great sociological interest, they are only now beginning to be framed in terms for sociological inquiry. The following discussions, consequently, rely largely on commission reports, conferences, public forums, social commentary in the media, brief reports in such journals as Omega, Issues in Law and Medicine, Journal of the American Geriatrics Society, Hospice Journal, and various unpublished materials.

The Living Will. As noted above, one of the most easily understood and practical developments in response to the dilemmas of dying in America is the "living will," the so-called durable power of attorney, or some other form of advance directive. These are quasi-legal instruments, signed by the patient, that instruct attending physicians (or surrogates) as to the patient's preferred treatment at the end of life. Such directives are widely varied as to their specificity and the conditions of application, and it is currently impossible to know how many and what types of directives have been executed. There is, however, ample evidence that they are in widespread use. Simple do-it-yourself forms are available in stationery stores, and countless specialized directives have been developed to cover a wide variety of conditions and contingencies. But both the effectiveness and the ethics of such directives have become subject to wide debate: When and under what conditions is the withdrawal of food or fluids legally and medically permissible? When may guardians or surrogates act for incompetent patients? When does the constitutional right to privacy prevail? Under what conditions may the patient refuse treatment or take the initiative and disconnect respirators or tubes? When do oral directives, if ever, take precedence over written ones? The answers to such questions tend to be moot, although a broad legal doctrine has been promulgated that bears on the availability and use of advance directives. There must be "clear and convincing evidence" that the directive accurately reflects the patient's precise intentions—or would in cases of incompetency. This legal dictum, however, has proved to be both burdensome and murky. The well-known Karen Anne Quinlan case is illustrative. This young woman "existed" in a persistent vegetative state for ten years while the legal process could determine whether Karen's parents had met the "clear and convincing evidence" test (Karen's parents had testified that they knew their daughter well enough to be certain that she would not wish to live in such circumstances). In another widely cited case, Nancy Cruzan "lived" in a similar state for seven years while the intricacies of the law were being debated. These and other such cases point to the need for more useful and practical evidentiary tests. The Hastings Center published a special supplement titled "Advance Care Planning" in 1993.

In 1990, the Patient Self-Determination Act (PSDA) raised a set of new questions. The PSDA requires hospitals, nursing homes, and health providers to inform patients of their right to prepare a living will or some document of end-of-life preferences. The significance of the PSDA was underscored by an occasionally distributed joint statement by the American Medical Association and the Harvard Medical School:

Modern medicine can keep one alive long after any reasonable prospect of mental, spiritual, or emotional life is gone. The only way for a person to retain autonomy in such a situation is to record his or her preferences for medical care before they are needed. (Published in The Harvard Health Letter and elsewhere.)

The force of the PSDA, however, has not been great and today it is generally believed that its lasting importance will be found in its power to enhance understanding of the still-developing and changing doctor-patient relationship. Indeed, the drama of that relationship has now been moved to a larger stage that involves both assisted suicide and the quality of dying.

Assisted Suicide. The role of law in cases where patients or their surrogates seek to control end-of-life decisions has always been debated. The early cases in the 1950s and 1960s had revolved around "informed consent." This rule surfaced when medical treatments resulted in unanticipated negative consequences, and when it could be shown that the patient had not been informed of the risks. Not surprisingly, this rule led to more complicated ones and, during the 1970s, the increasing demand for patient control resulted in an implied "right" to die by refusing treatment. Of sociological interest, it was popular experience—not statutory law or court decisions—that was bringing about social change (see M. W. Riley 1978 for a theoretical statement). Nor was it long before demands for the "right" to receive treatments specifically designed to hasten death were seriously being discussed and in some states actually outlawed. As these events unfolded they have been reported by major news services, and analyzed by Hastings Center reports beginning in 1995.

In 1996 the U.S. Court of Appeals for the Ninth Circuit struck down a Washington state statute that had been passed specifically to deny such a right. The presiding judge included this noteworthy statement:

A competent, terminally ill adult, having lived nearly the full measure of his life, has a strong liberty interest in choosing a dignified andhumane death rather than being reduced at the end of his existence to a childlike state of helplessness—diapered, sedated, incompetent.

