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Edited by Dennis R Cooley & Lloyd Steffen Re-Imaging Death and Dying Probing the Boundaries Series Editors Dr Robert Fisher Dr Nancy Billias Advisory Board Dr Alejandro Cervantes-Carson Dr Peter Mario Kreuter Professor Margaret Chatterjee Martin McGoldrick Dr Wayne Cristaudo Revd Stephen Morris Mira Crouch Professor John Parry Dr Phil Fitzsimmons Paul Reynolds Professor Asa Kasher Professor Peter Twohig Owen Kelly Professor S Ram Vemuri Revd Dr Kenneth Wilson, O.B.E A Probing the Boundaries research and publications project. http://www.inter-disciplinary.net/probing-the-boundaries/ The Making Sense Of: Hub ‘MSO: Dying and Death’ Re-Imaging Death and Dying Edited by Dennis R Cooley and Llyod Steffen Inter-Disciplinary Press Oxford, United Kingdom © Inter-Disciplinary Press 2009 http://www.inter-disciplinary.net/publishing/id-press/ The Inter-Disciplinary Press is part of Inter-Disciplinary.Net – a global network for research and publishing. The Inter-Disciplinary Press aims to promote and encourage the kind of work which is collaborative, innovative, imaginative, and which provides an exemplar for inter-disciplinary and multidisciplinary publishing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means without the prior permission of Inter-Disciplinary Press. Inter-Disciplinary Press, Priory House, 149B Wroslyn Road, Freeland, Oxfordshire. OX29 8HR, United Kingdom. +44 (0)1993 882087 British Library Cataloguing in Publication Data. A catalogue record for this book is available from the British Library. ISBN: 978-1-904710-82-0 First published in the United Kingdom in eBook format in 2009. First Edition. Table of Contents Introduction Dennis R. Cooley and Lloyd Steffen PART I ix Philosophical Re-Imaging Pragmatic Immortality and the Insignificance of My Own Death Peter Caws 3 Concepts of Value, Attitudes toward Death Stephen E. Rosenbaum 15 There Is Good Hope That Death Is a Blessing J. F. Humphrey 25 Dignity of the Dead? Julia Apollonia Glahn 33 The Haunt/ Demons and The Complex of Noon Tolulope Onabolu The Concept of Death in Children’s And Juvenile Literature - Reading and Interpreting Death in The Book Thief by Markus Zusak Maria Kissova The Confrontation with Death from Rilke to Heidegger Jacob N. Graham Burial Law as View-Point towards Death Wim Cappers To Death - To Life: Grounding Sigurd Lewerentz and Erik Gunnar Asplund’s Tallum Cemetery Courtney D. Coyne-Jensen 43 57 69 77 85 Heroic Death and Selective Memory: The U.S.’s WWII Memorial & The U.S.S.R.’s Monument to The Heroic Defenders of Leningrad Susan M. Behuniak Rethinking and Recognizing Genocide: The British and the Case of the Great Irish Potato Famine Neysa King Death in Self-harmers’ Eyes Namino Kunitoh PART II 113 123 Communication Re-Imaging Analysis of Terminally Ill Patients’ Weblogs Using the Linguistic Inquiry and Word Count (LIWC) Program Nothando Ngwenya, Stella Mills, and Paul Kingston 135 Archiving Grief: (Re-) Writing Histories in the Aftermath of Loss Nate Hinerman 151 Communicating with the Dead through the Newspaper: A Quantitative and Qualitative Analysis Patricia L. Bromley and Mitte J.A. Nimocks Agencies of the Afterlife: Weblogs and Television Shows on Death in the Netherlands Marga Altena PART III 99 163 173 Ethical Re-Imaging Physician-Assisted Suicide and the Supreme Court: A Decade in the Life of a Constitutional Issue That’s “Not Dead Yet” Arthur G. Svenson and Susan M. Behuniak 183 The Ethics of Patient Non-Treatment Lloyd Steffen 201 What's Wrong with the Brain Death Debate? Joseph Wang 215 Death & Justice: An Ethical Response to Massacre Vanessa Fredericks 227 Kantian Obligatory Suicide: Further Developments Dennis R. Cooley PART IV 237 Experiencing Re-Imaging “I’d Rather Be Home All My Life”: Older People and Place Care at the End of Life Eileen Sutton and Joanna Coast Waiting for Death: An Exploration of Suicide and Old Age in Ireland Christine De Largy To Worship God or Celebrate a Life: Conflicting Scottish Perspectives on Funerals? Glenys Caswell Quasi-Widowhood: Crossing Boundaries of Marriage, Divorce, and Death Jacque Lynn Foltyn The Survivor’s Guilt: The Case of Cancer Shulamith Kreitler, Frida Barak, and Nava Siegelman-Danieli Bereaved Employees, Professional Activity and Pain of Loss Marc-Antoine Berthod 249 261 277 285 297 307 Introduction Re-Imaging Death and Dying Dennis R. Cooley and Lloyd Steffen Apprehension – some might call it an outright fear - surrounds the efforts to investigate, analyse, or discuss the inescapably profound experiences of dying and death. Most people have encountered death and its consequences in their own lives in some way; many have suffered from a loved one’s dying process. The experiences associated with dying, especially in regards to a loved one, are not abstract but emotionally involving and very personal, and discussion can be provocative and emotionally arousing. It is even possible that conversations that open on the topics of dying or death may include participants who are themselves dying or undergoing a grief or mourning experience that makes them much more sensitive to the subject than would otherwise would be the case. So the topic is itself an emotionally sensitive one, and sensitive people do not want to cause hurt or offend. The result is that there are so many difficult and complex emotions involved in death and dying issues that, at times, it is hard to focus clearly on the cognitive aspects.1 The prospect of hurt feelings does not, however, provide adequate grounds to avoid controversial issues. The central flaw with the sensitivity argument – which makes morality depend upon the emotional reactions of one or more people – is that merely feeling a certain way does not entail that one should feel that way. At one time, interracial relationships caused extreme reactions from racists, but obviously, what the racists felt indicated nothing about such relationships but a great deal about their own moral failings as people. The same conclusion might apply when emotions are involved in death and dying discussions. On the other hand, feelings and emotional reactions should not be ignored or discarded. Emotion is a fundamental component in ethics for without it, morality and ethics would be empty terms. Recall Hume’s argument that without emotions, especially sympathy or what we call empathy, it would be impossible to select between the pricking of one’s thumb and the destruction of the world. Should we be so devoid of emotion, so indifferent as not to care more about the destruction of the world than the pricking of one’s thumb, we would be like Buridan’s ass starving to death between two equidistant bales of hay. Hence, in order to be applicable to the real world, emotions and feelings have a role to play in ethics, but what that role is to be must itself be subject to critical scrutiny. The 6th Global Conference: Making Sense of Dying and Death held in Salzburg, Austria in October and November, 2008 is a component of the Inter-Disciplinary.Net’s Probing the Boundaries project. The project’s x Introduction ______________________________________________________________ purpose is “to create working ‘encounter’ groups between people of differing perspectives, disciplines, professions, vocations and contexts.” The interdisciplinary and multi-disciplinary aim of the conference, and hence, of this book and its articles, is the building of an enduring, useful marketplace of ideas much along the lines John Stuart Mill advocated. Mill argued that if too few people control information processes or if access to data is too restricted, then the beliefs people have and the solutions they create to solve problems are likely to be more myopic than if an unrestricted marketplace of ideas existed.2 A lack of diversity gives some individuals excessive power over those lacking the ability to be fully invested in the market, and although the former might be well intentioned, the beliefs they have and solutions they pursue could themselves be distortions that fail to reflect reality. On the other hand, inclusiveness and diversity, by definition, beneficially increase the supplies of information, relevant insights, experience, and other essential components of good decision-making to a far greater number of affected people. Through the wide variety of views being presented in the market, individuals are able to use their critical reasoning skills to find what is correct in each position, and then to build toward a true belief that will guide their decisions. Generating more options, for example, increases the likelihood that a superior alternative can be chosen, or at least a solution that each concerned party can accept. If dying and death “information” is in a market open to all, then each stakeholder will have the opportunity to share in the work of clarifying the issues involved in dying and death moral problems. Each person can lay claim to helping fashion necessary compromises because each person is contributing to the solution. The conference’s approach to moral issues promotes the freedom of thought in a way in which Mill would have approved. For Mill, people must not only have the total freedom to form true opinions, but they also need liberty to act upon those beliefs. Liberty does not extend to unjustified harm to others, but if liberty is curtailed too much, the results are dire. People who do not think and act for themselves are merely “automatons in human form,” whose minds are “bowed to the yoke.”3 Eventually, “their human capacities are withered and starved”, so much so that they become mere husks of human beings.4 Thus, in order to reach their full potential, individuals must have intellectual vigour and manifold diversity, which come from freedom and the variety of situation’s union. In other words, people need originality that is agreeable to each individual and all of society.5 Moral agents, in order to realize their intellectual potential as human persons, must be given free reign to think and discuss opinions as they choose, make informed decisions, and then act upon them. The alternative is far too costly for it takes from individuals what, in part, makes them persons with intrinsic worth.6 The inter-disciplinary and multi-disciplinary nature of the conference itself and this e-book collection of conference papers add in a Dennis R. Cooley and Lloyd Steffen xi ______________________________________________________________ significant way to Mill’s marketplace of ideas. Often, professionals with good intentions believe that their field can find the answer for many, if not all, questions. However, this overly narrow approach often leads to solutions that do not address real world situations, but rather merely give additional support to the wrongheaded view that many professionals are ivory-tower thinkers who have little to nothing to say about how they should live their lives or think about the important issues confronting them. This volume’s diversity of offerings counteracts that unfortunate view by showing how each discipline captures part of the overall truth, which must then be synthesized into a whole. What is most interesting is how this weaving together of ideas is achieved in this anthology. The articles located within challenge the perceived status quo; use familiar ideas in new, useful ways, or work to add other innovative knowledge to our databases. However, it should not be thought that any one of the papers does just one thing. Rather although each might primarily operate in one of the three aforementioned ways, it also has elements of the remaining two. This fact could very well be one of the reasons that every paper contributes significantly to its disciplinary field as well as others. Perhaps more importantly, the combination of papers provides greater insight into the subjects of death and dying – hence the eBook’s title and theme of re-imaging. Not only do some of the works support components in other authors’ papers, but the former augment them with new ideas, information, or arguments. That is not to say that all the works are in agreement or that the claims and positions are consistent with each other. Far from it. And that is not to say that the mere fact there is disagreement entails that there is anything defective in any one of them. Again, far from it. Through clashing opinions, we are able to come closer to what is real and true in three different ways. First, if we are right in what we say, our arguments and thoughts can benefit from the challenge of intellectual exchange. We know better what works and what does not work in our intellectual encounters, as well as coming to know in more detail why we are correct in our beliefs. In addition, a benefit in common to all three ways, we hone our critical reasoning processes to create more useful mental tools. Second, if we are wrong, then obviously we will be in much better intellectual shape to discover the truth for ourselves. One joy of entertaining clashing opinions is that by doing so we overcome our natural reluctance to give up a cherished position that we have come to through careful, but somehow incomplete, reasoning. We know that often we do not want to admit either to others or ourselves that we are wrong; hence, it is sometimes necessary to challenge ideas in a more aggressive way to force a needed reconsideration. xii Introduction ______________________________________________________________ Finally, we know that in the vast majority of cases, people find part of the truth, but not the entire whole of it. Our hope is that this collection of essays will contribute to the process of reflection and critical discernment that will uncover and discover yet more truth, so that readers can improve their belief sets and decision-making processes. What follows is a short introduction and overview of the papers included in this volume. One of the great benefits of the conference and eBook is the vast differences in subject matter addressed. This diversity also makes it difficult to segregate cleanly the material into distinct groups. As a result, we have created four useful, general categories. The volume is divided into re-imaging the philosophical, communication, ethical, and experiential aspects of dying and death. 1. Philosophical Re-Imagings Each society and culture has conventions and mores about death and dying, which it believes to capture the full truth of reality. Often, when these fundamental components of the society or culture are challenged, the response is neither thoughtful nor measured by the components’ dogmatic adherents. However, even in the face of resistance from the public and academic communities, it is a duty of those working on dying and death issues to examine the concepts and arguments being used in the various conversations to evaluate their perspicacity, accuracy, and soundness. After all, to be human we must strive to find out how the world really is rather than merely accepting how we individually would like it to be or what the vox populi claims it is. The contributing authors from the conference make use of a variety of ways to re-image the philosophical groundwork of the field. Included among these is re-defining terms by either narrowing or expanding the meaning of the concept, throwing out the old definition and replacing it with a better working model, or demonstrating the need for, and value of, a new term or argument in the debate. Peter Caws starts off this section by arguing that a person can have pragmatic immortality in his or her life by realizing that death itself cannot harm the person, since nothing remains to be injured. In addition, people can be liberated to live their lives more fully and enjoyably if they realize that a quick and painless death need not be feared by them. Stephen Rosenbaum challenges the still relatively common belief in philosophical circles that Aristotle’s view of death as a great harm to those who die and Epicurus’ position that death means nothing to us since there is nothing left of us to be harmed are incompatible positions. To show consistency, Rosenbaum points out an equivocation often made on the word “value.” According to him, Aristotle uses the concept of abstract value in his work, which does not have effects on individuals, while Epicurus’ position incorporates the concept of concrete harm, which does have effects on individuals. J. F. Humphrey Dennis R. Cooley and Lloyd Steffen xiii ______________________________________________________________ considers three views of death found in Plato’s Apology: death is a long dreamless sleep, death is a journey to another place, and death is a way to become immortal. Humphrey presents an argument that Socrates’ adoption of the latter position leads to an interesting result. If the position is accurate, then Socrates’ death immortalized the practice of Socratic philosophy, as well as himself. Julia Apollonia Glahn questions the western belief that cadavers have no dignity because they do not exist as human beings. After demonstrating with examples of cadavers used in car crash tests that people are uncomfortable with treating cadavers as mere objects, Glahn states that by redefining dignity as a social and interactional concept, it becomes apparent that dead bodies still have dignity, and thus, should be treated accordingly. Tolulope Onabolu maintains that “nonsensical” definitions of dying and death are not only possible; they are extremely valuable in the discussion of these issues. Using a Deleuzian thesis of becomings, Onabolu argues that death is a transformation into “something else,” which should be embraced by us. Maria Kissova employs a book by Markus Zusak, The Book Thief, to find a new way of understanding death and its interconnectivity to Art, Literature, and human psychology. Kissova weaves a narrative explaining why Death can be both frightening and fascinating to us, as well as being a constant companion guiding our lives. Jacob Graham combines philosophy and literature in his paper on Martin Heidegger and Ranier Maria Rilke. Concentrating on Rilke’s literary work, letters, and correspondence, Graham argues, “In our very affirmation of being, we solemnly, quietly, and perhaps even unwittingly affirm death.” Death, hence, is nothing to be feared, but something that is part of our true being, or as Rilke calls it, our friend. Wim Cappers’ research focuses on Dutch burial law and its influence on the taboo towards death. Cappers shows that burial law medicalised death’s definition based on the medical facts that dead bodies pose hygiene problems and that medicine could not clearly demarcate between life and death. The result was a significant shift in mores and social beliefs about death and death related processes. Courtney D. Coyne-Jensen examines Tallum Cemetery to see if its design provides a better linkage between the living and the dead than is used in standard practice. She argues that a Heideggerian notion of ground is key to understanding not only the cemetery but many of the death concepts associated with such places. Susan M. Behuniak’s work on heroic death, selective memory, memorials and monuments takes the stand that the USSR’s Monument to the Heroic Defenders of Leningrad and the US’s World War II Memorial serve to commemorate the sacrifice made by those involved in the conflicts, but also act as political statements that heroic deaths for patriotic causes are worth the price paid. Memorials and monuments, hence, can shape collective memory xiv Introduction ______________________________________________________________ in such a way that terms in the public mind can be redefined and ideas implanted to suit those in power. Contradicting standard conceptions, Nyesa King contends that the concept of genocide as currently used by most is lacking significant elements, which can be discovered in a careful study of the Great Irish Potato Famine. King maintains that genocides are unfolding processes rather than the standard contained systematic events definition. If correct, King’s re-imaged concept would expand genocide’s definition to include many additional events, which in turn, would cause a re-thinking of what those episodes actually mean and entail. Finally, Namino Kunitoh discusses her pilot study on self-harmers’ beliefs about suicide and self-harm, such as cutting oneself. She finds that self-harmers’ actions are generally intended to solve problems in their lives rather than end their existence. As a result, treatment of such individuals would require a different framework from that used in helping suicidal people. 2. Communications Re-Imaging Dying is an experience in life, and difficult and profound as that experience is, it nonetheless presents opportunities for continued human contact, reflection, and interpersonal exchange. People who confront death and dying communicate with other people about this fact of life - death - that is at once a certainty as well as an unknown, an inescapable reality yet a contentious mystery. In their communications about their fears and anxieties, their hopes, and their concerns for loved ones, those who are dying or who have experienced the loss of loved ones reach for the mechanisms of communication available to them, and thus do they speak, write, go on-line, devise and visit the internet and blogs, and even share their personal feelings of grief and suffering in ways that seek to draw in anonymous individuals through mass media communications. Certain papers delivered in Salzburg reflect the effort some authors have made to investigate how living and dying people come to express themselves about their experiences and feelings related to dying and death through modes of communication as basic as speech or as up-to-date as internet access. Nothando Ngwenya, Stella Mills, and Paul Kingston have investigated the way some hospice-bound individuals dying of terminal illness and acutely aware of their situation have resorted to using weblogs. Weblogs provide a form of therapeutic writing to journal and, as the authors say, “help interpret death.” The authors contend that the weblog provides an opportunity to address the physical and spiritual needs of dying patients through therapeutic writing, and they share the results of having subjected the writings to a word counting program that then can be used to analyse and more deeply understand the cognitive, emotional and structural components Dennis R. Cooley and Lloyd Steffen xv ______________________________________________________________ of these terminal communications. Nate Hinnerman, a religion professor who sometimes teaches nurses in training, shares his experience of having students write their personal reactions to loss, which are then compiled into “grief archives.” Hinnerman focuses on his students’ reactions and feelings of loss in the wake of the September 11, 2001 attacks, the grief archive providing a way to scale down a bewildering national tragedy to personally felt loss. The death or grief archives he has complied give evidence that sharing stories of loss not only can bring people together but can allow as well for the continuation of relational connectedness with those who are mourned. Patricia Bromley and Mitte Nimocks explore the phenomenon of “In Memoriam” advertisements in newspapers, many seemingly directed toward the dead themselves. The advertisements direct a statement of feeling to a public who know neither the writer of the advertisement or the deceased who is its subject. Their quantitative analysis reveals that such a mode of communication commemorates the dead, but more importantly expresses the desire of the still grieving for richer and more extensive community. Finally, Marga Altena discusses the role weblogs and television programs dealing with death are providing people in the Netherlands with a new way to deal with death, mourning and memorialising. With special attention given to the Dutch television series, Over My Dead Body, Altena argues that modern media allow unexpected opportunities for people to express themselves emotionally and spiritually in relation to dying and death. 3. Ethical Re-Imagings Dying is a natural process, but not simply so. Human action and all that human action entails – motives, intentions, aims, purposes, emotions, values, evaluations, judgments, care-giving, virtues, and many other matters – infiltrate the dying process and render it a fit subject for ethical interpretation. Technology is a major factor in this ethical infiltration, since technology has extended life beyond the point where nature, left to its own devices, would end it, and all kinds of questions – ethical questions – arise concerning the good, fitting and right thing to do in particular situations or in relation to certain kinds of care-giving practices or medical procedures. What is a good death, ethically speaking? The papers that were contributed to ethics discussions at the Salzburg conference addressed many of these broader issues by focusing on particular aspects of the ethics of dying question, and the authors have explored some difficult issues as they have reimaged ethics in relation to dying and death. Arthur G. Svenson and Susan M. Behuniak explore the ethical issue of physician-assisted suicide as it has presented itself as a legal and constitutional issue in the United States. The authors consider various landmark decisions relevant to court determinations about the permissibility xvi Introduction ______________________________________________________________ of physician assistance in dying, concluding that conflicts between federal and state laws over physician assisted suicide parallel similar conflicts over legislation by states authorizing medical uses of marijuana. They argue that congressional power could rule the day and overcome legal efforts to prevent physicians from prescribing the particular drugs individuals would use in an instance of physician assisted suicide. Lloyd Steffen investigates the ethics of not treating severely handicapped newborns. Despite the widespread moral agreement that ordinarily newborns facing medical issues should be treated, Steffen points to some particularly catastrophic disorders that present compelling evidence for non-treatment, and he re-images the ethical approach to this issue by using the structure of “just war” thinking to make his case, that is, laying out conditions that would have to be met to overrule the basic moral agreement that ordinarily handicapped newborns should be treated. Joseph Wang undertakes an inquiry into the ethical meaning of brain death. He argues that physicians approach the questions in ways philosophers do not, and that a way beyond some of the disputes over whole brain death versus the death of a whole person can be gained by shifting the focus from ontological questions to the issue of organ transplantation, for which a practical ethic is required to guide the process of preparing for a removal of organs. Wang calls for a new ethic of organ transplantation to supplant the sometimes irresolvable conflicts between physicians and philosophers over how to define and interpret the meaning of death. Vanessa Fredericks applies Derrida’s “politics of mourning” idea to the Katyn massacre in Poland during the Second World War. Concerned about the ethical silence concerning Russian involvement in the massacre of up to 22,000 Polish prisoners of war by the Red Army, and then the subsequent failure to admit involvement, Fredericks finds in Derrida’s idea of a mourning, which is constructed as an ethically responsible “future-oriented memory,” a way of constructing ethical response to this particular act of genocide. And Dennis R. Cooley considers the question of a good death by asking how the looming and imminent prospect of dementia and loss of agency could – and should - affect the decision of Alzheimer patients to end their own lives. His controversial argument, based on a modified interpretation of Kant, is that the “soon to be demented” have a duty, while not yet demented, to end their lives before they lose their moral agency. Suicide in such a circumstance could be seen as a loving and caring act, Cooley argues, with the obligation to suicide yielding benefits to the patient, loved ones and society in general. 4. Experiencing Re-Imaging The experience of dying is not the end of death-related experiences. Death comes with an aftermath for the living - the grief, the mourning, and all kinds of other possible reactions, including guilt and even possible relief Dennis R. Cooley and Lloyd Steffen xvii ______________________________________________________________ that a difficult dying is over. The papers in this section focus on how people deal with the end of life experience and how those who experience the loss of loved ones confront and deal with the pain of bereavement. The essays here re-image the reality of the dying experience itself, as roles like caretaking present a trajectory of emotional reactions subject to change, and as people in the aftermath of a death find themselves adopting new identities as survivor, or widow, or even colleague of the bereaved. Eileen Sutton and Joanna Coast investigate the “National End of Life Care Strategy” devised in the United Kingdom and published in 2008. Given that a mismatch has been occurring between the fact that most people die in hospitals while the dying themselves self-profess a desire to die at home, the researchers consider problems with hospital and nursing care and reflect on the way state policies affect the quality of dying. At issue in their article is the need to allow more people to exercise choice and thus maintain personal dignity when they are dying. Christine De Largy examines the phenomenon of older adult suicide in Ireland, concerning herself with the complex motives that lead some older adults to suicide. Research indicates an increase of older adult suicide in Ireland by 30% from 2000-2005, and this leads the author to reflect on the kinds of preventive strategies that might be called for as government and social programs coordinate to address a significant problem that is often overlooked due to the heavy focus given to suicide among the young. Glenys Caswell, a doctoral student in sociology at the University of Aberdeen, shares the results of research she has been doing in Scotland on funerals in the context of the increasingly secular, non-religious orientation of survivors and mourners. Her inquiry is directed at how Scottish clergy and mourners alike are devising new ways of responding to spiritual need even amid secular and humanistic orientations. Caswell explores the new movement toward religious and secular coexistence as clergy try to maintain balance between their own beliefs and integrity while still attending to the needs of secularly oriented people who present themselves as wanting to celebrate the life of the deceased life yet who are also spiritually grieving loss. Jacque Lynn Foltyn draws on her experience as a divorced woman who was primary caretaker for her dying ex-husband, Matt, who, divorced a second time and now single, still considered her his primary relationship. Foltyn, a death researcher, shares how this experience jarred her from her previously abstract encounter with dying and death and led her to a transformative reconciliation, grief, and healing, stating, “we honoured a bond that would not be broken, no matter what social mores dictate.” Shulamith Kreitler, Frida Barak, and Nava Siegelman-Danieli conducted research into the topic of survivor’s guilt. Using as their research population 195 caretakers of cancer patients, they discovered that survivor’s guilt among caretakers is not so much related to depression and pathology as xviii Introduction ______________________________________________________________ it is to remorse. Guilt is aroused by the intensity of the personal relation to the patient. The authors conclude that such guilt is an affective response that corresponds positively to pro-social behaviours, such as increased volunteerism and other positive forms of social bonding. And Marc-Antoine Berthod undertakes an anthropological inquiry into the phenomenon of the bereaved employee. Berthold found evidence that co-workers and superiors in the work hierarchy go out of their way to be flexible with an employee and colleague who has experienced loss, adjusting schedules yet trying to keep the rules governing bereavement still in place. Bereaved people experience the pain of loss even while they are also working people with colleagues and bosses and policies governing what to do in the event of death, and Berthold reminds his readers that this topic – bereavement in the workplace – is an understudied topic that is here reimaged to expand the boundaries of the way the bereavement experience affects all of life. Notes 1 This does not entail that we think pure reason is the only or best method to use in analyzing this subject area. Emotions have a vital role to play, but they should not be allowed to overplay it. 2 J Mill, On Liberty, in Utilitarianism, On Liberty, and Consideration on Representative Government, H B Acton (ed), J.M. Dent & Sons Ltd, London, GB, 1988, chapter 2. 3 ibid., pp. 127 and 129. 4 ibid, p. 129. 5 ibid, pp. 101 and 132. 6 Mill, however, does not promulgate a system of absolute freedom to do as one pleases whenever the desire strikes one to do so. Freedom in action, though not in opinion, may be limited if the agent makes “himself a nuisance to other people”. ibid., p. 124. Nevertheless, if the action does not entail harm to anyone other than the actor, and perhaps a more minor injury to others than that would have been suffered by the loss of autonomy to the agent, then it is permissible to do it. Bibliography Mill, J., On Liberty, in Utilitarianism, On Liberty, and Consideration on Representative Government, H. B. Acton (ed), J.M. Dent & Sons Ltd, London, GB, 1988, pp. 69-187 PART I Philosophical Re-Imaging Pragmatic Immortality and the Insignificance Of My Own Death Peter Caws Abstract The human being who lives and dies, seen not as a biological entity but as a centre of experience and feeling, is a transcendental subject in the Husserlian sense, essentially temporal in its structure (though essentially timeless in its situation), essentially situated over against a world. “Transcendental” means that the subject is not an object in its own world but is presupposed by the experienced unity of that world. The transcendental subject in time remembers past states and anticipates future ones, but can know neither its beginning nor its end. It can accept the prediction that its embodiment will cease, but this is to cast itself in the role of another, as seen from outside. It cannot anticipate its own cessation from within - at every moment into which it can imaginatively enter there will always be another moment to come. This situation satisfies the Aristotelian definition of infinity: a quantity is infinite if, however much has been taken, there is always more.1 Infinity of lived subjectivity is equivalent to immortality. Put aphoristically and paradoxically, “until the moment of death, everyone is immortal.” In less abstract terms this attitude opens up the possibility of living an effective or pragmatic immortality, not being touched by death at all, suspending all attention to it, like a permanent phenomenological bracketing. Even if we accept and anticipate death it still matters less than most people think and fear. My own sudden and painless death cannot possibly matter to me, and even pain can be borne. It can of course matter to those who love or depend on me, but this point, while crucial in other contexts, falls outside the scope of the present paper. Key Words: Death, subjectivity, transcendental, infinity, immortality, bracketing, Epicureanism, lifeworld ***** Diogenes of Oenoanda (2nd century CE) left a legacy to his fellow townspeople in the form of excerpts from the doctrines of Epicurus, carved into a wall in a public place. Four of the principal maxims were: God is not feared Death is not felt Good is easily grasped Evil is easily overcome.2 4 Pragmatic Immortality and the Insignificance of My Own Death ______________________________________________________________ Subscription to these claims would clearly go some way to producing the ataraxia, or untroubled state, that the Epicureans valued. It is a state that is still desirable today. For the purposes of this communication I concentrate on the first two, since they are connected in the popular mind: death is feared, because God’s judgment is feared, but also because death is associated with pain. I remember being struck in a book I read as an adolescent, a great Antarctic adventure story by Apsley Cherry-Garrard called The Worst Journey in the World, with a passing remark as he is recounting one of the nearly fatal episodes of the journey: “men do not fear death, they fear the pain of dying.”3 This seemed to me, when I thought about it, to be obviously true, perhaps especially because I had been taught to fear both death and God and had come to regard both threats with a kind of native scepticism. When, later on, I discovered Diogenes (in Gilbert Murray’s elegant little book on Greek religion), I recognized him at once as an ally. If death is not felt, and God not feared, I am free to direct my life to higher objectives than craven avoidance or propitiation. My own death, I concluded, could not really matter much to me. If it were sudden, quick, unexpected, and painless, it would not matter at all. That is what I mean by “insignificance” in my title. My death could matter to others, and the anticipation of it could matter, temporarily, to me. But my subsequent thinking about death has led me to even more radical conclusions. I sometimes amuse and sometimes perplex my students by telling them, quite matter-of-factly, that I’m not going to die. Dying, I say, is just not the sort of thing I do - it would be quite out of character, and I have no intention of starting now. I can’t envisage making a true assertion using the first person active singular of that particular verb. Does that mean I think I’m going to live forever? Well in a sense yes (making sense of this sense is partly what this paper is about), but in another of course not. I’m not denying that some years from now (their number depending on luck, prudence, and the state of the art of medicine) this body will be absent in its present form from the earthly scene. It will be present as distributed in other forms, but they won’t be me. The question is whether between now and then something called “my dying” will take place. Nothing can be “mine” except in relation to me, so that even my eventual absence can be properly spoken of only from the point of view of my present presence - in the event it won’t be my absence. Similarly for my dying - if I decline to do it, will it have taken place? Eventually, someone might insist, I will certainly be dead. But there’s that troubling first person: I will be - but if the time ever comes, I won’t be, anything or anywhere. It is possible to envisage someone else’s use of the first person active singular of the verb “to die,” but even then only by literary device. Two classic cases come to mind, out of many, no doubt; one Peter Caws 5 ___________________________________________________ is of playing dead, one of being dead. In Shakespeare’s A Midsummer Night’s Dream Bottom the weaver, as Pyramus, shattered by the death of Thisbe, decides to join her: Thus die I, thus, thus, thus. Now am I dead...4 There are many comic examples of this sort, in some of which the dead actor gets up to reassure the audience that it is, after all, only a play. The second case is early science fiction, in Edgar Allen Poe’s “The Facts in the Case of M. Valdemar.” The narrator wishes to try mesmerism (i.e. hypnotism) in articulo mortis, and succeeds in this with his friend M. Valdemar, who is on the point of death. On being asked at intervals whether he is asleep (hypnotic subjects can apparently understand and respond to such questions) M. Valdemar gives a succession of answers that Poe builds to a point of horror: “Yes; --asleep now. Do not wake me! - Let me die so!” “No pain - I am dying!” “Yes; still asleep - dying,” and finally, in a hollow voice that “seemed to reach our ears ... from a vast distance, or from some deep cavern within the earth,” “Yes;--no;--I have been sleeping--and now--now--I am dead.” 5 The whole apparatus of the story has been devoted to rendering this last remark plausible, and Poe can stand in here for generations of writers who have explored similar themes, the most notable among them perhaps Bram Stoker and his imitators with their tales of the Undead. All this is fiction. Such imaginations apart, there seems to be a problem about being dead, as seen from the point of view of the speaking subject. Hoping for life on the other side of death doesn’t really change things, because that will after all be life, not death. Plato encourages us to practice death metaphorically - as the separation of the soul from the body but this is not real death, not death as the end of existence. Socrates confronts his own bodily death quite cheerfully, and seeks to reassure his disciples: “I can’t persuade Crito that I am this Socrates here who is talking to you and marshalling all the arguments. He thinks that I am the one who he will see presently lying dead...”6 6 Pragmatic Immortality and the Insignificance of My Own Death ______________________________________________________________ Socrates is not quite sure whether, after his bodily death, he will be nowhere or elsewhere; at his trial he explains that one of two things must be the case - an endless sleep without dreams, or a journey to another place, where he will meet the good judges. Going to sleep is clearly not really dying - even the resurrection miracles in the Gospels involve sleep, on the part of Lazarus and the daughter of Jairus, rather than real death. Still this option is suggestive: according to Socrates, time in dreamless sleep will be like a single night, and if one went to bed the night before exactly as on all the other nights, in the assured expectation of waking up the next morning, how could one distinguish between the last day and all the others? One might have lived as fully on that day as on any day, physical weakness apart perhaps. The sleep analogy can be reinforced by a technological one, that of the turning off (or putting into “sleep mode”) of a computer. I may turn a computer off and never turn it on again; sometimes I can’t turn it on again, in which case I may say of it that it died. But from the computer’s point of view, if I am allowed a bit of anthropomorphism (something I’ve explored elsewhere7), is there an obvious difference between the two cases? Life, we might say, is animation and metabolism, death the suspension of these things - if it really is death, their definitive and not merely temporary suspension. The program is no longer running, and can’t be re-started. What happened to it? Children sometimes ask: what happens to the light, when it goes out? We have to explain that that is not a well-formed question: there is no longer a light for anything to happen to. To revert to Aristotelian infinity, one doesn’t just keep taking away and seeing what’s left, the whole thing is gone, at one swoop - and we with it, so that we can’t know it didn’t go on forever. Taking a journey is not dying either, even less so. If “death” were really, convincingly, understood as a change rather than as an ending, if it marked a stage in a history of which only a part (perhaps a minor or preliminary part) was called “life,” or if there were two or more successive lives separated by one or more deaths, the first death would lose, for most people, most of its seriousness. There would remain of course the fear of the unknown, the sadness of friends or lovers bereaved, the terror (for imprudent believers) of eventual judgment - but there might also remain a hope of being agreeably surprised, of being reunited, of being pardoned. Clinging to such a hope might be one way of refusing death, or of accepting it under a more comforting description: transition, metamorphosis, temporary state. Another way of refusing death is to refuse to think about it: this was Spinoza’s strategy in the Ethics. “The free man thinks of nothing less than of death, and his wisdom is a meditation, not upon death, but upon life.”8 This can be construed in two ways, one obvious, and the other less so. (a) We can take it to mean that the free man is the courageous man, who, knowing that death is certain, refuses to be preoccupied with it, having liberated himself from mundane cares. This refusal implies a prior acceptance, and rests on Peter Caws 7 ___________________________________________________ self-mastery, the conquest of fearful and obsessive thoughts. But it does not go deep enough for my purpose here. The second construction is much stronger: (b) The free man is liberated from death itself - it will not touch him, so he need not think of it at all. For Spinoza this sense is possible, but in a purely cerebral fashion. Living sub specie aeternitatis, under the aspect of eternity - living, that is, under the dictates of reason, which operates in the same way whether its objects are past, present, or future - frees the subject from time, but it takes devotion, the cultivation of the intellectual love of God, through which the philosopher can participate in God’s timelessness, in Being outside of Time. It has also, however, been given a much more down to earth doctrinal form, in the story of the conquest of death by the Atonement: “O death, where is thy sting? O grave, where is thy victory?”9 This constitutes a refusal not so much of death itself as of its power. Instead of being difficult to attain, this state is preached as simply accessible to anyone: all can face death and the idea of death in tranquil confidence. That is what has happened, in effect, throughout the centuries of Christian faith. It is one of those cases, like conversion or sin, in which a mystery of belief is doubled by a perfectly secular philosophical understanding - and vice versa. Other philosophers have made other attempts to tame death, in some cases by embracing it - I think of Heidegger’s “Being-towards-death,” which he takes to be constitutive of the existential condition. Heidegger’s problem is that he wants to characterize Dasein as a whole, which it cannot be until it is finished. But the defining character of Dasein is care, which is always ahead-of-itself, so how is he to understand the moment of completion, i.e. death? Up to that point Dasein has a constitutive “not-yet,” because there is always something outstanding - hence Being-towards-death. But if it ever got there it would become a thing, present-at-hand, and that is not admissible. So there has to be something called “demise” which is not death, and death has to be “impending” rather than something that ever actually happens: ...