Focusing on the US and, to a lesser extent, Northern Europe, Haider Warraich’s Modern Death: How medicine changed the end of life identifies how far-reaching these changes are. A physician and clinical researcher, Warraich is well placed to observe the dubious implications of an expanded medicalization of death. Most people want to die at home, but the majority continue to die in hospital, surrounded by medical equipment. In general, life expectancy in the past century has increased, but so has the use of medicine to prolong it artificially. Definitions of death have grown more complicated – does it lie in brain function or in the heart and lungs? – and are openly contested. And despite what Warraich calls medicine’s “obsession” with preventing or delaying death, there is no clear provision for bereaved families. That task waits to be taken up. Kathryn Mannix agrees in With the End in Mind: Dying, death and wisdom in an age of denial, suggesting that it “has become taboo to mention dying”. Through a “gradual transition”, Mannix says, we have lost the vocabulary for talking about death and depend instead on euphemism, lies and ambiguity; she wants us to “reclaim” a language of death.
This is a recurring theme among these seven books. For some, our inability to talk straight about death and dying is partly about the mystery of the end. Andrew Stark, in The Consolations of Mortality: Making sense of death, identifies the decline in religion in the West and the idea of the afterlife as pivotal to our lack of confidence in confronting death. Robert McCrum, in Every Third Thought: on life, death and the endgame, speculates that ageing and death present a particular conundrum to self-assured baby boomers, who try to give death the slip (“let’s talk about it another time . . .”). In From Here to Eternity: Travelling the world to find the good death, Caitlin Doughty expands the problem into a generic Western culture of death “avoidance” – we duck awkward conversations with the dying, hand our corpses to corporate professionals and, worst of all, treat grief with embarrassment and shame. Kevin Toolis, in My Father’s Wake: How the Irish teach us to live, love and die, describes a veritable “Western Death Machine”, in which public services, health professionals, the media and corporate bodies all conspire towards the removal of death and dying from the purview of ordinary people. A former war correspondent, Toolis has seen more than his fair share of death and is here to shake us out of our complacency.
The measure for our current climate of denial is typically set against an assumed past where we were collectively better at death. The pinnacle of this “Golden Age”, the so-called Celebration of Death, was the nineteenth century, when religions helped to explain death and provide a set of shared practices for marking our passage into it. Consumer culture provided a public medium for expressing loss and offering condolence, from the burgeoning trade in mourning – exemplified by the rise of the mid-Victorian death superstore Jays’ Mourning Warehouse, on Regent Street – to the birth of the “With Sympathy” condolence card where ready-made sentiment overcomes the awkwardness of finding something meaningful to say. Most important of all, high death rates and low expectations of medicine (beyond palliation) meant that families commonly experienced death within their home. It is the loss of this familiarity with death that is most lamented by Toolis, who relates the story of his elderly father’s peaceful death at home in rural Ireland, contrasting a disappearing world of traditional community-based rites of passage – keening, the help of a death (or soul) “midwife”, washing the corpse, and the “steady stream” of visitors who arrive with simple words of condolence (“Sorry for your loss”) – with our “modern” culture of hygiene, individualism and emotional reticence. The author isn’t subtle about which culture he prefers. Over in “Anglo-Saxon land”, we whisper about death, “putting our hands over our ears, blinding ourselves with the Western Death Machine”, but it doesn’t change anything: “it just leaves you naked and exposed”.
Doughty finds something similar to the Irish way in nineteenth-century America, where death was a family and community affair, while Mannix identifies a pre-1950s culture in the West of accumulated “rich wisdom” garnered from observing death and dying at close quarters. Stark, however, draws on a more generic “wisdom of ages” to outline four propositions that might provide solace in a secular age (again, the assumption is that religion once provided the consolation that we postmodern “bundles of ego and anxiety” now lack): death is benign; mortality can imitate the good things about immortality (notably, technology facilitates the preservation of treasured memories granting us virtual immortality, at least); immortality would be grim; and life, suffused with repeated loss and suffering, might not be terribly different to death anyway. Stark concludes that none of the propositions really provides much consolation after all, and suggests that perhaps the only real consolation comes with the knowledge that we are continually moving towards death. But is it even true that, as all these authors suggest, people in times past did not face the same difficulties?