The case was striking not only for its human interest but also because it invoked the guarantee of personal liberty in the Fourteenth Amendment to the U.S. Constitution. Shortly thereafter a New York statute was struck down by the U.S. Court of Appeals for the Second Circuit (Quill 1996), which had argued that if physicians were allowed to help people die it would put society on a slippery slope leading inevitably to abuse. The court pointed out, however, that physicians are not killers if they prescribe drugs to hasten death any more than they are killers when they discontinue life supports.

As expected, both cases were sent to the U.S. Supreme Court which has, at this writing, let stand state laws that prohibit any form of physician-assisted suicide. But the issue is far from settled. The Court's decision concluded with this surprising statement by Chief Justice Rehnquist:

Throughout the nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician-assisted suicide. Our holding permits this debate to continue.

This statement was all the more remarkable since the chief justice, in his long opinion, rejected both the "liberty" and "due process" constitutional arguments, but came far short of putting the matter to rest. Indeed, continuing developments indicate that the question of physician-assisted suicide is not likely to go away soon. For example, the State of Oregon has passed two voter referenda, the most recent in 1998 with a 60 percent majority support which makes Oregon the only state (as of 1998) to permit, under strict conditions, physician-assisted suicide. The State of Michigan has rejected an Oregon-type statute and has finally convicted Dr. Kevorkian of second degree murder. Several other states are reported to be experimenting with alternatives that enhance the "right" of the individual to choose to die (for details of these developments see The Hastings Center reports). It may be that the law is overreaching its capacity to deal with such a basic and philosophical issue. The question is profound. Is there any logical (or sociological) difference between the right to refuse treatment designed to prolong life and a parallel right to receive treatment designed to hasten death? Sociologists would ask: What is the distinction between the acceptance of death and its acceleration? Is the question so abstract that it defies empirical inquiry? Both the medical and legal answers to the issue are ambiguous and have been discussed in a book by a physician who publicly admitted helping a patient to die. Dr. Timothy Quill not only was the main plaintiff in the New York case, but he has become the leading medical voice on issues of assisted suicide. He writes with authority and sensitivity: "Death seems antithetical to modern medicine—no longer a natural and inevitable part of the life cycle, but a medical failure to be fought off, ignored, and minimized. The dark side of this desperate battle has patients spending their last days in the intensive care units of acute hospitals, tubes inserted into every body part, vainly trying to forestall death's inevitability. No one wants to die, but if we have to, there must be a better way" (for an account of the issues see Quill 1996).

The Quality of Dying. Sociological concern with assisted suicide has been paralleled with concern for how people die. It had been hoped that the PSDA not only would make advance directives more effective, but would also bring about better communications between doctors and terminal patients. The act, however, was deemed a failure even before it was formally put in place. An impressive experiment, of great sociological interest, was designed to solve these basic issues. Funded and launched by the Robert Wood Johnson Foundation, it was the advance directive problem cast in research terms. The "Study to Understand Prognoses and Preferences in Risks of Treatment" carried such an unwieldy title that it was quickly shortened to the acronym SUPPORT (for a detailed account see The Hastings Center special supplement that carries the subtitle "The Lessons of SUPPORT" 1995). Five teaching hospitals were invited to participate in this multimillion dollar project. Phase One called for baseline data on the end-of-life experiences of some 9,000 dying patients. When the data were analyzed, the researchers were not surprised to find much to criticize in various regimens of hospital care. Their main finding, however, was that doctors and attending nurses must attend not only to the physical comfort and pain management needs of patients but, more importantly, to their psychosocial needs. Phase Two, consequently, called for experimentation. The 9,000 cases were randomized and an experimental intervention consisting of a protocol designed to sensitize doctors to attend more closely to psychosocial needs was administered to one-half of the cases and withheld from the other half, which had served as a control group. The experiment was continued for two years and expectations were high. Much to the chagrin of the study directors, when the two groups were compared, no differences were found! The experimental intervention showed no effects. This negative finding was so shocking that a number of evaluation panels were enlisted to reanalyze the data and scrutinize the research design. Their efforts, however, only served to corroborate the original analysis and Daniel Callahan (1995), then president of The Hastings Center, concluded with this statement, "This painstaking scrutiny into how people die only goes to show how difficult it is to make the process any better. . . We thought that the care of dying patients could be set right by . . . some good talk between doctor and patient . . . we thought that we just needed reform . . . it is now obvious that we need a revolution" (Callahan 1995).