[J]ust as Dasein is already its ‘not-yet,’ and is its ‘not-yet’ constantly as long as it is, it is already its end too...Death is a way to be, which Dasein takes over as soon as it is.10 This seems to me a quite unnecessary encumbrance for the existential subject, a response to a problem that need not even arise if we are content with a less portentous conception of our own existence. The everyday attitude of most people is to accept death as a fact of life, to think about it just enough - by making a will, or buying life insurance - but not to talk about it too much. Like taxes, it is taken to be inevitable. The evidence that I am going to die is provided for me by the deaths of other 8 Pragmatic Immortality and the Insignificance of My Own Death ______________________________________________________________ people - it seems to be forced on me, even if I rarely or never see actual corpses. There are pictures in the newspapers, there are obituaries and printed cards, and hospitals, and funerals, and cemeteries, and monuments, not to speak of more immediate cases when I myself am mourning someone whom I loved and who will never return. But all these are the deaths of others. Am I entitled to draw any conclusion from them about my own case? Their deaths I can experience, given the right circumstances - but mine? Wittgenstein says bluntly that “death is not an event in life.”11 The deaths of others count as events in my life - they have their before and after, they have their place alongside other events, other events succeed them. But the sense that we give to the term “event” involves a certain unity and totality, it implies a closure, whereas my death, even if it comes to me out of some other place (which is the root sense of “event”), cannot be packaged or confined like this. It lacks a conclusion. In the limit I can imagine something that could be called the beginning of my death, but after that point everything becomes indefinite. “In the limit” - limits can be approached asymptotically, and do not necessarily coincide with boundaries. What if life were like that, ending with a Zeno paradox? Clearly the death I am talking about here is not my physical death as seen from the point of view of other people, for whom it can begin and end like any other event. For them I am one among others. It is myself for myself that is in question. Where will I be when they dispose of my body? How will I have arrived there? Death is not a state that I can realize, voluntarily or involuntarily. What about suicide? someone may ask. One might suppose that one could always kill oneself, se donner la mort, as the French have it, “give oneself death.” But the problem with suicide is not that those who kill themselves have given themselves death - on the contrary this death, which they thought was theirs, has been given to us, who are left with its consequences. To give ourselves death is less easy than we thought (though there is an interesting inversion of this case - by not committing suicide we can give ourselves life, and this can be a powerful psychological strategy). Jacques Derrida gives a different sense to the idea of my giving myself death - I must, he says, take my death upon myself as a condition of being a self at all: The sameness of oneself, what remains irreplaceable in dying, doesn’t become what it is - in the sense of a same that relates to self in the oneself - before encountering what relates it to its mortality understood as irreplaceability.12 No one can die in my place, and making myself the gift of that realization is the only way in which I can achieve autonomy and responsibility, or put myself in the position of giving anything (including my own death, in heroic Peter Caws 9 ___________________________________________________ sacrifice) to anyone else. There is an obvious echo of Heidegger here. But no one can have lunch in my place either, not my lunch, and it seems extravagant to insist that I give myself my death as a passport to my life as an individual. That is a gift I can safely refuse without compromising in any way my capacity for giving, or even for self-sacrifice. If I were to “go to my death” for the sake of another or others it would make no difference to the thesis of pragmatic immortality. The situation in which I find myself in relation to my own death is reproduced in relation to my own birth. I can observe the birth of others as a daily fact, I can be present at it, it can be - if for example the birth is that of one of my own children - a central fact of my life. But I cannot know my own birth except as a story told me after the fact, and long after. There is of course a significant difference between the cases, in that nobody can tell me the story of my own death. But my birth cannot be an event in my life as lived by me any more than my own death can. Everything happens as if I myself, in contrast to anything else in the world, were a being without beginning and without end. Events happen around me; time passes, but this passage belongs to it, not to me - I remain immobile at the centre of my world. A megalomaniacal position, you may say. And yet a comparable position, bearing on my spatial position at a cosmic level, follows necessarily from the theory of relativity, and can be applied (as I have shown elsewhere13) locally as well. Why not apply the same principle to my temporal situation? To maintain that it is other things that move around my immobility, that just now Salzburg and Austria itself took the trouble to come towards me so as to make possible my presence here, obviously involves an element of fantasy. And yet, from my original point of view on the world, that is what I was bound to think - I had to learn that it was I who moved against a fixed background of space and time, I had to construct (or have constructed for me) the system of coordinates of a world that existed before I was born, that would continue to exist after my death, and that existed elsewhere, out of the reach of my perception. This whole external world, this universe, is in a way only a part of my own personal world, at the centre of which I remain in my here and my now. It was Husserl who best understood the relation between the subject and its world, reversing the familiar order of container and contained so that the world was carried in the ego rather than the ego in the world. Every subject lives his or her own world, a world-of-living or Lebenswelt, a “lifeworld” (the expression “lived world” that is sometimes used misses the active sense).14 “Living” could thus be understood as “having a lifeworld.” The contrast between life and death is intelligible only from within the lifeworld, whose unity and coherence are presupposed by every human 10 Pragmatic Immortality and the Insignificance of My Own Death ______________________________________________________________ activity, including philosophy. It is the life of this world whose ending cannot be incorporated into itself, which renders it effectively boundless. This boundless character of the lifeworld is also stressed by Wittgenstein, though he does not use that term. Having remarked that death is not an event in life he continues: If we take eternity to mean not infinite temporal duration but timelessness, then eternal life belongs to those who live in the present. Our life has no end in just the way in which our visual field has no limit.15 The analogy is not exact - our visual field is normally limited on all sides by the materiality of seen objects. At the same time we can always push back the limits, for example by using a microscope, or by walking around objects in search of new perspectives. The visual field (and here I think of Plotinus) can be identified with the field of Being itself - if this has limits they can only be at the threshold of Nothingness, and these are limits that as we have already seen can only be approached asymptotically, and thus never reached. According to this view, even if we think of a death long prepared, at the end of a slow illness or in extreme old age, it will always be too soon to accept it as definitive. How can I know, given the total absence of relevant experience, that some purely internal detour is excluded a priori? I think we should maintain until the very last moment the attitude of the old codger in Vermont, who, when a visitor to the village asked him condescendingly: “So, my good man, you’ve lived here all your life?” replied “Not yet I ain’t!” This “not yet” expresses the central idea of this text. My Vermonter’s “not yet” is not, like Heidegger’s, “towards-death,” it is serenely indifferent to death - he is evidently, like me, of Spinoza’s mind. Situated as I am at the immobile centre of my lifeworld (immobile because it is the point of reference for all motion), able always to take refuge in the fortress of the transcendental ego, whatever may happen to the “naively interested ego” (as Husserl describes it16), I remain exactly what I was at the dawn of my consciousness, and will I am convinced to continue to be that for ever. For if this being that I am one day ceases to be, it certainly won’t be I who know it. I am not in a position to know what I shall know, and moreover no one is or could be in a position to know that. Which is to say that in spite of the “neardeath experiences” reported by Elizabeth Kübler-Ross,17 in spite of the long history of speculation and of doctrine on the topic, we are still in complete ignorance of what our own death will be like. It is, to repeat, the one thing about which it is in principle impossible for us to have any empirical knowledge. That being the case, I have no reason whatever to draw any conclusions about my own mortality. And in this light there is no reason either not to attribute to myself and to everyone else the pragmatic Peter Caws 11 ___________________________________________________ immortality of my title. In the absence of all definite knowledge on what the moment of death may be, nothing prevents us from living, to adapt Spinoza’s formula about eternity, “under the aspect of immortality.” Notes 1 Aristotle, Physics, 207a8, in The Complete Works of Aristotle, Bollingen Series LXXI:2, J Barnes (ed), Princeton University Press, Princeton, 1984. 2 Cited in G Murray, Five Stages of Greek Religion, Watts, London, 1935, p. 170. 3 A Cherry-Garrard, The Worst Journey in the World: A Tale of Loss and Courage in Antarctica, The Narrative Press, Santa Barbara, California, 2001, p. 337. 4 W Shakespeare, A Midsummer Night’s Dream, act V, scene I, lines 295-6. 5 E A Poe, ‘The Facts in the Case of M. Valdemar’. in Poetry and Tales, The Library of America, New York, 1984, pp. 840-1. 6 Plato, Republic, 115c7-10, in The Collected Dialogues of Plato including the Letters, eds. E Hamilton and H Cairns, Bollingen Series LXXI, Princeton University Press, Princeton, 1961. 7 P Caws, ‘Subjectivity in the Machine’. in Yorick’s World: Science and the Knowing Subject, University of California Press, Berkeley and Los Angeles, 1993. 8 B Spinoza, Ethics, J Gutmann (ed), Hafner, New York, 1949, part IV, proposition LXVII. 9 I Corinthians 15:55. 10 M Heidegger, Being and Time, J Macquarrie and E S Robinson (trans), SCM Press, London, 1962, Division Two, I, p. 46. 11 L Wittgenstein, Tractatus Logico-Philosophicus (6.4311), C K Ogden (trans), Routledge and Kegan Paul, London, 1922, p. 185. 12 J Derrida, The Gift of Death [second edition] and Literature in Secret, D Wills (trans), University of Chicago Press, Chicago, 2008, p. 46. 13 P Caws, ‘On Being in the Same Place at the Same Time,’ in Yorick’s World. 14 E Husserl, Cartesian Meditations: An Introduction to Phenomenology, D Cairns (trans), Martinus Nijhoff, The Hague, 1960, pp. 24-6. 15 L Wittgenstein, loc. cit. 16 E Husserl, op. cit., p. 35. 17 See e.g. E Kübler-Ross, On Life after Death, Celestial Arts, Berkeley, 2008. 12 Pragmatic Immortality and the Insignificance of My Own Death ______________________________________________________________ Bibliography Aristotle, The Complete Works of Aristotle. J Barnes (ed), Bollingen Series LXXI:2. Princeton University Press, Princeton, 1984. Caws, P., Yorick’s World: Science and the Knowing Subject. University of California Press, Berkeley and Los Angeles, 1993. Cherry-Garrard, A., The Worst Journey in the World: A Tale of Loss and Courage in Antarctica [Constable, London, 1922]. The Narrative Press, Santa Barbara, California, 2001. Derrida, J., The Gift of Death, 2nd edn, and Literature in Secret. D Wills (trans), University of Chicago Press, Chicago, 2008. Heidegger, M., Being and Time, J Macquarrie and E S Robinson (trans), SCM Press, London, 1962. Husserl, E. Cartesian Meditations: An Introduction to Phenomenology. D Cairns(trans), Martinus Nijhoff, The Hague, 1960. Kübler-Ross, E., On Life after Death. Celestial Arts, Berkeley, 2008. Murray, G., Five Stages of Greek Religion, Watts, London, 1935. Plato, The Collected Dialogues of Plato including the Letters. E Hamilton and H Cairns (eds), Bollingen Series LXXI, Princeton University Press, Princeton, 1961. Poe, E A., ‘The Facts in the Case of M. Valdemar’, in Poetry and Tales. The Library of America, New York, 1984. Shakespeare, W., A Midsummer Night’s Dream, in The Riverside Shakespeare. G B Evans (ed), Houghton Mifflin, Boston, 1997. Spinoza, B., Ethics. J Gutmann (ed), Hafner, New York, 1949. Wittgenstein, L., Tractatus Logico-Philosophicus (6.4311). C K Ogden (trans), Routledge and Kegan Paul, London, 1922. Peter Caws 13 ___________________________________________________ Peter Caws is University Professor of Philosophy and Professor of Human Sciences at the George Washington University. His eight books and more than 150 articles include work on the philosophy of the natural sciences, on ethics and continental philosophy (Sartre, and the structuralists), and more recently on psychoanalysis and the human sciences. Concepts of Value: Attitudes toward Death Stephen E. Rosenbaum Abstract Philosophers have for 40 years actively discussed ancient Aristotelian and Epicurean differences regarding the value of death for individuals who die. Aristotle thought that death was a terrible thing, whereas Epicurus believed that it “is nothing to us,” not bad for people who die. The discussion has proceeded along many fronts, basically considering whether the Epicurean view can accommodate common “intuitions” about death valuation, such as the ideas that killing is generally wrong, that death’s not being bad is inconsistent with important “life-death comparisons,” and that it is widely incompatible with many value judgments people make about death. Clarification of the different views shows how they are each plausible and defensible. However, contrary to still relatively common opinion, I argued in a 2000 article that the Aristotelian and Epicurean views over which philosophers have long argued are strictly compatible. Although they appear contradictory, they are not, because they employ two quite different concepts of value, and are thereby consistent. One notion of value at issue is “concrete,” necessarily involving effects on individuals. The other notion is “abstract,” involving facts about people, which do not entail effects on them, but might nevertheless be good or bad for them. This paper will clarify further the distinction between the two relevant “modes of valuation,” and suggest how it applies to such issues as the fear of death; the death penalty; the rationality of suicide; and life-death comparative judgments, like the belief that life is sometimes better (or worse) than death. The purpose is to suggest that in light of different human concerns and attitudes, one concept of value may be appropriate and useful in issue contexts in which the other may not be appropriate and useful. A further result is a demonstration of how to explore more comprehensively various issues about death. Key Words: Aristotle, Epicurus, value concepts. ***** 1. Introduction One of the issues, which have occupied philosophical thinkers over the past 35 years, is the question of the value of death for those who die. They have discussed whether death is or can be good or bad for those who die, and have recurred to Aristotle and Epicurus, who apparently disagreed about the matter. Aristotle declared that “death is the most terrible of all things” while Epicurus, argued, “Death is nothing to us.” Most thinkers have 16 Concepts of Value, Attitudes Toward Death ______________________________________________________________ followed Aristotle’s thinking about this, but a few have endorsed Epicurus’ thinking on the matter. While I do not have time now to recount all the aspects of Epicurus’s or Aristotle’s views, or the outlines of the philosophical dialogue about this over the past 35 years, I do want sketch Epicurus’s argument, and to share reflections about how different concepts of value affect the dialogue and how they operate generally in our thinking about death. These notions of value can shape our attitudes toward many aspects of death. However persuasive Epicurus’s thinking about death is and however well it can be defended, it has encountered considerable resistance, mostly on the ground that it is starkly incompatible with many of our most common judgments and attitudes toward death. For this reason, many have rejected it. There are serious methodological issues involved in the issue and the dialogue, but I do not have time now to review these. Epicurus based his thinking on the idea that something could not be (good or) bad for someone unless it could affect the person in a way of which the person might be able to be conscious. Being, like Democritus, a physicalist, he thought that death, by which he understood being dead (as distinct from the process of dying or the moment of death), was the end of consciousness, the end of a person’s conscious existence. Since he thought that the dead could have no experiences, he concluded that death couldn’t be bad for them. It cannot affect the dead.1 The idea that death is not and cannot be bad (or, for the same reasons, good) for those who die seems to result in several untoward consequences, which would apparently require a significant revision in many of the things we think about death. It seems to imply, for example that death itself cannot be a penalty. However much capital punishment might satisfy feelings of vengeance, it cannot literally be a penalty or punishment, since it cannot be bad for the one killed. Since it cannot be experienced, it cannot be a punishment as incarceration or fines. Epicurus’s view also calls into question the ground on which killing could generally be wrong (since many think that the wrongness of killing is rooted in the badness of death for those who die.) It also would seem to question many comparative judgments we make about death.2 We think, for example, that suicide might be unreasonable, because it might be better for someone to continue living than to be dead. We also sometimes suspect that death might be better for some people than continued life, in cases in which continued life would generate great physical and/or psychological misery. Although one could discuss many of the conundrums clustered around the Epicurean view, I shall focus on life/death comparisons, and then make a few general remarks about other issues at the end. I am going to urge that comparative judgments we make about life and death are compatible Stephen E. Rosenbaum 17 ______________________________________________________________ with the Epicurean idea that one’s death cannot be bad for one and that they thus constitute no adequate ground to question Epicurus’s idea. Operating implicitly and mostly unnoticed in ideas we have and express about death are two concepts of value, and in light of these different and logically compatible concepts, one can argue not only that Aristotle’s and Epicurus’s views are consistent, but also that many ideas we have about death which may seem initially opposed to the Epicurean view are really consistent with it.3 Additionally, these concepts should perhaps engender possible revisions in various of our views about death. I want first to explicate these different ideas of value. One concept of value is concrete, and the other is abstract. Epicurus’s concrete notion of value is that nothing can have any value for someone; nothing can be good or bad for someone, unless it can affect him or her in some way. This is a concrete concept of bad (or value) requiring for its applicability some concrete effect on someone, say a pain, or something else which is capable of being experienced. The other concept of value is abstract in that it attributes value to propositions about people, which might not entail concrete effects on them, but would be true of them at any time, before and after they live. In fact, some propositions about people, which are supposed to have value for people, are according to this view not associated with any concrete effects on them. There are possibly numerous facts in some sense about us, which are not connected to effects on us. One might think of such facts as being remarked about in passing by two strangers, where whatever they say, however positive or negative, never affects one. There are similarly facts about one concerning events which happen after one dies, which can have no effect on one. If after one’s death lies by maleficent enemies destroy one’s reputation, this can have no effect on one, but is nevertheless a fact about one. If, after one’s death, one’s descendents, about whose future welfare one cared deeply, are destroyed horribly, this is a fact about one, about one’s life narrative, but cannot affect one literally. Yet, we tend to have some sort of feeling about such cases, especially if we project ourselves into such circumstances. How would we feel if that happened to us? Such ideas about abstract valuation have been used to support the idea of posthumous harm for individuals who are dead (and there is a considerable literature on this). We may believe that the betrayal of someone, after he or she dies, by his best friend is unfortunate and “too bad for the person betrayed.” We may continue to think this even in the face of realizing that although the person was betrayed by the friend, it did not affect the person in any way, assuming with Epicurus that in some important sense he or she ceased to be at death. It may have had no negative effects on the person, and have not affected the quality of life. If we think this way, we may implicitly be using/accepting an abstract notion of valuation, according to which 18 Concepts of Value, Attitudes Toward Death ______________________________________________________________ propositions may have value for someone, even if they do not entail effects on the person. Those who, like Epicurus, endorse a concrete notion of value could accept and countenance the narrative elements about a person’s life, but deny that those narrative elements which do not have any effects on the person who lived and existed have any value for the person, at least from the point of view of concrete valuation. They might think that to the extent that a person’s narrative is not identical with the person and effects on the person, the narrative can have no value, except perhaps in some artificial sense, which might depend on culturally specific and possibly relative ways of valuing. Events, which affect people and cause effects on people, can have concrete value for them. These events, like all events within a person’s life, can be expressed in statements about the person, and can be part of his or her life narratives. All events, which affect people, are parts of the complete narrative about his or her life, but not all propositions included in the complete narrative of people’s lives, entail effects on them. Think of abstract valuation in relation to propositions about people and/or people’s lives. Human lives are described by, and conceived in terms of, stories, narratives, which may be thought of as conjunctions of propositions. Some of the propositions in a person’s narrative may be value neutral, in the sense that they are neither good nor bad. The proposition that a person woke up on January 20 at 8:31 am, could well be neither good nor bad “for the person of whom it is true,” given that it is not logically related to non value neutral propositions (ones that are good or bad for the person) and does not entail that a person either is in or is caused to be in states or conditions which are good or bad for the person. Many of the statements in a person’s narrative will, however, not be value neutral, but will rather be, or may occasionally be described as being, good or bad for the person. 2. Life/Death Comparisons Let me turn to life/death comparisons. Among the things we sometimes think about people’s lives involve comparisons between death and life. We sometimes judge for example that someone’s suicide is irrational partly on the ground that it would have been better for him or her to have continued living. In other words, death was worse for him or her than continuing to live would have been. We also sometimes think that death is better for certain people than continuing to live, say because continuing to live would be very physically and psychologically painful. Whether we are right about these judgments in whatever cases in which we make them is less my concern now than the logical and conceptual basis for thinking or saying such things. These judgments, which can be proper, would seem to undermine the Epicurean idea that death (being dead) can have no value for people and can be neither good nor bad for them. Such judgments implicitly Stephen E. Rosenbaum 19 ______________________________________________________________ assign a comparative value to death for some people, and thus imply that death can have some value for people, can be at least relatively (or comparatively) good or bad. You see here the shadow of a kind of paradox: Either we give up the logically strong Epicurean view, or we give up the conceptual basis for comparing life and death in the way suggested. Most have just rejected the Epicurean view and have insisted that contrary to Epicurus and in accord with Aristotle, death is bad for those who die, or it can be. We can account for the basis of our concept of comparative evaluation of the kind illustrated by using the idea of abstract valuation. Accordingly, we can think of life/death comparisons we might feel inclined to make as being about comparisons between the actual narrative of a person’s life and possible different, alternative narratives, which might depend upon the fact about when the person dies in relation to various narrative elements in a person’s life. For example, when we think that it would be better for a person to continue living than to die, we would judge this on the basis of believing that the narrative in which the person lives for 20 more years rather than dying in the next three months is a better narrative. When we think, in other cases, that it was better for a person to die yesterday than to continue living for another six weeks, we are judging that the person’s life story was better than it would have been if he had continued living. I think that the grounds on which we make such judgments are complex and depend on various values we have about human lives and the structure of those lives. Those values and the ideas with which they are associated are important, and would be interesting to explore, but I want to focus on the idea that when we make such comparative judgments, we are using the idea of abstract valuation, according to which propositions about a person can have value for the person, whether or not they are associated with any effects on the person. When we think that it would be better for a person to die than to continue living, our thought does not imply either that the condition of being dead would have positive value for the person or that anything occurring while the person is dead would have such value. We are just attributing value to a fact about a person’s life, to a statement about a person’s history. If we can account for comparative judgments about people’s deaths using the notion of abstract valuation and thus think that the fact that a person died when he or she did can be good or bad for the person, then the propositions which have value in relation to statements about the person’s life narrative need not entail that any condition of the person is actually good or bad for the person. Therefore, comparative judgments are not incompatible with the Epicurean idea that death is not bad for those who die, and constitute no ground on which to reject or question the Epicurean idea. The main argument against the Epicurean idea, the “deprivation argument” is supported by many who endorse Aristotle and reject the idea 20 Concepts of Value, Attitudes Toward Death ______________________________________________________________ that “death is nothing to us.” They argue that death can be bad for those who die because of that of which it deprives them, namely continued life, and the possibility of completing projects and plans they have. Most human lives have a kind of structure, they argue, which requires time for completion, roughly an average human life span. Without seeing clearly how long they will live, most people nevertheless make plans to accomplish certain goals, to raise their children and enjoy their grandchildren. When an unexpectedly early death interrupts those plans and makes them impossible to complete, it will be bad for the person who dies, according to those who endorse the deprivation argument. This deprivation argument, sympathetic to Aristotle, depends on the idea of abstract valuation. Those who advocate this idea4 are implicitly using the idea of abstract valuation. They would not declare, contrary to Epicurus, that the condition of being dead is or could be bad for people, but they nevertheless think that death could be bad for people. They can believe this only if they employ a sense of value, which gives value to propositions about people’s lives, which may not entail that they suffer negative effects in their lives or deaths. They are thinking about, say, the proposition that the person died at a time before he or she could finish projects or complete the plan for his or her life. This is not inconsistent with the Epicurean view that being dead is not bad for those who die. Therefore the “deprivation argument” does not negate the idea that death is not bad for us. There are many judgments we make about individual deaths, which fit into the framework of abstract valuation, and are not inconsistent with the Epicurean view. One might in light of my discussion wonder whether the Epicurean view is perhaps mildly interesting, but may not be able to find any interesting traction in many of our concerns about death and how we think about death in human life. After all, if it is consistent with judgments people feel it important to make about death, why does it merit any attention. How could it be useful? I can only sketch an answer to this question, by raising other considerations related to other ideas about death. First, one of the points of Epicurus’s efforts was to undermine the fear of death, as is clear both from what he says and how Lucretius developed his ideas. How relevant to the fear of death is the idea of concrete value is certainly central here. The idea of the fear of death is not very definite, but if it is fear of the condition of being dead or fear of what will happen to one after death, rather than the fear of, say, dying too early and then there being undesirable aspects of one’s life narrative, then the Epicurean idea, with its notion of concrete value would be relevant. If, as Epicurus thought, there is nothing bad, which can happen to one in death, then it might be groundless to fear death (being dead).5 I do not have time to discuss the fear of death, but I would urge further reflection on this, and the relevance of Epicurean ideas. Stephen E. Rosenbaum 21 ______________________________________________________________ The Epicurean view also raises questions about the death penalty, as it did for Julie Caesar when he considered punishments for the Cataline conspirators. If death, being dead, cannot be bad for people, how can it then be any sort of punishment, since it would be unlike incarceration and fines, which affect people badly and are thereby said to be bad for people?6 Unless punishments are not literally bad things (concretely bad things) done to people in relation to what they are said to deserve, but are rather something else such as state-sponsored indirect substitutes for direct revenge, or perhaps something else, then it is difficult to see how the death penalty could be much of a punishment.7 If one assumes that punishments necessarily have concrete (negative) value for those punished, then it seems that the Epicurean idea does imply that death cannot be much of a penalty for anyone, certainly not significantly more of a penalty than, say, incarceration. Finally, I should mention the general idea of the wrongness of killing in societies across the globe. Killing is commonly regarded as morally wrong in all human societies, with possibly appropriate exceptions, such as killing in self-defence. Where does this moral prohibition come from? That is, what is its logical source? Many have suggested to me that this thought about the morality of killing is reason enough to reject the Epicurean view of the value of death, because it seems conceptually inconsistent with the very widely shared view that killing is morally wrong. Obviously a full discussion of this issue is not possible now, but I want to share a few thoughts. The objection made here depends on the idea that only if death is bad for those who die can killing be morally wrong. Some theories of morality may take this view, such as possibly a utilitarian ideal. However, such theories are not the only possible accounts of morality and its precepts. Some think that morality is a social phenomenon, and arises as implicit and explicit understandings of what behaviour is proper and what improper. Epicurus was this sort of moral thinker, and like Democritus before him (and Hobbes after), thought that morality was the result of a compact or contract (syntheke).8 Accordingly he believed that society somehow adopted the prohibition against killing as one its most serious principles for conserving social order and the basis for personal happiness. A contractarian view of morality is entirely compatible with the Epicurean idea that death is not bad for people. Whether such a view of morality can accommodate the various proper desiderata of moral theory is a large question, certainly beyond the scope of what we can address here. However, it is worth considering and suggests another possible implication of the Epicurean view and its companion notion of concrete value. 3. Conclusion I hope my sketchy arguments have not been too opaque, but I wanted to share with you some ideas about value in the context of thinking 22 Concepts of Value, Attitudes Toward Death ______________________________________________________________ about death, and express a few ideas in order to provoke further thinking. There are two notions of value underlying what we think about say about death and numerous issues surrounding death, and it is important to consider their implications and their significance in various contexts. Notes 1 S E Rosenbaum, ‘How To Be Dead and not Care: A Defence of Epicurus’, American Philosophical Quarterly, vol. 23 (1986), p. 217-225. 2 J McMahan pursues this issue in ‘Death and the Value of Life’, in The Metaphysics of Death, J M Fischer (ed), Stanford, Stanford University Press, 1993, p. 231-266. 3 S E Rosenbaum, ‘Appraising Death in Human Life: Two Modes of Valuation,’ in Midwest Studies in Philosophy, P A French and H K Wettstein (eds), Oxford, Blackwell Publishers, 2000, p. 151-171. 4 For just a couple of examples, Thomas Nagel, ‘Death,’ in The Metaphysics of Death, J M Fischer (ed), Stanford, Stanford University Press, 1993, p. 5969. Among many others, Martha Nussbaum and Gisela Striker also take this view in various places.. 5 Diogenes Laertius, Lives of Eminent Philosophers, Epicurus’s ‘Letter to Menoiceus’, R D Hicks (trans), London, W. Heinemann, 1925, Book X, 125. 6 S E Rosenbaum, ‘Death as a Punishment: A Consequence of Epicurean Thanatology’, in Epicurus: His Continuing Influence and Contemporary Relevance’, Gordon and Suits (eds), Rochester: Rochester Institute of Technology Cary Graphic Arts Press, 2003, 195-206. 7 This is obviously more of a concern for the North American conversation about the death penalty than for other conversations. 8 Diogenes Laertius, op cit., Book X, 139-154, especially Kuriai Doxai #3138. Bibliography Nussbaum, M., The Fragility of Goodness. Cambridge, Cambridge University Press, 1986. _____., ‘Therapeutic Arguments: Epicurus and Aristotle,’ in The Norms of Nature, M. Schofield and G. Striker (eds), Cambridge, Cambridge University Press, 1986. Rosenbaum, S., ‘How to be Dead and not Care: A Defense of Epicurus’. American Philosophical Quarterly, vol. 23 (1986), 217-225. Stephen E. Rosenbaum 23 ______________________________________________________________ _____., ‘Appraising Death in Human Life: Two Modes of Valuation,’ in Midwest Studies in Philosophy, P A French and H K Wettstein (eds), Oxford, Blackwell Publishers, 2000, 151-171. _____., ‘Death as a Punishment: a Consequence of Epicurean Thanatology,’ in Epicurus: His Continuing Influence and Contemporary Relevance, D. R. Gordon and D. B. Suits (eds), Rochester: Rochester Institute of Technology Cary Graphic Arts Press, 2003, 195-206. Silverstein, H., ‘The Evil of Death.’ The Journal of Philosophy 77, 1980, 401-424. Striker, G., ‘Commentary on Mitsis.’ Proceedings of the Boston Area Colloquium in Ancient Philosophy, vol. 4, J. J. Cleary (ed), Lanham, 1988, 315-320. Stephen E. Rosenbaum is Professor of Philosophy at University of Nevada, Las Vegas USA There Is Good Hope That Death Is a Blessing J. F. Humphrey Abstract In Plato’s Apology (29a-b), Socrates agues that he does not fear death; indeed, to fear death is a sign of ignorance. It is to claim to know what one in fact does not know (Ap. 29 a-b). Perhaps, Socrates suggests, death is not a great evil after all, but “the greatest of all goods.” At the end of the dialogue, after the judges have voted on the final verdict and Socrates has received the death penalty, the philosopher considers two common views of death: that death is a long dreamless sleep and that death is a journey to another place Hades. According to Socrates, either of these views of death would be acceptable to him; the one, because he would receive a wonderful rest with no dreams to disturb him; the other, because he would be able to talk philosophy with those who had gone before with impunity. In this paper, I will examine Socrates’ view of death, and I will argue that, according to Socrates, there could be a third perspective on death that will not only make him truly immortal in a certain way, but will also immortalize the practice of Socratic philosophy. Hence, Socrates embraces his sentence because dying at the right time and dying in the right way provides him the possibility of a good death. Key Words: Plato’s Apology, Socrates, ‘good death,’ immortality. ***** 1. Socrates’ Defence In Plato’s Apology of Socrates, Socrates is at the Stoa of the King, the court that tried cases involving offences against the citizens and the city.1 He has been accused of doing “injustice by corrupting the young, and by not believing in the gods in whom the city believes, but in other diamonia that are novel” (Ap. 24b). In the course of his apologia, Socrates defends himself, first against his first accusers - those who are not presently accusing him, but who, by slandering him in the city, created the conditions whereby he has now been called to the court to answer an indictment, and then against his second accusers - those who are actually accusing him and bringing him to court because they believed the slanders of the earlier accusers. Although they are not actually accusing him in the court, because their accusations may have influenced those on the jury, Socrates defends himself against the many unknown first accusers by arguing that he is not the kind of man that Aristophanes makes him out to be in the Clouds because he does not walk on air or have magical knowledge. Then, he argues that he is not a Sophist; he 26 There Is Good Hope That Death Is a Blessing ______________________________________________________________ does not teach because he does not teach for money. Finally, he contends that he does not corrupt the youth because he does not teach them; they simply follow him around the city and enjoy listening to him question himself and others. When they try to imitate Socrates with their parents and family members, the family members do not blame the youth, they blame Socrates. He defends himself against the second set of accusers, Meletus, Anytus, and Lycon, by interrogating the young Meletus. Against the second set of accusers, Socrates argues that it would be absurd to think that he is the only one who corrupts the young and that it is far more likely that it is the many, the citizens of the city, who corrupt the youth. Next, he claims that if he corrupts the youth, he must have done it unknowingly and that he should not be brought to court for committing a crime but should be educated about his mistakes. Finally, he argues that Meletus contradicts himself by accusing him of atheism; since he believes in the offspring of the gods, he must believe in the gods themselves. In the detour found in the arguments against the first accusers, Socrates claims that Apollo, the god that governs the Oracle at Delphi, told his now deceased friend Chaerephon “no one was wiser than Socrates” because the god, made use of my (Socrates’) name in order to make me a pattern (paradeigma), as if he would say, ‘That one of you, O human beings, is wisest, who like Socrates, has become cognizant that in truth he is worth nothing with respect to wisdom’ (Ap. 23a-b). Socrates, then, is wise because he recognizes his own ignorance and we should pattern ourselves on him and recognize our own ignorance. Furthermore, in concluding his defence speech, Socrates argues that he has been directed by the god to investigate others and that if he discovers that his interlocutors are unable to give an adequate account of themselves, he (Socrates) must obey the god and point out his their ignorance. “I have been ordered to practice this by the god, as I affirm, from divinations, and from dreams, and in every way that any divine allotment ever ordered a human being to practice anything at all” (Ap. 33c). To support this claim, Socrates asserts that it would be ignoble, “to suppose that a man who is of even a little benefit should take into account the danger of living or dying, but not rather consider this alone whenever he acts: whether his actions are just or unjust, and the deeds of a good man or a bad” (Ap. 28b). Although he does not refer to Achilles by name, according to Socrates, the son of Thetis had been warned by his mother that if he avenged J. F. Humphrey 27 ______________________________________________________________ the murder of his friend, Patroklus, by killing Hektor, he would die shortly thereafter; Achilles, however, chose to avenge his friend’s death and die without giving a thought for death and danger. “So I would have done terrible deeds,” Socrates tells the jury, if, when the rulers whom you elected to rule me stationed me in Potidaea and Amphilpolis, and at Delium, I stayed then where they stationed me and ran the risk of dying like anyone else, but when the god stationed me, as I supposed and assumed, ordering me to live philosophising and examining myself and others, I had then left my station because I feared death or any other matter whatever (Ap. 28d-e). Just as Achilles did his duty in avenging Patroklus’ death, so too, Socrates did his duty by obeying his generals in war and hence he must also do his duty by obeying the god who, he claims, has ordered him to practice philosophy by examining himself and others. Had he failed to do his duty, had he committed such terrible deeds against the city and the god, it would indeed be just for him to be brought into court and punished. Terrible that would be, and truly then someone might justly bring me into a law court, saying that I do not believe that there are gods since I would be disobeying the divination, and fearing death, and supposing that I am wise when I am not. For to fear death, men, is in fact nothing other than to seem to be wise, but not to be so. For it is to seem to know what one does not know: no one knows whether death does not even happen to be the greatest of all goods for the human being; but people fear it as though they knew well that it is the greatest of evils. And how is that not that reproachable ignorance of supposing that one knows what one does not know? But I…am perhaps distinguished from the many human beings also here in this and if I were to say that I am wiser than anyone in anything, it would be in this: that since I do not know sufficiently about the things in Hades, so also I suppose that I do not know (Ap. 29a; italics added). One might object that Socrates misses the point here. Certainly, Crito and the many understand death to be the greatest evil (Cr. 44c-e). Are the many wrong to fear death? Perhaps the fear of death is associated with the fear of the painful ways in which people die. Another possible reason that 28 There Is Good Hope That Death Is a Blessing ______________________________________________________________ people seem to fear death is not because we know it to be an evil, but because we do not know what the experience of dying will bring; the fear of death is the fear of the unknown. Still, according to Socrates, since no one has ever returned to report his or her experience, we cannot actually know what death is and since we do not know what death is, we should not judge it to be an evil. For the same reason, however, despite what Socrates says, it would also follow that one ought not to assume that death is good. Socrates, however, raises the possibility that death may be “the greatest of all goods” for humans. After Socrates makes his speech defending himself from the charges brought against him by Meletus, Anytus, and Lycon, the jury finds Socrates guilty by a narrow margin. Meletus proposes the death penalty and Socrates offers his counterproposal. After considering Meletus’ proposal and Socrates’ counterproposal, the jury votes to condemn Socrates to death. Before he is taken away to await his execution, however, Socrates has the opportunity to make a few remarks to the jury. He begins by addressing himself to those who voted to condemn him to death. He warns them that given the fact that he is advanced in age, had they only waited a short time, he would be dead. Since Socrates wrote nothing, had he died of old age, we might not have heard of him and his philosophical pursuits; indeed, had he not received the death penalty all we would probably know of his trial is a brief line in the history books. We know of this philosopher through the writings of those who knew him and were impressed by his attempt to appeal to principle to convince the jury, The fact that he stood before the city and defended himself and his philosophical life without compromising his principles has made this philosopher live in the imagination across generations. By killing him, the city and its citizens make Socrates a martyr for philosophy. 2. Socrates’ Response to Those Who Voted to Put Him to Death “Perhaps you suppose,” Socrates claims, “that I have been convicted because I was at a loss for the sort of speeches that would have persuaded you, if I had supposed that I should do and say anything at all to escape the penalty. Far from it.” He continues, Rather, I have been convicted because I was at a loss, not however for speeches, but for daring and shamelessness and willingness to say the sorts of things to you that you would have been most pleased to hear, me wailing and lamenting, and doing and saying many other things unworthy of me, as I affirm - such things as you have been accustomed to hear from others. But neither did I then suppose that I should do J. F. Humphrey 29 ______________________________________________________________ anything unsuitable to a free man because of the danger, nor do I now regret that I made my defence speech like this: I much prefer to die having made my defence speech in this way than to live in that way (Ap. 38d-e). Socrates was convicted not because he lacked words to defend himself, but because he refused to beg in the courtroom. Instead, he stood on principle and he chose to present himself as a free man. In battle, one can easily escape death with little effort if one is willing to become a slave; all one need do is to throw down his or her weapons, turn to face the enemy, and plead for mercy. “And there are other devices to escape death in each of the dangers, if one dare to do and say anything at all” (Ap. 39a). “But it is much more difficult, according to Socrates, to escape evil for it ‘runs faster than death’” (Ap. 39a). Socrates then delivers his prophecy to those who voted for the death penalty. He accuses the jurors who voted to put him to death of thinking that once they have killed him, they will not have to give an account of themselves; they will be quit of philosophy. However, he warns that his death will be avenged in the near future by those who follow him and there will be more of them and they will be “harsher,” “younger,” and “more indignant” (Ap. 39d). Socrates chides them for thinking that they can escape from giving an account of themselves by killing people. For if you suppose that by killing human beings you will prevent someone from reproaching you for not living correctly, you do not think nobly. For that kind of release is not at all possible or noble; rather, the kind that is both noblest and easiest is not to restrain others, but to equip oneself to be the best possible (Ap. 39d; emphasis added). However, if those who voted to put Socrates to death, equip themselves to be the best possible, they will be examining themselves and others; they will be practicing philosophy. Ironically, Socrates encourages the jurors who voted to put him to death to become philosophers. 3. Socrates’ Response to Those Who Voted to Acquit Him Next, Socrates addresses himself to those who voted to acquit him, his true judges. With them, he wants to talk about what has happened to him. Socrates tells those who voted for acquittal that since there is time, nothing prevents them from talking philosophy until he is taken away to the place where he will die. Socrates explains, “something wondrous has happened” in the court (Ap. 40a). Formerly, his divine sign had warned him when he was about to do “something incorrectly” - “even in quite small matters” - and had 30 There Is Good Hope That Death Is a Blessing ______________________________________________________________ never told him what to do (Ap. 40a). Anyone who observed what had happened to him, however, would believe that he had suffered “extreme evils” (Ap. 40b). However, Socrates explains that his divine sign had not opposed him when he left his house in the morning, when he came to the court, nor at anytime during his defence speech. The reason for this, Socrates concludes, is that: probably what has occurred to me has turned out to be a good and there is no way that those of us take it correctly who suppose that being dead is bad. In my view a great proof has happened. For there is no way that the accustomed sign would not have opposed me unless I were about to do something good (Ap. 40b-c). Then, Socrates asks the jurors who voted for his acquittal to consider “how great a hope there is that it (death) is a good” (Ap. 40c). But to say that there is hope that death is a good is not to say that death is a good; hoping for something is not the same as saying that something is the case. On the other hand, if one believes that death is a blessing, one might be released from the fear of death and be free to do wondrous things in this life. Even though Socrates does not know what death is and whether it is good or evil, he considers two common views of death, namely, that death is “either like being nothing and the dead person has no perception of anything, or else, in accordance with the things that are said, it happens to be a sort of change and migration of the soul from the place here to another place” (Ap. 40c). If death is the former, i.e., if the dead have no perception of anything, it is like a dreamless sleep and this would certainly, be a wondrous gain” (Ap. 40d). If one compares the one night during which, because of exhaustion, one slept so soundly that one did not dream with those other nights during which one dreamed, one would conclude that the one night without dreams would be better and more pleasant than all the other nights and days. If death is like that one night of dreamless sleep, Socrates argues, then it would indeed be a gain. But what allows us to have dreamless sleep if it is not the ability to be free of worry and care? Hence, only those who are able to live a virtuous life will achieve dreamless sleep. However, if death should turn out to be like a journey to another place and everything that one hears about death should turn out to be true, Socrates claims, then there would be no greater good for us. When one is released from the judgments against him or her in this life, one would arrive in Hades to face true judges, those “who turned out to be just in their own lives” (Ap. 41a). Socrates admits that he would be willing to die many times J. F. Humphrey 31 ______________________________________________________________ to spend his time “examining and searching out among those there,” as he has done in the city of Athens, “who among them is wise, and who supposes he is, but is not” (Ap. 41b). Unlike the Athenians, the residents of Hades will not put Socrates to death; they “are happier than those here not only in other things but also in that they are immortal henceforth for the rest of time, at least if the things that are said are in fact true” (Ap. 41c). Socrates concludes his conversation with those who voted for his acquittal by encouraging them to be hopeful regarding death. But you too, judges, should be of good hope toward death, and you should think this one thing to be true: that there is nothing bad for a good man, whether living or dead, and that the gods are not without care for his troubles. Nor have my present troubles arisen of their own accord, but it is clear to me that it is now better, after all, for me to be dead and to have been released from troubles. This is also why the sign did not turn me away anywhere, and I at least am not at all angry at those who voted to condemn me and at my accusers. And yet it was not with this thought in mind that they voted to condemn me and accused me: rather, they supposed they would harm me. For this they are worth of blame (Ap. 41c-e). Finally, Socrates asks that when his sons grow to be adults that the citizens punish them just as he had pained them. This much, however, I beg of them: when my sons grow up, punish them, men, and pain them in the very same way I pained you, if they seem to you to care for money or anything else before virtue. And if they are reputed to be something when they are nothing, reproach them just as I did you: tell them that they do not care for the things they should, and that they suppose they are something when they are worth nothing. And if you do these things, we will have been treated justly by you, both I myself and my sons (Ap. 41e-42a). But what is Socrates asking of the jurors when he asks them to punish and pain his sons as he has punished and pained them? In The Apology, he mentions having three sons (Ap. 34d) and he certainly may be talking about his three sons here. But it is also possible that he is talking about all the people in the city for he says that he is a gift given by the god to the city to make certain that the citizens are attuned to virtue. 