At the end of the nineteenth century, only 2 per cent of the UK population had a non-religious burial service. In 2010, in the UK, only 27 per cent of respondents to an ICM poll wanted a religious funeral. In the past, public narratives of death were heavily inflected with heavenly reunion. The Victorians spent vast amounts of money on death, propelling the humble carpenter into big funeral business and changing the urban landscape with magnificent cemeteries. Mourning was a fashion extravaganza, from shroud couture to ear trumpets in black crêpe. Framed post-mortem photographs hung over glass-domed “immortelle” displays, while the bereaved wore elaborate jewellery made of the deceased’s hair. These practices clearly favoured those with money, but a creative culture of improvisation and exchange meant that even the less affluent could participate in some tokens of mourning. A combination of consumerism and spirituality provided a range of vocabularies for communicating death. Undoubtedly, most people died at home and, until the rise of the mortuary (or “Chapel of Rest”) in the early twentieth century, most corpses remained there until burial.
Gorer set the tone for holding this culture as death par excellence. It received strong endorsement from Philippe Ariès, whose The Hour of Our Death (1981) was the first comprehensive survey of Western death cultures from the Middles Ages to the present day. Both Gorer and Ariès saw the nineteenth century as offering tangible psychological support to the dying and those who mourned them. Modern death, in contrast, was privatized, medicalized and emotionally stunted. Toolis is a clear heir to this ideological view of two divergent death worlds. The real villains in his story are less the health practitioners, coroners, or funeral directors, than Western capitalism as a whole with its obsession with material success and longevity. The irony for Toolis is that amid all this “eager capitalism” there isn’t more cutthroat competition: a FixUpYourFuneral.com price comparison website or an UberHearse app. And, writing from the frontline of Toolis’s “Western Death Machine”, Doughty, who runs a funeral parlour in Los Angeles, agrees. America is home to the most commercial, corporate death culture in modern times. In Doughty’s words, the US is now the best in the world at separating the grieving from their dead. Americans have become “squeamish”, which makes death both expensive and emotionally unsatisfactory. Doughty is on the side of angels: her funeral home enables mourners to do death in the old style, involving friends and family in traditional rites such as washing and dressing the corpse and building the coffin.
Criticism of, and attempts to row back on, the commercialization of death and its seemingly fake emotion isn’t new, though; it was just as prevalent in the nineteenth century, when Dickens railed at the skewed sense of priorities whereby “everything that money could do was done”, so “feathers waved, horses snorted, silk and velvets fluttered”, but weeping with genuine grief, as old Chuffey does at his master’s funeral in Martin Chuzzlewit, was mawkish and embarrassing. To eulogize traditional death rites is problematic in other ways, too. Getting more people to die at home has been a stated goal of successive British governments. But the idea is founded on romanticized notions of what dying at home involves. It is cheap for the state but exacts a heavy cost on family life. It is also heavily gendered. Even with access to palliative care nurses, caring for the dying involves a lot of gruelling work, which has historically fallen to women, who also undertake the majority of emotional labour for the bereaved, not to mention the catering. Toolis, in his account, smokes, drinks and eats the sandwiches the women have made. Most of these “traditional” rites were, in their own time and place, contested, too. Religion brought recrimination as well as consolation. Elaborate codes of mourning created an oppressive regime of sentiment that some people did not feel. For others, the location of personal loss in a public context was intolerable. Some bereaved families felt supported by visitors; others deeply resented the intrusion and the effort required to be hospitable. If the public nature of mourning created material expectations around what grief looked like, it also provided scope for the cruellest social exclusion. Families who could not buy grave space, for example, were humiliated by having to surrender their dead to a public grave. The clue is in the name: public in that they contained multiple corpses unrelated except by poverty, and public in declaring the family’s shame.
Finally, the idea of community is deeply ambiguous, too. Fear of contagion militated against communality, while some families were afraid of the dying who, extremely sick, could change beyond recognition. As Daniel Miller shows, plenty of people died lonely deaths at home in the past and where community did exist, it was often born of necessity, not choice. Against this backdrop, Miller explores social relationships at the end of life through a collation of patient narratives taken from one hospice and biased towards people from rural communities now. Some of his narrators appear relatively lonely and socially isolated, partly from preferences for privacy, independence and a desire not to impose on others. Miller, an anthropologist, is one of the few writers here to confront our nostalgic view of the good death and to question the extent to which the challenges we associate with dying and isolation are manifestations of recent social fragmentation. For one thing, as The Comfort of People reminds us, “community” was often the result of poverty and the need to share resources; it compromised privacy and independence. It did not necessarily correlate to emotional succour and support.
In short, there was never a time when we did death well. James Turner lost his daughter in Halifax in 1882, not 2018. An unskilled labourer living in a context where children were expected to die before the age of one, he might have been expected to be au fait with death. But he wasn’t. He didn’t know what death looked like, he didn’t want to talk about it, he didn’t want neighbours prying, he didn’t go to church, and only his immediate family attended the funeral. We know this because he wrote about it in his diary. And he was not an exception. At the other end of the social scale, families were equally caught between a social script that demanded spiritual contrition and “celebration” and their private processes of anguish, rage and religious doubt. Some of the authors here tacitly acknowledge that we might cope better with death if we unshackled ourselves from nostalgia for cultures that didn’t really exist in the first place.
