Denial of Death? - Dilettante Army

Denial of Death?
In my last article, I introduced how the need for a shift in funeral practices advocated by the self-defined “death positive” movement is predicated upon the idea that “death itself is natural, but the death anxiety and terror of modern culture are not.” The three projects discussed (Coeio, Capsula Mundi, and the Order of the Good Death) all refer explicitly, in their websites or in interviews, to the fact that death is a taboo in modern society, one which their innovative approaches are intended to confront. Such confrontation, which aims to accept the naturalness of our mortality, is seen by the death-positive movement as ultimately beneficial, although it remains unclear precisely in what terms. The manifesto of the movement clearly exemplifies these assumptions, being entirely based on the supposition that death is somehow denied in modern Western society. The Order of the Good Death encourages its participants to break the “culture of silence” around death.
However, there are good reasons to believe that the grounding claim upon which groups such as the Order of the Good Death predicate their importance, namely the idea that death is a taboo in our society, and that the infringement of such a taboo is beneficial, is unsubstantial if not entirely false. In this article, I criticise the premises of the death-positive movement, discussing the evidence that has been advanced to disprove the definition of Western society as death-denying.
First of all, let us define the terms. Author and end-of-life expert Allan Kellehear argues that the idea of death denial seems to have first emerged in psychoanalysis to describe, among other things, the attempt to avoid the prospect of the annihilation of the ego.[1] And in The Denial of Death, Ernst Becker famously argued that fear of death is the greatest catalyst to human invention and creativity, and that heroism is an attempt to overcome and deny the finitude of human existence. According to Kellehear, this universalizing psychoanalytical concept, which assumes that death denial is a natural human response to the fear of death, was then adopted by the social sciences, and Western society at large came to be seen as death-denying.
Woodcut illustration from Ars Moriendi, a tractus on dying first published in 1415. Image via Pallimed.
Philippe Ariès, another author who did much to provide a historical context to the denial of death thesis, popularized this narrative in his monumental The Hour of Our Death. The argument goes as follows: from an initial condition of indifference or familiarity with the idea of dying, death gradually began to inspire horror, and was repulsed to the margins of society. In the past, a series of institutions and practices prepared individuals for the coming of the last hour. The presence of the clergy in the life of common people, the production of treaties on how to conclude one’s life with a “good death,” the writing of the will, and the abundance of practices surrounding mourning were part of a social fabric which wrapped death in an aura of familiarity and predictability. Such practices being in place, in the circumstance of a death people would perform socially defined roles which left nothing to chance. From the ritual of the last words to the prayers for the dead included in homilies, death was experienced in a public dimension. By contrast, Ariès argues, the 20th century marked a definite and sudden shift in such practices. The dying were hospitalized instead of being cared for at home, and death began to be medicalized. This, according to Aries, caused a shift in the understanding of death, which came to be equated with disease, something dirty and contaminating which needed to be concealed in the rooms of clinics. Progressively, death lost its public connotation, such as the overt display of grief at funerals and the communal recitation of prayers for the dead, and mourning became a private matter. Cemeteries, once lively centers where public events such as executions, announcements and commerce took place, were confined to the outskirts of towns for sanitary reasons. The disappearance of the roles which people acquired in the circumstances of a death (the confessor, the mourner, the doctor who prepared patients for death rather than curing them) led to a dislodging of death from social relations and to confining the last hours to the secret of the hospital, away from the eyes of society. Death came to be seen as dirty, repulsive, and, to the detriment of the bereaved, an inappropriate topic of conversation.
Ariès’s narrative, especially concerning the assumedly alienating effects of medicalization, is upheld by the Order of the Good Death and the proponents of Death Education. Death Education, also known as thanatology, is a field of study dedicated to bereavement counselling, grief-therapy, and care of the dying. Its vision, at least according to the Association for Death Education and Counseling, appears to be rather broad:
The Association for Death Education and Counseling® envisions a world in which dying, death, and bereavement are recognized as fundamental and significant aspects of the human experience.[2]
Both the Order of the Good Death and Death Education purport to shatter what Elizabeth Kubler-Ross defined as a conspiracy of silence,[3] bringing the supposed exclusion of death from public discussion to an end. Yet, despite the fact that The Hour of Our Death is the product of a spectacular amount of research, the evidence provided by Ariès in support of his thesis is virtually nonexistent and arguments are entirely speculative, as the author quickly glides over the emergence of the taboo of death in the twentieth century. The shifts described are entirely theoretical, and they contradict Ariès’s initial intention of demonstrating how mental and attitudinal changes were reflected in physical and material changes.[4] By as early as 1984, Kellehear stated that the idea of the taboo of death was untenable, and that “Western societies are not “death-denying” by any of the major criteria posed in the literature on the subject.”[5]
Like other scholars who challenge the denial-of-death thesis, Kellehear does not deny that, in the present day, people are less familiar with death than they would have been a century ago, when the average person would have witnessed several deaths due to the inefficiency of medical treatment. But he still opposes the notion that death is being ignored, avoided, or denied to the point of being considered the greatest taboo in contemporary Western society. In particular, he opposes the understanding of medicalization as a form of denial. Since dying, in modern times, occurs in hospitals, death has certainly been increasingly conflated with illness, becoming a “technology intensive and potentially contaminating situation in need of sanitising”.[6] Yet, while death has been re-interpreted, this new interpretation is not denial. Likewise, embalming is used as a classical example of death denial because it delays the visible symptoms of decomposition, but it is interpreted by Kellehear as merely a manifestation of a capitalist strategy and a general concern (common also to the living) for the preservation of physical appearance. Funeral firms, he argues, succeed in promoting embalming not because it denies death by avoiding the disfigurement of the corpse, but because they recognize the marketability of the beautification of the body. After all, in natural funerals the body is also arranged and composed, albeit without chemicals, to simulate sleep.