32 There Is Good Hope That Death Is a Blessing ______________________________________________________________ That I happen to be someone of this sort, given to the city by the god, you might apprehend from this: it does not seem human, on the one hand, that I have been careless of all my own things and that for so many years now I have endured that the things of my family be uncared for; and on the other hand, that I always do your business, going to each of you privately, as a father or an older brother might do, persuading you to care for virtue (Ap. 31a-b). Furthermore, if Socrates comes to the citizens as a father, then the inhabitants of the city are his children. And if the jurors are to punish and pain his children as he has pained them, they will be practicing Socratic philosophy with the people in the city. If they are practicing Socratic philosophy, there is a third possible way to understand death. Suppose that death does not involve a journey to another place. Suppose that death is more like a long dreamless sleep. Still, if those who voted for the death penalty equip themselves to become the best that they possibly can, they will be practicing philosophy. If those who voted for his acquittal treat his sons, whether Socrates means his own biological sons, the entire city, or both, they too will be doing philosophy. And if the citizens of the city are doing philosophy, not only will the citizens of the city become better, but the city will also become better. More importantly, Socrates will have become a martyr for philosophy; he will have achieved a certain kind of immortality. Notes 1 Plato, Euthyphro in Plato and Aristophanes, Four Texts on Socrates: Plato’s Euthyphro, Apology, and Crito and Aristophanes’ Clouds, T G West and G S West (trans), Ithaca, NY, Cornell University Press, 1986, n. 5, p. 41. Bibliography Plato, Euthyphro, in Plato and Aristophanes, Four Texts on Socrates: Plato’s Euthyphro, Apology, and Crito and Aristophanes’ Clouds, T G West and G S West (trans), T G West (“Introduction”), Cornell University Press, Ithaca, NY, 1986. J. F. Humphrey teaches at the North Carolina Agricultural and Technical State University, The Department of Liberal Studies and The Division of University Studies, Greensboro, North Carolina, USA Dignity of the Dead? Julia Apollonia Glahn Abstract Dealing with death confronts us with a cornucopia of problems. A particular albeit long neglected - difficulty arises concerning the moral status of dead human bodies. On the one hand, we assume that what constitutes a human being - in particular human value und dignity - comes to an end with her death. On the other hand, we have strong intuitions about the duty to handle dead bodies with respect instead of violating their dignity. For example, consider the debates on organ transplantation, the plastination of human corpses for public exhibitions, and the use of human corpses as crash test dummies. Thus, paradoxically, we seem to simultaneously deny and recognize the dignity of dead human bodies. However, this tension can be resolved by way of two argumentative steps. First, it behoves us to reconsider the status of dead human bodies. Second, we have to clarify our understanding of human dignity. In my paper, I argue that a human being’s existence does not end with her death. In fact, dead people are still human beings. Although we usually do not treat dead humans as if they have dignity, because they do not fulfil the particular sets of criteria we associate with dignity, it turns out that dead human beings still have dignity. So, far from being without dignity, dead humans belong to a group of people who are extremely vulnerable to dignity violations. Therefore, any concept of dignity that fails to incorporate these most vulnerable beings is highly deficient and problematic. Instead of arguing in favour of the traditional criteria of dignity, I develop a social and interactional concept of dignity. According to this approach, refusing decent and humane treatment to the dead is what Avishai Margalit called “human-blindness” and constitutes an instance of a violation of dignity. Key Words: Human dignity, human dignity violation, dead, death, interaction, human-blindness. ***** Although philosophy has, for a long time, neglected the problem of the moral status of human corpses, reality frequently teaches us otherwise. It confronts us with situations, in which we have to decide how to treat dead human bodies. Many of these situations take place in the private realm. Others, however, become a matter of special public interest. When journalists exposed that an Austrian University was using human corpses as crash test dummies1 to get more realistic testing results, the public was shocked. In 34 Dignity of the Dead? ______________________________________________________________ many people’s opinion, such a handling of dead human bodies was disrespectful and a violation of the people’s human dignity. The sentiment that a lot of people seem to share is that dead human bodies are not at the mere disposal of others,2 but, in fact, deserve a particular treatment that respects their human dignity. Yet, we share another strong intuition about human dignity as something that is closely related to certain human characteristics and capabilities. Prominent candidates for the basis of human dignity are the human capacity for reason, self-consciousness, morality3 or free will.4 All these human capacities that are supposed to justify human dignity have one thing in common though: They all require being alive. Only living people and, in fact, not all of them, are capable of being self-conscious, reasonable, free willing or moral agents. Usually, we share the assumption that with a person’s death, not only her life comes to an end, but accompanied by it, all her mental and physical capabilities as well. After death, no one is able to be reasonable, self-conscious, free willing or a moral agent anymore. However, if everything that constitutes human dignity in human beings is lost with death, a dead human being cannot hold human dignity. So, obviously, we are running into a dilemma. On the one hand, we share the intuition that dead human bodies are not at the mere disposal of others and deserve a treatment that respects their human dignity. But on the other hand, we assume human dignity to be linked to certain human capacities that dead humans are definitely lacking. One possible answer to this problem is to say that dead human bodies indeed do not have human dignity, but instead a weaker form of dignity called residual or contingent dignity, which protects them from the mere disposal by others and guarantees them some post mortem rights,5 e. g. to respect a last will or not to do anything to the corpse the person did not give her agreement to before she died; but this is not the “full” human dignity. However, this answer is misleading. The idea of a residual dignity is not reconcilable with the important aspect that human dignity does not know any gradation. Moreover, these granted post mortem rights based on a residual dignity do not satisfy our intuition about the proper handling that dead human bodies actually deserve. Rules, derived from a residual dignity seem arbitrary and lack a sound justification. Why, for example are U.S. citizens allowed to keep the ashes of their loved ones at home, whereas in Germany ashes have to be buried at the cemetery? So, as we still hold the two contradicting intuitions, we are still on the horns of a dilemma. Paradoxically, we seem to simultaneously deny and recognize the human dignity of dead human bodies. How can this be correct? Doesn’t one of these assumptions necessarily have to be wrong? Either our intuitive language of human dignity in connection with the handling of dead Julia Apollonia Glahn 35 ______________________________________________________________ human bodies is wrong and misleading or the limitation of human dignity to only living human beings is wrong. In the following, I would like to suggest a way out of this dilemma. I claim that we only run into this dilemma, because we stick to a misleading description of human dignity. Let me show you why our common idea of human dignity is deceptive and what a better concept of human dignity can look like. The fact that most conceptions of human dignity limit the scope of potential bearers of human dignity merely to living people is due to the ways they try to justify human dignity in general. These conceptions identify some human characteristics as crucial for the assigned special status of human beings. They do so in order to give convincing reasons, why human beings have dignity and therefore deserve certain rights and treatments. Different approaches throughout history suggested a big variety of substantially human qualities. As mentioned above, the human capacity for reason and autonomy, self-consciousness or free will were and still are common candidates for the one and essential human quality that justifies the special human status and, in consequence, human dignity. All these proposals have their shortcomings, but what they all have in common is that they focus on something characteristic within the individual human being – i.e. something that characterizes a human individual as being worth having the highest normative standard called human dignity. But this focus is off target. The commonly shared problem of all these concepts is that they always and necessarily exclude certain groups of people. Relating the attribution of human dignity to certain cognitive capacities means to ignore all the people who are temporarily or permanently lacking these capacities.6 A comatose patient, a severely brain damaged or profoundly mentally disabled person, or even a healthy unborn or newborn infant is lacking most or all of these capacities. To account for human dignity by referring to one or a set of these qualities must fail, because it is requiring too much. It is extremely misleading to ground the highest normative standard among human beings on supposed characteristics that a lot of people do not even share. The capacity for reason, self-consciousness, morality or free will might be typical for human beings. But the mere identification of a capacity as typical for most human beings is not a sound and plausible reason to make it crucial and essential for the constitution of a status that should be granted to every human being regardless of their natural capabilities. An alternative concept that avoids this mistake is founded on the fundamentals of Christian ethics.7 It considers all human beings to be God’s children. Regardless what qualities they have they are all created in God’s image and it was God himself who gave them their human dignity.8 Secular concepts however, which try to rely on this argumentation are confronted 36 Dignity of the Dead? ______________________________________________________________ with the lack of a theological authority like God, as an approach like this can only be convincing for those who believe in God. Unlike the religious approach, the preamble to the Charter of the United Nations9 describes a modern and secular concept, in which the equality of all human beings is agreed on, regardless of their ethnicity, social status, nationality or religion. Every one is born free in rights and dignity. Being human is the only condition one has to fulfil to have human dignity. This formulation is, above all, understandable as a strong refusal to all antiSemitic, racist and fascist ideologies, but remains problematic nonetheless, as it does not give a sound justification. Even though the attempt to enunciate human dignity’s inherent aspects of universality, equality and un-graduality, is invaluable, it fails to give a convincing justification beyond the divine authority or certain sets of mental capacities. The underlying concept of all people being born free and equal in rights and dignity might be a matter of course to people within the western world. But it could also be understood as a way of western cultural imperialism. We just do not know whether it is correct or not. Moreover, merely being a member of a particular biological species can hardly count for the justification of a moral status.10 The line between different biological species is drawn arbitrarily and lost to any good moral argument. Thus, it turns out that neither of these concepts can help us solve our problem. If we draw on certain mental capacities to justify human dignity we are doing so on good grounds, but we are unjustifiably excluding some groups of living people as well as human corpses. However, if we resort to the fact of being human as essential for human dignity, we do include all kinds of living and dead human beings, but we fail to give good reasons for it. So, we are faced with a Hobson’s choice. Either we accept a way too narrow concept or one that is lacking a sound justification. What could be the way out? Although it is unsatisfying, what the genuinely Christian approach correctly emphasises is the relational moment of human dignity. According to this concept, human dignity is not only founded in any individual human being, but it is in fact constituted in her relation to God. I think this relational element of human dignity is the key to a satisfying concept of human dignity. In order to develop a convincing concept of human dignity, we need to replace the idea of a divine authority with the social interaction among human beings. It is, in fact, the social interaction all human being always naturally engage in, that makes human dignity possible. Every time, two or more people interact with each other, they create a realm in which dignity arises. As social interaction is something all beings are bound to, it represents one cornerstone of human togetherness. It is exactly the fact that and the way that we interact with other people that constitutes human dignity. Julia Apollonia Glahn 37 ______________________________________________________________ It was Avishai Margalit who, in his work “A Decent Society,”11 developed this idea of a social concept of human dignity. He proceeds ex negativo by defining “a violation of human dignity”. Essentially, violations are acts of humiliation. The strongest way to humiliate a person is to exclude her from the community of human beings. This exclusion happens, when people are treated as if they were not human beings. Naturally, all human beings are capable of recognizing other beings as human. What they recognize in the other one is themselves. To see people as not being human requires an active effort: namely ignoring their humanity. Such a perception of human beings as if they were not human beings must be created actively and intentionally. So, if we actively try to see other human beings as if they were not human, if we ignore their humanity, we make ourselves guilty of what Margalit calls “human-blindness”.12 Acting human-blindly does not mean one does not recognize the humanity in another person. It rather means to make an active effort to ignore another person’s humanity intentionally. In most cases, where people ignore the humanity of others, it requires an intentional active effort to overlook another one’s humanity, to make oneself blind to the humanity of the other one. Margalit’s crucial point, hence, is not that we have to respect and treat people as people, but stronger, that as human beings we naturally cannot do differently. Seeing people as people that we ourselves are, is genuinely interpersonal. This active and intentional exclusion from the human community is what happens, when we feel uncomfortable with a certain handling of dead human bodies. The discomfort we feel, if a dead human body is used as a crash test dummy or is carelessly disposed in a trash can, is due to the fact that what we see in the corpse is a human being. Therefore, such a handling of human corpses is ignoring their humanity, it is human-blind. In those situations with dead human bodies, where we feel the diffuse discomfort that we try to name by saying: this is violating or disrespecting the dead person’s dignity, we recognize that someone is recognizing the corpse as human, but is treating him as if she were not a human being and hence is making himself guilty of being human-blind. By treating dead human bodies incorrectly, namely as non-humans, we erroneously and unjustifiably exclude them from the community of human beings. And being excluded from the community of human beings is humiliating and therefore violates one’s human dignity. But in order to be excluded from the community of human beings, it is necessary to be a member in the first place. Thus, the question comes up whether dead human bodies are still human beings. From the legal perspective (at least in Germany), they are entities between a ‘person’ and an ‘object’, which leads to the odd formulation of ‘personal objects’ and even some philosophers prefer the idea that dead human bodies, although they have certain rights, actually are objects. 13 38 Dignity of the Dead? ______________________________________________________________ But I think this is wrong. Philosophically, there are reasons to assume that dead human bodies are still human beings. Although, as stated at the beginning, a lot that we care about comes to an end, when we die, it is not true for everything. Instead of limiting the membership in the human community to the living ones, I want to argue for an overcoming of the boundary between life and death. This border might be incisive and morally relevant in several regards, but it is not when it comes to a proper handling of human bodies. Being alive or dead is not the crucial criterion for the treatment as relevant as the realm of human dignity is not marked by the biological dimension between life and death, but rather by the social dimension between people. So there is no good reason to assume a significant and morally relevant difference between the claims for respect in interactions among living people, or between living and dead people. This becomes obvious, when we look at the proper treatment of comatose or brain dead patients. In these situations we become aware that the mere fact of being alive is not as pivotal for the evaluation of a treatment as we might think. Like with a comatose patient, we might not be able to hurt a dead human body physically or psychologically, but we can harm him by neglecting the status that he deserves as a member of the human community, dead or alive. What is much more important for the question of human dignity in this case is the existence, the mere being there. Usually, when a person dies, there is a corpse. This corpse, although subjected to severe physical changes, namely degeneration and autolysis, is recognizable as human. By this, he does not only provide the above-mentioned surface of identification, but does something more. By being there he calls for action. In the presence of a dead human body we cannot omit acting. No matter what we do, what is crucial is that we have to do something. We cannot do nothing. The physical presence of the dead body requires our action. For Margalit, towards human beings we are always and necessarily acting beings. To respect someone’s human dignity means to see him as a human being and therefore, treat him as a human being. Whereas a violation of human dignity means to see someone as a human being, but ignore his humanity and, in consequence refuse him the human treatment he actually deserves. By this postulation of human beings as necessarily acting beings, interaction among humans inevitably has to happen and therefore, the possibility of the constitution of a realm of human dignity is given. Where does this conception lead us to? Does it mean there is no difference between the interactions among living people or between living and dead people? As interpersonal interaction is so closely related to the physical presence of its participants, we have to acknowledge that in cases of dead human bodies it is definitely limited. As mentioned above, the human corpse is on the point of physical disintegration, which marks the limits of Julia Apollonia Glahn 39 ______________________________________________________________ interactions. Many ways of interactions necessarily need to be limited. Imprisonment, torture or other ways of physical harm are pointless. However, dead human bodies are still potential victims of human dignity violations. The fact that dead human bodies are immune to some of the most common violations of human dignity does not mean that they are immune to all possible violations. In fact, they belong to a group of people, like comatose patients, severely brain damaged or mentally disabled persons or unborn and newborn infants, who are limited in their interpersonal interaction and thus extremely vulnerable, when it comes to the most fundamental violation of human dignity: the exclusion from the human community! Exactly because they cannot defend and protect themselves, others have to be particularly careful with them. So, a proper handling of dead human bodies does not mean treating a dead human body in the same way we would treat a living person. It means to recognize and treat him as human and thereby respect his human dignity. By ignoring his humanity, we automatically exclude him from the human community. And such exclusion would necessarily be intentional and humanblind, as it ignores the potential of identification that dead human bodies have for living people. By means of their presence, corpses enable people to recognize themselves in them. The realm, in which human interaction takes place, creates the basic requirement for the constitution of human dignity. When this realm that comes to existence naturally and directly between all human beings who interact with each other is neglected, it is our feeling of discomfort and the intuition that arises telling us that this is not the way to treat dead human bodies, because it disrespects their human dignity. Therefore, we are justified to use human dignity as the valid criterion for the evaluation of a treatment of dead human bodies. Our intuition is not doomed to be a naïve illusion, but is shown to be correct, as it is possible to formulate a concept of human dignity to which it reconciles itself. Notes 1 T Hofstätter, ‘Crahstests mit Leichen. Skandal rund um die Crash Test Dummies’, in Via Medici Online, April 2005, viewed on 25 January 2009, http://www.thieme.de/viamedici/studienort_graz/aktuelles/crashtest.html. Veröffentlichungen des Instituts für Deutsches, Europäisches und Internationales Medizinrecht, Gesundheitsrecht und Bioethik der Universitäten Heidelberg und Mannheim (eds), Kommerzialisierung des menschlichen Körpers. Leichen-Schau und Menschenwürde. Von Körperwelten, Kuriositätenkabinetten und Crash-Test-Dummies, Springer Verlag, Berlin, 2007. 40 Dignity of the Dead? ______________________________________________________________ 2 A Esser, ‘Respekt vor dem toten Körper’. Deutsche Zeitschrift für Philosophie, 56, 1, 2008, pp. 119-134. 3 I Kant, Groundwork of the Metaphysics of Morals, Wilder Publications, Radford, 2008. 4 Augustinus, ‘De libero arbitrio – Vom freien Willen’, in Theologische Frühschriften – Vom freien Willen – Von der wahren Religion, Artemis, Zürich, 1962. G Pico della Mirandola, On the Dignity of Man (De hominis dignitate), Bobbs-Merrill, Indianapolis, 1965. 5 D Sperling, Posthumous Interests. Legal and Ethical Perspectives, Cambridge University Press, Cambridge, 2008. 6 P Balzer, K P Rippe, and P Schaber, Menschenwürde vs. Würde der Kreatur. Begriffsbestimmung, Gentechnik, Ethikkommissionen, Alber, Freiburg, 1999. ‘Symposium on the Identity and Dignity of Man 1969’, in Ethical Issues in Biology and Medicine, P N Williams (ed), Schenkman Pub. Co., Cambridge, 1973. 7 R Duffy and A Gambatese (eds), Made in God's Image. The Catholic Vision of Human Dignity, Paulist Press, New York, 1999. 8 Bible, Genesis, I, 26-27. 9 Charter of the United Nations and Statute of the International Court of Justice, 1978. 10 P Singer, Practical Ethics, Cambridge University Press, Cambridge, 1993. 11 A Margalit, The Decent Society, Cambridge University Press, Cambridge, 1996. 12 ibid., pp. 96-101. 13 S Schenk, Die Totensorge – Ein Persönlichkeitsrecht. Zivilrechtliche Untersuchung der Verfügungsbefugnis am menschlichen Körper, Verlag Dr. Kovač, Hamburg, 2007. M Weck, Vom Mensch zur Sache? Der Schutz des Lebens an seinen Grenzen, Shaker Verlag, Aachen, 2003. Bibliography Augustinus, ‘De libero arbitrio – Vom freien Willen’, in Theologische Frühschriften – Vom freien Willen – Von der wahren Religion. Artemis, Zürich, 1962. Balzer, P., K.P. Rippe, and P. Schaber, Menschenwürde vs. Würde der Kreatur. Begriffsbestimmung, Gentechnik, Ethikkommissionen. Alber, Freiburg, 1999. Bible, Genesis, I, 26-27. Julia Apollonia Glahn 41 ______________________________________________________________ Charter of the United Nations and Statute of the International Court of Justice. 1978. Duffy, R. and A. Gambatese, (eds), Made in God's Image. The Catholic Vision of Human Dignity. Paulist Press, New York, 1999. Esser, A., ‘Respekt vor dem toten Körper’. Deutsche Zeitschrift für Philosophie, 56, vol. 1, 2008, pp. 119-134. Hofstätter, T., ‘Crahstests mit Leichen. Skandal rund um die Crash Test Dummies’, in Via Medici Online, April 2005, viewed on 25 January 2009, http://www.thieme.de/viamedici/studienort_graz/aktuelles/crashtest.html. Kant, I., Groundwork of the Metaphysics of Morals. Wilder Publications, Radford, 2008. Margalit, A., The Decent Society. Cambridge University Press, Cambridge, 1996. Pico della Mirandola, G., On the Dignity of Man (De hominis dignitate). Bobbs-Merrill, Indianapolis, 1965. Schenk, S., Die Totensorge – Ein Persönlichkeitsrecht. Zivilrechtliche Untersuchung der Verfügungsbefugnis am menschlichen Körper. Verlag Dr. Kovač, Hamburg, 2007. Singer, P., Practical Ethics. Cambridge University Press, Cambridge, 1993. Sperling, D., Posthumous Interests. Legal and Ethical Perspectives. Cambridge University Press, Cambridge, 2008. ‘Symposium on the Identity and Dignity of Man 1969’, in Ethical Issues in Biology and Medicine. P N Williams (ed), Schenkman Pub. Co., Cambridge, 1973. 42 Dignity of the Dead? ______________________________________________________________ Veröffentlichungen des Instituts für Deutsches, Europäisches und Internationales Medizinrecht, Gesundheitsrecht und Bioethik der Universitäten Heidelberg und Mannheim (eds), Kommerzialisierung des menschlichen Körpers. Leichen-Schau und Menschenwürde. Von Körperwelten, Kuriositätenkabinetten und Crash-Test-Dummies. Springer Verlag, Berlin, 2007. Weck, M., Vom Mensch zur Sache? Der Schutz des Lebens an seinen Grenzen. Shaker Verlag, Aachen, 2003. Julia Apollonia Glahn is, after graduating in Philosophy in 2008, a research fellow at the Institute of History, Theory and Ethics of Medicine at the RWTH Aachen, Germany, where she is mainly working in philosophical thanatology. Currently her research and writing is devoted to various problems with death, dying and the dead. Moreover, she is interested in moral theory, ethics and applied ethics. The Haunt: Demons and The Complex of Noon Tolulope Onabolu Abstract Above the Gate of Intrepid is painted the inscription… “He who follows this path alone and without looking behind him, will be purified by Fire and Air; and if he strives to conquer the dread of Death he will emerge from the underworld, and will behold the Light once more, and will be worthy to be admitted into the company of wise men and men of valour.”1 This is the moment when the sun, at its zenith divides the day into equal parts, each governed by the opposing signs of rise and decline. This, then, is the moment when the forces of life and light yield to the powers of death and darkness. In ancient Greece, noon was in fact the hour of transition marking the boundary between the reign of the Uranian and of the infernal gods.2 To make a “nonsensical” reading of dying, or of death, is problematic – for a subject which is taken so seriously - the tone set up in the call for papers implies such (discussions on euthanasia, abortion, suicide, homicide, genocide, infanticide, etc.) However, (as part of a creative practice) is not this “nonsensical” reading precisely what is required for a theme which is caught up in the form of its description (making sense of) - precisely what is the sense (or nonsense) of dying and death? Between the sovereignty of initiation, sacrifice and the rites of passage, and the death of the soul implied in ennui (specifically psychasthenia and acedia with reference to Caillois3), this paper will attempt (by expanding on Lequeu’s Gothic House, also known as The Haunt of Magicians, and Caillois’ “The Noon Complex”4) to make sense of dying and death. As implied in The Haunt,5 we will argue that the transformation in dying/death is indeed “an awakening.”6 Key Words: Becoming(s), creative practice, death, desire, initiation, sympathetic magic, transformation, virtual. ***** 44 The Haunt/ Demons and The Complex of Noon ______________________________________________________________ 1. Preface In this paper, I attempt a creative approach to death, within a Deleuzian thesis of becomings.7 Thus, taking cue from Caillois, death becomes a threshold for virtual becomings: a transformation from a previous state of being, emerging from a state of boredom, drudgery, or delirium8 and located within a propositional framework - in this case, a paradoxical, or affirmed and negated (fictive) architecture. There are three seemingly unrelated issues in this paper: acedia or sinful sadness, legendary psychasthenia or the maligned perception of self, and finally, initiation. What these three have in common is death. In acedia, there is a protracted death of the soul, born out of boredom; in legendary psychasthenia, there is a death of self - from a dissolution of perceived reality (the subject does not distinguish between itself and its environment); and in initiation, there is a death to a previous state of being and a subsequent transformation into “something else.” In all three, “something else,” something phantasmatical happens after death - this is what I have termed (borrowing from Tolstoy) an awakening. As such, the awakening is a transformation into something other than one’s previous state of being or in another sense, a magical becoming. Further, there are three unrelated authors: Lequeu, Caillois, and Tolstoy. These authors in various ways support a love of and a desiring into death; viewing death as a transformative process, which one must necessarily go through to achieve the transformative becomings argued in this paper. In Lequeu and Tolstoy, through a materialist mysticism, and in Caillois though delirium. We will confront these awakenings and magical becomings through the transformative texts of these authors. 2. Introduction Initiating this magical reading into Dying and Death, I open from the third part of Memories of a Sorcerer in Deleuze and Guattari’s “1730: Becoming-intense, Becoming Animal, Becoming Imperceptible…” A man totters from one door to the next and disappears into thin air: ‘All I can tell you is that we are fluid, luminous beings made of fibres.’ All so-called initiatory journeys include these thresholds and doors where becoming itself becomes, and where one changes becoming depending on the ‘hour’ of the world, the circles of hell, or the stages of a journey that set scales, forms, and cries in variation. From the howling of animals to the wailing of elements and particles.9 Tolulope Onabolu 45 ______________________________________________________________ In presenting the three disparate concepts of death previously stated, will discuss some events between Volumes 1 and 2 of Tolstoy’s War and Peace, demonic transformations in Caillois, and a site of one such transformation (The Haunt of Magicians) rendered by the 18th Century Architect, JeanJacques Lequeu. A nonsensical reading of death is therefore a virtual sense of death, as opposed to any representation of death itself, which I believe permanently eludes us, i.e. death knows us, but we cannot know death. Thus in speaking about demons, we are actually speaking about phantoms of the undead: those awakened or transformed beings, which elude representation. Starting with Lequeu, we will explore the Haunt of Magicians, a formless form, where one goes through an initiatory process by dying (passing through the realm of the dead), then proceeding to Caillois to uncover the demonology of the hour of the dead, and the resulting excess leading to delirium and war, and finally concluding in a treatise on war (through Tolstoy), itself a confirmation of excess, springing from an entering or desiring into death. What is argued in this paper is that the initiatory death in Lequeu is akin to the death in war, i.e. the initiate must go through The Haunt, to enter into a becoming, just as the warrior must go to war to enter into a dying (by entering into war, one is entering into dying). In both cases, the field of battle (death) is rife with its own excesses and inflections. Therefore death is initself not an instant, but a process leading to other transformations, or awakenings; or to use a Deleuzian term, Death is the process of transformation where “becoming” itself becomes. In this, The Haunt of Magicians becomes The Field of Battle and The Circle of Hell through the given Hour of The World. The Haunt enters into a transformation of becoming war and becoming field of battle. 3. Lequeu Jean Jacques Lequeu was an 18th century French architect. In the foreword to Philippe Duboy’s volume on him10, Middleton draws to our attention in the opening lines, the impact of a materialist mysticism in art (to a certain degree, and with reference to Bataille, a sort of artistic eroticism). Central to Duboy’s representation of Lequeu, is representation itself, and along with it the history of art, exemplified in the exclamation “a blank page!” against the outlined statement “Science of natural shading and wash for finished drawings” - on the first page, under “A Certain Chinese Encyclopaedia,”11 a statement made by Foucault in The Order of Things, on the classifications of Borges - itself an analysis of the history of representation.12 46 The Haunt/ Demons and The Complex of Noon ______________________________________________________________ In the collection of works that constitute the volume by Duboy, we are presented with a somewhat enigmatic Lequeu - a sort of creative genius; whereas Lemagny in Visionary Architects has him down as a tormented mind - “a motionless and disturbing universe.”13 Again we are presented with the undeniable impact of representation. The words or gaze upon a thing, within which it is described i.e. its signifier. In my reading of Lequeu, (taking a cue from Duboy) I attempt a similar non-representational reading. Hence in The Haunt of Magicians, which I will discuss below, I make no allusion to any representation of a building. A. The Haunt of Magicians14 In The Haunt of Magicians, which is alluded to in both the abstract and title of this paper, Lemagny presents us with a somewhat sombre representation of the building. He states: “From one of the grilled openings comes “moaning and weeping.” We are unmistakably in the age of tales of terror.”15 By contrast, in Duboy, we are presented with a frivolous/delirious Lequeu who wishes to impose a Masonic initiation on his public. What is clear from both Duboy and Lemagny is that The Haunt of Magicians, or the Gothic House as it is also known, is a temple of initiation, of which Death is a threshold that must be crossed. In describing this path of initiation, or confrontation with death by Lequeu, Lemagny citing Metken states: All the steps along his road to true knowledge appear again in Lequeu’s picture, where they are accompanied by explicit legends. The aspirant’s first trial is ‘Tartarus,’ a ‘fiery furnace’ hung with instruments of hellish torture. From the centre of this grotto emerges a statue symbolic of fire. Farther on, ‘the forbidden River Cocytus … [with] waterfall and pool’ opens up. A statue symbolising water stands in its midst. Next, in the hollow pedestal of a colossal statue of wisdom, there is a mesh of wheels, pins, and pulleys. They command the opening to the sanctuary itself. Finally, within the sanctuary is the full cup of water of forgetfulness, ‘Mnemosyne’s potion.’ Here in the ‘place where true wisdom is learned.’ It is “the sanctuary of the initiated, the content.” Günter Metken, ‘Jean-Jacques Lequeu ou L’Architecture Rêvée,’ Gazette des Beaux-Arts (April, 1965), pp. 223-225.16 Tolulope Onabolu 47 ______________________________________________________________ B. The Haunt/ Demons We thus have three elemental constituents of the Gothic House: Tartarus, Cocytus, and Mnemosyne, all of which have Death at their core. We know from The Theogony of Hesiod that Tartarus, third after Chaos and Earth, and last before Eros, is both deity and abyss located in Hades (the mythological abode of the dead); also, that [it] “is the unbounded firstexisting ‘thing’” from which is born Light and Cosmos.17 Again, from Greek Mythology, Cocytus is a river which flows in the domain of the dead, but represented as a lake (frozen by the flapping wings of Lucifer) in Dante’s Divine Comedy as the ninth and lowest circle of hell, and home to traitors (the biblical Cain, Judas Iscariot, etc.). Finally, Mnemosyne, mother of the nine Muses by Zeus, and presider over one of the pools in Hades, of which initiates of Orphic poetry were encouraged to drink so as to enter into forgetfulness. We can thus conclude that for Lequeu, The Haunt of Magicians was a place where one descended into the very depths of the underworld (Hades/ Hell), to come out renewed. Hence the inscription on the drawing: Above the Gate of Intrepid is painted the inscription… ‘He who follows this path alone and without looking behind him, will be purified by Fire and Air; and if he strives to conquer the dread of Death he will emerge from the underworld, and will behold the Light once more, and will be worthy to be admitted into the company of wise men and men of valour.’18 Whether or not it is the protracted form of a Masonic initiation according to Duboy remains the subject of a different sort of speculation. We will now proceed to Caillois for the demonology of the hour of death, and the conditions and excesses of the said hour. 4. Caillois In A Caillois Reader, Claudine Fink suggests, in the Introduction to The Noon Complex, that Caillois might have written the essay as a treatise on laziness, and of what I might add, boredom. Fink suggests that between Les Démons de midi (The Demons of Noon), and The Noon Complex, Caillois addresses one of the questions central to the College of Sociology: of what has replaced the excess of the archaic festival?19 In Man and the Sacred, Caillois suggests that the period of excess, which was marked by festival, has come to be replaced by the vacation, that the escape from the drudgery of organised life which culminated in the orgiastic festival has been replaced by the ephemeral pleasure of the vacation. 48 The Haunt/ Demons and The Complex of Noon ______________________________________________________________ He asks: “Is not the ephemeral pleasure of vacation one of those false senses of well-being that mask death throes from the dying?”20 In this we see a suggestion of the relationship between laziness, drudgery, boredom, and death (in the form of a prohibition, or denial of orgiastic excess). In fact, Caillois suggests that this state of existence was reserved exclusively for those under sovereign exception i.e., sacred beings (the ideal being that they did nothing). A. “The Noon Complex” Referencing Virgil’s Georgics, Caillois states that Servius’ assertion that the demons appeared mostly at noon provided sufficient grounds for his research into solar mythology.21 In a similar vein, I will present Caillois essay as adequate for a demonology of noon, or what I have termed (borrowing from his Noon – Hour of Transition) The Hour of The World. Caillois’ essay on the “Noon Complex” is fascinating in terms of its revelation. We have the transitional phase of day into night occurring at noon, similarly the transformation from the reign of (heaven/ the sky) Uranus, to the reign of (Hades) the Abyss, and through a form of sympathetic magic (where the soul is identified with the body’s shadow), the reemergence of the dead (those who cast no shadow). This is a fairly simple analogy, which when associated with Bataille (Solar Anus),22 becomes fairly complicated. Thus, we will take it in its simple form, as the hour when the sun is at its zenith. At its zenith, the intensity of the directly overhead sun brings with it certain physiological conditions that were related to these infernal beings (those who cast no shadow). Caillois states: The sun’s burning heat is unforgiving at this time of day. Heat stroke, sunstroke, cerebral fever, and their attendant mental and physical ailments offered sufficient proof of demonic activity to persuade people that they existed.23 This strain of thought is followed by a discussion of the decline of the pre-eminence of noon through Christianity, and the invention of the chiming clock, but again undermined by the human condition of hopelessness experienced at noon. Caillois states: At noon, it would seem like life takes a pause, organic matter returns to an inorganic state, and everything blazes pointlessly and without ardour in a futile desire for luxury and display. Activity of any kind seems to involve unpleasant and risible agitation. All heartbeats come to a Tolulope Onabolu 49 ______________________________________________________________ halt. The supreme triumph of all the positive forces dissolves into renunciation, their surging forth into slumber and their plenitude into resignation. The will to live withdraws somewhere unknown, as if absorbed by thirsty sands. This silent exaltation of every abdication, like a flood invincibly overwhelming all morality, swiftly drowns any uncertain inclination or remorse it might find.24 Caillois thus suggests that at this time, and with particularly association to medieval monks, there is a feeling of boredom, drudgery, and insuperable laziness – the acedic condition, overwhelmed by carnal desire. Elsewhere, he suggests that the demon of noon would disguise itself as a nun, assault the monk during its siesta, and caress it like a prostitute. He states: The ailing monk comes to feel an overwhelming revulsion for his life, for his monastery and companions. He is overcome with insuperable laziness. Daily work disheartens and repels him; even reading fills him with disgust. He is weary and yet ravenously hungry, with a kind of morbid need to sleep as the sixth hour is drawing near - the fearful hour of noon. At that time, he keeps on watching the sun, judging that its decline towards the sun is too slow. […]. Here then is acedia: […]. Acedia is a sense of apathy towards life, the dull anxiety of a frustrated heart, and an intellect confused by irrationality. […]. And beneath it all we find the lure of sexuality: the acedic subject will like to visit a woman with no one to support her. Sometimes the sexual obsession is more explicit.25 Caillois concludes his essay by suggesting that if the tendency in nature is towards a state of delirium, and the irrationality of the monk is justified as a state of absolute becoming,26 again suggesting that human excess manifests itself in this state of becoming. We can conclude that the death being sought in Caillois is one brought about in the excess of the orgiastic event, (again, with reference to Bataille) in the ejaculatory eruption of blood, sweat, and semen.27 In Lequeu, we have located the place, and the demonic constitution of death, and in Caillois, the demonology of the hour of dying. With a certain empirical twist, we may suggest the event necessary for a transformative becoming (dying) - War; for as is in orgiastic event, in war we have all the eruptions of excess (blood, sweat, and semen). 50 The Haunt/ Demons and The Complex of Noon ______________________________________________________________ B. War: Legendary Psychasthenia, Boredom and Delirium In “Mimicry and Legendary Psychasthenia”, Caillois introduces a form of dematerialised space, what Lacan terms “dark space,”28 and Deleuze “black holes.”29 Dark space is any non-geometric definition of space: the space of music, of groping, of hallucination - a space where one feels oneself permeable to ones surroundings. Within a similar framework, The Haunt of Magicians is a dark space, transformed into a field of battle by the very act of initiatory transformation that occurs within it. As such, the architecture of Lequeu becomes the dematerialised/deterritorialised architecture of the battlefield. Further, the demons of The Gothic House become the asthenic conditions of the battlefield: boredom, fear, delirium, and the eruption of excess. We know that the asthenic conditions of Caillois’ insects (which he termed Legendary Psychasthenia), where the insect became indiscernible to its kind, was not as a form of protective or defensive camouflage, but an eruption of excess (as it no longer knows what to do with itself), culminating in cannibalism (the insects appeared as food to each other).30 5. War and Peace In my reference to war, I draw upon Volumes 1 and 2 of Tolstoy’s War and Peace. In Tolstoy’s recollection of war, and in some other fictional works on war, the movie Jarhead and Sebastian Faulks book Birdsong, some of the most demonic manifestations are boredom and delirium, followed by excess: torture, looting, the use of women, etc. Tolstoy brings this to bear in many ways; from the inanity of aristocratic life to actual psychological turmoil in the field of battle. While it might appear outrageous to engage the acedic or asthenic condition with warfare, Tolstoy already provides us with the conditions: boredom, sexual tension and anxiety; from the teenage girls in the Rostov household to members of the infantry’s preoccupation with climbing over a convent wall. …’No, but what I’d like’ he added chewing a little pipe with his handsome, moist mouth, ‘is to climb in there.’ He pointed to the convent with its towers, visible on the hilltop. He smiled, his eyes narrowed and lit up ‘…At least to put a fright to those little nuns. There are some Italian ones, young ones they say…’ ‘They must be bored, too’ an officer, a bolder one said laughing.31 Elsewhere, we experience delirium in Rostov, while he is advancing with his regiment, he is finding difficulty keeping awake, and begins daydreaming, again an engagement with dark space - psychasthenia: Tolulope Onabolu 51 ______________________________________________________________ ‘It must be snow - this spot; a spot - une tache,’ thought Rostov. ‘Tache or no tache….’ ‘Natasha, my sister, dark eyes. Na…tashka… (She’ll be so surprised when I tell her how I saw the sovereign!) Natasha…take the…tashka…’ A young, childish sleep was irresistibly coming over him. ‘…Yes,yes! Na-tashka…at-tack a… attack who? Hussars. Whose hussars? The hussar you saw ride down the boulevard, remember, just across from Guryev house… Old man Guryev.