Callahan's dramatic statement had the effect of nourishing a spate of organizations and proposals that had sprung up to improve the care of dying patients. For example "Project Death in America" (PDIA), centered at Sloan Kettering Hospital in New York was funded by the billionaire George Soros; the "Center to Improve Care of the Dying" (CICD), based in the George Washington Medical School and originally funded by the Retirement Research Foundation in 1995, enjoys wide institutional support and in 1997 launched a program for individual advocacy, "Americans for Better Care of the Dying" (ABCD); the American Board of Internal Medicine (ABIM) began publishing educational materials on techniques to improve care of the dying in 1996; and the American Medical Association (AMA) began alerting its members to the most recent developments in end-of-life care. And finally, the Robert Wood Johnson Foundation, which has long served as the collective voice for issues on dying, launched "Last Acts" in 1997, which is designed to involve the public through such participating organizations as the Institute of Medicine, the American Hospital Association, the Health Care Financing Administration, the National Hospice Organization, the Veterans Health Administration, the American College of Physicians, and a host of specialized associations such as the American Pain Society, the American Cancer Society, Choice in Dying, Partnership for Organ Donation, Memorial Societies of America, Wellness Councils of America, and on and on. Former First Lady Roslyn Carter, in a nationally broadcast speech, proclaimed that, "We need this coalition so that fewer people will die alone, in pain, and attached to machines, with the result that more people. . . can experience dying for what it ought to be. . . the last act in the journey of life." The President of the Robert Wood Johnson Foundation was both optimistic and enthusiastic:

With all that is going on. . . we are seizing the moment, "Last Acts" will be much more than platitudes about a good death. . . it will undertake to improve care at the end of life. . . If the campaign succeeds . . . we will find a significant decrease in the number of people dying in pain, an increase in referrals to hospice, more people dying at home outside the hospital, and fewer requests for physician-assisted suicide (1997).

If, however, the campaign does not live up to expectations, the foundation will work with the American Medical Association "on helping physicians to work with patients on advance care planning, and providing opportunities for physicians to increase their skills in palliative medicine and comfort care." It is too early to estimate the long-term effects of this blizzard of efforts to improve the way people die, but it is not too early to predict that any improvements in the quality of dying based only on comfort care are likely to be short term. But change is in the air. Dying persons are pressing for more participation in when and how they die, and caregivers are coming under increasing criticism of the limitations of their caring regimens.


AN EVOLVING PERSPECTIVE

As indicated by this review of past research and current issues, the limitations of both legal and medical approaches to the problems of dying in contemporary society mean that the perspectives of sociology will be brought to bear. Perhaps future sociological attention will focus on the uniquely sociological principle that the dying process is not understandable in individual terms. This, in turn, provokes a series of predictions: Sociologists will focus on how dying persons are defined by their survivors and caregivers as well as on the sociological hypothesis that dying persons are more concerned for others than they are for themselves. Sociologists will be required to disentangle the concatenation of forces that has produced today's caregiving regimens in which terminal patients tend to be treated more as objects than as persons. Sociologists will be asked to explain how the process of socialization has seemingly been reversed, with the individual being figuratively stripped of years of social experience and defined as a nonperson. In effect, sociologists will be asked to explain the historical alchemy whereby dying persons themselves have been conned into believing that all they needed was palliation and comfort care.


references

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John W. Riley, Jr.

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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.

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 .

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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

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 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


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.

Poe, Edgar Allan. "The Philosophy of Composition." 1846. In Essays and Reviews, edited by G. R. Thompson, pp. 13–25. New York: Library of America, 1984.

Stowe, Harriet Beecher. Uncle Tom's Cabin; or, Life among the Lowly. 1852. In Three Novels, edited by Kathryn Kish Sklar, pp. 1–519. New York: Library of America, 1982.

Secondary Works

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.

Levine, Robert S. Martin Delany, Frederick Douglass, and the Politics of Representative Identity. Chapel Hill: University of North Carolina Press, 1997.

Sundquist, Eric J. To Wake the Nations: Race in the Making of American Literature. Cambridge, Mass: Harvard University Press, 1993.

Tompkins, Jane. Sensational Designs: The Cultural Work ofAmerican Fiction, 1790–1860. New York: Oxford University Press, 1985.

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

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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