Kellehear challenges as well the reluctance to speak about death or show grief in public, which is often advanced as further evidence of death-denial. Such reluctance, he argues, is not much dissimilar from the one characterizing situations in which people avoid difficult or personal topics, as well as excessive manifestations of feeling, in polite company; reserve and self-control are traditional middle-class values. Thus, Kellehear ultimately establishes a distinction between individual behaviour and collective, societal behavior. While individuals can refuse to acknowledge their own mortality, just as they can cry, laugh, or experience sorrow, personal psychological reactions must not be conflated with societal processes, as societies “do not deny death but instead organise for it and around it”.[7]
Another convincing case against the narrative of death denial has been made by Zimmermann and Rodin in “The denial of death thesis: sociological critique and implications for palliative care.” The authors make reference in particular to “The Pornography of Death,”[8] in which Gorer argued not only that death had substituted sexuality as the great taboo of Western society, but also that it was harmful and morally wrong not to openly speak about dying. This idea finds fertile ground in clinical medicine to the present day: through a literature search, Zimmermann and Rodin discovered that clinical literature, especially in relation to palliative care, uncritically embraced this idea, neglecting or ignoring evidence to the contrary. In the literature analyzed by the authors, the negative effect of the taboo on dying patients was commonly emphasized: the dying supposedly want to know they are dying, but the culture of silence surrounding death does a disservice to such patients by preventing them from freely discussing their mortality.[9]
Despite its presence in the literature, Zimmermann and Rodin state that the idea that conversations on death are shut down is hardly tenable. In sociologist Lofland’s words, “one might consider it somewhat odd that the statement that death is a taboo topic in America should continue to be asserted in the face of nearly a decade of nonstop talking on the subject.”[10] More ironic still, despite the omnipresence of death in the media, reports on the subjects are conventionally introduced by the assumption that death is a taboo.
Like Kellehear, Zimmerman and Rodin also contest the equation of medicalization with death denial. Speaking of the dying in a medical context is a consequence of understanding our demise as a scientific reality and attempting to tackle it scientifically.[11] Similarly, the institutionalization of death and dying is not a willful segregation of a process which is perceived as repulsive, but the result of bureaucratization, which is “our characteristic form of social structure.”[12]
In “Death denial: obstacle or instrument for palliative care? An analysis of clinical literature,” Zimmermann evaluates the implications of the death denial thesis. She discusses how denial, as implied by the grounding principles of Death Education and the Order of the Good Death, is assumed to stand in the way of open discussion of dying, of dying at home, of care/funeral planning, and of stopping “futile” treatments.[13] In particular, she focuses on how openly talking about death came to be perceived as useful, while refusing to speak about dying in palliative care situations became labelled as an obstacle and even as lying. This generated a moral discourse defining “a ‘right’ and a ‘wrong’ way to die, the right way being exemplified in the creation of the ideal of the ‘good death’ […] and the wrong way represented by the demon of death denial.”[14] Thus, although the rationale of the projects I presented in the previous article is purportedly a rejection of the uncritical acceptance of the status quo, such innovations are actually generating a newly prescribed way of dying, where a good, responsible death includes openly talking about death, making funeral plans in advance, choosing to die or to be displayed at home instead of in a hospital, with deviations from such a pattern being labelled as denying or impersonal.
Although I am still researching on the topic, I believe that the evidence presented in the articles I discussed exposes the lack of substance behind the taboo of death, and I find it particularly disturbing that a variety of associations, groups, and publications still predicate their importance upon a claim which, aside from being most likely baseless, manufactures an imaginary enemy against which a whole body of more or less mediocre scholarship can justify its existence by claiming a role in contributing to shattering the taboo. As Novalis wrote, “History is one great anecdote,” and the denial of death thesis appears more as a story we like to tell about ourselves, a story which once more counterposes a romanticized vision of harmonious social relationships against the technological, alienating order of the present day.