…’32 Further on, we experience the excesses of war, in the place of the bodies of the dead and wounded over the battlefield, and a robbery. Denisov robs the infantry supplies transport, he is court-marshalled, but gets shot and ends up in hospital. In the hospital, again, more death, decay and disease; the description of the hospital wards is so invoking, that one almost experiences the stench and decay of the multitude of human bodies. Even more remarkable is the doctor’s indifference to death. In all, war which is also an engagement with death brings with it transformations of a sort not usually associated with it. One step beyond that line, reminiscent of the line separating the living from the dead, and it’s the unknown, suffering, and death. And what is there? Who is there? There, beyond this field, and the tree, and the roof lit by the sun? No one knows, and you would like to know; and you’re afraid to cross that line, and would like to cross it; and you know that sooner or later you would have to cross it and find out what is there on the other side of the line, as you will inevitably find out what is on the other side of death.…33 Is this any different from the Masonic initiation of Bezukhov that is folded into the story, especially in volume 2, where he is encouraged to embrace death, to love death…? “Whatever happens to you,” he said, “you must courageously endure everything, if you are firmly resolved to enter into our brotherhood…”34 Also, in the virtues of which he is supposed to uphold, the love of death (the seventh virtue) is tantamount to his redemption. ‘Seventh’ said the rhetor, ‘try by frequent thoughts of death to bring yourself to the point where it no longer seems a fearsome enemy to you, but a friend…who delivers the The Haunt/ Demons and The Complex of Noon 52 ______________________________________________________________ soul grown weary in the labours of virtue in this calamitous life and leads it to the place of recompense and peace.’35 Between books 1 and 2 of War and Peace, a number of deaths are recorded. Beginning with Count Bezukhov, the uncountable deaths and fields filled with masses of dead and wounded soldiers during the war with Napoleon’s army, the blissful and somewhat heroic and puzzling death of Andrei Bolkonsky, the duel between Bezukhov and Dolokhov over the latter’s intimacy with Bezukhov’s wife, the death of Andrei’s wife and the birth of their son at the moment of his return from the dead. These deaths, or seeming deaths and their associated becomings/ transformations constitute the war machine of Tolstoy. The transformations in the characters, especially Andrei Bolkonsky, through his actual engagement and erstwhile purported heroic death in battle, and Pierre Bezukhov’s transformation through Masonic initiation, also an engagement with death through a form of sympathetic magic a la Lequeu, become the dark space or “night of senses” of death in this paper. The principles of their engagement can be summarised in the three central principles of Bezukhov’s initiation:    6. Self-knowledge - for man can only know himself through comparison Perfection - for it is achieved through struggle The main virtue - The Love of Death Conclusion: Becoming-Myth/ Desiring into Death At the onset of this paper, we set out to confront the magical becomings (myths of dying) from a desiring into death. We can conclude as follows: We have seen that death is in-itself a transformation into “something else”, we have seen that whether in war, delirium or initiation, one is entering into death; as such, death is a sort of “dark space” through which one must necessarily enter to re-emerge transformed in a demonic becoming. In speaking about a desiring into death, we have been speaking about sorcery, or would-be sorcerers: Deleuze, Lequeu, Caillois, and Tolstoy, and their planes of composition: The Haunt of Magicians, The Circle of Hell, The Hour of the World, and The Field of Battle. We have argued that each (plan(e)) becomes the other through constant transformations or demonic awakenings centred on a desiring into death. And especially, that The Haunt of Magicians that we started with, in this empirical twist (becoming) enters into a becoming - Battle Field (the dark space of demons). Tolulope Onabolu 53 ______________________________________________________________ Finally, whether in Lequeu, Caillois or Tolstoy, we have been encouraged to embrace death (in a becoming-sorcerer/ becoming-demon): through initiation and strife in Lequeu and Tolstoy; and through orgiastic excess, boredom, and delirium in Caillois. Notes 1 J-J Lequeu in P Duboy. Lequeu: An Architectural Enigma, Thames and Hudson, London, 1986, p. 72. 2 R Caillois, ‘The Noon Complex’, in The Edge of Surrealism: A Caillois Reader, C Frank (ed.), C Frank and C Naish (trans), Duke University Press, Durham and London, 2003, p. 125. 3 R Caillois. ‘Mimicry and Legendary Psycasthenia’, in The Edge of Surrealism: A Caillois Reader, C Frank (ed.), op. cit. 4 R Caillois, ‘The Noon Complex’, op cit. 5 The Haunt is a shortened form for Lequeu’s drawing The Haunt of Magicians also known as The Gothic House that I have adapted for this essay. http://visualiseur.bnf.fr/ark:/12148/btv1b7703097t 6 See L. Tolstoy, War and Peace, Vintage, 2007. 7 See G Deleuze, Logic of Sense, Continuum, London, 2004; see also, G Deleuze and C Parnet, Dialogues II, Continuum, London and New York, 2006. 8 See R Caillois ‘Mimicry and Legendary Psycasthenia,’ op cit. 9 G Deleuze and F Guattari, A Thousand Plateaus: Capitalism and Schizophrenia, Continuum, London, 2004, p. 274. 10 R Middleton, foreword to Lequeu: An Architectural Enigma, op. cit. 11 P Duboy, Lequeu: An Architectural Enigma, op. cit. 12 See M Foucault, The Order of Things: An Archaeology of the Human Sciences, Routledge, London and New York, 2008, pp. xvi – xxvi. 13 J-C Lemagny, Visionary Architects: Boullée, Ledoux, Lequeu, Hennessy and Ingalls, California, 2002. 14 See P Duboy, Lequeu, op. cit. ‘Le Repaire des Magiciens’ (‘The Haunt of Magicians’), p. 75, Illustrations on p.84, p. 215. See also: http://visualiseur.bnf.fr/ark:/12148/btv1b7703097t 15 J-C Lemagny, op. cit. p. 187. 16 ibid. 17 Hesiod, The Theogony, H G Evelyn-White (trans), http://www.sacredtexts.com/cla/hesiod/theogony.htm. See also, A Pérez Gómez, Built upon Love: Architectural Longing after Ethics and Aesthetics, MIT Press, Massachusetts, 2008, pp. 32-33. 18 J-J Lequeu, op. cit. 54 The Haunt/ Demons and The Complex of Noon ______________________________________________________________ 19 C Fink, ‘Introduction to The Noon Complex,’ The Edge of Surrealism: A Caillois Reader, op. cit., pp. 124-125. 20 ibid. 21 R Caillois, ‘The Noon Complex,’ op. cit., p.125. 22 G Battaile, ‘Solar Anus,’ in Visions of Excess: Selected Writings, 19271939, Theory and History of Literature Vol 14, University of Minnesota Press, Minneapolis, 2006, pp. 5-9. 23 R Caillois, ‘The Noon Complex’, op cit., p.126. 24 ibid., p.127. 25 ibid., p.128. 26 ibid., p.129. 27 See G Bataille, ‘“Story of The Eye” by Lord Auch’, J Neugroschal (trans), Penguin Classics, England 2001. 28 J Lacan, ‘The Mirror Stage as Formative of the I Function as Revealed in Psychoanalytic Experience’, in Écrits, B Fink (trans.), W W Norton and Company, Inc., London and New York, 2006, pp. 75-81, 93-100. 29 See G Deleuze and C Parnet, Dialogues II, op. cit. 30 R Caillois, ‘Mimicry and Legendary Psycasthenia,’ op. cit. 31 L Tolstoy, op. cit. p.138 32 ibid., p. 266. 33 ibid., p. 143. 34 ibid., p. 355. 35 ibid., p. 357. Bibliography Bataille, G., ‘Story of The Eye’ by Lord Auch. J. Neugroschal (trans), Penguin Classics, England 2001. Bataille, G., Visions of Excess: Selected Writings, 1927-1939, Theory and History of Literature Vol 14. University of Minnesota Press, Minneapolis, 2006. Caillois, R., The Edge of Surrealism: A Caillois Reader. C. Frank (ed), C. Frank and C. Naish (trans), Duke University Press, Durham and London, 2003. Deleuze, G., Logic of Sense. Continuum, London, 2004. Deleuze, G. and F. Guattari, A Thousand Plateaus: Capitalism and Scizophrenia. Continuum. London, 2004. Tolulope Onabolu 55 ______________________________________________________________ Deleuze, G. and Parnet, C., Dialogues II. Continuum, London and New York 2006. Duboy, P., Lequeu: An Architectural Enigma. Thames and Hudson, London, 1986. Foucault, M., The Order of Things: An Archaeology of the Human Sciences. Routledge, London and New York, 2008. Hesiod, The Theogony. H. G. Evelyn-White (trans), viewed Friday 30th January 2009, http://www.sacred-texts.com/cla/hesiod/theogony.htm. Lacan, J., Écrits, B Fink (trans.). W. W. Norton and Company, Inc., London and New York, 2006. Lemagny, J.-C., Visionary Architects: Boullée, Ledoux, Lequeu. Hennessy and Ingalls, Berkeley, CA, 2002. Pérez-Gómez, A., Built upon Love: Architectural Longing after Ethics and Aesthetics. MIT Press, Cambridge, MA, 2008. Tolstoy, L., War and Peace, Vintage, New York, 2007. Tolulope Onabolu is in the final stage of a PhD in Architecture at Edinburgh College of Art. His research is by creative practice, where explores “seduction and eroticism” in architecture within a Deleuzian virtuality. In his approach to Deleuze, he has had recourse to Sovereignty, Eroticism, and Nonsense. The Concept of Death in Children’s and Juvenile Literature: Reading and Interpreting Death in The Book Thief by Markus Zusak Maria Kissova Abstract The paper deals with the representation of death in children’s and juvenile fiction written in English. It briefly introduces historical background of death and dying in literature for children and teenagers and presents trends of depicting various forms of death in contemporary literature. Here, death appears in several genres such as domestic fiction, girls’ stories, adventure stories, war and historic novels, and many others in different forms. The depiction of death is thus hugely based on specific genre differences and there are some basic trends and even stereotypes, which the paper also suggests and presents. The analytical part of the paper is focused on the work The Book Thief by an award-winning Australian author Markus Zusak (2005). The paper discusses the concept of death in the story set in Nazi Germany and depicting the life of a girl Liesel Meminger at the time when death could have been felt everywhere. The paper tries to deal with three main issues. The first one is the analysis of death in the novel – its different forms, thematic concepts and Death being a narrator of the story. The second one is more interdisciplinary and connects death, literature and art in general when Death stands in opposition to Literature and Art in the novel. This contrast is explained in terms of psychology when Artistic expression is natural to humankind in any condition. The third issue is the reader’s role or position in interpretation of this appealing and very emotional novel. It also discusses the terms such as irony, catharsis and reader’s response to the literary work. Key Words: Children’s literature, juvenile fiction, taboo topics, death, literature, art, interpretation, narrator. ***** 1. Encounters with Death My great-great-grandmother told me a mysterious and fascinating story about her encounter with Death. Once - as a little girl - while running up the hill alone in the autumn afternoon she spotted something she could not explain. The growing object resembled a white salty pile appearing out of nowhere. My great-great-grandmother later said that she somehow felt it must have been Death. She interpreted the pile as a symbol of Death and in 58 The Concept of Death in Children’s and Juvenile Literature ______________________________________________________________ her old age linked the strange event with a folk wisdom connecting the meeting Death with longevity. While telling her story, my great-greatgrandmother was always very calm with a serene look and as a devout Christian seemed to have accepted death peacefully when it comes. As if the encounter from the past had prepared her for the coming end of life. However, when lying on the deathbed, she strongly required company of her daughters; afraid and adamant not to be left alone at the moment of death. Her fear strongly disturbed her previous peace and I have realized then that it is really difficult not to be afraid of the unknown though one may think to be prepared to face it. My great-great-grandma passed away two years ago in sleep, just a few months before her hundredth birthday. I have decided to put her story into the conference paper for two reasons. First, for me as a child it was the first encounter with Death in literature through an oral tale. The story introduced me into its enigmatic concept and I could see that Death does not have to be depicted just as a woman with a scythe – a traditional portrayal of Death in Slovak cultural tradition; but it may be utterly personal and individual notion. A capturing story blurred the distinction between things known and unknown and shaped my childhood ideas about Death for future years. Since the topic of my paper is an interpretation of a literary work - which is a highly subjective act - one cannot and does not want to escape previous personal experience. Second reason is that reading The Book Thief I have found parallels with the story of my great-great-grandma. Death had accompanied my great-greatgrandmother in a very alike way he accompanied the main character Liesel in The Book Thief. Though Liesel is unaware of his presence as a being, he followed her all her life taking most of her beloved away but leaving her alive. My great-great-grandma claimed to have met Death and since then she believed Death somehow guided her through life with a promise of a long age. In both stories the presence of Death fascinates and frightens at once. An interpreter tends to believe them but has some doubts as well. I do not know whether the story which great-great-grandma told me really happened and I have realized that it does not matter so much. 2. Death in Children’s and Juvenile Literature The representation of death in children’s and juvenile fiction written in English is analysed in detail in Representation of Childhood Death (2000) edited by Gillian Avery and Kimberley Reynolds. Studies in the book provide the historical overview of child death depicted in literature starting with the oral tradition of folk tales, ballads and song cycles; moving to Victorian and Edwardian fantasy books for children. I assume that most important fact is - also stressed by Avery and Reynolds - that death is a cultural construct and it is apt to change with prevailing belief system.1 How different nations and cultural groups depict and interpret death depends Maria Kissova 59 ______________________________________________________________ strongly on their cultural background and tradition. In the 18th century early literature for children, children’s death is described mainly through parental grief and there is almost no evidence of child perspective of death and dying. Literature for children was also much influenced by Puritanism and its stress on the fear of death. For Victorian literature, probably most well known depiction of death is in dying Dickensian children evoking social, moral and often sentimental effect on the reader. Modern children’s literature stands in contrast with its previous tradition as the spectrum of literary works for children has widened enormously and books have started to bring various challenging and also until recently taboo topics. There is no doubt that the trend which has been set in recent years is rooted in the loosening boundaries of what is suitable for children and what is not. The trend is noticeable in various genres of children’s literature. In domestic fiction, for instance, it is the depiction of lesbian/ gay parents, violence, and the use of harsh language. There have also been a number of books published in English, which have some political matter or some political problem as their major issues (e.g. war or social conflicts). The books such as Peter Dickinson’s AK, David Almond’s The FireEaters, Gillian Cross’s The Wolf, Michael Morpurgo’s Private Peaceful and Pam Munoz Ryan’s Esperanza Rising present sensitive political and social issues such as terrorism, war, social unrests, discrimination, the problems of immigration, etc. In the above-mentioned stories death occurs very often. It is presented as a consequence of some political acts and children prove to be strong enough to face death in a brave and adult-like way often with no help from their parents who might have died in a conflict. In girls’ stories often a beloved person - a girlfriend or a boyfriend - dies and the story describes how one overcomes the loss of the beloved, which is followed by the return to everyday (and again happy) teenage life. The depiction of death thus mainly depends on specific genre differences and its analysis would need a separate complex paper or study. 3. The Book Thief – The Story Told by Death Markus Zusak’s award winning book The Book Thief (2005) may be included in the works with above-mentioned taboo topics uncovered in children’s and young adult literature just recently. The story is set in the 2WW Nazi Germany and apart from the war conflict itself and the Munich air raids, it also depicts cruelties of the Holocaust, ever-present fear, terror and the dominance of the only one truth prescribed by the Nazi Party. The book thief is Liesel Meminger, a young girl, brought up by foster parents of Hans and Rosa Hubermanns in Munich. Liesel loves reading and in the ruins of the war city she comes across books in different ways and under different circumstances. Liesel is a character that any reader just must 60 The Concept of Death in Children’s and Juvenile Literature ______________________________________________________________ love. Her beautiful and rosebud-like innocent friendship with Rudy Steiner, her taking care of the Jew Max Vanderburg hiding in Hubermanns’ cellar and Liesel’s all-embracing love for life strongly contrast with the war-destroyed, cold and devilish Nazi Germany regime. The seriousness of the theme and the explicit presence of Death raise the question of the suitability of the book for a child or a young adult reader. Avery and Reynolds explain: Death today can only be understood as ‘good’ when it comes painlessly at the end of a long life of achievement all elements which effectively preclude child death. This situation makes representing child death both peculiarly powerful and peculiarly problematic in contemporary art forms.2 The Book Thief is full of “bad deaths” of children and adults alike, since dying is the consequence of the war conflict. The following analysis and a feedback I got from my teenage student have provided me with the clear answer to the challenging question of the book, namely, its suitability for specific age groups. Apart from that, it is also important to mention that The Book Thief belongs to so-called “cross-over” literature, which covers works read by children/young adults as well as by adult readers. The novel may be interpreted from several aspects, and I have chosen to deal with its three main issues. The first one is the analysis of various forms and concepts of death in the novel. It closely discusses death as a narrator and a character (i.e. Death with a capital letter “D”) present in the story, but also death as an end of a man’s life (i.e. death and dying as the end of one’s life). The second issue is more interdisciplinary and connects death, literature and art in general. The analysis tries to show how artistic expression is natural to humankind regardless the political or social conditions. The third issue is the reader’s role in interpretation of this appealing and very emotional novel. It then discusses the terms such as reader’s response to literary work and irony. There are two main concepts of death in the story. First, Death has the function of an omniscient narrator and a character. Besides that, there are deaths and dying of particular characters. These two concepts are naturally connected – since Death takes the dead - but it is important to analyse them separately because of their significance for the story. Death as a narrator/ character in The Book Thief is a spiritual entity invisible to a man but having specific physical (a body) and psychical (thoughts, emotions) attributes of a person. He breaks and detaches himself from the traditional depiction of Death as could be found in art and mythologies: Maria Kissova 61 ______________________________________________________________ I do not carry a sickle or scythe. I only wear a hooded black robe when it’s cold. And I don’t have those skull-like facial features you seem to enjoy pinning on me from a distance. You want to know what I truly look like? I’ll help you out. Find yourself a mirror while I continue.3 This quotation will prove to be a key to understanding Death in The Book Thief. The main contrast of the story is between life and death, with Liesel Meminger representing the power of life and love. To mark the position of Death as the negative opposing force would be too oversimplifying because another stereotyped view about death as a close friend of war is broken by the narrator: To me, war is like the new boss who expects the impossible. He stands over your shoulder repeating one thing, incessantly. ‘Get it done, get it done.’ So you work harder. You get the job done. The boss, however, does not thank you. He asks for more.4 Death in the novel declines to be a force to be scared of. He is not the one who is powerful, taking life when he wishes. He is actually an employee, like a person complaining about work he hates but as a worker has to do. We trust this merciful Death who feels pity for the dying. Death is rather a father-like character sorrowing over the “bad” deaths and unnatural losses he has to collect: I shiver when I remember – as I try to de-realise it. I blow warm air into my hands, to heat them up. But it’s hard to keep them warm when the souls still shiver. ‘God.’ I always say that name when I think of it. ‘God.’ Twice, I speak it. I say His name in a futile attempt to understand. ‘But it’s not your job to understand.’ That’s me who replies. God never says anything. You think you’re the only one he never answers? ‘Your job is to…’ and I stop listening to me, because to put it bluntly, I tire me.5 The author’s strategy makes Death a positive character responsible only for “good deaths” as a natural part of life and in accordance with accepted laws of biology and who thus cannot be blamed for the “bad dying” of violent deaths. Probably the greatest irony and power of the story lies in the realisation of human culpability for the deaths of millions, an act which even Death is terrified of and cannot understand. He says: “That’s the sort of thing I’ll never know, or comprehend – what humans are capable of.”6 The 62 The Concept of Death in Children’s and Juvenile Literature ______________________________________________________________ roles of Death and a man are thus reversed in the story; a man is made responsible for suffering and has to bear the burden of guilt. It is interesting that though the story is told by Death, there is nothing said about the afterlife, God, resurrection or redemption. Omitting God’s voice, heaven and hell has a specific purpose in the narrative because it stresses the thematic concept of man’s responsibility for the tragedy. The frequent depiction and presence of death, dying and close-todeath states evoke the sad and gloomy mood of the story. In extreme life-anddeath situations people react unpredictably and in different ways. It is influenced by various factors such as their age, emotional stability, health condition, faith, presence of relatives and other social circumstances. Two basic and opposing attitudes of the adults in The Book Thief are that of the acceptance and fighting, most obviously represented by Max Vandenburg and Frau Holtzapfel. The development of two mentioned characters is quite ironical. Max Vandenburg, a Jew hiding at the Hubermanns, has a strong will to live and succeeds in the pretended fight with Hitler and also with Death. The narrator describes the fight: It must have been one of the few moments when the girl was not there with him, for all I saw was a man in bed. I kneeled. I readied myself to insert my hands through the blankets. Then there was resurgence – an immense struggle against my weight. I withdrew, and with so much work ahead of me, it was nice to be fought off in that dark little room.7 Before both her sons die, Frau Holtzapfel approves of the current political situation. She is more than optimistic until the encounter with the death of her sons makes her realise the opposite. From never-ending optimism she turns into a live corpse. Once she loses both sons, she declines to live. She does not want to hide during an air raid and passively waits for Death. Max is quite the opposite. He hates Hitler and would do anything to revenge the life tragedy he has to experience. Max remains active though he is more-or-less awaiting death as well. The emotional appeal of the story is strengthened through the depiction of suffering and dying children. There are two main deaths of children in the story: the death of Rudy followed by the social death of Liesel. When Liesel loses her family, and above all Rudy, she is socially dead. There is no one related to her and all links she has with people disappear. Rudy’s death is described with a strong emotional appeal and love of Death: Maria Kissova 63 ______________________________________________________________ I carried him softly through the broken street, with one salty eye and a heavy, deathly heart. (…) I saw him hipdeep in some icy water chasing a book, and I saw a boy lying in bed, imagining how a kiss would taste from his glorious next-door neighbour. He does something to me, that boy. Every time. It’s his only detriment. He steps on my heart. He makes me cry.8 Avery and Reynolds state that children belong not only to their families, but also represent the future of society. Times when children and young people die en masse threaten the fundamental mechanism by which societies as well as individuals reproduce themselves.9 The dying of innocent children by an unnatural and violent end of life is “bad” as such, which is particularly stressed in Death’s dealing with children, which is different than his dealing with adults: “Five hundred souls. I carried them in my fingers, like suitcases. Or I’d throw them over my shoulder. It was only children I carried in my arms”10 or in another place when he is taking a young boy’s life: It was exactly when I kneeled down and extracted his soul, holding it limply in my swollen arms. He warmed up soon after, but when I picked him originally, the boy’s spirit was soft and cold, like ice cream.11 Analysing depiction of different attitudes facing death, we come again to Death as a human-like character. He lets people fight him and some people are strong enough to succeed in the fight. There is a strong contrast between Death as a character in The Book Thief, the conventional depiction of Death, and death as the moment of violent dying traditionally perceived as unwanted and tragic. The contrast is caused by the war setting when dying children (with whom Death himself feels pity) stand in opposition to the cruelty of mankind – adults (blamed for all deaths). 4. The Power of Texts Though it is true that “Inter Arma Silent Musae, ”Art is a natural and fundamental expression of a man in any time. Even in the time of war there is a need to create, have and interpret Art. Though the works of Art in The Book Thief are of a questionable artistic value in terms of applying traditional critical judgement and textual criteria, their perception and 64 The Concept of Death in Children’s and Juvenile Literature ______________________________________________________________ acceptance is unique for their subjective significance for an individual. Hans’s accordion, Liesel’s love for books and writing, Max’s desire to give something precious to thank Liesel so that he makes a picture book for her – these all support the idea of the strong purpose of Art in times of crisis. Though in this case we do not deal with artistic criteria, we are on the ground of the contextual importance of a specific work. The Book Thief presents Art as a powerful means to escape from harsh and cruel reality; it provides people with mental strength, unites them, and makes them feel safer as well. Liesel is eager to read. After she learns that, she would read anything just to satiate the urge. She needs books because of the social webs, associations and memories they bring back to her. Literary works she finds are not of much worth in the terms of aesthetic and artistic value, but their pure existence and the ways of acquiring make them special. The first book she steals (though she cannot read at the time) is actually a morbid manual - The Gravedigger’s Handbook lost by a young digger at her brother’s grave. She takes the book so that she has something to remember her late sibling. However, the manual changes its function. It is not a non-fiction book any more because it has become an intimate work of Art for Liesel. She learns its content by heart, which suggests an attempt to keep the memories on her late brother alive. Other books she gets are poor Faust the Dog and The Lighthouse - for Christmas and later she steals The Shoulder Shrag from the Nazi fire of entartete Kunst. There are many situations in the story where literature gives people the strength to survive. When Liesel reads stories during aid raids in a shelter, everyone feels somehow safer; Liesel’s patient reading to unconscious Max keeps him alive. Her visits to mayor’s wife help to better the poor woman’s hopeless life. Literature and the power of words are stressed in the story; they are both highly praised but also disapproved since people’s works can also be poisonous. It is ironical enough when Max’s present – a book written and drawn by him for Liesel – is written on pages of Hitler’s Mein Kampf in which words manipulate in order to support the sick idea of one’s ultimate superiority over others. The power of words is so enormous that even Death is enchanted by it. The title of The Book Thief is meta-textual. It is also the title of Liesel’s book that she writes hiding in the cellar and which saves her life when all her beloved are killed overnight in an air raid while she was putting her story down. Literature and Art in general link the contrasts and oppositions between life and death, hope and despair, memory and oblivion, immortality and temporariness in the book. “Real” life and fiction have a lot in common and the boundaries between them are often blurred. Most people read literature for their love of stories. Through reading, we get to know the characters and they might be more or less likeable so that we develop a specific relation to them (believing in their real nature until we close the book) often resulting in identification. Maria Kissova 65 ______________________________________________________________ The process of reading may thus strongly resemble life situations and social contacts in general. It is, of course, clear that the character is not a “real” person but the power of words and the verisimilitude of the narrative make him so. There are for sure parallels between social bonds we have in reality and those in the fiction. What Scarre says about real life situations is then true also about fiction: Because we are social animals, we are characteristically involved in a host of different, criss-crossing and overlapping relationships with other people, some intimate and private, others more impersonal and public. When we die, our death disrupts this extensive set of relationships, forcing a greater or lesser reconstruction of the social web.12 When we experience any kind of loss, we feel sad and frustrated. It is true of material things as well as of nonmaterial property such as relationships, values or hopes. The Book Thief is a story of permanent loss which provokes strong emotional reactions in the reader. It is not only because of the permanent loss and the sad and hopeless atmosphere of the story. The reader feels powerless and frustrated mainly because specific traditional conventions of the novel are broken. It is not very often that the reader learns about the death of the character(s) before it really happens. Usually, death comes by surprise and its unpredictability emphasizes its effect. In The Book Thief it is just the opposite. Death as an omniscient narrator knows who will die and when, and he mercilessly informs us about several deaths before they occur in the story: Of course, I’m being rude. I’m spoiling the ending, not only of the entire book, but of this particular piece of it. I have given you two events in advance, because I don’t have much interest in building mystery. Mystery bores me. It chores me. I know what happens and so do you. It’s the machinations that wheel us there that aggravate, perplex, interest and astound me.13 So we know about Hans Hubermann’s death beforehand: “We’ll give him seven months. Then we come for him. And, oh, how we come.”14 Reinhald Zucker’s death is also unavoidable because Death pronounces it: He was twenty-four. When he won a round of cards, he gloated – he would hold the thin cylinders of tobacco to his nose and breathe them in. ‘The smell of victory,’ he would 66 The Concept of Death in Children’s and Juvenile Literature ______________________________________________________________ say. Oh, and one more thing. He would die with his mouth open.15 However, probably the most powerful foreshadowing of loss is that of Rudy’s death: “One day, Liesel,” he said, “you’ll be dying to kiss me.”16 How one can be calm and relaxed being frequently reminded of ever-present loss and dying? This technique would be rather distressing if it were not balanced somehow. That is achieved through the reader’s constant awareness of Liesel’s possible “bad” death. In the state of permanent loss of characters we expect her death as well. Even more when Death predicts again: “Yes, it was a great night to be Liesel Meminger, and the calm, the warm and the soft would remain for approximately three more months. But her story lasts for six.”17 What a cathartic relief when the reader finds her dying a good death as an old lady in Australia. 5. The Power of The Book Thief I usually recommend and lend books which I really like to my pupils and students who then often give me the feedback on the experience with the book. I lent The Book Thief to a fifteen-year-old student who told me that it was the only book which made him cry. I do not claim that a worthy book must inevitably make its readers cry, but my student’s confession persuasively proved that The Book Thief is a narrative of enormous power. Notes 1 G Avery and K Reynolds (eds), Representations of Childhood Death, Macmillan Press LTD, London, 2000, p. 8. 2 ibid., p. 8. 3 M Zusak, The Book Thief, The Bodley Head, London, 2007, p. 329. 4 ibid., p. 331. 5 ibid., p. 373. 6 ibid., p. 25. 7 ibid., pp. 339 – 340. 8 ibid., p. 565. 9 Avery and Reynolds, op. cit., p. 6. 10 Zusak, op. cit., p. 359. 11 ibid., p. 21. 12 G Scarre, Death, Acumen, Stocksfield, 2007, p. 19. 13 Zusak, op. cit., p. 263. 14 ibid., p. 139. 15 ibid., p. 493. 16 ibid., p. 56. Maria Kissova 67 ______________________________________________________________ 17 ibid., p. 524. Bibliography Avery G. and K. Reynolds (eds), Representations of Childhood Death. Macmillan Press LTD, London, 2000. Barley, N., Dancing on the Grave: Encounters with Death. John Murray, London, 1995. Morra J., M. Robson and M. Smith (eds), The Limits of Death. Manchester University Press, Manchester & New York, 2000. Reynolds, K., ‘Fatal Fantasies: the Death of Children in Victorian and Edwardian Fantasy Writing’, in Representations of Childhood Death. G. Avery and K. Reynolds (eds), Macmillan Press LTD, London, 2000, pp. 169188. Scarre, G., Death. Acumen, Stocksfield, 2007. Warren, J., Facing Death. Oxford University Press, New York, 2004. Wyatt, R. ‘Art as Afterlife. Posthumous Self-Presentation by Eminent Painters’, in Remember Me. Constructing Immortality. Beliefs on Immortality, Life and Death. M. Mitchell (ed), Routledge, New York & London, 2007, pp.193 – 207. Zusak, M. The Book Thief. The Bodley Head, London, 2007. Maria Kissova is a Ph.D. student and a lecturer at the department of English and American Studies at the Faculty of Arts at the University of Constantine the Philosopher in Nitra, Slovakia. Her doctoral research concentrates on specific aspects of children’s literature translation which has been a central topic of a few papers presented at Slovak and international conferences. Her interests cover a wide spectrum of literature, art, cultural studies as well as interdisciplinary studies combining the above-mentioned fields. The paper is a part of the KEGA3/6468/08 project: Teaching Intercultural Awareness through Literature and Cultural Studies. The Confrontation with Death from Rilke to Heidegger Jacob N. Graham Abstract The 20th century played host to a remarkable and revealing, philosophical attention to death. Martin Heidegger, the herald and impetus for such attention, disclosed to the West compelling reasons why death is not only worthy of our thought, but perhaps, alongside being and in direct relation to it, necessarily thought provoking. Heidegger showed us that death is not an object of our fear, but rather a reality that we live and may authentically take over for ourselves. However, Heidegger was not without an important predecessor (indeed, a German predecessor): Rainer Maria Rilke. Whether in his poetry, stories, or most candidly and plainly in his personal letters and correspondences, Rilke’s work is not short on food for thought concerning death. Though Rilke’s approach is, of course, markedly different from Heidegger’s, there are noteworthy similarities to be found in the insights provided by both of them. Rilke, too, quietly and carefully brought the seriousness and gravity of death to light. Death, again, is not something to be feared, but a mystery in and toward which we find our being. Death, as it were, is able in some sense to grant life; while a life fully lived is a life lived in a solemn recognition and realization of death. Through a philosophical analysis of a short story and excerpts from Rilke’s letters, the inextricable relationship between being and death will be explored, while peripherally addressing Heidegger for points of clarification. In such an analysis, it is almost inevitable that the traditional western views on death must be at least partially addressed to demarcate Rilke’s position from that of the culture in which he found himself. It will be seen that Rilke’s insights provide a more authentic posture toward death; a posture moulded by truth and the fullness of human being. . Key Words: Heidegger, Rilke, Being, Death, Possibility, Impossibility. ***** 1. Introduction Philosophy is sometimes too complex. When it is, it has strayed too far from the simplicity of its beginning, its source. Other times, however, we mistake the difficulty of its simplicity for complexity; what is most simple is often for us most difficult. We are. We exist. We die. Are these not the simplest, and yet the most difficult realities to accept, to bear, let alone understand? Yet, the greatest of thinkers have tended, in one way or another, to these immense simplicities. Heidegger’s monumental Being and Time is 70 The Confrontation with Death from Rilke to Heidegger _____________________________________________________________ notoriously difficult, particularly in English. But this difficulty should not be mistaken for complexity. The difficulty is rather a product of the great simplicity of that toward which his thought tended; namely, being and death. Heidegger’s language often springs from the truth of being and death and therefore is necessarily difficult, but perhaps, simple. Heidegger, however, had his predecessor; a predecessor also speaking within and from his own German tongue. He was the poet, Rainer Maria Rilke. I would like to discuss Rilke’s thoughtful confrontation with being and death as found in selections from his personal letters.1 However, I will begin with a brief and no doubt crude discussion of Heidegger’s thought as found in Being and Time, so that we may then approach Rilke’s thought from philosophical grounds. I will not, for sake of time, discuss in any detail Heidegger’s analysis of Rilke’s poetry in the former’s What Are Poets for?, nor do I aim for the sake of academic pedantry to merely highlight connections between Heidegger and Rilke, or argue for Rilke’s profound influence upon Heidegger’s thought. I only mean to pull from the well of thought belonging to two of the greatest thinkers in the 19th and 20th centuries in order to help us along the way to thinking being and death more seriously and soberly. Already, I have geared us toward thinking being and death. Does the conference this week not call for papers only on death? Why do I insist on both being and death? I argue, with the help of Heidegger and Rilke, that death cannot be thought without being. “Death,” says Heidegger, “is a way to be.”2 Indeed, we take our deaths over for ourselves as soon as we come to be.3 What is the meaning of this? Is death not the opposite of being, or simply put, non-being? Already we find ourselves in an apparent quandary; more precisely, we find ourselves in the mystery of being and death. We do ourselves harm if we consider death to be an intellectual “problem” that by dint of effort we might one day solve. It is, rather, a mystery that we must live.4 But it is not my task to leave these statements as they stand. Let us delve further into what has been said. It is no mere problem of language that we find ourselves saying, “is not death non-being?” The very fact that we necessarily resort to saying “death is” heightens the mystery in which we find ourselves. We may already notice that the language we hear speaking about death finds its locus in being. Death is a way to be, says Heidegger. This “is” is unavoidable. When we speak of death, we speak of death in and from being. But what Heidegger has said is more than a commentary on language. Heidegger says, if I may paraphrase it in an un-Heideggerian manner, that we live our deaths. Death is a way to be, once again, and it is a way to be that we take over for ourselves as soon as we are. By virtue of being at all, we are being our deaths. Death, for Heidegger, is not some event in which one day or another each of us must partake. “Death is not something not yet present-at-hand, nor Jacob N. Graham 71 ______________________________________________________________ is it that which is ultimately still outstanding…Death is something that stands before us - something impending.”5 Death is not “out there” somewhere, waiting to one day blithely harvest our ripened lives. Death is always with us, there for us, impending upon our being; not intrusively or morbidly, but as part of who we are. Our death is for us a possibility, but it is not a possibility outstanding, a possibility outside us or without us, a possibility among possibilities; but rather, it is a possibility of our very being - a possibility that is here with us, and impending.6 “Death is the possibility of [our] absolute impossibility.”7 But, being in this possibility of the impossibility of our being, we are able to stand before ourselves, disclosed, in our “own most potentiality-for-Being.” We are able, in the face of our deaths, not only to recognize, but realize (make real for ourselves), the possibility of our impossibility - a possibility that we are, a possibility that we live. The more unveiledly this possibility gets understood, the more purely does the understanding penetrate into it as the possibility of the impossibility of any existence at all…It is the possibility of the impossibility of every way of comporting oneself towards anything, of every way of existing.8 Further, my death is my own; no one can die my death for me. Even if someone were to take a bullet for me, and dies as a result, this lifesaver has died his own death, and has not died my death for me. My death is still there for me, ever present, as who I am, and as the possibility of my no longer being able to be. Thus, with my death as my own, understanding and realizing the possibility of my impossibility “individualizes” me “down to” myself.9 Death, as my possibility, allows me to see myself in my own most potentiality-for-being, and in fact, this possibility of my impossibility is what grants me my own most potentiality-for-being.10 My death brings me face to face with myself, when I see it as the possibility of my impossibility, and I am then able to take myself over in an authentic way. “Holding death for true does not demand just one definite kind of behaviour for [us], but demands [us] in the full authenticity of [our] existence.”11 In coming face to face with the end of who I am, I am most able to see who I am and who I am able to be. Though this is only a quick and crude gloss of Heidegger’s analysis of death, we must let this suffice for our discussion of Heidegger. Let us now see what Rilke has to offer for our thinking. 2. Rilke and Death Rilke’s poetic approach to death carries no less force or gravity than the rigor of Heidegger’s philosophical endeavour. In its own way, the seriousness and lived insightfulness that permeates Rilke’s thought perhaps 72 The Confrontation with Death from Rilke to Heidegger _____________________________________________________________ allows our thinking death more breathing room. Though we will not see the sort of rigorous analysis of death in Rilke that we see in Heidegger, we nevertheless see a thoughtful language that not only likely informed Heidegger’s thought, but we see in Rilke a thoughtfulness which deserves our utmost attention, whether the attention manifests in strict philosophical thinking or contemplative reflection. In addition, we find in Rilke an explicit acceptance of, and confident attitude toward death, whereas such an attitude can only be implied from Heidegger. For Rilke, too, death is intimately part of life. “Death is the side of life that is turned away from us and out of our light’s reach.”12 And again, “death is only an unsparing way of placing us on intimate and trusting terms with that side of our existence that is turned away from us.”13 Death is here treated as the half of our life (notice the necessary placement of death within being) which is dark, unknown, but not entirely removed from the reaches of our understanding; and it is shown to be especially close to a way of life that entrusts itself to itself, and thus reaches into death. But this half, as I have called it, is in no way distanced from or out of reach of life. I do not mean to say that one should love death. But one should love life so unreservedly and without any calculation or deliberation that death (the half of life that is turned away from it) is at all times unwittingly included in and loved along with life.14 Here in Rilke, we have seen a definitive turn toward the acceptance of death as death, but also of death as that side or part of our lives that is generally held remote from us, but is actually in great proximity to us; even if this proximity is shrouded in mystery. If we are not careful with the last passage quoted, we may rashly conclude that Rilke’s focus is on life, with death following close behind on the shirttails of this focus. Rilke, however, is not suggesting a sort of love that privileges life over death, or a temporally or causally successive love that “first” loves life, and so “then” must also love death. Rather, Rilke urges a unity of life and death such that, loving the life that we most clearly see, hear, feel, and to some degree understand here, will always, even if unknowingly include a solemn love for that side of life that is as yet unclear to us. But to be clear, neither is Rilke suggesting that death is merely some other life, or perhaps, a portal into an afterlife. When we refer to death as “that side of life…” we do not mean that it, in itself, is also a kind of life. Instead, Rilke is recognizing that our view of death is not a distant, removed view, but that it is a view founded in being - a being, as it were, surrounded by the possibility of its own impossibility. Death never leaves us, never takes its rest from us, and we never escape death. But I insist, as I think Rilke and Jacob N. Graham 73 ______________________________________________________________ even perhaps Heidegger might also insist, that asserting the proximity of death does not necessitate a morbidity or brooding disposition on our behalf. Rather, to truly think death is to think life in its fullness; full, because at its limit in death. Life and death are joined. This means that death cannot be thought outside life. We cannot somehow pry ourselves free of life to think death. Rilke poignantly highlights this jointure: It is possible that death is infinitely closer to us than life itself…What do we know of it! Our effort (this had become increasingly clear to me over the years, and my work has maybe only this one purpose and task: to bear witness to this realization, which so frequently overwhelms me unexpectedly and always more impartially and independently…maybe more like a vision, if that does not sound too conceited)…our effort, I believe, can aim only at presupposing the unity of life and death so that it may gradually prove itself to us…Believe me that death is a friend, our most profound friend, maybe the only one who is never, never deterred by our actions and indecision…and this, you understand, not in the sentimental-romantic sense of a denial of life, of the opposite of life, but our friend especially then when we most passionately most tremblingly affirm our being-here, all that happens, nature, love…Life says always at the same time Yes and No. Death (I implore you to believe it!) is the actual yes-sayer. He says only: Yes.15 I have here included such a lengthy passage not only for its poignancy, but also because it is essential to understanding Rilke’s confrontation with death. Rilke goes so far as to say that the presupposition of the unity of life and death has perhaps been his life’s work. His work, he says, has born witness to this realization. The proximity of death to life is a reality we must realize - it must be made real to us, not denied by us. To follow Rilke and Heidegger, a denial of death is essentially a denial of life and the fullness or authenticity of that is our greatest possibility in life. Rilke’s so-called “unity of life and death” is not a unity of two objects or things that stand in qualitatively equal relation with one another. Nor are life and death identical. To presuppose or even consider life and death as standing enjoined in unity does not mean that we must insist upon any shared identity of life and death. “How tremendous both life and death are as long as one does not incessantly consider both of them to be a part of one greater whole while making hardly any distinctions between them.”16 74 The Confrontation with Death from Rilke to Heidegger _____________________________________________________________ Again, we would be too hasty in concluding that Rilke has spoken contrary to what he regards as the unity of life and death. That we can call life and death united does not preclude making any thoughtful distinctions between them. When a couple is united in marriage, we could hardly strip either party of his or her individuality. To the contrary, it may well be that the closer this couple grows, the more starkly distinctions regarding the individuality of each person could be drawn. In short, distinctions do not build walls between those things, which are considered distinctly. Likewise, to say that death and life are enjoined to one another in unity does not mean they are numerically one or identical. They are perhaps infinitely different, but the differences do not prevent their closeness, their jointure. They are enjoined to one another so inseparably that we cannot genuinely think one without - whether explicitly or implicitly - the other. Rilke suggests that, if this unity is presupposed by us, it may gradually prove itself to us. It is not a unity that, once realized, we can then lay up in the store-room of all the other knowledge and information we’ve gained for ourselves in this so-called information age. By its very realization, it is made real to us as a reality that we must live. It is a reality that we are able to realize so long as we are open to it; perhaps so long as it is presupposed by us. And gradually, as it becomes more real to us, it proves itself to us. It proves itself to us not in an argument or logically ordered propositions and assertions, but by confronting it through our being. 