For Doughty, then, the challenge is not how to recover the past, but rather how to engage with the “spectacular” rites of passage she finds now: including the periodic cleaning of unwrapped mummified corpses in Tana Toraja (Indonesia), the Fiesta de la Ñatitas (the veneration of human skulls) in La Paz, Bolivia, and eco innovations, such as corpse composting in North Carolina – this last, still in the design stage, would transform human remains into nutrient rich soil within six weeks, reducing land use (burial) and toxic pollutants (cremation). Since Doughty is a funeral director, it is not surprising that her chief interest lies in what we do with the corpse, and her enthusiasm for the manifold options is all but infectious. While lamenting commercialization, her survey includes tech-savvy approaches to remains, notably the Ruriden columbarium in Tokyo, where smartcards allow visitors to identify individual sets of remains in an archive of thousands; once activated, an illuminated Buddha will signal the position of the remains, and give mourners something to focus on. If her aim is to demolish a culture of squeamishness, then her descriptions of such practices are the first blows. But Doughty’s major point is that Western customs don’t create what she calls a “holding space” – a temporal, emotional and spatial interlude – where the bereaved can “grieve openly and honestly without being judged”. The practices of other societies illuminate the shortcomings, or absurdities, of our own.
Mannix doesn’t suggest a return to the death practices of yore, either. Denial, she says, stems from fear and ignorance; when dying is demystified, it is less terrifying. It is notable that her manifesto for looking death in the eye is rooted in personal, rather than historical, experience. With the End in Mind collates case histories from Mannix’s career in palliative care to elucidate patterns of physiological and psychological change that mark various stages of death, including the emotional challenges of navigating conversations about dying, contemplating the legacies we leave and, most of all, learning how to live at the end of life. Mannix sets the stories in an explanatory framework, which could have come across as didactic; in fact, her tone is that of a wise storyteller, telling us about Dan, a young man with Duchenne Muscular Dystrophy who overcomes suicidal feelings in favour of making the most of life at the end; relating the resourcefulness of family and friends who carry fragile Holly, restless with manic energy in the hours before death, from her low-rise flat to an impromptu party; and introducing us to Nelly and Joe, married for fifty years, who believe that their individual refusal to name death is protecting the other from unbearable knowledge. Each narrative runs like a fable on the incredible resourcefulness of humanity in the face of death. Affecting in their simplicity, the range of stories support Mannix’s contention that death has recognizable patterns from which we can learn strategies for managing better. Many of her stories are moving because they bear witness to the expansive emotional reserves of sick individuals and their families including, in some cases, their pets. In one account, Walter slips into death supported by his partner, adult daughters and faithful collie dog, Sweep, who has refused to move from under his bed for days. In another, Bob, an apparently anti-social man with cancer of the tongue, has refused medical assistance from fear of having to leave his cat. In the event, the cat too moves into the hospice and lies alongside Bob as he dies.
For all the references to a thriving death taboo, one thing these books make clear is that there is a long history of conversation about death – although it tends overwhelmingly to be in written form, as with James Turner’s diary. And the literary critic McCrum’s otherwise rather slight volume is worthwhile for locating conversations about dying now (including with the surgeon Henry Marsh and the neurologist Andrew Lees) in a cornucopia of vignettes from literature, including insights from Shakespeare’s Mistress Quickly on the enigma of faith at Falstaff’s death in Henry V, Donne’s “bleak formula” that “No man hath affliction enough that is not matured and ripened by it” (apt given Robert McCrum’s experience of having survived a stroke at the age of forty-two), and those recorded by the biographer James Boswell of the irreverent David Hume, who was unwilling to renounce the Devil on his deathbed because “now is not the time to be making new enemies”. Could writing be our comfort now? Modern Death and The Comfort of People point to increased use of social media to access and discuss information about end of life and post-mortem possibilities, connect the dying with the world around them, and extend commemoration beyond time and place. This is a new kind of community, quite different to that problematized by Daniel Miller. As for Caitlin Doughty, she wants us to grieve honestly, which also means creating space for anger, ambivalence and resentment. It is deeply flawed but social media offers a platform for this, too.
So it seems we are open to talking about death, only that the language and spaces we use to do so shifts constantly. The mistake is to think that these spaces were ever uncomplicated; the lesson, that we should stop giving ourselves a hard time about it. Death is hard enough already.