3. Conclusion Rilke calls death a “friend” but is quick to note that he intends this friendship not in a romantic sense, or certainly not in a favouring of death over life. Rather, this profound friend might be called a friend because it is not put off by our indecision, or even our ignorance or denial of death itself. It is always there for us. It is especially there for us when we are here most fully. When we, as Rilke says, affirm our being, our life, it is precisely then when death stands there with us most clearly and audibly saying “yes” to our yes-saying. In our very affirmation of being, we solemnly, quietly, and perhaps even unwittingly affirm death. We affirm our being in its fullness, right up to its limit, and at the limit of our being, we breathe confidently and most self-assuredly into the abyss of death. Thus, the unity of this friendship grows, and death becomes more and more the wholly other, yet the other that is joined to this being. In being and in life, however, we tend to waiver. We are often pulled in the various directions of our everyday lives; sometimes directions that seem more undirected than directed. It is the business of the day that reigns, and the busy-ness of the streets, of work, of the latest news that often slyly steals our attention. And perhaps even more surreptitiously sneaks into our lives the voices that appeal to the adventurous side of us telling us to Jacob N. Graham 75 ______________________________________________________________ “seize the day,” or “live for the moment.” Such attitudes and statements, though pretending, even to the point of self-conviction, to bring us to a fullness of life often lead us further into a muddled, misdirected path that takes us further from ourselves and a truly full or authentic life. But even in such cases, death has not left our side, even when we are not aware of it, or have yet to realize it. Death’s proximity to our lives, to our being, is not a cause for brooding or despair. It is rather a reality that we confront in our most genuine hour, our most far-reaching thoughts. Our understanding peers into the darkness of this mystery, so that the light it does shed is shed on our very being; because it is only through and in our very being that we are able to think death at all. Heidegger tells us that death is a way to be that we take over as soon as we are.17 As we are, so are we in a close proximity with our death. But, the more fully we are, the more fully we take care in and of this life, the more fully and richly we live it and love it, the more, in short, that we affirm this being, the more we are able to see the quiet, solemn yes-saying of our own death that is always there for us. It is death, which, by its very nature, grants us a limit by which to live. It is not the foolish or charlatan way of “living for the moment,” but of living to our utmost capacity as human beings. Thus, Rilke is able to say: You have to live life to the limit, not according to each day but according to its depth…one ought to turn the most extreme possibility inside oneself into the measure for one’s life, for our life is vast and can accommodate as much future as we are able to carry.18 Notes 1 These selections are chosen from R M Rilke, Letters on Life, U Baer (ed and trans), Modern Library, New York, 2005. 2 M Heidegger, Being and Time, J Macquarrie and E Robinson (trans), Harper & Row Publishers, San Francisco, 1962, p. 289. 3 ibid. 4 The difference between a “problem” and a “mystery”’ is this: a problem stands over against us as something that by its very nature contains the possibility of being solvable (of course, this does not necessitate its being solved). The mystery, on the other hand, is that in which we find ourselves. This spatial language is no metaphor; it is real, and unavoidable. We find ourselves in our being, and this being is mysterious. We are enshrouded in mystery. 5 ibid., pp. 293-294. 76 The Confrontation with Death from Rilke to Heidegger _____________________________________________________________ 6 ‘For one thing, death as possible is not something possible which is readyto-hand or present-at-hand, but a possibility of Dasein’s Being.’ ibid., p. 305. 7 ibid., p. 294. 8 ibid., p. 307. 9 ibid., p. 308. 10 ‘If Dasein stands before itself as this possibility, it has been fully assigned to its ownmost potentiality-for-Being’. ibid., p. 294. 11 ibid., p. 310. 12 Rilke, Letters, p. 121. 13 ibid., p. 115. 14 ibid., p. 111. 15 ibid., p. 112. 16 Ibid., p. 13 17 (Original German text): ‘Der Tod ist eine Weise zu sein, die das Dasein uebernimmt, sobald es ist.’ ibid., p. 245. 18 Rilke, Letters, p. 13-14. Bibliography Heidegger, M. Being and Time. J Macquarrie and E Robinson (trans), Harper and Row Publishers, San Francisco, 1962. Rilke, R. M. Letters on Life. U. Baer (ed and trans), Modern Library, New York, 2005. Jacob N. Graham is currently a graduate student in Philosophy at Duquesne University in Pittsburgh, Pennsylvania, U. S.A. Burial Law as Viewpoint towards Death Wim Cappers Abstract Few researchers examined the way in which the first signs of the secularisation of western society during the second half of the eighteenth and the nineteenth century brought about the taboo towards death. Burial Law is an important source to investigate this change. Physicians became the exponents of a way of living that was orientated towards improvement of life on earth. They focused on two themes. First, from the investigation of dead bodies it became clear that it is difficult to pinpoint the dividing-line between life and death. Second, a burial should not be postponed too long because of hygienics. The government used the medical ideas on dying and death to improve the health care and public order. This is illustrated with the activities of the Society for Rescuing the Drowned, founded in Amsterdam in 1767 and the fight against a malaria epidemic in Groningen during the years 1826-1827. By investigating the enforcement of the law, one gains an insight into the acceptance of medical ideas by the people who did not have the right to vote. Therefore, the study of Burial Law can give insight into the medicalisation of death in the entire country. Key Words: Secularisation, medicalisation, taboo, burial law, apparent death, drowning, cemeteries and hygienics. ***** 1. Preface Salzburg, the place of this conference, is famous for the Salzburger Festspiele. During the last edition, Don Giovanni was conducted. In this famous opera of Mozart who was born in Salzburg, Don Giovanni seduces Dona Anna and kills her father, the Commendatore. Later on, Don Giovanni visits his grave and invites the statue on the grave for a dinner. At last, the statue, which resembles the Commendatore, visits the house of Don Giovanni and asks him to better his life. Don Giovanni refuses and thereupon the flames of hell decompose the body of the seducer.1 It’s interesting that the libretto with the stories on the revival of a dead person and the definitive destruction of all life by means of fire was written in 1787 when the enlightened Joseph II reigned over the Austrian empire. These themes were well known in popular culture. My investigation concentrates on the problem of apparent death and the decomposition of corpses around 1800. 78 Burial Law as View-Point Towards Death ______________________________________________________________ How did the people react when the government tried to regulate death by means of law? However, first I shall explain why I use burial law as a central source. Then I will explicate how physicians and other medical orientated opinion leaders made the prevention of apparent death and relocation of cemeteries, the two important themes of the Dutch Burial Law of 1869. I will illustrate this method of investigation with two examples. In each case I will concentrate on the question how the medical opinion leaders and the political authorities dealt with the reaction of the people. 2. Introduction Why, then, does burial law take such a central place within my investigation? Roughly speaking, an examination of the historiography learns that most historians tried to answer the question how the de-Christianisation of the attitude towards death in western society started in the early modern period. On the other hand, sociologists and psychologists have written many books on death as a taboo during the twentieth century. However, it is surprising that few researchers examined the way in which the first signs of secularisation of western society brought about this taboo during the nineteenth century.2 Until 1800, the Catholic church - and later on the Protestant churches managed to Christianize the attitude of the people towards death to a large degree. Not the belief in ghosts wandering around on earth after death, but the faith in the transition towards heaven or hell became the main point of attention. Nevertheless, the churches had to make some concessions to the people. So, the Catholic councils of the first centuries after the birth of Christ were forced to Christianize popular customs like the burial of the deceased near the grave of a martyr. These places became a fairly safe guarantee for salvation. However, suicides and other excommunicated people were banned from the churchyard. On the other hand, during the sixteenth century the Protestant synods tried to banish Catholic habits like praying for the salvation of the dead. According to their belief, only God could decide who was to be saved or damned.3 During the second half of the eighteenth century, in addition to priests, vicars and the people, a fourth group, the physicians began to express their opinion on death.4 Of course, they had urged special measures towards burying the dead in case of a plague during earlier centuries. Now, they developed a more systematic approach towards a safe and hygienic disposal of the dead. So, in the age of Enlightenment, medical opinion leaders became the exponents of a way of living orientated towards improvement of life on earth. The medical view towards death focused on two themes. First, investigation of dead bodies learned that it is very difficult to pinpoint the exact dividing-line between life and death. After all, life seemed to leave the body only gradually. After a person had stopped breathing, it seemed that parts of the body like nails and hair continued to grow for a while. Therefore, according to Wim Cappers 79 ______________________________________________________________ the physicians, only the smell of decomposition indicated that someone had really died. The possibility of being buried alive was considered to be so great that only doctors should certify dead. On the other hand, a burial should not be postponed too long because a decomposing body was a danger to the living. Above all, the medical opinion leaders warned against the habit to bury the dead in and around churches. The repeated opening of the graves could spread miasmata that caused diseases among churchgoers and local residents. Accordingly, physicians and others pleaded the relocation of cemeteries outside cities and villages. At first, the medical opinion leaders obtained little hearing within Dutch society because of the costs, force of habit and disbelief in the correctness of their ideas. This hardly changed in 1795, when the French helped to establish the Batavian Republic as a unitary state where politically like-minded persons took control. Just during the period 1827-1869 the government made laws that prescribed the draw up of a death certificate by a doctor before someone was buried and the relocation of cemeteries outside the built-on area. At the same time the administration had to reckon with religious and financial interests of the different denominations by allowing the relocation of ecclesiastic cemeteries and the compensation for the loss of funeral revenues. The well-to-do were allowed to place monuments on the new graves. By investigating the enforcement of these laws, one gains an insight into the acceptance of the medical ideas by the people who did not have the right to vote. Therefore, the study of the passing and the enforcement of the Burial Law and other relevant laws over a long period provide insight into the medicalisation of death in the entire country.5 3. The Society for Rescuing the Drowned Next, I illustrate the use of burial law as view-point towards death with two examples. The fight against apparent death shall be illuminated by the activities of the Society for Rescuing the Drowned, hereafter referred to as the Society.6 This society was founded in Amsterdam in 1767. It is not an accident that death because of drowning occurred quite often in a city containing many canals, few lighting and handrails and almost no citizens who could swim. Before the founding of the Society, a person falling into the water nearly always drowned. Naturally, some bystanders brought a victim ashore, but they saw to it that his feet remained in the water. According to old regulations, the court had to examine the possibility of murder or suicide first. Others tried to resuscitate a drowning person. However, believing that the victim had water in his stomach, these bystanders rolled him over a barrel or hang him on his feet. Usually, these methods did not contribute to the recovery of the victim. In 1767, the Society began to propagate a different approach of persons, who fell into the water. In accordance with the latest medical insights, they argued that the dread of being buried alive paralleled the fear of being 80 Burial Law as View-Point Towards Death ______________________________________________________________ drowned. Both victims were apparently dead and should be resuscitated without delay. Therefore, the bystanders should help a drowned person first and warn the court later. People should realize that a drowned person was not necessarily the victim of a crime but a patient in the first place. Furthermore, the Society pleaded a different treatment. Recent medical research had made clear that a drowned person did not have water in the stomach but in the lungs. Accordingly, he should not be ill-treated by rolling him over a barrel or hanging him on his feet, but his respiration should be cured. The ten inhabitants of Amsterdam who founded the Society had several means at their disposal to reach this goal. First of all, they published a few articles in the Dutch spectatorial periodical, The Philosopher, to propagate the resuscitation of the apparently drowned. Furthermore, it was a great help for the Society that political authorities in all parts of the Republic approved of its insistence on immediate help. They agreed that the court could be warned later. Moreover, as well-to-do men, the initiators furthered their case with the promise that would-be rescuers could count on a medal, sometimes combined with a financial reward. The Society described precisely how the resuscitation should take place. To this end, the initiators, of whom only one was a physician, chose methods that every layman could apply. The tobacco fumigator was the most important instrument. With this apparatus tobacco-smoke could be blown into the anus of the victim. This procedure was thought to stimulate the lungs. At first, the initiative of the Society, which was supported by the political authorities, seemed a great success. The first reward was given to a layman who saved someone's life with an improvised tobacco fumigator. On second thought, the results fell short. Although the Society distributed thousands of pamphlets all over the country, there were signs again and again that the people were not willing to help a drowned person. In 1769 F. H. Bronkhorst, a surgeon from Rhenen, was called to attend Cornelis van den Brink, who had fallen into the water in the village of Opheusden. After Bronkhorst had tried to revive Van den Brink in vain, he presented the Society with a bill of 19.12 guilders. Since this total nearly reached the maximum permitted indemnification of 21 guilders, the directors asked for a specified account. Presently, it became apparent that the cost of the bribes and the liquor that were necessary before the people of the town of Opheusden would help led to such a steep bill. The Society repaid Bronkhorst for his expenses in the Van den Brink case, but asked him to pay more attention to his expenses in the future. The people of Opheusden and elsewhere seem to have had good reason for their unwillingness to help. Of course, they were religious people, who simply had faith in God and thought no one could help a drowning person. Above all, the popular belief in ghosts living in the water was probably still wide-spread. Therefore, helping an unlucky person could bring misfortune. It is remarkable that the directors of the Society did not try to disprove this popular belief. It’s likely that this misunderstanding between the enlightened culture of Wim Cappers 81 ______________________________________________________________ the directors and the popular culture of the people contributed to the moderate success of the Society for Rescuing the Drowned.7 4. The Relocation of Two Cemeteries in Groningen The relocation of cemeteries will be exemplified by the measures taken by the political authorities in the fight against a malaria epidemic in the city of Groningen during the years 1826-1827.8 Until then, the dead of this city in the north of the Netherlands were buried in and around the churches within the town ramparts. Two originally Catholic parish churches, the Martinikerk and the Akerk, were located in the old centre. After the establishment of the reformed religion in 1594, the third parish church, the Noorderkerk, was built within the town-development. Together with the Southern Churchyard, laid out in the same period, they were the main burial places. The sites, where executed civilians and soldiers were buried, lay outside the community south of the town and on the Jacobijnen bastion in the northeast. In 1826, the question, if cemeteries had to be laid out outside the builton area for hygienic reasons, was urgent. The year before, a commission of physicians and scientists had advised the government that this was indeed necessary. While the political authorities still had not made a decision, a malaria epidemic broke out in the swampy area around Groningen in June. The farmers, who normally visited the town to do business, began to avoid the place for fear of contagion. The collapse of commerce was understandable. At the end of the year, ten percent of the 28,000 inhabitants of Groningen had died. The poor were especially stricken. Within eight weeks 700 of them were buried on a section of the Northern churchyard. Therefore, in September the governor of the province ordered the burial of the poor in cemeteries outside the city. Since the local authorities could not find a useful plot outside the town ramparts at first, they considered the use of the Jacobijnen bastion for a moment. This ground was situated high and full of fresh air. Nevertheless, they rejected the idea. Until 1767, this bastion was a burial place for military criminals and now and then the plot was still used as such. The poor would not accept a cemetery there. At that moment, the magistrate even tried to cancel the costly project. By now, the poor were buried on the entire Northern churchyard. Furthermore, according to the local politicians the stench did not come from the Northern churchyard but from the polluted water of the nearby canal, the Boterdiep. The city council couldn’t convince the state authorities. On the contrary, the situation deteriorated. In November, the Department of the Interior ordered that all deceased should be buried on the churchyards from the first of December. Now the magistrate began to confer with the churchwardens to avoid commotion among the grave owners. It was agreed that the owners should get a grave of the same value in one of the new cemeteries. 82 Burial Law as View-Point Towards Death ______________________________________________________________ In 1827, the local government finally bought two suitable plots north and south of the city. Due to the haste, these so-called Northern and Southern cemeteries were laid out straight ahead. Not a beautiful garden but a precise division of the graves and the five classes to prevent disorderly burials and unrest among the well-to-do was the main object. During the summer of 1827 the malaria epidemic broke out again. When graves that were filled the year before were opened on the Northern churchyard, the governor demanded the burial of the poor in the new cemeteries beginning the first of September. Two months later, all the deceased were buried outside the town ramparts. In the meantime, the central government had reached a decision with regard to a nationwide law. Before 1829 each place with more than 1.000 inhabitants should have a cemetery outside the built-on area. As we have seen, the hygienic view towards the burial of the dead prevailed. Nevertheless, the local government had to reckon with the opinion of the rich and the poor. It was impossible to bury the poor on a cemetery where criminals were interred. I hope to have shown that investigating burial law produces insight with regard to constructing a history of the medicalisation of the attitude towards death in The Netherlands. Enlightened ideas on dying and death had to reckon with popular believe in ghosts and a decent burial. Notes 1 P Stefan, Don Giovanni: Die Opernlegende von Don Juan, dem Versucher und Sucher, Herbert Reichner Verlag, Wien, Leipzig and Zürich, 1938, p. 25. A Rosenberg, Don Giovanni. Mozarts Oper und Don Juans Gestalt, Prestel Verlag, München, 1968, 290-292. 2 T Walter, ‘Three Ways to Arrange a Funeral: Mortuary Variation in the Modern West’, Mortality, vol. 10, August 2005, pp. 173-192. 3 P den Boer, ‘Naar een geschiedenis van de dood. Mogelijkheden tot onderzoek naar de houding ten opzichte van de dode en de dood ten tijde van de Republiek’, Tijdschrift voor Geschiedenis, vol. 89, 1976, pp. 161-201. 4 P Ariès, L’homme devant la mort, Éditions du Seuil, Paris, 1977, pp. 347399, 468-513. 5 W Cappers, ‘Op zoek naar zekerheid omtrent de dood: Totstandkoning en uitvoering van de Begrafeniswet van 1869 in Nederland’, Groniek, vol. 21, 1987, pp. 98-109. 6 H M Brokken and W Th M Frijhoff (eds), Idealen op leven en dood: Gedenkboek van de Maatschappij tot Redding van Drenkelingen 1767-1992, Stichting Hollandse Historische Reeks, Den Haag, 1992, pp. 1-101. W Cappers, ‘Money and Medals for Saving the Drowned: The Financial Factor in the Dutch Discourse on Apparent Death during the Second Half of the Wim Cappers 83 ______________________________________________________________ Eighteenth Century’, in Curing and Insuring. Essays on Illness in Past Times: The Netherlands, Belgium, England and Italy, 16th-20th Centuries, H Binneveld and R Dekker (eds), Verloren Publishers, Hilversum, 1992, pp. 8394. W P R A Cappers, ‘Aardse begrenzing van bloeddorst en ademnood: De vampier als fysiologische pendant van de drenkeling’, Holland, vol. 26, 1994, pp. 35-62. 7 W P R A Cappers, ‘Lasten en baten rond het redden van drenkelingen. De financiële factor binnen het Nederlandse vertoog over schijndood in de tweede helft van de 18e eeuw’, Tijdschrift voor Sociale Geschiedenis, vol. 17, 1991, pp. 271-294. 8 M Ramaker, ‘In de ban van de beet: De malaria-epidemie in de stad Groningen in 1826’, Gronings Historisch Jaarboek, 1998, pp. 66-81. Bibliography Ariès, P., L’homme devant la mort. Éditions du Seuil, Paris, 1977. Boer, P. den, ‘Naar een geschiedenis van de dood: Mogelijkheden tot onderzoek naar de houding ten opzichte van de dode en de dood ten tijde van de Republiek’. Tijdschrift voor Geschiedenis, vol. 89, 1976, pp. 161-201. Brokken, H. M. and Frijhoff, W. Th. M. (eds), Idealen op leven en dood: Gedenkboek van de Maatschappij tot Redding van Drenkelingen 1767-1992. Stichting Hollandse Historische Reeks, Den Haag, 1992. Cappers, W., ‘Op zoek naar zekerheid omtrent de dood: Totstandkoning en uitvoering van de Begrafeniswet van 1869 in Nederland’. Groniek, vol. 21, 1987, pp. 98-109. Cappers, W. P. R. A., ‘Lasten en baten rond het redden van drenkelingen: De financiële factor binnen het Nederlandse vertoog over schijndood in de tweede helft van de 18e eeuw’. Tijdschrift voor Sociale Geschiedenis, vol. 17, 1991, pp. 271-294. Cappers, W., ‘Money and Medals for Saving the Drowned: The Financial Factor in the Dutch Discourse on Apparent Death During the Second Half of the Eighteenth Century’, in Curing and Insuring. Essays on Illness in Past Times: The Netherlands, Belgium, England and Italy, 16th-20th Centuries. H. Binneveld and R. Dekker (eds), Verloren Publishers, Hilversum, 1992. 84 Burial Law as View-Point Towards Death ______________________________________________________________ Cappers, W. P. R. A., ‘Aardse begrenzing van bloeddorst en ademnood. De vampier als fysiologische pendant van de drenkeling’. Holland, vol. 26, 1994, pp. 35-62. Ramaker, M., ‘In de ban van de beet: De malaria-epidemie in de stad Groningen in 1826’. Gronings Historisch Jaarboek, 1998, pp. 66-81. Rosenberg, A., Don Giovanni. Mozarts Oper und Don Juans Gestalt. Prestel Verlag, München, 1968. Stefan, P., Don Giovanni: Die Opernlegende von Don Juan, dem Versucher und Sucher. Herbert Reichner Verlag, Wien, Leipzig and Zürich, 1938, Walter, T., ‘Three Ways to Arrange a Funeral: Mortuary Variation in the Modern West’. Mortality, vol. 10, August 2005, pp. 173-192. Wim Cappers specializes in the history of death in the Netherlands. He works at the Centre for Thanatology at the Radboud University, Nijmegen. To Death - To Life: Grounding Sigurd Lewerentz and Erik Gunnar Asplund’s Tallum Cemetery Courtney D. Coyne-Jensen Abstract Few built forms concretise a society’s attitudes, philosophies and rituals of death as markedly as the design of its municipal cemeteries. These topographies explicitly embody the predominate “face(s) of death” within the wider culture, symbolically and literally. In 1915, Swedish architects Sigurd Lewerentz and Erik Gunnar Asplund won the Stockholm South Cemetery Competition; this “Woodland Cemetery” being the first in a series of the city’s 20C suburban, municipal cemeteries. Despite its pre-determined extra moenia location, their design - entitled Tallum meaning “pine” - exists as an extraordinary precedent: a cemeterial work endeavouring to counterpoise modernity’s prevailing tendencies to banish death (and the dead) from daily life. During the last decades, much research has been published on Tallum. However, the majority focuses more on determining stylistic and formal affinities, rather than on the primary understanding of the ground for the scheme itself within the broader socio-cultural context of the time. This paper will examine the architects’ profound pre-occupation with the site’s actual ground, and the ways this is (re) articulated to (re) consider linkages inbetween the living and the dead. Through a probing of this tensional topography, the argument shall be made that this pre-occupation becomes aligned with the modern attempt to re-establish a more meaningful existence via a more authentic and rigorous attachment to the ground itself. In short, we speak of the need for a more grounded and authentic reality (mode of being). The primary vehicle for situating Tallum will be through a discussion including the cemetery as “socio-political ground”, “primordial ground”, and “Christian ground”. Here, “ground” must be understood, foremost, in the ontological sense; as the Heideggerian notion of ground, as the embodied side of the lived-world, and as the support and setting for articulation.1 Key Words: Tallum, Woodland Cemetery, Lewerentz, Asplund, primordial ground, ontological, death, burial ***** 1. The Reassessment of ‘Ground’ in Socio-Political Reform A. Hygiene and Aesthetics: Denial of Death [19C Burial Reform] In the Church-State nation of Sweden, socio-political reforms and burial reforms are historically and indivisibly tied. Since the Middle Ages, there have been three major burial reforms in Sweden: banning ad sanctos 86 To Death - To Life ______________________________________________________________ burial (1783); modifying the Lutheran doctrine to permit cremation (1882); planning the first suburban municipal cemetery (Stockholm North, C.G. Blom-Carlsson, 1887). All these were determined foremost by postenlightenment concerns of efficiency, hygiene, aesthetics, and economy. The underlying aim was banishing the face of death from any aspects of daily life. Père Lachaise Cemetery (Paris, 1804), with its extra moenia sitting, was the main precedent for Stockholm North: mimicking a secular world of leisure, where all thoughts of urbanity’s chaos were to be forgotten amidst nature’s sanctity, and where death itself was to be hidden beneath a rationalised, hygienicised, sublime, park-like aesthetic. It reflected and concretised (Swedish) society’s predominate anxiety and denial of death, and desires to suppress the very fact of human finitude. This period produced not only a physical gap between the realms of the living and the dead, but more critically, widened the gap in the ontological continuum. All this, however, is not to say there was not a high concern for death. Contrarily, society was seemingly obsessed with death - with keeping it out of sight and sanitised. Death, or rather a being-toward-death, had been rejected by life, and with this a sense of wholeness was lost.2 B. Regeneration and the Search for Authenticity [20C Burial Reform] In early 20C Sweden, the social climate was characterised by a general feeling of World dissolution, or groundless-ness.3 Industrialisation, war, and the disappearance of any secure canon(s) contributed to a breakdown in the ontological continuum, including a general awareness of the unreplaceability of the actual ground of the earth. This was made most explicit in the period’s writings, for example in Nietzsche’s “crisis of the spirit”, and Rilke’s Worpswede. By the time Lewerentz and Asplund submitted their winning “Tallum” proposal for the Stockholm South Competition (1915), society’s previous sentiments of self-doubt had been considerably transposed by a revival of historical roots in State and Church. Swedish society experienced renewed self-consciousness, and collective-awareness of the need for increased sociopolitical and spiritual reformation(s). Church and State were united to establish a ground for the betterment of culture; characterised by flexible, anti-hierarchical social structures and an over-all more informal lifestyle. Burial reform was one of the major issues collaborated upon: planning new cemeteries, coupled with the reanimation of the practise of cremation, and thus an overall change in society’s attitude(s) toward death. The campaign‘s motto was jämlikhet, meaning “equality” and “sameness”; and as a part of this, all citizens were guaranteed a Lutheran burial by cremation. With this, death and the dead - once cast out of everyday life - were again included in society’s search for a more meaningful and authentic existence. Courtney D. Coyne-Jensen 87 ______________________________________________________________ Until the Helsingborg Crematorium Competition (1914), this new recognition of death had occurred chiefly through the auspices of social reforms, and the cemetery as an institution was still rationalised; death and its need for inclusion still pursued solely as socio-political constructs. The Helsingborg Competition is key, as it provided the first architectonic response to the socio-political desires of establishing an equalising, authentic ground, simultaneously embracing life and death. Architecture and landscape were embraced as the primary vehicle realising the desired socio-culturalspiritual evolutions. The belief was that to elevate the culture, the approach to architecture had to be transformed, and if this were done, it could provide a rejuvenation - even a salvation - of culture.4 The Helsingborg design significantly shaped Stockholm South’s brief, which called for an end to romanticised articulations of cemeteries. The new cemetery was to embody optimism and regeneration; renewal occurring individually and collectively - in death and in life. The previous period’s rationalisation and hygiene obsessions were now transformed towards jämlikhet. More significantly, the brief prescribed a psychological-spatiotemporal sequencing of spaces; where the mourners - confronting and accepting death - progress from darkness to light, low to high, built to natural,…from life to death…to new life.5 This psychological/emotive cycle of mourning was introduced as the necessary reciprocal to function(alism). The living, as well as the dead, were the point of departure in this new approach to cemeterial design. Lewerentz’s scheme6 was amidst the winning Helsingborg entries displayed at the 1914 Baltic Exhibition, and it was here, standing before his model entitled ‘To death—to life’, that Asplund and Lewerentz would meet and agree to collaborate on the Stockholm South Competition.7 2. Probing the Authenticity of Tallum’s Primordial Ground Stockholm South’s site was formerly a sand and gravel pit, with a prominent bedrock hill and a vast pine forest. In their Tallum proposal, Lewerentz and Asplund strove to not only further the programmatic ideals of the Helsingborg Competition, but also to maintain and enhance as many of the site’s inherent qualities as possible: using the granite ridge and forest as their constant points of reaffirmation and return. For the architects, this was to preserve, improve, and re-discover the (archê)typical, primordial Swedish landscape.8 Nature, as primordial ground (forest and mound), was understood as authentic because it was perceived as being prior to the present - or any other - culture. It was seen as the means for recovering the depths of (Swedish) tradition, and thus a more grounded existence. The site’s existing ground, as primordial ground, was seen as the more grounded representation of the ontological continuum; as the means and receptacle for recovering an ontological understanding of World. 88 To Death - To Life ______________________________________________________________ In their proposal, all things human-made are subordinated to the presence of the ‘primeval’ forest and mound. The pines are selectively, minimally thinned into smaller burial glades, and all buildings and individual graves are woven into the enveloping pines. Nearly all paths and roads follow the undulating topography; and the few formal, axial ‘ways’ are subtly articulated, interconnecting and approaching the chapels. In all cases, pathways are either narrow slices through the forest or earth-bound paths lined with trees and/or graves. A retaining wall formed from the site’s natural stone defines the cemetery’s boundary with suburbia. A. Forest (and Clearing) The importance of the forest is manifest not only in Tallum’s physicality, but also in the design’s naming: tall meaning ‘pine’. Although previous research notes National Romantic affinities to the naming,9 Tallum must be understood foremost, in the context of this paper, in its most primal sense: as pine. Read as such, it is the architects’ unspoken yet adamant declaration to reaffirm the land’s primordial pine forest and pine tree. The architects’ proposal preserved so much of the existing forest that the jury’s one main objection was the pines’ total dominance; monotony and uniformity. The call for “wider and more open clearings”10 and a more formalised architectonic reworking of the ground, deserves careful consideration, for it reflects the time’s wider cultural currents, externalising how society’s conception of nature (embodied in the jury’s comments) was informed primarily by the modern fear and avoidance of death. The fact that the jury envisioned the forest’s omnipresence as potentially “merciless and frightening” speaks of society’s tendency to equate nature - uncultivated nature - with death, melancholy, and the sublime.11 Despite beginning transformations in societal views, nature was still perceived, on the whole, as a sanitary aesthetic mask, holding death’s inevitability at bay. The jury’s comments were related more to purely functional and aesthetic approaches than an ontological one. If the architects were looking to the pine in its most primitive essence12 - as tree and forest, as both symbol of the pagan World Tree (Yggdrasil)13 and symbol of the primeval forest (Urskog) - then it can be argued that, for them, Tallum was perceived as the ultimate regenerationdomain. Tallum, as pine, stands for both the paradigmatic notion of the individual tree (symbolic of all vegetation), and for the forest made of many trees (symbolic of nature’s eternal, regenerative properties). In Tallum dwells the tension of belonging partly to the paradigm of the forest and partly to the actual forest itself. In Tallum one is confronted with death, so as to come to terms with death, and ultimately to renew attitudes towards life. The architects’ championing of the primordial was not a means of combating or creating an Ersatz for urbanity; as it was for Romanticism’s Courtney D. Coyne-Jensen 89 ______________________________________________________________ philosophising-poets and artists. They were clearly receptive to the era’s art,14 however they departed from it by not representing nature and man in ominous opposition. While Tallum’s forest recalled the modes of being of Sweden’s earliest peoples, it also approved and introduced the reality of the human-fabricated world of modern culture into its continuum. To maintain, and move within, Tallum’s primordial ground was not entirely a nostalgic longing for the past, but rather was about seeking/supporting an ontological mode of being. Like ancient Viking grave-fields, it was about living with, and accepting, the reality of death; death as an extension of life. The architects were not positing or planting an attack of nature over culture,15 but were preserving, recovering, and privileging what they saw to have always been there: primordial ground in illo tempore.16 Moving in relation to, and within, a horizon of a rich mytho-poetic past,17 Tallum’s forest was regarded as sacred by virtue of its tradition - one long preceding human history and extending before the gods.18 As hallowed ground, the primeval forest’s sacred depths were sought as dwelling place(s) by the gods.19 By minimally clearing the land, it is as if the architects were silently proclaiming - reminding - that salvation and authentic being-in-the-world are situated foremost in the deep past of primordial ground, not solely in the historical past of cultivated ground alone. It is important to consider the three conditions where clearings are introduced into Tallum’s forest: [1] in the smaller burial glades; [2] in the areas of the crematorium complex and chapels; [3] in the area surrounding the ‘Grove of Remembrance’ mound, extending to the Chapel of the Holy Cross and crematorium complex. In the first two instances, the forest is prudently carved into. When it became necessary to remove some pines - to situate graves, buildings, or provide more light to the forest floor - deciduous trees were replanted nearby. This replanting could be read as an attempt to hold the human-fabricated world of culture at a distance. Yet, since the reforestation was in itself cultivation, it must instead be perceived as a way of reintroducing cultivated ground into primordial ground, and life into the realm of death/rebirth. “Original” tree(s) and re-forested tree(s), the symbolic and the literal, co-habitate in an agonistic field of synthesis and conflict. Deciduous and coniferous bodies represent the temporal/mortal and the eternal/primordial. Nature’s cycles come to the fore as reminders of the equality had in the necessary death of all “back into those things from which they came” 20; the equality in life/death…social and cosmic jämlikhet. The third and most consequential clearing - between the “Grove of Remembrance” mound and the Holy Cross Chapel and crematorium complex - establishes the possibility for a constant movement, both actual and symbolic, between death (represented in both the deceased body and the buildings as a receptacle of death) and new life (represented in the mound, grove, and nature’s regenerative properties). Figure and field are set into a 90 To Death - To Life ______________________________________________________________ dialogue through the ground. This clearing yields absolute prominence to the mound and its symbolism of new life; while the chapel and crematorium complex sit in the valley, symbolic of death. The architecture mediates the boundary between forest and clearing. Like the burial glades, this clearing which makes way for the quasi-cultivated, quasi-urbanised nature of the mound and grove - also represents a welcoming of the site’s primordial ground on civic terms. B. Mound (and Valley) Even more than with(in) the forest, it was in the actual ground of the site itself - most readily in the “Grove of Remembrance” mound’s situation that the architects struggled to establish a basis for an ontological understanding of ground and more authentic mode of being. In the mound, recalling Scandinavia’s prehistoric burial tumuli (dommarringa)21and the borough moot (tingställa),22 the renewed attitude toward death and the search for jämlikhet are given their most articulate - and archaic - expressions. Like the ancient tumuli, Tallum’s mound symbolises regeneration within the earth; the preservation and regeneration of single bodies as much as the communal body. The Holy Cross Chapel rests in the clearing’s valley; the gravel pit’s former site. The ground’s undulating topos (a descent begun at the mound) flows into the chapel’s concave floor/ground. At the chapel’s nadir lies the catafalque, where the deceased is lowered for cremation at end of the funeral rite. This descent-point is defined by a void into the earth’s darkness. Reciprocal to this downward movement is the mound’s skywards movement. These antipodes are physically connected by the topography’s unbroken curvature, and visually by the chapel façade’s massive opening. It is as if this gesture signifies that as the body descends in the chapel, its soul simultaneously ascends through the aperture at the centre of the Remembrance mound’s grove. The valley, being linked with death, holds all things corporeal in her bosom, while the mound rises as a symbolic harbinger of regeneration/rebirth. This two-way tensional dynamic between valley/mound (earth/sky), is brought into equilibrium through the ground’s continuity. The topography’s ascent - from chapel, to mound, to tree(s) embodies the ritualised movement from funeral, to burial, to resurrection, as well as the progression from the fear of death to the promise of regeneration. This notion of equilibrium should also be linked back to a discussion of equality, and the fact that the mound was designed to not only be seen, but also to be seen out from; to be accessible by mortals. Like ancient tingställar, Tallum’s mound can also be seen as a “sacred centre,”23 encouraging human participation. Tallum’s mound is not intended as a privileged seat solely for the Divine. Being mimetic of pagan tingställar, it is on occasion meant to be co-habitated by mortals, affording them the Courtney D. Coyne-Jensen 91 ______________________________________________________________ possibility of momentary communication with the dead and/or Divine. At Tallum, mourners are encouraged to meander to the mound’s apex and stand amidst the grove - and this must ultimately be seen as a gesture of jämlikhet. Nevertheless, the fact the architects articulated the mound to imply that cosmic connections can occur via the individual alone - devoid of culture’s greater structure, which for example enabled intercession at the time of tingställar - reflects modernity’s24 lack of proper mediation in general. The design of Tallum’s mound affords absolute freedom to the individual. Yet, with this emancipation also comes the onus of having to mediate the World alone.25 Perhaps it is exactly this plight - a need for a more fully mediated understanding of World - that the architects were actually challenging us to remember and experience with(in) Tallum’s mound. On one level, the mound’s grove speaks of a jämlikhet found in the harmonic tension between primordial and cultivated (socio-political) ground. The architects retained the site’s primordial topography, yet cultivated its top with a clearly human-made, square-formed grove. On a deeper level, the trees speak of an equality inherent in human finitude. Standing solemn and dignified, the grove presides over Tallum’s entirety. Each tree, standing surrogate for the absent-present elders of Sweden’s primordial past, mediates between earth and sky.26 It can thus be argued that the architects have situated these deciduous trees principally as reminders of cosmic justice27 and jämlikhet. The trees’ branches weep ground-wards, as if to communicate remind - that all things arise from, and return to, the earth. Each tree, as arbiter, is Time. The law they proclaim - waning occurs following a fixed span of growth, then death balances birth - is silently manifested in nature’s continuous temporal pendulum of life, death, renewal… 3. The Absence of an Authentic Ground in Modern Christianity Christian iconography and symbolism in Tallum’s design are minimal and unfulfilled. Because the architects privileged the site’s primordial ground as the principal medium of symbolic representation, the notion of Christian ground is ambiguous and fragmentary. Thus, Christian ground must be discussed, as the architects dealt with it in praxis, not so much as ground, but as a series of fragments within the wider, primordial topography. From the competition sketches to the realised design, Christianity (as an institution) is reduced to a handful of biblical place names and dogmatic, ecclesiastical freestanding objects within the site’s primary clearing. To reach a deeper understanding of the ontological implications of situating Christian eschatological fragments within the greater context of a primordial understanding of nature-as-regenerator, Tallum’s Christian ground must now be discussed in terms of two major fragments: [A] “The Way of the Cross”; [B] “The Resurrection Monument”. 92 To Death - To Life ______________________________________________________________ A. The Way of the Cross [The First Major Fragment] Lewerentz’s “Way of the Cross” competition sketch depicts a narrowly winding footpath, slowly ascending through the burial glades’ mysterious darkness. At the path’s beginning stands a large, leaning, wooden cross. Simultaneously Christian and pagan, the path can be seen to fuse the Via Dolorosa28 and Via Appia,29 within the primeval forest. Representations of all levels of the ontological continuum - graves, mourners, cross, trees, etc. - are intended to coexist within the forest’s greater regenerative body. The cross’ situatedness can be read as the architects’ declaration that Christian redemption and rebirth are to be understood only as part of the primordial’s deeper promise of salvation. According to the sketch, it is within the forest, moving ritually towards the chapel, where death can truly be confronted, loss accepted, and the hope of new life (re)instilled. Lewerentz represented the cross as a tree-amongst-trees, within the forest’s greater entity. It is as if the Garden of Eden’s “original tree”, which later became Christ’s crucifix, is still metamorphosing - via nature’s regenerative cycles into becoming a perfectly upright, mediating tree once more. The location and articulation of the cross and path in Lewerentz’s competition sketch subsequently underwent several revision. When Asplund was later appointed sole responsibility of designing the Holy Cross Chapel and crematorium, he also inherited the dilemma of “The Way of the Cross”. Asplund’s situating of the cross became even more groundless: being transformed at one stage into a granite obelisk, and in another completely removed. The uncertainly can be seen as being indicative of the place of Christianity within Sweden’s cultural climate at the time. Numerous schemes later, Asplund eventually returned to the cross, and the path again named “The Way of the Cross”. As realised, it externalises the architects’ anxieties in dealing with the Christian fragment within a wholly other(wise) framework: where true authenticity and salvation were seen embodied in the depths of primordial ground. The realised Way, like the competition sketch, slopes slowly upward towards the chapel. Sinking into the ground, grass pushes up between the irregular paving stones. Like the forest and mound, this path is concurrently primordial and cultivated ground. Unlike Lewerentz’s sketch, the realised Way is axial and devoid of its forested setting. The once leaning, wooden cross has become a perfectly upright, monolithic, black granite cross. It has become “The Great Cross” yet signifies neither the path’s beginning nor end. It stands prominently ambiguous and free-floating, just before the great portico, in tension between the Holy Cross Chapel and the mound. The materiality of “The Great Cross” is inherited from its transitory design phase as a monolithic obelisk. More importantly, its overly-explicit monumental articulation should be understood as the consequence of placing so much symbolic weight on - in - primordial ground. The symbolism embedded in the mound’s mass could, in the end, Courtney D. Coyne-Jensen 93 ______________________________________________________________ only be countered with such a literal interpretation of mass as manifested in the cross’ granite materiality. B. The Resurrection Monument [The Second Major Fragment] From its beginnings, John Lundqvist’s statue “The Resurrection” was approached by the architects as a fragment. Designed in 1908, completely independent of any connection to the cemetery, it only first came into the realm of the public eye - and Tallum’s primordial ground - after being displayed at the 1930 Stockholm Exhibition in a special section on cemeterial art. Contemporary art critics heralded Lundqvist’s statue as representing the era’s spirit and pathos, and proposed it be erected in Tallum.30 Following the public’s favourable responses to “The Resurrection”, the cemetery committee asked the architects to suggest a location within Tallum. Again faced with the problem of the Christian fragment, devoid of any contextual ground, the architects struggled for almost ten years before ultimately locating the monument where it stands today: at the centre of the great portico’s impluvium. Like the need to be utterly literal with “The Way of the Cross” naming, the portico was subsequently named “Monument Hall”. Words were again made to bear the weight - the meaning - for the symbol, which no longer could. The statue, pregnant with symbolisms of Christian rebirth (three vertical figures ascend resurrected atop three horizontal purgatorio figures), is positioned in direct reciprocity to the “Grove of Remembrance” mound. The dialectical tension in-between these two figures’ differing notions of salvation is held in equipoise through the continuity of the topography. The portico is articulated as an inverted mimesis of the square-formed grove of trees that sits atop the mound. The mound rises, yet its movement is ultimately downward, back into the earth; as we are reminded by the trees’ weeping branches. Conversely, the portico lies in the valley with a concave floor and a skywards-pointing roof. At the grove’s centre is a void yielding to the ground and “salvation in the earth”; while at the portico’s centre is the solid of “The Resurrection’s” salvation. The overall irresolute manner in which the architects were left to deal with Christian symbolism at Tallum illustrates modernity’s prevailing problem in addressing the current cultural situation in any decisive way using Christian tradition. It also reflects the dilemma arising out of the architects’ extreme privileging of the site’s primordial ground above all else. It was almost as if the architects were positing that if they got the ground right than they did not need any thing else. In the end, the only place left for Christian dogma in Tallum is as a fragment - as scattered objects floating groundlessly in the modern clearing. 94 To Death - To Life ______________________________________________________________ 4. Conclusion The search for authenticity in the ground of Tallum was driven by a state of groundless-ness. The background of such groundless-ness has been seen in other, wider attempts to recover the ground; such as those in the domain of early 20C socio-political and spiritual reforms, aimed at recovering a more equalised and authentic existence. The architects, in turn, embodied the social quest for lost ontological ground within the site’s actual, primordial ground. The syncretic movement in-between socio-political ground and primordial ground, as well as the general problem of fragmentation, typifies the breakdown of a fully mediated ontological continuum in modernity in general. Through their extreme preoccupation with the site’s pervasive nature, it can be said that the view was that true authenticity resides foremost within the ground - in its most actual and primordial sense. In a most basic sense, the salvation of culture and the means for a more grounded being were seen lying tacit and latent in the sacrality of the earth. Due of this understanding and the endeavours to find most meaning within Tallum’s material ground, the ground itself was deeply invested with meaning. However, with meaning normally comes increased articulation, at a level, which consistently attempts to break free from the dumb and primordial; thus neutralising the significance invested in the earth as unshaped and archaic ground. As a result of this unremitting - almost viscous - circle, Tallum exists as an agonistic ground of tensions, mediated by a constant interplay of conflicts and syntheses. Within this exchange lies the fundamental dilemma with which the architects were invariably faced. Notes 1 M Heidegger, Basic Writings, Harper Collins, New York, 1993, pp. 171172. 2 M Heidegger, Being and Time: A Translation of Sein und Zeit, Joan Stambaugh (trans), Harper and Row, New York, 1972, pp. 239-242; 348-350. 3 C Hallendorff, History of Sweden, Cassell and Co., London, 1929, p. 382 and 423. 4 W Kandinsky ‘Concerning the Spiritual in Art and Painting in Particular 1912’. The Documents of Modern Art, 5, George Wittenburn, New York, 1955, p. 26. 5 A Schmarsow, ‘Utdrag ur arkitekernas beskrifning till krematorie i Helsingborg’. Teknisk Tidskrift: Arkitektur, 1914, p. 117. 6 Co-designed with former partner Torsten Stubelius. Courtney D. Coyne-Jensen 95 ______________________________________________________________ 7 Asplund and Lewerentz were already collegial, having studied together at the Klara School (1910). Prior to Tallum, both architects had practiced 7+ years, designing ecclesiastical, domestic and civic projects. 8 S Lewerentz, ‘Östra kyrkogården i Malmö’. Byggmästaren, 1928, p. 188. 9 B Johansson, Tallum: Gunnar Asplund and Sigurd Lewerentz’s Woodland Cemetery in Stockholm, Byggförlaget, Stockholm, 1996, pp. 16-18. 10 N Blanck, ‘Täflan om utvidgning av Stockholms Södra Begrafningsplats’ in Teknisk Tidskrift: Arkitektur, 1915, p. 44. 11 E Kant, The Critique of Judgement, Clarendon, Oxford, 1978, §26. 12 Although many publications have addressed Tallum relative to primitivism - stylistically - no research has yet looked at the word and meaning of tall in and unto itself, in its most indigenous and essential form. 13 In the Norse Gyllfaginning, Yggdrasil is the mighty ash structuring the cosmos, being continually destroyed and renewed. Every tree symbolises Yggdrasil, and every forest is sacred and magical due to its mediation between worlds. S Sturluson, The Prose Edda, University of California Press, Berkeley, 1964. 14 Specifically, the paintings of C.D. Friedrich (1774-1840) and Prince Eugene (1865-1947) would have been known to Lewerentz and Asplund: Eugen’s work displayed in the 1914 Baltic Exhibition, and Friedrich’s work widely-published. 15 O Spengler, The Decline of the West, Allen and Unwin, London, 1926; C Constant, The Woodland Cemetery, Byggförlaget, Stockholm, 1994, p. 172. 16 M Eliade, The Sacred and The Profane, Hartcourt Brace Jovanovich, San Diego, 1987, p. 68. 17 Concerning this return to mythical beginnings, W. Curtis, Modern Architecture Since 1900, Phaidon, London, 1996, pp. 130-147. 18 G Bachelard, The Poetics of Space, Beacon, Boston, 1958, pp. 186-188. 19 C Tacitus, Germania, Heinemann, London, 1970, p. 39. 20 C Kahn (ed), Anaximander and the Origins of Greek Cosmology, Columbia University Press, New York, 1960, p. 199 ff. 21 Dommarringa/domarhög/gravhög (“judgement rings/mounds”) were Scandinavia’s Bronze and Iron Age burial mounds, which co-functioned as judgement courts. N. Herlitz, Grunddragen av det svenska statsskickets historia, Oxford University Press, London, 1939. 22 Tingshög/tingställa is Swedish for “place/mound of the Thing” and “borough moot”. Svenska Akademiens Ordbok, Svenska Akademien, Göteborg, 1999. 23 M Eliade, The Sacred and The Profane, p. 36. 24 Addressing modernity and “the modern moral predicament”, C. Taylor notes that in modern culture two frontiers have been added to the original 96 To Death - To Life ______________________________________________________________ theistic one: nature and self: “A modern who recognises both these powers is constitutionally in tension”. Sources of the Self, pp. 383-390. 25 C Taylor, Sources of the Self, Cambridge University Press, Cambridge, 1989, pp. 497-501. 26 HR Ellis Davidson, Ancient Peoples and Places: Pagan Scandinavia, Thames and Hudson, London, 1967, pp. 108-109. 27 “Cosmic justice” implies the necessary dissolution of all things back into their source of birth, making room for new life. There is no wastage - only equality - in physical change from life to death. Anaximander, ‘Fragment 1’. The Presocratics, Collier Macmillan, London, 1966, p. 54ff. 28 C Constant, The Woodland Cemetery, pp. 40-41. 29 D Porphyrios, ‘Classical, Christian, Social Democrat: Asplund and Lewerentz's funerary architecture’. Lotus International, 38 (1983), 73. 30 G Nässtrom, ‘Utställningen: ett monument’. Stockholms Dagbladet, May 23, 1930. Bibliography Anaximander, ‘Fragment 1’. The Presocratics, Collier Macmillan, London, 1966. Bachelard, G., The Poetics of Space, Beacon, Boston,1958. Blanck,N., ‘Täflan om utvidgning av Stockholms Södra Begrafningsplats’. Teknisk Tidskrift: Arkitektur, 1915. Constant, C., The Woodland Cemetery, Byggförlaget, Stockholm, 1994. Curtis, W., Modern Architecture Since 1900, Phaidon, London, 1996. Eliade, M., The Sacred and The Profane, Hartcourt Brace Jovanovich, San Diego, 1987. Ellis Davidson, H., Ancient Peoples and Places: Pagan Scandinavia, Thames and Hudson, London, 1967. Hallendorff, C., History of Sweden, Cassell and Co., London, 1929. Heidegger, M., Being and Time: A Translation of Sein und Zeit, Joan Stambaugh (trans), Harper and Row, New York, 1972. Courtney D. Coyne-Jensen 97 ______________________________________________________________ _____, Basic Writings, Harper Collins, New York, 1993. Herlitz, N., Grunddragen av det svenska statsskickets historia, Oxford University Press, London, 1939. Johansson, B., Tallum: Gunnar Asplund and Sigurd Lewerentz’s Woodland Cemetery in Stockholm, Byggförlaget, Stockholm, 1996. Kahn, C. (ed), Anaximander and the Origins of Greek Cosmology, Columbia University Press, New York, 1960. Kandinsky, W., ‘Concerning the Spiritual in Art and Painting in Particular 1912’. The Documents of Modern Art, 5, George Wittenburn, New York, 1955. Kant, E., The Critique of Judgement, Clarendon, Oxford, 1978. Lewerentz, S., ‘Östra kyrkogården i Malmö’. Byggmästaren, 1928. Nässtrom, G., ‘Utställningen: ett monument’. Stockholms Dagbladet, May 23, 1930. Porphyrios, D., ‘Classical, Christian, Social Democrat: Asplund and Lewerentz's funerary architecture’. Lotus International, #38, 1983. Schmarsow, A., ‘Utdrag ur arkitekernas beskrifning till krematorie i Helsingborg’. Teknisk Tidskrift: Arkitektur, 1914. Spengler, O., The Decline of the West, Allen and Unwin, London, 1926. Sturluson, S., The Prose Edda, University of California Press, Berkeley, 1964. Svenska Akademiens Ordbok, Svenska Akademien, Göteborg, 1999. Tacitus, C., Germania, Heinemann, London, 1970. Taylor, C., Sources of the Self, Cambridge University Press, Cambridge, 1989. 98 To Death - To Life ______________________________________________________________ Courtney D. Coyne-Jensen, Architect M.A.A. / Ph.D. Independent architecture and urban design professional (CPH, DK), and Lecturer at DIS, Danish Institute for Study Abroad. Heroic Death and Selective Memory: The U.S.’s WWII Memorial & The U.S.S.R.’s Monument to The Heroic Defenders of Leningrad Susan M. Behuniak Abstract Just as war is a struggle to the death over conflicting values, so are war memorials a struggle over death and its meaning. This paper focuses on two parallel efforts to memorialise those who served during World War II (called the Great Patriotic War in Russia): the US’s World War II Memorial in Washington, D.C. and the USSR’s Monument to the Heroic Defenders of Leningrad, (now St. Petersburg, Russia). What I will argue is that both of these memorials, rather than simply honouring the sacrifices of the dead, convey a deliberate political message: that those who died were heroes, and that a heroic death is one in which the sacrifice is worth it. Such a politicised agenda requires not only that collective memory be formed and preserved by an architectural structure, but that these mnemonic spaces also promote a forgetfulness of memories to the contrary. In this, these two memorials, one originating within democracy and the other within communism, demonstrate Harvey Weinstein’s point that “memorials represent a complex nexus between politics, trauma, collective memory, and public art.” The paper begins with a brief discussion of heroic versus tragic death as archetypes. Next, I examine and compare the American and Soviet monuments with attention to how the elements of timing, geography, and architecture/art determine what is remembered and what is repressed. I suggest that despite their significantly different wartime experiences and politics, both countries built triumphant renderings of the war—memorials that celebrated heroic death while denying tragic death—to promote not only national unity but also a patriotism based on militarism. Key Words: War memorials, war monuments, heroic death, tragic death, WWII, siege of Leningrad. ***** 1. Introduction War memorials stir more than the heart and the head to remember; they also rouse the public to react politically. Their construction, then, comes not just from the shaping of granite but from a desire to shape the public’s perception of this “form of socially sanctioned death.”1 Yet, just as war is a 100 Heroic Death and Selective Memory ______________________________________________________________ struggle to the death over conflicting values,2 so are war memorials a struggle over death and its meaning. In this, memorials have “unique symbolic power because they invoke a sense of timelessness, awe, fear, and uncertainty.”3 They recall the “ultimate sacrifice” made by others, and so like graveyards, they are sites where the living and the dead meet. Memorials, then, serve not only to commemorate or mourn; they are also a “means for a community to stabilize an event [by making] the past consequential for the present.”4 Given their intent and impact, it is no surprise that war memorials can be highly politicised and contested sites. They are structures that demand answers to charged questions: Who should be remembered and how? Which events should be highlighted—or disregarded? Whether the message should be clear, ambiguous, or even absent? When should the memorial be built and where? What, indeed, is its purpose—to mourn, warn, consol, celebrate, instruct, propagandise, or several of these at once? One way to uncover the narratives contained within memorials has been to categorize them. “Monuments,” those structures built in celebration of victory have been distinguished from grief-laden “memorials” that primarily reference “the life or lives sacrificed for a particular set of values.”5 Another distinction has been drawn between “traditional memorials,” i.e., physical structures built of stone, and “living” memorials, an ironic word choice that erases “war” and “death” altogether. These living remembrances include such things as memorial highways, street names, social programs, and housing projects.6 Memorials have also been classified according to whether they glorify, contest, or disavow an historical event or person.7 What I explore here, however, is whether war memorials stylise death as heroic or as tragic. Tragic death is the more socially disturbing view because it is death without a clear purpose or meaning. Its associative grief comes from this understanding of death as disastrous—a life wasted or a loss that was preventable. Those who die tragically are characterized as having died too young, mistakenly, or without a justifiable cause. These dead (and even those who survive the horror8) are victims, innocents or unfortunates, but not heroes. In contrast, heroic death presumes the dead had both agency and courage; the dead hero freely gives up life for a cause, and so dies for others;9 a trop that is Christ-like. In this way, death itself is transcended through participation in something of lasting worth.10 This depiction of death as heroic is personally consoling, but also culturally meaningful as it “displace(s) awareness of what is terrible” with a dis-remembering so complete that it may at first seem impossible.11 To successfully depict heroic death, then, memorial designs must choose from among competing war memories those victorious images that reinforce the greatness and the rightness of the war and, by implication, the associated deaths. Such memorials trumpet military might rather than toll for the lives lost. Susan M. Behuniak 101 ______________________________________________________________ 2. The American and Soviet Memorials To explore this theme, this paper focuses on two parallel efforts to memorialise those who served during World War II (called the Great Patriotic War in Russia): the World War II Memorial in Washington, D.C. and the Monument to the Heroic Defenders of Leningrad, (now, St. Petersburg, Russia). These two memorials, one originating within democracy and the other within communism, demonstrate Harvey Weinstein’s point that “memorials represent a complex nexus between politics, trauma, collective memory, and public art.”12 Despite their significantly different wartime experiences and politics, both the US and USSR built triumphant renderings of the war—memorials that celebrate heroic death while denying tragic death. To do so, these physical narratives drew on three elements: the timing of construction, the geographic location, and the mnemonic features of the designs that incorporated some wartime memories while “forgetting” others. A. Timing Although the Great War ended in 1945 it was not until thirty years later that the Leningrad Monument was completed. The delay can be attributed to at least two things: the all-consuming effort to rebuild the USSR, and Stalin’s concerted effort to curtail further discussions about the war, (e.g., by demoting Victory Day from a national holiday to a working holiday in 1947.)13 Eventually, a tidal shift came from a mix of changing politics that distanced and re-examined the Stalinist regime, and the approaching 30th anniversary of Victory Day. As a result, the “cult of World War II” was born.14 The period between war and memorial was even longer in the US. Built in 2004, the memorial followed not only the Korean and Vietnam Wars but also the building of their memorials; the Vietnam Veterans Memorial (VVM) in 1982 and the Korean War Memorial in 1995. The delay in commemorating WWII can be explained both by a post-war preference in favour of “living” monuments (e.g., memorial highways, arenas, and scholarships) over traditional stone monuments,15 and by a public questioning of war in reaction to the Korean and Vietnam conflicts, neither viewed as triumphant nor heroic. In fact, between 1970 and 1998, WWII “virtually disappeared in US popular culture.”16 But as in the USSR, a cult of WWII eventually did arise in the US, this time heralded by the 50th anniversary of D-Day in 1995 and reflected by pop culture events such as Stephen Spielberg’s film Saving Private Ryan, Tom Brokaw’s book The Greatest Generation, and the HBO series Band of Brothers. The urgency for building the memorial only increased with the growing awareness that the WWII generation was dying off.17 If, as the geographer Yi-Fu Tuan reminds, “[t]he cult of the past calls for illusion rather than authenticity,”18 in arising from the cult of the 102 Heroic Death and Selective Memory ______________________________________________________________ “Great” war, the timing was right for American and Soviet memorials that would reflect heroic death. B. Geography Where, then, to place these memorials? It was only natural that Leningrad, the city that withstood a 900-day siege, would memorialise its own, but the specific location of the memorial was viewed from the start as a critical decision because it would determine whose experience would be set into stone.19 To build the memorial on the battlefront would pay homage to the soldiers; locating it within the historic district of the city would honour the civilians. The final decision was to build on the southern extreme of Moskovskii Prospekt, at a site dubbed Victory Square; an ellipse of land at the centre of a traffic circle that had been a part of a line of defence that ringed the city (i.e., where front and city met,) and where a Triumphal Arch had been temporarily erected in 1945 to greet the returning troops.20 Choosing a location for the WWII memorial in Washington was perhaps an even more contentious issue since one of the proposed sites was that of the “sacred” space of the National Mall; a two-mile promenade spanning from the Lincoln Memorial to the Washington Monument to the U.S. Capitol. To situate the memorial on the Mall was understood by both proponents and opponents as establishing a “specific vision of the war and its meaning in American history.”21 A public service advertisement featuring Tom Hanks, the star of Saving Private Ryan, fused fiction, myth, facts, and politics in the campaign to promote this site by quoting from the actor: “It’s the right time. It’s the right place. Please help build [the memorial] here on the Mall…”22 Eventually, the advocates for this prime location won. The announcement stone to the monument left no doubt as to the symbolic meaning of its chosen location: “Here in the presence of Washington and Lincoln, one the eighteenth-century father and the other the nineteenthcentury preserver of our nation, we honour those twentieth century Americans who took up the struggle during the Second World War and made the sacrifices to perpetuate the gift our forefathers entrusted to us: a nation conceived in liberty and justice.”23 Situating the WWII monument between these icons, then, deliberately constructed this “victorious” war, rather than the more problematic Vietnam or Korean conflicts, as the most significant event of the 20th century.24 Therefore, merely the choice of location foreshadowed the symbolic meanings of the memorials yet to be built. Both the US and USSR memorials were strategically located for the telling of a heroic narrative: the Leningrad monument positioned at the site where civilians and soldiers met to successfully defend their city from invasion, and the American WWII memorial situated between the Washington Monument, the symbol of democracy, and the Lincoln Memorial, the symbol of unity. Given this, it Susan M. Behuniak 103 ______________________________________________________________ would no longer seem possible to construct these tributes to the war in tragic terms—indeed the ground had literally been laid to erect structures that affirmed a national identity built on military superiority. C. Mnemonic Architecture and Forgetfulness Shanken summarizes the challenge of designing the US memorial in this way: “How would America commemorate a war that included genocide, mass killings, and nuclear death”?25 The construction of the heroic narrative of WWII was also threatened by other problematic memories: the government’s failure to foresee the attack on Pearl Harbour, the internment of Japanese-American citizens, the military’s discriminatory policies based on race and gender, and the country’s original resistance to entering the war. A similarly daunting challenge also confronted the choice of a heroic Soviet design: how to deal with Stalin’s pact with Hitler, the lack of preparedness for Germany’s Operation Barbarossa, the Kremlin’s policy that accepted the starvation of Leningraders over surrender, and the cannibalism and crime that occurred in Leningrad during the siege.26 In order that the memorials are constructed according to national narratives of heroic death in victorious war,27 memories such as these had to be omitted by both the American and Soviet designs. The use of numbers serves as a revealing example of what was to be remembered versus forgotten. The U.S. memorial, designed by Friedrich St. Florian includes a Freedom Wall containing 4,000 gold stars that pays homage to the 400,000 dead American troops with the inscription: “HERE WE MARK THE PRICE OF FREEDOM.” The memorial is silent, however, concerning the millions of dead among allied troops and civilians of all the involved nations—failing even to note those who died in the Holocaust, Hiroshima, and Nagasaki. In contrast, the numbers cited in the Soviet design are not employed to count the fallen but instead to mark the duration of the siege: 900 days, 900 nights. In emphasizing the longevity of the siege the focus of the memorial is on the heroism of Leningraders rather than on the tragic deaths of an estimated one million of them. Indeed, the Soviet monument names Leningraders as the “heroic defenders” of the city28 and not as the victims of the war or of government policy.29 This shift in terminology has been viewed as symbolically important; it is embraced by some scholars as acknowledgment of the sacrifices made by the mostly female population,30 while rejected by others as romanticizing the wretched struggle of children, women, and the elderly to survive in the midst of unspeakable conditions caused by political decisions.31 Both memorials adopt typical heroic elements on a grand scale. The American memorial spans 7.4 acres and incorporates the pre-existing Rainbow Pool. Its classical design includes: two 43-foot triumphal arches that honour the Pacific and Atlantic fronts; bronze eagles and wreaths; and a 104 Heroic Death and Selective Memory ______________________________________________________________ circular plaza with walls engraved with battle names and inspirational quotations. Emphasizing unity on the home front, there is a ring of fifty-six 17-foot-high pillars representing the states, territories, and District of Columbia, and a tiered ceremonial entrance lined by twenty-four bas-relief sculptures depicting scenes of America at war. That this triumphant monument was erected following the construction of the austere Vietnam Veterans Memorial (VVM) speaks to the deliberate message of the design. Whereas the competition rules for designing the VVM required that the design make no statement about the war,32 the WWII memorial was erected with a clear message of military victory. This triumphant narrative has been both lauded as “simple, solemn and dignified,”33 and disparaged as an “excessively busy design.”34 One critic charged that the memorial embodied the architecture of the Third Reich and faulted it as “gigantic and grandiose, bombastic and authoritarian, faceless and monolithic.” 35 To this others added the observations: “imperial and triumphant,”36 “Federalist Stalinist,”37 a “tasteless monstrosity,”38 and “a shrine to not knowing or, more precisely, of forgetting.”39 Its proponents argued that the “elegiac memorial”40 emphasizes national unity, undaunted courage, and the effort “to liberate a world fast falling to forces of tyranny.”41 The Monument to the Heroic Defenders of Leningrad designed by Valentin Kamensky and Sergei Speransky is equally as busy and triumphal a memorial. There is a 48-meter obelisk, a classical design element that connotes “imperial trophy,”42 that bears the dates of Soviet involvement in the war, 1941 to 1945. At its base stand larger than life sculptures of a male soldier and a male worker, unabashedly titled “The Victors.” Six sculptural groups by Mikhail Anikushin, a witness to the siege, line the sides of the staircase, giving human faces to the “defenders” of Leningrad: soldiers, sailors, pilots, snipe-shooters, a female medic, foundry workers, a mother saying farewell to her son, and civilians with shovels poised to dig trenches. Following a stairway downward through a ring of granite, the lower level contains the sculpture, “The Blockade,” that features the women of Leningrad: one woman whose breasts can be seen beneath a thin fabric stands holding a sagging child in her arms, another kneeling and cradling a younger woman, and a third limp and shrouded being supported by a male soldier. It is here that visitors leave red and white carnations. This sculpture documents the suffering that is noticeably absent from its American counterpart. (It is therefore ironic that the American structure is labelled a “memorial” although it clearly elevates the celebration of militarism over mourning, while the Soviet structure is termed a “monument,” a label indicative of victory remembered.) Yet, as Kirchenbaum notes of “The Blockade” sculpture, with the exception of the shrouded woman, this depiction of the women of Leningrad sanitizes starvation and suffering: their faces are stoic, they are unbowed, and their bodies are ample, even voluptuous.43 Susan M. Behuniak 105 ______________________________________________________________ Although there is an information booth near the American memorial, there is no museum attached to the site. In contrast, the Leningrad monument includes a subterranean museum that contains: artefacts from the siege; an electronic map of the front; a documentary film; two enormous mosaics, one depicting the start of the War and the other Victory; and 900 electric candles. The mosaics and candles are religiously laden symbols in that they co-opt the icons of the Russian church and recall the candles typical of the “red corners” (i.e., religious display corners) in many Russian homes. During the debate over what the design of this Soviet monument should say, polarizing urges emerged—that victory be celebrated or that tragedy be documented.44 During the public discussion of the proposed designs, one architect suggested, “[t]he need for a site specific narrative that did not try to redeem trauma with overblown images of victory.”45 The resulting design, instead, wedded heroism to military victory, a decision chastised by historian Nina Tumarkin as a “massive effort to obliterate collective memory of the most horrific war in the history of humankind.”46 Although both the American and Soviet WWII experiences are complex stories of defeat and victory, death and survival, and complicity and courage, the memorials erected to these experiences embellish their heroic elements. In this elevation of myth over memory, the two memorials illustrate how catastrophic events can be suppressed so they might be canonized into victories. 3. Discussion and Conclusion The connection between heroic death and successful warfare may seem inevitable, but I want to argue that they are not. Instead, the linkage between the two is one that is deliberately constructed to advance a particular political agenda. For example, the U.S. experience in WWI could also have been told using a heroic and victorious narrative, but the commemorative memorials told a different story. Rather than triumph, these memorials struck the theme of healing and of lessons learned. WWI was memorialised as “the war to end all wars” and as a promise of “never again.”47 The cultural discomfort with the notion of celebrating the victory explains the popularity of useful, living memorials over the building of symbols in stone48. And although “[i]mperial countries do not usually erect monuments that memorialise their guilt,”49 there are counterexamples of this as well. The VVM50 in the U.S. and the Solovki Stone51 (a gulag memorial) in Russia were built with the therapeutic objective of healing and so neither serves as a “tool of state power.”52 Both these memorials illustrate how the tragic view of death rejects a singular and coherent narrative of war, instead recognizing that great loss implicitly asks us to weigh whether the cost in human life was worthwhile.53 Whereas heroic death uses epic terms, clichés, and partial 106 Heroic Death and Selective Memory ______________________________________________________________ stories to fix a narrative to which contrary facts and memories must conform, tragic death employs a richer and multifaceted view of warfare that encourages public mourning and reflection. These memorials show a reverence for life and for death by inviting citizens to question the meanings of the killings and/or the war, and how, then, to heal in order to move forward.54 For example, Maya Lin, whose VVM design lists each name of the war dead on a V-shaped wall of black granite, said that her work was influenced by a sharp awareness of death as loss.55 Interestingly, this openended design that invited such reflection proved too disturbing to some, and so additions were later added to the site that were more in line with heroic symbolism: a flagpole and realistic sculpture of three male soldiers in 1984; and in response to this gendered image of the war dead,56 a sculpture of women nurses in 1993. Whereas tragic death accommodates complicated and even contradictory memories, heroic death depends on selective memory. Barbara Biesecker states that consciousness is reorganized “not by way of explicit propaganda, but by replacing and simplifying memories people actually have with image traces of political experience about which people can have political feelings that link them to other citizens and to patriotism.”57 The heroic narrative is well suited to this task since the hero’s world is a onedimensional pairing of polar opposites: us versus them; victory versus defeat; good versus evil.58 The hero, then, emerges as an uncomplicated and “untainted” figure.59 This rendering even makes death denial possible since heroes do not die;60 a sentiment encoded in eternal flames, granite structures, and larger-than-life statues. Because war memorials are indeed “self conscious attempts to solicit public participation in the politics of the day,”61 the choice of whether to depict death as tragic or as heroic not only determines interpretations of past wars but also instructs present day politics on both the national and individual levels. Again, memorials that embrace the tragedy of death not only encourage healing but also a weighing of the price of victory. In this rendering, neither national identity nor individual notions of citizenship are dependent on militarism alone for meaning. In contrast, the heroic renderings of war deaths discourage a questioning of war and instead pose an explicit threat of future warfare by showcasing military superiority. Both the American and Soviet WWII memorials illustrate this point. In that each nation claimed for itself the pivotal role of having saved the world from fascism,62 each memorial links heroic death to military success by cultivating the belief that the greatness of a generation, a city, or a country is due to victory in war. Such a message sanctions future warfare and constructs citizenship as a duty to fight to the death in the next patriotic war, or at minimum, to offer unified support at home. This distilling of wartime Susan M. Behuniak 107 ______________________________________________________________ deaths into the archetype of heroic death not only shapes an account about the past, but sets expectations about the present and the future. Notes 1 C A Corr, C M Nabe, and D M Corr, Death & Dying, Life & Living, Wadsworth, Belmont, CA, 2009, p. 79. 2 C L Griswold and S Griswold, ‘The Vietnam Veterans Memorial and the Washington Mall: Philosophical Thoughts on Political Iconography’. Critical Inquiry, vol. 12, Summer 1986, p. 689. 3 K Verdery as quoted in B Forest and J Johnson, ‘Unravelling the Threads of History: Soviet Era Monuments and Post-Soviet National Identity in Moscow’. Annals of the Association of American Geographers, vol. 92, September 2002, p. 526. 4 E Reimers, ‘Public Memorials as Communicative Tools to Construct, Deconstruct, and Negotiate History and the Present’. Paper presented at the Death, Dying and Disposal 8th Conference, Bath, UK, 2007, p. 1. 5 M Sturken, ‘The Wall, the Screen, and the Image: The Vietnam Veterans Memorial”. Representations, vol. 35, Summer 1991, p. 120. 6 A M Shanken, ‘Planning Memory: Living Memorials in the United States during World War II’. The Art Bulletin, vol. 84, March 2002. 7 Forest and Johnson, op. cit. 8 See T Des Pres, The Survivor: An Anatomy of Life in the Death Camps, Oxford University Press, NY, 1976, p. 4; T Todorov, Facing the Extreme: Moral Life in the Concentration Camps, A Denner and A Pollack (transl), Henry Holt and Company, NY 1996, p. 10. 9 Todorov, op. cit. 10 E Becker, The Denial of Death, Free Press, NY, 1973, 1997. 11 Des Pres, op. cit., p.5. 12 Quoted in J Barsalou and V Baxter, ‘The Urge to Remember: The Role of Memorials in Social Reconstruction and Transitional Justice’. Stabilization and Reconstruction Series No. 5, United States Institute of Peace, Washington, DC, January 2007, p. 4. 13 N Tumarkin, The Living & The Dead: The Rise and Fall of the Cult of World War II in Russia, Basic Books, NY, 1994, p. 104. 14 Tumarkin, op. cit. 15 Shanken, op. cit., p. 130. 16 B A Biesecker, ‘Remembering World War II: The Rhetoric and Politics of National Commemoration at the Turn of the 21st Century’. Quarterly Journal of Speech, vol. 88, November 2002, pp. 405. 17 L Benton-Short, ‘Politics, Public Space, and Memorials: The Brawl on the Mall’. Urban Geography, vol. 27, 2006, p. 305. 108 Heroic Death and Selective Memory ______________________________________________________________ 18 Y F Tuan, Space and Place: The Perspective of Experience, University of Minnesota Press, Minneapolis, 1977, p. 194. 19 L A Kirschenbaum, The Legacy of the Siege of Leningrad, 1941-1995, Cambridge University Press, NY, 2006, p. 211. 20 The State Museum of the History of St. Petersburg, ‘Monument to the Heroic Defenders of Leningrad’ Brochure, Leetsey Publishing House, St. Petersburg, 1999. 21 Benton-Short, op. cit., p. 297. 22 Mills, op. cit. 23 Mills, op. cit., p. 209. 24 Benton-Short, op. cit, p. 323; see also Mills, op. cit., p. 217. 25 Shanken, op. cit., p. 134. 26 Forest and Johnson, op. cit , p. 432; Shanken, op. cit., p. 145. 27 Kirschenbaum, op. cit., p. 283. 28 see C Simmons and N Perlina, Writing the Siege of Leningrad: Women’s Diaries, Memoirs, and Documentary Prose, University of Pittsburgh Press, Pittsburgh, PA, 2002. 29 see Tumarkin, op cit. 30 See Simmons and Perlina, op. cit. 31 See Tumarkin, op. cit. 32 Griswold and Griswold, op. cit., at footnote 21, p. 718. 33 M Fisher, ‘A Memorial, Yes, But What About Its Message?’ The Washington Post, July 22, 2000, p. B-1. 34 ibid. 35 S Kalson, ‘World War II Memorial a Classic Example of Excess’. Pittsburgh Post-Gazette, May 30, 2001, p. B-1. 36 Judy Scott Felderman as quoted by I Molotsky, ‘Panel Backs World War II Memorial on Mall in Washington’. New York Times, July 21, 2000, p. 13. 37 P Greenberg, ‘Monumental Mistake’. Arkansas Democrat-Gazette, May 30, 2001, p. B8. 38 R Ebert, ‘Bad Idea, Bad Spot for WWII Memorial’. Chicago Sun-Times, May 31, 2001, p. 41. 39 H Muschamp, ‘New War memorial Is Shrine to Sentiment’. The New York Times, June 7, 2001, p. 1. 40 Mills, op. cit., p. 216. 41 National Park Service, U.S. Department of Interior, ‘World War II Memorial’ Brochure. Washington, D.C., 2007. 42 Sturken, op. cit., p. 121. 43 Kirschenbaum, op. cit., p. 225. 44 ibid, p. 214. 45 ibid, pp. 214-15). Susan M. Behuniak 109 ______________________________________________________________ 46 Tumarkin, op. cit., p. 51. Sturken, op. cit., p. 122. 48 Shanken, op. cit., p. 130. 49 Etkind, op. cit., p. 40. 50 J C Scruggs and J L Swerdlow, To Heal a Nation: The Vietnam Veterans Memorial, Harper & Row, New York, 1986; Wagner-Pacifici and Schwartz, ‘The Vietnam Veterans Memorial: Commemorating a Difficult Past’. The American Journal of Sociology, v. 97, September 1991; Griswold and Griswold, op. cit. 51 Etkind, op. cit., pp. 51-55; Forest and Johnson, op. cit., p. 541. 52 Wagner-Pacifici and Schwartz, p. 407. 53 Griswold and Griswold, op. cit., p. 711. 54 Scruggs and Swerdlow, op. cit.; Griswold and Griswold, op. cit., p. 712. 55 Griswold and Griswold, op. cit., at footnotes 17 and 21, p. 718. 56 Sturken, op. cit., p. 131. 57 Biesecker, op. cit., p. 397. 58 Todorov, op. cit., p. 12. 59 R Wagner-Pacifici and B Schwartz, op. cit., p. 379. 60 Tumarkin, op. cit., p. 128. 61 S Cooke, ‘Negotiating Memory and Identity: The Hyde Park Holocaust Memorial, London’. Journal of Historical Geography, vol. 26, 2000, p. 450. 62 See the statements by the National Park Service, U.S. Department of Interior, and The State Museum of the History of St. Petersburg. 47 Bibliography Barsalou, J. and V. Baxter, ‘The Urge to Remember: The Role of Memorials in Social Reconstruction and Transitional Justice’. Stabilization and Reconstruction Series No. 5, United States Institute of Peace, Washington, DC, January 2007. Becker, E., The Denial of Death. Free Press, NY, 1973, 1997. Benton-Short, L., ‘Politics, Public Space, and Memorials: The Brawl on the Mall’. Urban Geography, vol. 27, 2006, pp. 297-329. Biesecker, B. A., ‘Remembering World War II: The Rhetoric and Politics of National Commemoration at the Turn of the 21st Century’. Quarterly Journal of Speech, vol. 88, November 2002, pp. 393-409. 110 Heroic Death and Selective Memory ______________________________________________________________ Cooke, S., ‘Negotiating Memory and Identity: The Hyde Park Holocaust Memorial, London’. Journal of Historical Geography, vol. 26, 2000, pp. 449465. Corr, C. A., C. M. Nabe, and D. M. Corr, Death & Dying, Life & Living, 6th ed., Wadsworth, Belmont, CA, 2009. Des Pres, T., The Survivor: An Anatomy of Life in the Death Camps. Oxford University Press, NY, 1976. Ebert, R., ‘Bad Idea, Bad Spot for WWII Memorial’. Chicago Sun-Times, May 31, 2001, p. 41. Etkind, A., ‘Hard and Soft in Cultural Memory: Political Mourning in Russia and Germany’. Grey Room, vol. 16, 2004, pp. 36-59. Fisher, M., ‘A Memorial, Yes, But What About Its Message?’ The Washington Post, July 22, 2000, p. B-1 Forest, B. and J. Johnson, ‘Unraveling the Threads of History: Soviet Era Monuments and Post-Soviet National Identity in Moscow’. Annals of the Association of American Geographers, vol. 92, September 2002, pp. 524547. Greenberg, P., ‘Monumental Mistake’. Arkansas Democrat-Gazette, May 30, 2001, p. B8. Griswold, C.L. and S. Giswold, ‘The Vietnam Veterans Memorial and the Washington Mall: Philosophical Thoughts on Political Iconography’. Critical Inquiry, vol. 12, Summer 1986, pp. 688-719. Kalson, S., ‘World War II Memorial a Classic Example of Excess’. Pittsburgh Post-Gazette, May 30, 2001, p. B-1 Kirschenbaum, L.A., The Legacy of the Siege of Leningrad, 1941-1995. Cambridge University Press, NY, 2006. Mills, N., Their Last Battle: The Fight for the National World War II Memorial. Basic Books, NY, 2004. Susan M. Behuniak 111 ______________________________________________________________ Molotsky, I., ‘Panel Backs World War II Memorial on Mall in Washington’. New York Times, July 21, 2000, p. 13 Muschamp, H., ‘New War Memorial is Shrine to Sentiment’. The New York Times, June 7, 2001, p. 1 National Park Service, U.S. Department of Interior, ‘World War II Memorial’ Brochure. Washington, D.C., 2007. Reimers, E., ‘Public Memorials as Communicative Tools to Construct, Deconstruct, and Negotiate History and the Present’. Paper presented at the Death, Dying and Disposal 8th Conference, Bath, UK, 2007. Scruggs, J. C. and J. L. Swerdlow, To Heal a Nation: The Vietnam Veterans Memorial. Harper & Row, NY, 1986. Shanken, A. M., ‘Planning Memory: Living Memorials in the United States during World War II,’ The Art Bulletin, vol. 84, March 2002, pp. 130-147. Simmons, C. and N. Perlina, Writing the Siege of Leningrad: Women’s Diaries, Memoirs, and Documentary Prose. University of Pittsburgh Press, Pittsburgh, PA, 2002. The State Museum of the History of St. Petersburg, ‘Monument to the Heroic Defenders of Leningrad’ Brochure. Leetsey Publishing House, St. Petersburg, 1999. Sturken, M., “The Wall, the Screen, and the Image: The Vietnam Veterans Memorial’. Representations, vol. 35, Summer 1991, pp. 118-142. Todorov, T., Facing the Extreme: Moral Life in the Concentration Camps. A. Denner and A. Pollack (transl), Henry Holt and Company, NY, 1996. Tuan, Y-F., Space and Place: The Perspective of Experience. University of Minnesota Press, Minneapolis, 1977. Tumarkin, N., The Living & The Dead: The Rise and Fall of the Cult of World War II in Russia. Basic Books, NY, 1994. 112 Heroic Death and Selective Memory ______________________________________________________________ Wagner-Pacifici, R. and B. Schwartz, ‘The Vietnam Veterans Memorial: Commemorating a Difficult Past’. The American Journal of Sociology, vol. 97, September 1991, pp. 376-420. Susan M. Behuniak is Professor of Political Science at Le Moyne College in Syracuse, NY, where she teaches constitutional law. Her publications include works on abortion, physician-assisted suicide, and elder rights. Rethinking and Recognizing Genocide: The British and the Case of the Great Irish Potato Famine Neysa King Abstract Today, Irish and British historians categorically reject the notion that British actions during the Great Irish Potato Famine (1845-1849) amounted to genocide. While the British Government may have been unresponsive to Irish suffering, they assert, its non-action was not a deliberate attempt to exterminate the Irish people. This essay, however, utilizing new research in genocide theory and a correspondingly complicated definition of genocide, argues that the relief efforts undertaken in Ireland by the Russell Administration from the winter of 1846 to 1849 did constitute genocide against the Irish people. To date, historians have paid little attention to the objectives, both stated and implicit, of British Famine relief efforts. Much of the analysis contends that Famine relief was a compromise between the Whig Party’s adherence to laissez faire governance and Lord Russell’s basic human empathy. However, if British relief is viewed in the context of Britain’s concern with the “Irish Question,” it becomes clear that relief efforts were not designed to relieve Irish suffering as much as to permanently reform the Irish economy. As a result, Irish Famine mortality gradually became the avenue through which the British pursued and attained this objective. By 1849, the forcible displacement of poor Irish cottiers, under the guise of relief legislation, became the major channel through which the Irish economy was remade. Thus, the British Government deliberately facilitated Irish deaths during the Great Famine, and therefore committed genocide against the Irish people. This analysis of the Irish Potato Famine may serve as a case study for a new method of analysing genocides in history as an unfolding process, rather than a discrete and mechanical occurrence. It should be kept in mind that a designation of genocide from the historian should not serve as a political condemnation, but as an analysis of a recurring human phenomenon. Key Words: Genocide, Ireland, England, potato famine. ***** Today, the “Irish Question” is most commonly associated with Irish nationalism, independence movements, and the IRA. However, over a century ago, British officials and intellectuals were discussing a different “Irish Question,” which concerned Irish economic and social regeneration. This question was not, “who will rule Ireland?” but “What is to be done with 114 Rethinking and Recognizing Genocide ______________________________________________________________ Ireland? What can be done with it?”1 A common 19th-century opinion was to introduce capital into Ireland’s agrarian economy while restructuring Ireland’s system of land ownership. When the potato crop failed in 1846 and the British Government undertook relief efforts for the starving poor, Lord Russell and his cabinet saw an opportunity in Ireland’s weakness. By using Famine relief legislation to transform subsistence into markets and small farming into waged labour, Russell could enact the kind of permanent change in Ireland the British had desired for years. This article will argue that the Russell Government attempted to marketise Ireland’s economy in the midst of The Great Famine, and used Irish deaths as a conduit. In light of this fact, I argue that much of Lord Russell’s legislation during the Famine can and should be considered genocidal. Genocide scholarship is a relatively young field. Blooming out of renewed interest in the Holocaust in the 1980s, scholars only took a serious interest in genocide as a broad category beginning in the 1990s. However, the growth of a body of genocide scholarship has been severely stunted by the glaring absences of a standard definition and a conceptual framework. Over the last decade, legal scholars and UN Tribunals have tried several individuals for genocide in international courts. Their work is admirable; however, their discussions of genocide have seeped into other fields of scholarship, especially history. This has led to an overemphasis on legal concepts, rather than historical precedents. In particular, the concept of intentionality has become a mainstay of genocide designations. In 1996, the International Criminal Tribunal for the Former Yugoslavia (ICTY) stated, “a general intent to commit one of the enumerated acts [in the Convention] combined with a general awareness of the probable consequences of such an act is not sufficient for the crime of genocide…[Genocide] requires a particular state of mind.”2 This legal focus on intent has motivated historians such as Guenter Lewy to take it up in their own definitions of genocide as well. Genocidal intent as the ICTY defined it, however, is a tool for prosecution, not historical inquiry. This miscommunication between lawyers and historians has caused confusion in definitions of genocide. So much confusion, in fact, that some have suggested throwing the term genocide out completely. For example, Christian Gerlach states that genocide has become an: outdated mechanistic model based on long-term planning…If there is one element agreed upon for the definition of genocide, it is a long-term murderous “intent,” which precisely contradicts the origins of a violence emerging in complex ways through a dynamic process.3 Neysa King 115 ______________________________________________________________ Yet there may be a way to coalesce the legal and historical worlds of genocide research, and it might begin with understanding instances of this phenomenon outside the current international legal apparatus. When discussing definitions, viability to some extent has to hinge on the definition’s applicability to historical events. If a definition of genocide cannot be utilized as a tool for pinpointing and understanding past genocides, then what is its use? In his article, “Conceptual Constraints on Thinking about Genocide,” David Moshman reminds us that “definitions are social conventions, not empirical truths about the world. Events are not inherently genocidal or not genocidal. It is up to us to determine what we mean by genocide.”4 What, then, should we look for in assigning labels of genocide to events in the past? First, intentionality should not be thrown out completely. However, intentionality does not necessarily mean a brazen and barefaced campaign of extermination. Genocide can be a mere link in a larger chain. When researching genocide in the past, it is not merely stated goals of extermination for its own purpose that should be examined, but policies that quietly condone the extermination of a group as a means to an end. In the case of the Irish Famine, this end was Ireland’s economic reformation. In the seventeenth and eighteenth centuries, the British saw the Irish as a semi-barbaric, indolent race, living in a backwards society. However, Ireland’s proximity to and historical relationship with Britain also bred a certain paternalism. After the Act of Union passed in 1801, and Ireland officially became a part of the United Kingdom, reforming Ireland’s agrarian economy became a pressing debate in London. In the 1840s, this debate zeroed in on issues of Irish landownership, poverty, and tenant-landlord relations. In 1843, Tory Prime Minister Robert Peel appointed the Devon Commission to investigate the system of land ownership in Ireland and make suggestions for its reform. The five-volume report discusses Irish landholding issues of tenure, consolidations, ejectments, emigration, wasteland reclamation, and public works. Through meticulous legislation and cooperation from the Irish people, the report stated, Britain may remove “many or most of those partial and particular obstacles, which have hitherto so greatly impeded the beneficial employment of labour…We are,” it continues, “satisfied that a very beneficial change may be effected.”5 This project to reform the Irish economy would become a primary influence on the creation of Government relief policies during the Famine years. John Russell became Prime Minister in June 1846. Only a month after Russell’s premiership began, reports surfaced that a potato blight had struck. Seventy-five percent of the crop withered, and accounts of starvation were already surfacing from the last year’s insufficient harvest. Come winter, Ireland would be in a state of crisis. The next month, in August, Russell outlined his plan for Ireland in Parliament. He proclaimed: 116 Rethinking and Recognizing Genocide ______________________________________________________________ We are now disposed to take advantage of the unfortunate spread of this disease among the potatoes to establish public works…which may be of permanent utility.6 Through the remainder of the Famine years, John Russell and his Whig Party would enact a series of intensifying legislation designed to reform Ireland through industry and capital. By implementing these policies in the midst of the Famine, Russell, his Administration, and several British intellectual circles, deliberately exploited and even accelerated the starvation of Irish labourers. Russell’s intention for Public Works to serve as capitalist reform rather than starvation relief is revealed in its emphasis on task-work, that is, payment by performance, rather than time. In a letter to Charles Trevelyan, Colonel Jones, the Head of the Public Works project, stated: [T]he sum to be paid for each portion of work, should be sufficient to enable an ordinary labourer to earn from 10d. to 1s. per day, and a good labourer, who exerted himself, from 1s. 4d. to 1s. 6d. per day.7 Thus, in a time when workers were weakened by malnutrition, physical exertion determined the wages they earned. In addition, if extraneous factors such as inclement weather impeded work, the workers’ pay was deducted. In a letter to Works Commissioners, Trevelyan recommended that on days of poor weather, half a day’s wages should be paid to those who turn up. If the weather clears, the workers who return may work and earn the other half.8 A normal day’s wages, around 10d, was a starvation wage for most, and Trevelyan was aware that that many workers had to walk several miles to and from the Works site. However, Public Works was to run as a training ground for waged labour, rather than an aid program. If the workers protested about wages or the nature of the work, the program was shut down. Although there is no official report which explicitly encourages compromising human life for the sake of economic reform, the officially-mandated procedure of the Public Works program valued providing relief, in the form of wages, less than extracting Irish labour. Soon, the Russell Government would begin willingly exchanging human life for industrial reform. By the spring of 1847, over 700,000 people (mostly men) were employed in the Public Works. With their extended families, this meant the Works was supporting over 3 million people. The system, overloaded, had devolved into chaos. On March 8, 1847, Russell stated his intentions in the House of Lords to extend the 1838 Poor Law to Ireland, thus forcing Irish Neysa King 117 ______________________________________________________________ taxes to pay for Famine relief. Again, this action was premised as a strategy to encourage industry and waged work. Russell stated: I believe that in laying this burden of maintaining their own poor on the landowners on the one hand…and on the other giving them the means of improving the cultivation of the soil, will cause them more readily to embrace every means of giving greater employment to labour than otherwise.9 The Bill passed, and the Russell Administration moved to shut down the Public Works almost immediately. Russell’s extension of the Poor Law included three important measures, workhouse operation, the Gregory Clause, and poor rate collection. First, the workhouse infrastructure was in place and active prior to the Famine. Sir George Nicholls had engineered the extension of the workhouse welfare scheme from England to Ireland in 1838. The purpose of the workhouse was to serve as a place of work for the able-bodied but unemployed. However, these workers were to be supported “under such restrictions as not to induce them to prefer it to a life of independent labour.”10 In other words, life in the workhouse was designed to be cramped, uncomfortable, and meager. This scheme operated under the assumption that it was “possible to obtain a mastery over pauperism by requiring the performance of hard and repulsive labour in return for relief.”11 In other words, the workhouse’s poor conditions were designed as a check on the numbers receiving government relief. Its ultimate purpose was to eventually abolish mendicancy and encourage industry.12 It was to this, then, that Russell assigned the Famine victims in 1847. In effect, he transferred three million people suffering from starvation to a workhouse network designed to accommodate roughly 100,000. Russell’s officially stated intention was to use this system to evoke Irish industry. It was utilized specifically to serve as a structural limitation to relief in a time of widespread need. For the sake of Irish industrial development, then, Russell deliberately targeted part of the Irish population for destruction, making this piece of legislation genocidal. Second, the Gregory Clause attached to the Bill, named for MP William Gregory who suggested it, excluded anyone who owned over a quarter-acre of land from government relief. Therefore, those who applied for a place in the workhouse and had over a quarter-acre of land, which was most, were forced to give it up in order to receive aid. With the Gregory Clause, the British Government intended to initiate the consolidation of these small plots into larger farms, a primary aim since before the first blight. As James Donnelly notes, the Clause’s “enormous potential as an estate-clearing device was widely recognized in Parliament,” and it passed by a vote of 119 to 9.13 The gravity of this situation for Ireland’s small cottiers cannot be 118 Rethinking and Recognizing Genocide ______________________________________________________________ overstated. In normal years, that small plot of land was their only means of subsistence. To give it up would mean certain death in the future, even if they survived the workhouse. Many refused and starved with their families in an attempt to hold onto their land through the Great Famine. Russell’s Government was well aware of the cottiers’ dependency on their small plots, as evidenced from the numerous reports, articles and Parliament discussions on the topic.14 The ramifications of the Gregory Clause on these small cottiers, then, were clear. This piece of legislation was designed to facilitate the removal of small cottiers from their only means of subsistence. The death of Irish cottiers became the channel through which farms could be consolidated, and Ireland could be reformed. The Poor Law Extension Act deliberately eliminated the part of Ireland’s population considered the largest impediment to Ireland’s economic development. In addition to the Government forcing small cottiers to abandon their lands, the Poor Law Extension Act facilitated additional evictions through the continued collection of poor rates. The Act, in effect, forced landlords to forego their tenants’ rent, who clearly had nothing to spare, but continue to pay a land tax from their own pocket. This led to widespread evictions of tenants, escalating each year from 1847 to the early 1850s. In 1848 and 1849, the British Government took advantage of the landlords’ initiative, and enacted legislation that would assist landlords who had evicted their tenants in selling their newly consolidated land. In these years, the Encumbered Estates Act encouraged a tremendous amount of small cottier evictions. In Parliament, the legislation was well received. In a memorandum to his cabinet in March of 1848, Lord Palmerston, the Secretary of State for Foreign Affairs, issued the statement that: [I]t was useless to disguise the truth that any great improvement in the social system of Ireland…necessarily implies a long continued and systematic ejectment of squatting cottiers.15 Eviction rates continued to increase. In 1849, 16,686 families were evicted. The next year, the number rose to nearly 20,000.16 These Acts, then, served as a final answer to the “Irish Question.” By encouraging landlords to evict their tenants during the harshest years of the Famine, the British Government had finally found the means to transform Ireland into a capitalist, industrial nation. Although the forced removal and death of Irish labourers were never explicitly advocated in Russell’s Government, with these severe and precise pieces of legislation Russell and his Administration were consciously trading Irish lives for Irish reform. In the years after the Famine, Ireland’s cottier class had all but disappeared. Nearly one-eighth of the population, or one million men, Neysa King 119 ______________________________________________________________ women, and children, had been wiped out. Roughly another one million had emigrated. Back in London, British officials spoke of the successful improvements Ireland had gained over the last four years. Several articles in the Times expressed the same sentiment. One article read: It seems not an unfair conclusion…that if Irishmen are true to themselves, the country at large will not only recover, but derive benefit from her present trouble, although at the cost of much individual suffering.17 For the British Government and the British press, the greater good had required individual sacrifices. After 1850, the British Government was free to move on to an entirely different “Irish Question,” having found their answer in the destruction of the Irish small cottier. This paper has attempted to demonstrate that genocide can be substantially more insidious, subtle, and routine than commonly thought. It is often an escalating and collaborative process, rather than a discrete top-down directive, and often holds a peripheral relation to intentionality. Committing genocide as this paper has defined it does not require a malicious character or an evil spirit. In other words, it does not take a Hitler or a Milosevic to commit genocide. Rather, genocide can result from a logical and widelyaccepted rationale that gradually heightens the importance of an issue, be it economic ideology, moral conviction, or fear of an enemy, above the value of human life. Notes 1 The London Times, April 14, 1846. Quoted in Guenter Lewy, ‘Can There Be Genocide without the Intent to Commit Genocide’? Journal of Genocide Research, 9, 4, 2007, p. 663. 3 Christian Gerlach, ‘Extremely Violent Societies: An Alternative to the Concept of Genocide’. Journal of Genocide Research, 8, 4, 2006, p. 465. 4 ibid., p. 444. 5 Report from Her Majesty’s Commissioners of Inquiry into the State of the Law and Practice in Respect to the Occupation of Land in Ireland, Vol. 1, Alexander Thom, Dublin, 1845, p. 43. 6 Hansard’s Parliamentary Debates, House of Commons, August 17, 1846. 7 Irish University Press Series of Parliamentary Papers. Famine, Irish University Press, Shannon, Ireland, vol. 6, 1968-70, p. 172. 8 ibid., p. 121. 9 Hansard’s, House of Lords, March 8, 1847. 2 120 Rethinking and Recognizing Genocide ______________________________________________________________ 10 Sir George Nicholls, A History of the English Poor Law, Augustus M. Kelley, New York, 1967, p. 238. 11 ibid., p. 291. 12 ibid., p. 197. 13 Donnelly, p. 102. 14 Including Report from her Majesty’s Commissioners, vol. 1, 23; Hansard’s, Commons, March 15, 1847, Trevelyan , pp.1-7. 15 Qtd. in Donnelly, p. 115. 16 Kissane viii. 17 ibid. Bibliography Donnelly, Jr., J S., The Great Irish Potato Famine. Sutton Publishing, Gloucestershire, United Kingdom, 2005. The Economist. 1845-1849, Boston Public Library Archives. Foley, T. and Ryder S., (eds), Ideology and Ireland in the Nineteenth Century. Four Courts Press, Portland, Oregon, 1998. Goldberg, D. T., Philosophers on Race: Critical Essays. Julie K. Ward and Tommy L. Lott (eds), Blackwell Publishing, Oxford, 2002. Gooch, G.P. (ed), The Later Correspondence of Lord John Russell, 18401878, vol. 1, Longmans, Green and Co., New York, 1925. Gray, P., Famine, Land and Politics. Irish Academic Press, Portland, Oregon, 1999. Guizot, M., The Memoirs of Sir Robert Peel, Questia, Richard Bentley, London, 1857. Hansard’s Parliamentary Debates, Middlebury University Microform. Irish University Press Series of Parliamentary Papers. Famine. Irish University Press, Shannon, Ireland, 1968-70. Kiernan, B., Blood and Soil: A World History of Genocide and Extermination from Sparta to Darfur. Yale University Press, New Haven, 2007. Kinealy, C., The Great Irish Famine. Palgrave, New York, 2002. Neysa King 121 ______________________________________________________________ Kissane, N., The Irish Famine: A Documentary History. National Library of Ireland, Dublin, 1995. Lal, V., ‘Genocide, Barbaric Others, and the Violence of Categories: A Response to Omer Bartov,’ The American Historical Review. Vol. 103, No. 4, October, 1998, pp. 1187-1190. The London Times, Northeastern University Electronic Archives. Timothy M., (ed), Questions of Modernity. University of Minnesota Press, Minneapolis, 2000. Nicholls, Sir G., A History of the English Poor Law. Augustus M. Kelley, New York, 1967. Ó Gráda, C., Black ’47 and Beyond: The Great Irish Famine in History, Economy and Memory. Princeton University Press, Princeton, 1999. Report from Her Majesty’s Commissioners of Inquiry into the State of the Law and Practice in Respect to the Occupation of Land in Ireland, Vol. 1 Alexander Thom, Dublin, 1845. Said, E., Orientalism. Random House, New York, 1994. G. Shaw-Lefevre, Peel and O’Connell: A Review of the Irish Policy of Parliament from the Act of Union to the Death of Sir Robert Peel. Kegan Paul, Trench and Co., London, 1887. Trevelyan, C., The Irish Crisis. Longman, Brown, Green and Longmans, London, 1848. Weitz, E., A Century of Genocide: Utopias of Race and Nation. Princeton University Press, Princeton, 2003, p. 14. Williams, L. A., Daniel O’Connell, The British Press, and the Irish Famine: Killing Remarks. Ashgate, Burlington, 2003. Woodham-Smith, C., The Great Hunger: Ireland 1845-1849. Penguin Books, London, 1991. 122 Rethinking and Recognizing Genocide ______________________________________________________________ Neysa King is a PhD student in World History at Northeastern University. She is interested in German cultural history, particularly films in postwar West Berlin. Death in Self-Harmers’ Eyes Namino Kunitoh Abstract For many years, self-harmers were considered suicidal. However, most modern psychiatric and sociological works show that self-harm is not a means to commit suicide; instead, is a way of relieving feelings and controlling oneself. Self-harmers do not harm themselves in order to commit suicide because they know that self-harm will not kill them. For self-harmers, self-harm is merely a tool that solves everyday problems; thus, self-harm and suicide are different from each other. This paper shows the relationship between self-harm and death and how self-harmers perceive death. Key Words: Self-harm, death, young people. ***** 1. Introduction The aim of this paper is to examine the relationship between selfharm and death. The definition of self-harm employed in this study is behaviour, which is deliberate, non-fatal, and meant to harm oneself. Although self-harming behaviour has been associated with suicidal attempts for many years, recent works, including sociological ones, illustrate other aspects of self-harm. This study examines the relationship between self-harm and death by analysing the data compiled from ten interviews. The results of the data demonstrate that self-harm and suicide or suicidal attempts are different. This study consisted of ten interviews: each with an individual who had demonstrated self-harming behaviour in the past or continued to do so. The subjects were aged between 17 and 26. The interviews were conducted in a semi-structured format wherein 14 questions were posed. Five of the said questions with responses have been selected for the purposes of this paper. The five questions are as follows: (1) Please give concrete examples of selfharming behaviour. Of these examples, which have you actually experienced? (2) Do you recall your first experience with self-harm? If so, please describe the moment of occurrence, the cause(s) of the self-harming behaviour, and any relevant condition(s) that may have provoked this behaviour. (3) Do you have experience with cutting and drug overdose? If so, do cutting and a drug overdose have a similar or a different meaning to you? (4) (for ex-self-harmers) What made you believe you could cease to harm yourself? (5) Do you believe self-harm is closely related to death? These five questions aim to clarify the following points: (1) ways of self-harm, (2) 124 Death in Self-harmers’ Eyes ______________________________________________________________ background of the start of self-harm, (3) whether overdose constitutes selfharm, (4) (for ex-self-harmers) reasons to stop the practice, and (5) relationship between self-harm and death. For the purposes of clarification, the definition of an ex-self-harmer is an individual who ceases self-harming behaviour for a period that exceeds 18 months and believes it is possible to halt the practice completely. This study employed the grounded theory approach and the results of the analysis are as follows. 2. Ways of Self-Harm The different forms of self-harm, according to the responses of this study’s participants, are categorized into two groups: the first excludes the employment of tools; the second includes the employment of tools. Non-tool methods include inflicting the following upon oneself: hurling the body against a wall, hitting, pinching, scratching by nails, and pulling hairs. As for tool methods, cutting is the most frequently employed method, with arms or wrists as the primary locations for cutting although some participants included the legs. Burning and pricking with needles are additional tool methods. All participants had engaged in cutting and some participants engaged in banging and hitting in addition to cutting. Participants who employed non-tool methods said that they had done so without the relative knowledge; therefore, these subjects proceeded almost unconsciously. In contrast, all participants had accessed information about the methods that include tools prior to attempting them. Amongst the various sources of information accessed were the internet, books, and television. Some of the participants acknowledged acquiring tool-aided methods from friends who themselves practiced self-harm. During the interview process, participants were asked to identify self-harming behaviour. Of the ten participants, only one included a drug overdose in their response. However, eight of the participants had experienced an overdose. When these eight participants were asked whether they regarded a drug overdose as a form of self-harming behaviour after they had given their responses to the first question, six of the eight agreed that they considered an overdose as self-harm, and one participant replied that an overdose might be self-harm. One participant viewed an overdose as somewhat different from self-harm. Her response was based on psychological information that had been acquired and ingrained in her, which defined an overdose as non self-harming behaviour. It is interesting to note that a drug overdose was not included in participants’ responses when they were asked to identify self-harming behaviour although many admitted to it being so when asked specifically whether an overdose constitutes self-harm. This response could be indicative of a low level of or complete lack of consciousness on the part of an individual with respect to the harmful nature of an overdose. Although they Namino Kunitoh 125 ______________________________________________________________ are aware of the undermining effects an overdose imposes on their bodies, the actual damages caused by an overdose are not taken into account. With cutting, an individual can see wounds and, therefore, an actual location identifies the pain. However, the harm caused by an overdose is internal and denies the perception or depth of pain. The following examples more clearly illustrate this. Participant 1: “Taking drugs, well...maybe I don’t have a clear concept of the harm in taking drugs.” Researcher: “Is that because you can’t see the wounds?” Participant 1: “If I were to experience some disorder of my internal organs, I may have a sense of awareness of the harm; but even when people tell me an overdose will lead to disorders, I haven’t experienced any yet and I can’t see any wounds, so it is different from cutting.” The one participant whose answer to the first question included overdose is an ex-self-harmer. Her last self-harming incident was about three years ago and she believed she could halt the behaviour completely. In this context, it was possible for the participant objectively to review self-harm through her past related behaviour: hence, her ability to include overdose as a form of self-harm. 3. Background of the Start of Self-Harm The background in which self-harming behaviour begins must equally be evaluated. Most participants first experienced self-harm during their teens. For some, the reasons for commencing are vague; for others, they have detailed recollections of the occurrence. One participant was almost unable to recall her first experience with cutting and did not believe she was in any kind of problematic situation at the time. Some participants clearly recalled their problems, depression, stress, or confusion. Others could not clearly recall their first experience with self-harm yet they recollected the presence of difficulties, anger, stress, or anxiety in their lives. Thus, these results produced distinct groups: participants who clearly recalled the incidents which incited their first self-harming act and others who did not. In conclusion, there is a framework in which one initiates acts of self-harm: negative feelings or situations incite acts of self-harm which are employed as an outlet for these feelings, a form of self-punishment, or a solution to problems. Therefore, given this framework and the information already acquired regarding self-harm before their first act, an individual chooses self-harm and the methods to commit it. However, it is interesting to note the various reasons an individual may opt for self-harm. First, the information gathered by those who engage in self-harm declares that these 126 Death in Self-harmers’ Eyes ______________________________________________________________ acts will help to relieve pain, resolve problems, cope with stress, or attract the attention of others. Second, most teenagers would not have many problemsolving options. Therefore, in a crisis, they must choose ways to resolve issues from a limited number of resources. When the existing options are not deemed enough, self-harm may appear to be an attractive alternative. 4. Whether Overdose Constitutes Self-Harm With respect to self-harming acts, one may wonder whether an overdose constitutes self-harm. Researchers differ in opinion. First, the difference between cutting and an overdose must be defined. Eight of the participants interviewed had engaged in more than one overdose. Six of the eight participants considered cutting to be different from an overdose, with one participant giving both acts equal meaning. One participant equated an overdose to a suicide attempt and not self-harm because he intended suicide with this act. The participants’ classification of an overdose correlates to their perception of the level of self-harm for this act. Participants who had classified an overdose differently had a self-harm hierarchy whereby an overdose was regarded as a stronger act than cutting. Therefore, the inability to think clearly or lose consciousness by overdose can affect the placement of this act within the hierarchy. Some participants, who accorded a different meaning to an overdose than to cutting, occasionally substituted cutting for an overdose. This occurred when they could not overdose; for instance, when they lacked a sufficient amount of drugs or they had plans for the next day. However, none of the participants substituted an overdose for cutting, which remains consistent with the hierarchy for self-harm whereby drug overdose is a stronger act than cutting. In contrast, one participant regarded the level of self-harm for a drug overdose as equal to that of cutting. For her, both cutting and a drug overdose were mutually suitable means of self-punishment and an overdose was employed as a substitute for cutting when she did not want others to see her scars. Therefore, does a drug overdose constitute self-harm? Six of the eight participants agreed it did and one believed it might be self-harm. Some participants who believed that a drug overdose was self-harm said it was selfharm by definition. One participant believed a light overdose—one that is slightly over regulation amounts—was self-harm; whereas an individual contemplating death and taking a heavy overdose—one that is significantly over regulation amounts—was not self-harm but a suicidal attempt. In the following interview, I asked other participants whether they thought the amounts of drugs used in an overdose created the boundary between selfharm and a suicidal attempt or suicide, all of them agreed that the amounts of drugs created the boundary. In the case of a light overdose, some participants engaged in the act knowingly while others did so without such knowledge; Namino Kunitoh 127 ______________________________________________________________ however, none of the participants equated the act as a suicidal attempt or suicide. In his book Le suicide: Etude de sociologie, Emile Durkheim states that one of the important factors for the definition of suicide is the knowledge one has of the results of the behaviour.1 An analysis of the interview data demonstrates that there is a distinguishable boundary between self-harm and a suicidal attempt or suicide in relation to a drug overdose; in the case of suicide, it is the knowledge that the act will result in a fatal outcome and the clear intention to commit suicide. According to Durkheim, the intention to commit suicide is difficult to observe. 2 This is because of the nature of Durkheim’s study, which focuses on society rather than on individuals. However, in this study, the number of subjects interviewed was small and each participant could be questioned on their propensity for suicide. In conclusion, the most important factors that distinguish an act of self-harm from a suicidal attempt or suicide, in relation to a drug overdose, are the knowledge of the fatal outcome of the act and the intention to commit suicide. In an act where there is no knowledge of the fatality of the outcome and no intention to commit suicide, it is self-harm. In other words, if an individual is aware that the amount of drugs consumed is over regulation amounts, but not of a fatal or lethal dose, it is self-harm. However, if an individual is aware that the amount of drugs consumed is over regulation amounts, is of a fatal or lethal dose, and is taken with the intention to commit suicide, it is not self-harm but a suicidal attempt or suicide. When participants use an overdose of drugs to self-harm, non-fatal amounts are employed. Participant 2: “I know it won’t kill me. I’ve got information about lethal doses and know the amounts that can kill.” Researcher: “What amount of drugs did you consume?” Participant 3: “Sleeping pills and antidepressant drugs...around 50 to 70, I think.” Researcher: “Were you aware that this dosage would not kill you?” Participant 3: “Yes, I knew that.” In conclusion, although suicide depends on the awareness of a fatal outcome and the intention to commit suicide, an overdose can also constitute self-harm. Most participants regard a drug overdose as self-harm and apply the definition of self-harm to the latter—deliberate, nonfatal, and meant to harm oneself. 128 Death in Self-harmers’ Eyes ______________________________________________________________ 5. Reasons to Stop Self-Harm We shall now examine the reasons ex-self-harmers ceased this practice. Two of the ten participants interviewed had ceased the practice of self-harm. These results may be due to the age of the participants. Participation in the interview was limited to young individuals; the age-group wherein self-harm is most present. As the data of the two participants is insufficient in evidence to draw a conclusion, the information may, nonetheless, be helpful to others who self-harm. During the interview with one ex-self-harmer, she recounted that her dreams for the future spurred the cessation of the practice. She worked hard towards achieving this dream, and these efforts led to her ability to control the urges to cut herself. The other ex-self-harmer described a change in circumstances as the factor to ceasing the practice; having begun a parttime job, she felt needed by others and recovered her self-confidence. Both participants followed hospital treatments consisting of drugs and psychotherapy although they declared these efforts as unsuccessful. Therefore, amongst the primary factors inducing the cessation of self-harm is hope for the future, confidence, and self-respect. On the other hand, a participant who ceased the practice of self-harm for over 17 months indicated that she did not believe she could completely halt the practice. The participant believed that once the habit to self-harm was acquired, she would be capable of self-harm in the future and, therefore, unable to cease the practice entirely. Other participants held similar opinions in that their future behaviour would be affected by that individual’s ability to repeat selfharming acts. 6. Relationship Between Self-Harm and Death Is there a relationship between self-harm and death? Participants were asked whether they believed self-harm was closely related to death; none agreed that this was the case. Most participants believed in a certain distance between self-harm and death: either self-harm was far from death or self-harm was completely different from death. One participant believed selfharm was diametrically opposite to death. This response is due to the individual’s acceptance of self-harm as a way of life. Participants perceived a distance between self-harm and death because the self-harming acts were not harmful enough to kill them. For all of the participants of the interview, self-harm was not a way to die but rather to resolve problems, cope with stress, acquire the attention of others, or punish oneself. One participant stated, “I think I haven’t died yet because of self-harm”; she would cut herself in the place of a heavy overdose. A participant who believed self-harm to be different from a drug overdose stated that cutting did not approach death whereas an overdose did; an overdose was a form of release for her and she believed that death Namino Kunitoh 129 ______________________________________________________________ achieved the same effect. For her, cutting provided no such relief. She considered cutting to be a form of self-harm, and it is clear that the participant did not believe this self-harming behaviour approached death. In conclusion, self-harm was not closely associated with death for participants. Although the participants did not closely correlate self-harm to death, one participant did indicate a relationship between the two. This response was affected by a personal experience: the participant was hospitalised for five days due to a very serious overdose. However, the act was not performed with the intention to kill herself as can be witnessed by her response: Researcher: “Have you ever harmed yourself with an intention to commit suicide?” Participant 4: “Never. But people say to me, “You wanted to die, didn’t you?’” This participant’s overdose led her near death although this was not her intention. This experience allowed her to comprehend that it is possible to die as a result of self-harm, even without the desire to end one’s life. Consequently, for this participant, self-harm and death are not unrelated. Participants were additionally asked to describe their image of death. The answers varied. One participant described a romantic image of being forever memorialized in the minds of others while several participants imagined this moment as an “escape”. For some, negative images were not associated with death; for others, negative images were clearly connected to the event. Some described fearful or painful images of death. Interestingly, several participants described death by suicide. Among these individuals, opinions on the matter were divided. One participant viewed death by suicide as the ultimate escape and one’s last resort; however, no negative images were associated with this moment. Others maintained a negative image of death; one participant described the event as the ultimate betrayal because dying would entail the betrayal of family and others. The participants’ ability to imagine death by suicide may be associated to their age; their youth may have precluded their ability to imagine a natural death or one by illness. Suicide may also be the closest form of death for these participants since they include one who have attempted suicide and they maintain friendships with others who themselves have attempted suicide. Nonetheless, the variety of the images on death described by the participants indicates the individual nature of each of their experiences, even with the commonality of self-harm or suicidal attempts. 7. Conclusion In conclusion, self-harm is a behaviour that is not to die even though this behaviour can extend beyond certain boundaries and approach death. 130 Death in Self-harmers’ Eyes ______________________________________________________________ When cutting or a drug overdose is employed as the method to self-harm, it is not done with the intention to harm oneself to the point of death by suicide. Rather, many of this study’s participants described their self-harming behaviour as an attempt to live. Self-harm is employed by the participants as the outlet of, amongst other things, negative feelings, stress, and anger. When an individual is aware that their self-harming behaviour will be fatal to the point of death and acts with a clear intention to commit suicide, it is a suicidal attempt or suicide. Therefore, self-harm and suicidal attempts or suicide should be treated separately. Notes 1 E Durkheim, Le suicide : etude de sociologie, Presses universitaires de France, Paris, 1976 printing, p. 5. 2 ibid., p. 4. Bibliography Adler, P. A., and P. Adler, ‘The Demedicalization of Self-Injury: From Psychopathology to Sociological Deviance’. Journal Of Contemporary Ethnography , vol. 36, October 2007, pp. 537-570. Beautrais, A., ‘Life Course Factors Associated With Suicidal Behaviors in Young People’. AMERICAN BEHAVIORAL SCIENTIST, vol.46, May 2003, pp. 1137-1156. Brickman, B. J., ‘’Delicate’ Cutters: Gendered Self-mutilation and Attractive Flesh in Medical Discourse’. Body & Society, vol. 10, December 2004, pp. 87-111. Durkheim, E., Le suicide : etude de sociologie. Presses universitaires de France, Paris, 1976 printing. Favazza, A. R., ‘Why Patients Mutilate Themselves’. Hospital and Community Psychiatry, vol. 40, February 1989, pp. 137-145. Hawton, K., K. Rodham, and E. Evans, By Their Own Young Hand: Deliberate Self-Harm And Suicidal Ideas in Adolescents. Jessica Kingsley Publisher, London, 2006. Kidd, S. A., ‘FACTORS PRECIPITATING SUICIDALITY AMONG HOMELESS YOUTH: A Quantitative Follow-Up’. YOUTH & SOCIETY, vol. 37, June 2006, pp. 393-422. Namino Kunitoh 131 ______________________________________________________________ Pitts, V., ‘Body Modification, Self-Mutilation and Agency in Media Accounts of a Subculture’. Body & Society, vol.5, June 1999, pp. 291-303. Sinclair ,J., and J. Green, ‘Understanding resolution of deliberate self harm: qualitative interview study of patients’ experiences’. British Medical Journal, vol. 330, May 2005, pp. 1112-1116. Walsh, B. W., and P. M. Rosen, Self-Mutilation: Theory, Research, and Treatment. Guilford Press, New York, 1988. Young, R., H. Sweeting, and P. West, ‘Prevalence of deliberate self harm and attempted suicide within contemporary Goth youth subculture: longitudinal cohort study.’ British Medical Journal, vol. 332, May 2006, pp. 1058-1061. Namino Kunitoh is MA student at Waseda University. She is studying sociology and her main interest is in social deviance. PART II Communication Re-Imaging Analysis of Terminally Ill Patients’ Weblogs Using the Linguistic Inquiry and Word Count (LIWC) Program Nothando Ngwenya, Stella Mills, and Paul Kingston Abstract The phenomenon of death is common to us all, yet the experience of dying is rarely openly discussed. Patients with terminal illness receiving palliative care are more aware of their imminent death. The impact of technological advancement has had an effect on the way some terminally ill patients in American and Australian hospices express themselves through the use of weblogs as a form of therapeutic writing to journal and help interpret death. According to the WHO’S definition of palliative care, patients’ psychosocial and spiritual needs have to be addressed alongside their physical and mental health needs. Using a weblog can help address mental and spiritual needs of terminally ill patients through therapeutic writing. This paper describes the use of the Linguistic Inquiry and Word Count (LIWC) program to analyse the emotional, cognitive and structural components present in the blogs of five terminally ill adult patients. The results of this study show that terminally ill patients use a high percentage of affective words, and have a high percentage use of the word death as a personal concern. Key Words: Linguistic analysis, therapeutic narratives, weblogs, hospice, terminal illness, dying, death. ***** 1. Introduction A. Dying and Death Even though death is a universal human experience, responses to this phenomenon vary across cultures and societies. Conceptualisation of death in Western society has moved from the eighteenth century where it was public and visible to the nineteenth century where it became an invisible and private affair.1In the twentieth century, death became bureaucratised and the conduct of society encouraged people to place all their faith in medical technologies thus effectively denying death.2-5 For people to accept death as part of nature and to deal with dying in a dignified manner, they need to understand the phenomenon of dying and death.6 The twenty first century has seen a slight change of attitude towards dying and death within society, where death is becoming perceptible once more with a move towards open awareness of death. Open awareness is when the patient, medical staff and relatives are all aware of the patient’s impending death and can openly talk about it.7 Taylor argued that the twenty-first century has not really embraced 136 Analysis of Terminally Ill Patients’ Weblogs ______________________________________________________________ open awareness, but instead has moved towards conditional open awareness.8 Field et al supported this argument by reporting on how medical professionals were not comfortable about disclosing undesirable information especially when it involved a terminal prognosis.9 Miyaji provides evidence which supports this argument in research conducted with physicians in USA, who reported that they modified information given to terminally ill patients according to the patient’s questions and what they felt the patients needed to know.10 All this research substantiates the view that open awareness and honesty is still not fully practised when dealing with dying and death. The increased mortality rate and technological innovations used to prolong life may be well and good for today’s society but they raise significant questions about what life, dying and death mean to people. Deconstructing or defining the meaning of death can help people understand and deal with the practical aspects of the dying process and more so for terminally ill patients facing an imminent death. Talking about dying and death to terminally ill patients helps them make meaning of their death as well as informing us about the dying process which can assist in caring for dying patients.11 B. Weblogs and Therapeutic Writing With the reluctance of some professionals to provide open awareness, some terminally ill patients have found other ways to communicate openly, through the use of technology.12 The internet has become an important way for patients to find information and support.13 Patients using this form of communication have reported that use of the Internet encouraged active coping and made them face their fears and has been a personally empowering experience.14 Some critics have argued against the use of technology in palliative care suggesting that technology is impersonal and objective.15-17 Seely et al, go on further to suggest that technology eliminates the personal care involved in palliative care and does not help to heal the patient.18 In contrast to this stance, a growing body of literature shows that internet technology does help in the process of healing for patients.19-21 Internet-based interventions in hospices and palliative care are proving effective for patients, caregivers and palliative care providers.22, 23 Most of the patients use the internet for e-mails, support groups or seeking information, although there is a growing number of patients using weblogs for communication. The weblogs referred to in this study are the journal type web pages that have posts in reverse chronological order and function as a two way communication by affording visitors to post comments.24 Many blog authors claim their blogs offered them some form of catharsis although there is no formal evidence of this; thus, this study explores the use of weblogs for terminally ill patients. By offering a form of catharsis, weblogs are in effect promoting therapeutic writing. Nothando Ngwenya, Stella Mills, and Paul Kingston 137 ______________________________________________________________ A growing body of literature has demonstrated the positive effects of writing on physical, emotional and mental well-being.25-27 Writing can help individuals to process and express their emotions. Cancer patients who have used this mechanism of coping have experienced less cancer-related morbidities, decreased stress and enhanced health compared to those with low emotional expression.28 Functionalist theories of emotion suggest that emotions can draw individuals’ attentions to their goals and concerns prompting them to take adaptive action.29 Most research on emotional processing and expression has utilised writing as a channel through which people can express themselves.30,31 This is because writing is the most appropriate method of translating emotional experience into words, therefore being a gateway to understanding people’s underlying emotional and cognitive processes.32 C. Language Use and LIWC Research evidence suggests that individuals construct the meaning of situations and experiences through the language they use.33, 34 The study of language use is not a new concept with research as early as 1901 where Freud purported that errors in speech reflected an individual’s deeper fears.35 The literature on language use has continued to grow indicating the importance of language use in understanding individuals. Ricoeur suggested that the way we describe an event defines the meaning of the event and we use those meanings as a bridge to reality.36 Analysis of text can help to deconstruct these individual meanings and explore people’s emotional and cognitive functioning.37 There is empirical evidence that suggests a link between biological activity and function words. Research also shows that depressed people and individuals experiencing a stressful situation use more first person pronouns.38 Words can also help in the prediction of physiological and health changes with the use of emotion and cognitive words being correlated with health changes.39 By analysing the text of terminally ill patients, the important aspects of their psychological world can be revealed helping us to deconstruct and understand the meaning of the dying process and their imminent death. Methods of studying language use vary from those that make an assumption that language is contextual to those that statistically count the words within text.40 Within the quantitative approach there are different variations of word analysis, namely judge based thematic content analyses, word pattern analysis and word count strategies. Thematic content analyses have been used mainly for studying psychological phenomena whilst the word pattern analysis is useful for determining the co-variance across samples of text. The word count strategies make the assumption that words convey psychological information that is independent of their semantic context and is therefore suitable for use within this study. Computerised text analysis programs have become widely used in the study of language use 138 Analysis of Terminally Ill Patients’ Weblogs ______________________________________________________________ increasing the efficiency and accuracy of analysis .41 The LIWC (Linguistic Inquiry Word Count) text analysis software was initially developed in the context of Pennebaker’s work to identify words that could predict health improvements.42 This program is now widely used in clinical psychology to explore psychological and linguistic dimensions of language. This paper evaluates and describes the use of the LIWC program to analyse content of terminally ill patients’ weblogs. In contrast to previous work in palliative care, where the investigator interviews participants, records and decodes what is said, this paper focuses on the emotional, cognitive and structural components of written language. 2. Method A. The Use of Weblogs in Palliative Care For clarification purposes within this paper, Schiano et al’s definition of weblogs will be applied - a weblog is a web page that is frequently updated with posts in reverse-chronological order with the latest post at the top.43 The present study is based on weblogs of five terminally ill patients who have maintained their weblog for over two years. Writing samples from the patients’ blogs were analysed using LIWC. From the content of the blogs, the patients indicated how the Internet has enabled them to obtain social support and express their emotions whilst discussing issues of importance to them related to their illness and imminent death. B. Participants Participants were five patients with varying terminal illnesses based in North America. Two of the patients have cancer, one has AIDS, one has leukaemia and the fifth an undisclosed terminal illness. Three of the participants are male and two are female. The participants are between the ages of 31 and 53 years old with a mean age of 44 (SD = 8 years). One participant is a visionary artist, one is a former newspaper reporter, one is a student, one is a radio news reporter and the fifth is a journalist. Participants have been blogging at their own initiative and convenience for at least two years. Within their blogs, participants reported on their illness, progress of their respective treatments and other general life issues. C. Materials – Software The Linguistic Inquiry and Word Count software 2007 version was used to identify the emotional, cognitive and structural categories of the words used within the text of the blogs.44 The default LIWC 2007 dictionary has 4,500 words that define the word categories. One word can be part of more than one category. The program analyses text, word by word and calculates the percentage of words that match each of the language dimensions or categories defined within the dictionary. If a word belongs to Nothando Ngwenya, Stella Mills, and Paul Kingston 139 ______________________________________________________________ more than one category, each of the categories is incremented if the word is identified in the text. The output variables include general descriptors (e.g. word count, word per sentence), standard linguistic dimensions (e.g. pronouns, verbs, articles), and psychological constructs (e.g. affective processes, cognitive process, social references). The results of the output variables are listed as percentages of word use. D. Procedure A total of 15 blog posts by terminally ill patients were analysed. Three posts from different stages of blogging were selected from each participant’s blog (early, middle, and late). The posts were loaded into Microsoft Word and edited for typographical errors. All postings were saved as Word text files and analysed using the LIWC program. The LIWC data were aggregated by phase and patient, and therefore for each patient, 3 data sets corresponding to the three blog phases were available. The construct validity of the program was assessed by comparing the LIWC results obtained from the participants’ blogs with the norm values from the program authors.45 The LIWC has 90 language dimensions, but for this study, only 12 dimensions that have been found to correlate with social and psychological variables were examined in the analysis of function and emotion words. This analysis was used to explore the participants’ social and psychological profiles. 3. Results Table 1 summarises the LIWC categories relevant in this study that were analysed. The numbers shown are the mean percentages of the total word use from the three different phases of the blog posts that were analysed. A comparison of this study’s results was carried out against the average values published by the program’s authors. The LIWC 2007 authors carried out a study to evaluate the program’s word usage across various setting which included emotional writing, control writing, science articles, novels, talking and blogs. The three classes of text from Pennebaker’s study are shown in bold (Emotional writing condition; Control writing condition; Blogs). Analysis of Terminally Ill Patients’ Weblogs 140 ______________________________________________________________ Table 1: Means for LIWC Categories Case 1 Case 2 Case 3 Case 4 Case 5 Emotiona lW Contro lW Blogs Word Count (mean) 632. 33 669. 00 306. 00 959. 67 407. 00 443.00 405.00 7,304.00 Words > 6 Letters 15.7 4 15.8 3 11.1 4 19.2 0 16.2 7 13.27 13.87 14.12 Total function words 60.0 4 56.0 0 62.1 3 57.2 1 58.1 2 63.93 57.53 55.29 Pronouns 13.2 9 10.9 6 18.2 5 14.1 8 16.8 7 20.23 14.29 16.07 Affect 5.81 5.28 5.06 6.27 5.76 6.02 2.57 5.84 Positive emotion 3.36 3.92 3.84 3.10 3.43 3.28 1.83 3.72 Negative emotion 2.33 1.39 1.22 3.10 2.22 2.67 0.71 2.07 Anxiety 0.89 0.13 0.17 0.75 0.06 0.68 0.21 0.3 Anger 0.69 0.30 0.26 0.53 0.25 0.66 0.14 0.76 Sadness 0.79 0.76 0.17 1.29 0.76 0.63 0.14 0.42 Cognitive Processes 16.3 7 15.5 4 17.3 9 16.2 3 15.2 9 19.66 14.42 15.97 0.14 0.16 0.30 0.90 0.72 0.18 0.03 0.15 Category Linguistic Processes Psychologica l Processes Current Concerns Death Table 1, shows how all the participants used a high percentage of function words with the lowest being 56%. This corroborates with the literature which identifies how the use of function words is diagnostic of emotional and biological states and can also reveal personality and cognitive styles. It is also of interest that all the participants have higher percentage use of positive emotion words compared to negative emotion words. These effects could be Nothando Ngwenya, Stella Mills, and Paul Kingston 141 ______________________________________________________________ due to the low rate use of anger and hostility words across all the cases analysed. Figure 1 shows a comparison of the results from this study and the means of three settings listed by the program’s authors - emotional writing, control writing, and blogs. Figure 1: Comparison with standard original values Construct validity was carried out on the affect processes as they are most relevant to the emotional components of words. Figure 1 visually demonstrates how the word usage for the cases in this study are very much similar to those carried out on emotional writing studies and general blogs. In all three of these texts, there is a higher percentage of words counted in affect, positive emotion and negative emotion than that counted for the control. It is interesting to note that with the cases in this study, lower proportion of negative emotion words were expressed compared to Pennebaker’s emotional writing group. The control group recorded the lowest word count in all categories with more differences to the terminally ill patients’ group than any of the other texts. The blog group’s pattern from Pennebaker’s findings is similar to the terminally ill patients’ pattern. It is interesting to note that the terminally ill patients group had a higher word 142 Analysis of Terminally Ill Patients’ Weblogs ______________________________________________________________ usage of death compared to all the other groups of text. These results support the efficacy of the LIWC program in this setting. 4. Discussion The results of this study confirm the possibility of using the LIWC in analysing the emotional, cognitive and structural components present in the writings of terminally ill patients. It is a useful way of measuring people’s linguistic characteristics. This study is preliminary work on the use of weblogs in an end of life context, and the results encourage further development within the subject area. Through the use of a blog as a form of disclosure channel, the terminally ill patients had a high percentage use of affective words, both negative emotion and positive emotion. The word usage pattern for the terminally ill patients was very similar to the data reported by the program’s authors for the emotional writing group and for blogs. There were differences observed however from the control writing group and the terminally ill patients’ word usage results. These results can be interpreted in many ways, including the suggestion that blogs can be therapeutic and, just like emotional writing, may have positive health benefits.46-49 This is evidenced by the patients’ high word use of affective words mostly positive emotion words. The LIWC has many more word categories (up to 90) that were not used in this study that can be encompassed in future work to reveal individual personalities and the personalities that can benefit positively from maintaining a weblog. Previous research suggested that linguistic characteristics can predict health outcomes; therefore the application of the LIWC program can help to identify predictors in patients who may need specific personal attention and possible interventions.50,51 Advice or suggestions can be made to people to change their style of writing (e.g. encourage the expression of positive emotions) if it helps them in a positive way. Different kinds of information and knowledge can be gained from examining the written words of individuals including their psychological state and this is confirmed from the results in this study.52 Limitations of this research should be noted. The small and specific sample used in this study means care should be taken in the generalisation of the results to other populations. Individual differences were not analysed as there were only five participants. The length of the messages varied between participants and from time to time whilst the participants wrote about anything within their blogs which produced a combination of emotional and control writing.53 The results however seemed to corroborate the program authors’ “norm” values which concludes that the tool was accurate in identifying the linguistic dimensions present within the blog content. Nothando Ngwenya, Stella Mills, and Paul Kingston 143 ______________________________________________________________ 5. Conclusion The LIWC is a simple and very flexible tool which can be modified according to specific research needs. The dictionary can be modified or a new one installed to suit the purpose of research. The LIWC program has the potential to be used within other settings to help and give insight to the psychological and emotional state of individuals. This information could be used within a wider context for other clinical purposes.54 The study has demonstrated that LIWC can be used to analyse terminally ill patients’ blogs and further evaluation can be carried out according to specific research needs. Research has suggested that cognitive words can reveal how a person thinks and, from the cognitive processes word usage in this study, there is an indication that terminally ill patients have a more reflective manner and approach to life. The high percentage use of cognitive process words may be interpreted in line with previous research which suggested that during stressful or unpleasant situations, individuals use words that reflect cognitive processing.55 This supports evidence that states that there is higher prevalence of stress among terminally ill patients. Further work will examine changes in word use over a period of time and their relationship to psychosocial indicators used to predict health outcomes. More work can be conducted with a larger sample size of terminally ill patients to establish the generalisability of these findings. Other characteristics of participants could be profiled to explore if individual differences may have influenced the results in this study. It may also be useful for future research to explore other categories and aspects of word usage other than emotion words such as religion, to see if it has an influence on how individuals understand and construct the meaning of dying and death. Exploring non-emotion words people used whilst going through intensely emotional experiences can reveal the principal emotion processing mechanisms. Future work could also use objective biological markers of health to corroborate the LIWC analysis results. Notes 1 P Aries, The Hour of Our Death, Oxford University Press, Oxford, 1991. R Blauner, ‘Death and Social Structure’, Psychiatry, vol. 29, 1966, pp. 378 – 394. 3 B G Glaser and A L Strauss, Awareness of Dying, Aldine, New York, 1965. 4 J W Riley, ‘Dying and the meanings of Death: Sociological Inquiries’, Annual Review Sociology, 1983, pp.191 – 216. 5 ibid., pp. 191 – 216 6 B G Glaser and A L Strauss, op. cit. 7 B G Glaser and A L Strauss, op. cit. 2 144 Analysis of Terminally Ill Patients’ Weblogs ______________________________________________________________ 8 K M Taylor, ‘Telling Bad News: Physicians and the Disclosure of Undesirable Information’, Sociology of Health & Illness, vol. 10, 1988, pp. 109 – 133. 9 D Field and G Copp, ‘Communication and Awareness about Dying in the 1990s’, Palliative Medicine, vol. 13, 1999, pp. 459 - 468. 10 N J Miyaji, ‘The Power of Compassion: Truth Telling among American Doctors in the Care of Dying Patients’, Social Science & Medicine, vol. 36, 1993, pp. 249 – 264. 11 E L Emanuel, D L Fairclough, P Wolfe and L L Emanuel, ‘Talking with Terminally Ill Patients and Their Caregivers about Death, Dying and Bereavement’, Archives of Internal Medicine, vol. 164, 2004, pp. 1999 – 2004. 12 D Field and G Copp, loc cit. 13 A Meier, E J Lyons, G Frydman, M Forlenza and B K Rimer, ‘How Cancer Survivors Provide Support on Cancer-Related Internet Mailing Lists’, Journal of Medical Internet Research, vol. 9, 2007. 14 ibid. 15 D Thorne, ‘Adding Technology to Care – Is This Progress?’, Progress in Palliative Care, vol. 7, 1999, pp53 - 54. 16 J C Hays, ‘High-Technology and Hospice Home Care’, Nursing Clinics of North America, vol. 23, 1988, pp. 329 - 340. 17 D M Dush, ‘High Tech, Aggressive Palliative Care: In the Service of Duality of Life’, Journal of Palliative Care, vol. 9, 1993, pp. 37 – 41. 18 J F Seely and B M Mount, ‘Palliative Medicine and Modern Technology’, JAMC Canadian Medical Association Journal, vol. 161, 1999, pp. 1120 1121. 19 L Willis, G Demiris and D Parker-Oliver, ‘Internet Use by Hospice Families and Providers: A Review’, Journal of Medical Systems, vol. 31, 2007, pp. 97 – 101. 20 K T Washington, G Demiris, D Parker- Oliver and M Day, ‘Home Internet Use among Service Recipients: Recommendations for Web-Based Interventions’, Journal of Medical Systems, vol. 31, 2007, pp. 385-389. 21 G W Alpers, A J Winzelberg, C Classen, H Roberts, P Dev, C Koopman and C Barr-Taylor, ‘Evaluation of Computerised Text Analysis in an Internet Breast Cancer Support Group’, Computers in Human Behaviour, vol. 21, 2005, pp. 361 – 376. 22 L Willis, G Demiris and D Parker-Oliver, loc. cit. 23 K T Washington, G Demiris, D Parker-Oliver and M Day, 2007, loc. cit. 24 M A Stefanone and C Y Jang, ‘Writing for Friends and Family: The Interpersonal Nature of Blogs’, Journal of Computer Mediated Communication, vol. 13, 2007, viewed on 27 July 2008, http://jcmc.indiana.edu/Vol.13/issue1/stefanone.html. Nothando Ngwenya, Stella Mills, and Paul Kingston 145 ______________________________________________________________ 25 C Hunt, Therapeutic Dimensions of Autobiography in Creative Writing, Jessica Kingsley, London, 2000. 26 G Bolton, ‘Writing or Pills: Therapeutic Writing in Primary Care’, in The Self on the Page: Theory and Practice of Creative Writing in Personal Development, C Hunt and F. Sampson (eds), Jessica Kingsley, London, 1998. 27 J W Pennebaker, ‘Writing about Emotional Experiences as a Therapeutic Process’, Psychological Science, vol. 8, 1997, pp. 162 – 166. 28 A L Stanton, S Danoff-Burg, C L Cameron, M Bishop, C A Collins, S B Kirk and L A Sworowski, ‘Emotionally Expressive Coping Predicts Psychological and Physical Adjustment to Breast Cancer’, Journal of Consulting and Clinical Psychology, vol. 68, 2000, pp. 875 – 882. 29 N H Frijda, ‘Emotions are Functional, Most of the Time’, in The Nature of Emotion: Fundamental Questions, P Ekman & R J Davidson (eds), Oxford University Press, New York, 1994, pp. 112 – 122. 30 J W Pennebaker, ‘Writing about Emotional Experiences as a Therapeutic Process’, 1997, loc. cit. 31 J M Smyth, ‘Written Emotional Expression: Effect Size, Outcome Types, and Moderating Variables’, Journal of Consulting and Clinical Psychology, vol. 66, 1998, pp. 174 – 184. 32 J W Pennebaker and C K Chung, ‘Expressive Writing, Emotional Upheavals, and Health’, in Handbook of Health Psychology, H Friedman, & R Silver, (eds), Oxford University Press, New York, 2007, pp. 263 – 284. 33 C J Groom and J W Pennebaker, ‘Words’, Journal of Research in Personality, vol. 36, 2002, pp. 615 – 621. 34 J W Pennebaker, R J Booth and M E Francis, ‘Linguistic Inquiry and Word Count: LIWC, 2007’, viewed on 12 February 2008, www.liwc.net. 35 S Freud, Psychopathology of Everyday Life, Penguin, New York, 1975. 36 P Ricoeur, Interpretation Theory: Discourse and the Surplus of Meaning, Texas Christian University Press, 1976. 37 J W Pennebaker and A Graybeal, ‘Patterns of Natural Language Use: Disclosure, Personality and Social Integration’, Current Directions in Psychological Science, vol. 10, 2001, pp. 91 – 93. 38 C Chung and J W Pennebaker, ‘The Psychological Function of Function Words’, in Social Communication, Friedler (ed), Psychology Press, New York, 2007, pp. 343 – 359. 39 J W Pennebaker and A Graybeal, ‘Patterns of Natural Language Use: Disclosure, Personality and Social Integration’, 2001, pp. 91 – 93. 40 J W Pennebaker, M R Mehl, and K G Niederhoffer, ‘Psychological Aspects of Natural Language Use: Our Words, Our Selves’, Annual Review of Psychology, vol. 54, 2002, pp. 547 – 577. 41 G W Alpers, A J Winzelberg, C Classen, H Roberts, P Dev, C Koopman and C Barr-Taylor, loc. cit. 42 J W Pennebaker, loc. cit. 146 Analysis of Terminally Ill Patients’ Weblogs ______________________________________________________________ 43 D J Schiano, B A Nardi, M Gumbrecht and L Swartz, ‘Blogging by the Rest of us’, CHI, 2004, ACM. 44 J W Pennebaker, R J Booth and M E Francis, loc. cit. 45 ibid. 46 J W Pennebaker, loc. cit. 47 G Bolton, op. cit. 48 J M Smyth, 1998, loc .cit. 49 C Hunt, 2000, op. cit. 50 C J Groom and J W Pennebaker, loc. cit. 51 J W Pennebaker, R J Booth and M E Francis, loc. cit. 52 J W Pennebaker, M R Mehl, and K G Niederhoffer, loc. cit. 53 J H Kahn, R M Tobin, A E Massey and J A Anderson, ‘Measuring Emotional Expression with the Lingusitic Inquiry and Word Count’, American Journal of Psychology, vol. 120, 2007, pp. 263 – 286. 54 G W Alpers, A J Winzelberg, C Classen, H Roberts, P Dev, C Koopman and C Barr-Taylor, loc. cit. 55 S W Stirman and J W Pennebaker, ‘Word Use in the Poetry of Suicidal and Non Suicidal Poets’, Psychosomatic Medicine, vol. 63, 2001, pp. 517 – 522. Bibliography Alpers, G. W., A. J. Winzelberg, C. Classen, H. Roberts, P. Dev, C. Koopman, and C. Barr-Taylor, ‘Evaluation of Computerised Text Analysis in an Internet Breast Cancer Support Group’. Computers in Human Behaviour, vol. 21, 2005, pp. 361 – 376. Aries, P., The Hour of Our Death. Oxford University Press, Oxford, 1991. Blauner, R., ‘Death and Social Structure’. Psychiatry, vol. 29, 1966, pp. 378 394. Bolton, ‘Writing or Pills: Therapeutic Writing in Primary Care’, in The Self on the Page: Theory and Practice of Creative Writing in Personal Development. C. Hunt and F. Sampson, (eds), Jessica Kingsley, London, 1998. Chung, C. And J. W. Pennebaker, ‘The Psychological Function of Function Words’, in Social Communication, Friedler (ed), Psychology Press, New York, 2007, pp. 343 - 359. Dush, D. M., ‘High Tech, Aggressive Palliative Care: In the Service of Duality of Life’. Journal of Palliative Care, vol. 9, 1993, pp. 37 - 41. Nothando Ngwenya, Stella Mills, and Paul Kingston 147 ______________________________________________________________ Emanuel, E. L., D. L. Fairclough, P. Wolfe, and L. L. Emanuel, ‘Talking with Terminally Ill Patients and Their Caregivers about Death, Dying and Bereavement’. Archives of Internal Medicine, vol. 164, 2004, pp. 1999 2004. Field, D., and G. Copp, ‘Communication and Awareness about Dying in the 1990s’. Palliative Medicine, vol. 13, 1999, pp. 459 – 468. Glaser, B. G. and A. L.. Strauss, Awareness of Dying. Aldine, New York, 1965. Groom, C. J. and J. W. Pennebaker, ‘Words’. Journal of Research in Personality, vol. 36, 2002, pp. 615 – 621. Freud, S., Psychopathology of Everyday Life. Penguin, New York, 1975. Frijda, N. H., ‘Emotions are Functional, Most of the Time’, in The Nature of Emotion: Fundamental Questions, P Ekman & R J Davidson (eds), Oxford University Press, New York, 1994, pp. 112 – 122. Kahn, J. H., R. M. Tobin, A. E. Massey, and J. A. Anderson, ‘Measuring Emotional Expression with the Lingusitic Inquiry and Word Count’. American Journal of Psychology, vol. 120, 2007, pp. 263 – 286. Hays, J. C., ‘High-technology and Hospice Home Care’. Nursing Clinics of North America, vol. 23, 1988, pp. 329 – 340. Hunt, C., Therapeutic Dimensions of Autobiography in Creative Writing. Jessica Kingsley, London, 2000. Meier, A., Lyons, E. J., Frydman, G., Forlenza, M., & Rimer, B. K., ‘How Cancer Survivors Provide Support on Cancer-Related Internet Mailing Lists’. Journal of Medical Internet Research, vol. 9, 2007. Miyaji, N. J., ‘The Power of Compassion: Truth Telling Among American Doctors in the Care of Dying Patients’. Social Science & Medicine, vol. 36, 1993, pp. 249 – 264. Pennebaker, J. W., ‘Writing about Emotional Experiences as a Therapeutic Process’. Psychological Science, vol. 8, 1997, pp. 162 – 166. 148 Analysis of Terminally Ill Patients’ Weblogs ______________________________________________________________ Pennebaker, J. W. And A. Graybeal, ‘Patterns of Natural Language Use: Disclosure, Personality and Social Integration’. Current Directions in Psychological Science, vol. 10, 2001, pp. 91 – 93. Pennebaker, J. W., M. R. Mehl, and K. G. Niederhoffer, ‘Psychological Aspects of Natural Language Use: Our Words, Our Selves’. Annual Review of Psychology, vol. 54, 2002, pp. 547 – 577. Pennebaker, J. W., and C. K. Chung, ‘Expressive Writing, Emotional Upheavals, and Health’, in Handbook of Health Psychology, H. Friedman and R. Silver, (eds), Oxford University Press, New York, 2007, pp. 263 – 284. Pennebaker, J. W., R. J. Booth, M. E. Francis, ‘Linguistic Inquiry and Word Count: LIWC, 2007’, viewed on 12 February 2008, www.liwc.net. Ricoeur, P., Interpretation Theory: Discourse and the Surplus of Meaning, Texas Christian University Press, 1976. Riley, J. W., ‘Dying and the Meanings of Death: Sociological Inquiries’. Annual Review Sociology, 1983, pp. 191 – 216. Schiano, D. J., B. A. Nardi, M. Gumbrecht, and L. Swartz, ‘Blogging by the Rest of Us’. CHI, 2004, ACM. Seely, J. F., and B. M. Mount, ‘Palliative Medicine and Modern Technology’. JAMC Canadian Medical Association Journal, vol. 161, 1999, pp. 1120 – 1121. Smyth, J. M., ‘Written Emotional Expression: Effect Size, Outcome Types, and Moderating Variables’. Journal of Consulting and Clinical Psychology, vol. 66, 1998, pp. 174 - 184. Stanton, A. L., S. Danoff-Burg, C. L. Cameron, M. Bishop, C. A. Collins, S. B. Kirk, and L. A. Sworowski, ‘Emotionally Expressive Coping Predicts Psychological and Physical Adjustment to Breast Cancer’. Journal of Consulting and Clinical Psychology, vol. 68, 2000, pp. 875 – 882. Stefanone, M. A. And C. Y. Jang, ‘Writing for Friends and Family: The Interpersonal Nature of Blogs’. Journal of Computer Mediated Communication, vol. 13, 2007, viewed on 27 July 2008, http://jcmc.indiana.edu/Vol.13/issue1/stefanone.html. Nothando Ngwenya, Stella Mills, and Paul Kingston 149 ______________________________________________________________ Stirman, S. W. And J. W. Pennebaker, ‘Word Use in the Poetry of Suicidal and Non Suicidal Poets’. Psychosomatic Medicine, vol. 63, 2001, pp. 517 522. Taylor, K. M., ‘Telling Bad News: Physicians and the Disclosure of Undesirable Information’. Sociology of Health & Illness, vol. 10, 1988, pp. 109 – 133. Thorne, D., ‘Adding Technology to Care – Is This Progress?’. Progress in Palliative Care, vol.. 7, 1999, pp. 53 – 54. Washington, K. T., G. Demiris, D. Parker-Oliver, and M. Day, ‘Home Internet Use among Service Recipients: Recommendations for Web-Based Interventions’. Journal of Medical Systems, vol. 31, 2007, pp. 385-389. Willis, L., G. Demiris, and D. Parker-Oliver, ‘Internet Use by Hospice Families and Providers: A Review’. Journal of Medical Systems, vol. 31, 2007, pp. 97 – 101. Paul Kingston is Professor of Health and Social Care and Director of the Centre for Ageing and Mental Health at Staffordshire University, UK. Stella Mills is Professor of Multimedia Technology, Staffordshire University, UK and an Honorary Research Fellow in the School of Mathematics and Statistics at Birmingham University, UK. Nothando Ngwenya is a Ph.D. Candidate in Health Studies at Staffordshire University, UK, where his work is focused on the use of weblogs within an end of life context and on cyberspace therapy. Archiving Grief: (Re) Writing Histories in the Aftermath of Loss Nate Hinerman Abstract: This paper examines how we might use personal grief archives (such as those constructed in a classroom, explained below) as a way to study communitywide outpourings of grief and the archives they produce following tragedies labelled as “public” and/or “national.” The theoretical nature of this paper considers personal grief archives as a way to reflect on death attitudes derived from various agents of socialization. In this case, the personal archives discussed result from a series of in-class writing assignments that include death inventories, childhood loss/early thoughts about death diaries, questionnaires about life threatening illness and death fears, advance directives, and ethical wills. The practical nature of this paper considers a pedagogical mechanism to approach the events of September 11th, 2001 in light of personally constructed grief archives. My research will elaborate how meaning-making on the individual level in times of loss provides a vital lens through which to consider, to critique, and ultimately to evaluate the meaning assigned to those same events vis-à-vis more “national” or “public” stages. Every death, like any archive, tells a story. Sharing these stories can provide emotional relief and promote a search for meaning. Grief archives can function as a means to bring people together in mutual support during a time of loss. Grief archives also assist individuals and communities to revise, reform, and continue relationships with the deceased over time. Bonds sustained through memories and linking objects serve as “threads of connectedness” to those deceased whose deaths are grieved and remembered. They also form complex (and sometimes problematic) lineages through which individuals preserve, (re-)orient and (re-)frame their own histories/ identities within the context of a larger societal matrix. Key Words: Grief, archive, death attitudes, national, meaning, writing, teaching end-of-life. ***** 1. A Research Study Provides Unexpected Results In 2004, I began teaching a course entitled, Death and Dying. Primarily designed for nursing students seeking to complete a core requirement in Theology and Religious Studies, I crafted a syllabus that addressed both the clinical and more “metaphysical” aspects of dying in the 152 Archiving Grief ______________________________________________________________ U.S. On the first day of class, I passed out a survey. The survey was an adaptation of a famous assessment developed by Edwin Shneidman from the Centre of Advanced Study of Behavioural Sciences in consultation with other researchers at Stanford University during the early 1970s. Their survey, “You and Death: A Questionnaire,” probes important terrain for any student (or professor, for that matter) studying death and dying. My purpose in passing out this questionnaire was to ascertain, in advance of any formal group research, the exposure to and experiences of death and dying by my students. My hope was that by reading these questionnaires at the start of our class, I could cultivate important sensitivities to any traumatic grief encounters potentially experienced by my students. In this way, I hoped to tailor my lectures and our group discussions in ways that might best honour and respect their difficult experiences of loss and bereavement. I also wanted a clue into the general exposure my students had with death and dying. The questionnaire results gave me this information, and much more. Before covering some results of the survey, let me say that I have taught this class each semester since 2004, and I still use this questionnaire to gauge the students’ experiences with death and to calibrate initial sensitivities to the material we must explore carefully together. Each time I give the questionnaire, the responses follow a typical pattern with respect to six questions in particular (discussed below). I originally developed these particular six questions as way to help me understand the individual perceptions of students to the events of September 11th, 2001. Although that material is always slated towards the end of the term, I am always concerned about how to cover this incredibly complex chapter of recent U.S. history. So, I asked the students six specific questions to learn how they felt about these events. Overall, 201 students took the survey in 2004. Here are the six questions to which I am referring, and the responses I received in 2004: 75. Are you actively grieving the events of September 11th, 2001? 196- No 5-Yes 76. Do you sometimes experience confusion, disbelief, anxiety or even depression concerning the events of September 11th, 2001? 11- No 190- Yes Nate Hinerman 153 ______________________________________________________________ 77. Do you sometimes experience anger or outrage concerning the losses from the events of September 11th, 2001? 4-No 197- Yes 78. When reflecting on the events of September 11th, 2001, do you sometimes sigh, feel an emptiness in your abdomen, or experience shortness of breath? 32-No 169-Yes 79. When reflecting on the events of September 11th, 2001, do you sometimes cry, or avoid talking or thinking about those events, and those that died? 26-No 175-Yes 80. Since the events of September 11th, 2001, have you questioned or re-examined your religious or spiritual beliefs as a result of failed attempts to make meaning of the losses? 34-No 167-Yes The research I present here is “rough,” and so I will resist making any wide-sweeping generalizations due to the informal setting in which this information was gathered. However, given my original purposes, the exercise proved helpful (i.e., I simply wanted basic access into how my students were grieving and coming to terms with September 11th, 2001 so that I could teach the topic more effectively and most respectfully). And for those basic motives, these results proved both staggering and quite revealing. Notice question 75 in particular. Only 5 students were aware of their active grief response to the aforementioned events. Yet, if you look to questions 76-80, the overwhelming majority of students reported an experience of grief. Grief is defined most simply as the reaction to loss, and we can grieve in many different ways: mentally (question 76), affectively (question 77), physically (question 78), behaviourally (question 79), and even spiritually (question 80). Even though we must proceed cautiously when interpreting the survey data, 154 Archiving Grief ______________________________________________________________ the results of this informal survey still communicate a simple message: so often, we do not consciously realize we are grieving even when we are presenting classic signs of grief. For a professor who crafted a class syllabus where grief was a central theme, I realized (quickly) I needed a skilful mechanism that could be individually tailored to each student to assist his/her efforts to contact his/her experiences of grief. The rest of this paper elaborates that mechanism I developed, which I refer to as a grief archive. Before detailing my approach to creating grief archives, let’s consider briefly some factors that often make it so difficult to acknowledge occasions of active grief in the U.S. 2. Current Attitudes toward Death and Dying in the U.S. Many behavioural psychologists assert that many contemporary attitudes toward death in the U.S. serve an explicitly death-denying function.1 First, there is no reason to be simple-minded: death is arguably the most challenging of all human experiences. When we face our own mortality, or when our loved ones die, we can be (and usually are) affected powerfully in every aspect of our personhood. However, given the magnitude of death's significance to living persons, it may seem odd to some that death and dying seldom gets discussed amongst friends, family, or even health care professionals in today’s America.2 Instead, death exists for many as a mysterious, anxiety-producing possibility looming on life’s horizon. Given such a perception, it’s no wonder that many avoid, repress, or deny altogether the reality of death.3 Second, in the U.S., life expectancy continues to increase, which obviously means Americans are living longer.4 In part as a result of advances in life-sustaining technologies developed and perfected primarily during the late 1950s and early 1960s, many Americans have come to view death as something to be “mastered” (or at least controlled) through continued technological advancements. In addition, the primary causes of death now are slow, progressive illnesses (cancer, heart disease, liver disease) rather than acute infectious diseases (diphtheria, syphilis, etc).5 These epidemiological transitions have pushed end-of-life care from the home to the hospital, in part so that the dying can be proximate to important life-extending technologies. Resulting from these transitions, care giving at the end-of-life largely has been (re-)assigned to medical professionals, rather than friends and family. The impact of this migration has caused the average person in the U.S. to have an increasingly passive role in caring for the dying.6 Even more, many chaplains assert that a serious challenge has arisen surrounding how to explore spiritual issues with the dying (i.e. questions of meaning, questions of value, and questions of relationship) when the context of care they are receiving is almost purely geared towards the biological dimension of their personhood.7 Nate Hinerman 155 ______________________________________________________________ Third, infant mortality rates have decreased dramatically over this past century,8 and given that many who are the end-of-life no longer live at home, the average American is unlikely to be confronted by death early on in the lifespan as has been true for every generation prior to 1950. Furthermore, consider the fact that one out of every six Americans changes residences annually.9 Multi-generational homes, once the norm, are now the exception; cities have become the chosen locus for living instead of rural environments (many factors play into this migration). Odds are that many cannot actually provide care to their dying loved ones even when they would like to due to prohibitive geographic distances. On average, American families simply do not live as close to one another as they once did. Each of these changes in our collective attitudes toward death has contributed to a “cultural lag” in terms of our willingness and overall capacity to address directly issues of death and dying (including grief). For many in the U.S., death has become a “medical failure” rather than a “natural event.” While science tries to “tame death” on the one hand, death continues to become increasingly more “invisible” on the other.10 The sum of these attitudes has contributed to a special form of death denial: a state in which death is not discussed, confronted, or directly experienced with an active and open orientation by most in society. Instead, most take an increasingly passive role in caring for the dying, and this trend further pushes dying into institutional settings (and more out of mainstream view). Augmenting “American individualism” and a privileging of patient autonomy within our health care systems, our increasingly passive role in providing care to the dying leaves, for many, few opportunities to reflect on and consider carefully one's own mortality. 3. The Rise of Death Anxiety An unintended cost of this growing passivity in care giving for and decreased exposure to the dying has been an increase in Americans’ death anxiety (i.e. fear of death).11 Certainly, the events of September 11th, 2001 exacerbated such fears. Interesting research has emerged that studies the relationship between “terror” and death anxiety. A burgeoning field within psychology addresses squarely the consequences of death anxiety, and hundreds of recently-conducted empirical research studies support many of its core tenants. Known as Terror Management Theory (TMT), the common thesis in these studies suggests that when people are confronted with or reminded about death, the test subjects tend to demonstrate aggressive behaviour towards those perceived as different and positively towards those perceived as similar. Test subjects also tend to exhibit both intolerant and aggressive behaviour towards those perceived to support immortality ideologies different from the test subject's own. One implication from this research posits that increases in our individual and collective death anxieties 156 Archiving Grief ______________________________________________________________ often render us more inclined to exhibit intolerant beliefs, attitudes, and actions towards those perceived or labelled as “different.”12 TMT researchers commonly cite such intolerance as advancing in four stages: accommodation, dismissal, assimilation, and if these fail, annihilation. TMT also asserts that people have a deep need to sustain faith in a meaningful worldview.13 A “meaningful worldview” can be described as a need to feel valued, protected, and ultimately, significant. Psychologists generally might call this self esteem, but in this case the taproots extend deeper. These meaningful constructs function securely when they are met and unthreatened. When they are threatened, anxiety arises and the push to defend them occurs. Building from TMT, the “mortality salience hypothesis” argues that if culture really does provide a death-denying capacity, then alerting people (or reminding them) about their impending mortality should induce a greater need for these death-denying constructs of their belief systems, and this need should be evidenced in their actions.14 Considered through the lens of these research findings, the attacks of September 11th, 2001 serve as a compelling real life example of these impulses to act aggressively towards others labelled as “different.”15 The aftermath of the attacks in the media clearly posed the attacks as a clash of American (i.e. “Christian”) and Middle Eastern (i.e. “Muslim”) world views. At first, after the initial shock of the attacks, many felt strong feelings of anxiety and anger. Clearly, these events served as powerful reminders to all Americans of their mortality. Returning to the death questionnaire discussed in the first section, the student responses to the six questions I provided support the notion that feelings of grief continue to emerge, often from depths below the surface of conscious awareness. Furthermore, this is precisely the scenario in which TMT research claims the most potentially hazardous kinds of “labelling of difference” occur (i.e., when personal anxieties about death and the grief that accompanies loss go unacknowledged and unexplored). 4. Creating Grief Archives In an attempt to reach these more subterranean death anxieties, and their corresponding grief responses, I began work on a collection of in-class assignments designed to explore in a personal way various aspects of dying. I initially wrote and refined one reflection for each class (so a total of 32). I coordinated each reflection with the topic of the unit we covered in class for that day. At the start of each class, I provide the reflection exercise to each member of the class and they then complete the exercise (time extensions are happily granted for students who want to think more deeply outside of class about a particular subject). After the class completes a reflection, I almost always notice a palpable change in the mood of the room. As we reflect individually on our fears, anxieties, and wishes for end of life care, and especially as we make contact with our grief, I sense a gradual “opening up” Nate Hinerman 157 ______________________________________________________________ in the overall orientation of the class to the topics of death and dying. These exercises create a special sense of reverence, which often produces genuine, honest moments of discussion, ones that encourage compassionate responses to the experiences of their fellow students, and those of the authors we study. Students do not read each other’s work. They are free to share anything (or nothing) about their own experiences. I do read the reflections after class and return them at the start of the next class. I treat each reflection in each student’s burgeoning “grief archive” as I would a diary entry. I do not pressure students to complete them in any particular way; however, I do ask that they complete each reflection in a way that accords genuinely with their experiences. Here is a sample list of names from the 32 reflections I developed: My Earliest Memories of Loss My Losses: An Inventory My Feelings Concerning Death My Philosophy Concerning Death Coping with a Life-Threatening Illness My Fears about Death My Values: A Worksheet When the End is Near Reflections on the Virginia Tech Shootings Reflections on September 11th, 2001 My Ethical Will My Funeral My Wishes for Organ Donation The very last reflection exercise we do is an advance directive. I feel that it’s most appropriate to enter the terrain of advance planning only after each of us has meditated on these other areas first. (I personally do each exercise anew along with the students each term.) Once we complete the advance directive, I have the students create some type of “vessel” in which to house their individual grief archive reflections. Commonly, students will design a folder with the names (and sometimes images) of those who have died in their life. Others have created more elaborate ways to preserve their archives. The goal with these exercises is for the students to investigate their narratives and to explore affectively, intellectually, physically, and spiritually their losses, and to make contact with certain aspects of grief that accompany each case. 4. Conclusions I review each archive at the end of the term. I then return them for the student to keep. Every archive, like every death, tells a unique story. I 158 Archiving Grief ______________________________________________________________ believe that sharing these stories can provide emotional relief and promote a search for meaning, both individually and collectively. TMT research posits that intolerant reactions in the face of death anxiety and grief are likely to emerge if such experiences and feelings go unacknowledged. Seen then in their best light, grief archives function as a means to bring people together in mutual support during a time of loss. Although I never force students to speak about their experiences of grief and loss, many do (and cite specific questions in a particular reflection as the launching point for their comment). In this way, grief archives can assist individuals and communities to revise, reform, and continue relationships with the deceased over time. As opposed to more Freudian notions of “attachment theory” or “grief-work models” that attempt to help a client break bonds with the deceased and re-invest them in something or someone else, my approach using these archives is more narrative-based. My work in using grief archives has, in my experience, demonstrated that bonds sustained through memories and linking objects can serve as valued “threads of connectedness” to those deceased whose deaths are grieved and remembered. When we make contact with our own grief responses, we often are better active listeners to another’s story of grief. These grief archives also can reveal complex (and sometimes problematic) lineages through which individuals preserve, (re)orient and (re)frame their own histories/identities within the context of a larger societal matrix. Said differently, many students begin to notice half-way through the term the many ways in which their respective views about death have been shaped by agents of socialization such as peers, family, religion, political ideology, and sometimes even the socio-economic circumstances in which grew up. Questions of ethno-cultural identity surface throughout the course, too, in relation to the construction of these archives. In the context of a course on religious studies and philosophical theology, these are precisely the topics I want to raise and address together with my students. Death, and our complex reactions to it, has the capacity to link all of these existential concerns together in powerfully significant ways. Grief archives not only provide a mechanism to initiate such meaning-making, but they also serve as an important lens through which to consider larger, more public tragedies such as the events of September 11th, 2001, and all those labelled “public” or “national.” Grief archives reveal the variety of reactions we have to death, and allow us to cultivate vital sensitivities to differences, broadly conceived, as well as refine our lenses of critique with regard to how certain memorials archive collective losses. Nate Hinerman 159 ______________________________________________________________ Notes 1 See S Solomon, J Greenberg, and T Pyszczynski, ‘A Terror Management Theory of Social Behaviour: The Psychological Functions of Self-Esteem and Cultural Worldviews’, in Advances in Experimental Social Psychology, M P Zanna (ed), vol. 24, San Diego, Academic Press, 1991, pp. 91-159. 2 C Shilling, ‘Modernity, Self-Identity and the Sequestration of Death’, Sociology: The Journal of the British Sociological Association 27 (3), 1993, pp. 411-431. 3 In an effort to avoid extremes, we must both accept and deny death. Talcott Parsons expressed the American attitude towards death well when he wrote, “[rather than deny death] modern societies bring to bear every possible resource to prolong active and healthful life, and come to accept death only when it is inevitable.’ Cf. T Parsons, ‘Death in American Society: A Brief Working Paper’, American Behavioural Scientist 6 (9), 1963, pp. 61-65. 4 ‘Deaths and Death Rates’, Historical Statistics of the United States, 2006, p. 74. 5 R N Anderson, ‘Leading Causes for 2000’, National Vital Statistics Reports 50 (16), Hyattsville, MD: National Centre for Health Statistics, 2002, p. 8. Also, see ‘Resident Population by Age’, Statistical Abstract of the United States: 1999, p. 869; and ‘Death and Death Rates by Leading Causes of Death and Age: 2000’, Statistical Abstract of the United States: 2002, p. 82. 6 J J Farrell, Inventing the American Way of Death, 1830-1920, Philadelphia, Temple University Press, 1980. 7 T E Quill, ‘Initiating End-of-Life Discussions with Seriously Ill Patients: Addressing the “Elephant in the Room”’, JAMA, 284, 2000, pp. 2502-2507; and T E Quill, Caring for Patients at the End of Life: Facing an Uncertain Future Together, New York: Oxford University Press, 2001; also see M J Silveira, A DiPiero, M S Gerrity, & C Feudtner, ‘Patients' Knowledge of Options at the End of Life: Ignorance in the Face of Death’, JAMA, 284, 2000, pp. 2483-2488. Also see J Lynn, ‘Learning to Care for People with Chronic Illness Facing the End-of-Life’, JAMA, 284, 2000, pp. 2508-2511. 8 U.S. Census Bureau, ‘Expectation of Life at Birth’, Historical Statistics of the United States, Colonial Times to 1970, Washington, D.C., Government Printing Office, p. 55; and Statistical Abstract of the United States: 2006, 126th ed., Washington, D.C., Government Printing Office, 2006. 9 Cf. ‘Mobility Status of the Population’, Statistical Abstract of the United States: 2006, p. 29. 10 D Callahan, ‘Frustrated Mastery: the Cultural Context of Death in America - Caring for Patients at the End of Life’, Western Journal of Medicine 163 (3), 1995, pp. 226-230. 11 Cf. E Becker, Denial of Death, New York, Free Press, 1973, pp. 1-75. 160 Archiving Grief ______________________________________________________________ 12 See ‘An Interview with Dr. Sheldon Solomon and Dr. Tom Pyszczynski: Symbols: Jumping the Spatio-Temporal Gap to Make the Unreal Real’, ESI Special Topics, November 2005. The Interview transcript can be found here: http://esi-topics.com/terrorism/interviews/SheldonSolomon.html. 13 S Solomon, J Greenberg, and T Pyszczynski, ‘A Terror Management Theory of Social Behaviour: The Psychological Functions of Self-Esteem and Cultural Worldviews’, in Advances in Experimental Social Psychology, ed. M. P. Zanna, vol. 24, San Diego, Academic Press, 1991, pp. 91-159. 14 J Greenberg, S Solomon and T Pyszczynski, ‘Fear of Death and Human Destructiveness,’ The Psychoanalytic Review, vol. 90 (4), August 2003, 457474. 15 T Pyszczynski, S Solomon, and J Greenberg, ‘In the Wake of 9/11: The Psychology of Terror’, in American Journal of Psychiatry, vol. 160 (5) May 2003, 1019-1023. Bibliography Anderson, R. N., ‘Leading Causes for 2000.’ National Vital Statistics Reports 50 (16). Hyattsville, MD: National Centre for Health Statistics, 2002, p. 8. Becker, E., Denial of Death. New York: Free Press, 1973, pp. 1-75. Callahan, D., ‘Frustrated Mastery: the Cultural Context of Death in America Caring for Patients at the End of Life’. Western Journal of Medicine 163 (3), 1995, pp. 226-230. ‘Deaths and Death Rates’. Historical Statistics of the United States, 2006, p. 74. ‘Death and Death Rates by Leading Causes of Death and Age: 2000’. Statistical Abstract of the United States: 2002, p. 82. Greenberg, J., Solomon, S., and Pyszczynski, T., ‘A Terror Management Theory of Social Behaviour: The Psychological Functions of Self-Esteem and Cultural Worldviews’, in Advances in Experimental Social Psychology, M P Zanna (ed), vol. 24, San Diego: Academic Press, 1991, pp. 91-159. –––, ‘Fear of Death and Human Destructiveness’. The Psychoanalytic Review, vol. 90 (4), August 2003, pp. 457-474. Nate Hinerman 161 ______________________________________________________________ –––, ‘In the Wake of 9/11: The Psychology of Terror’. American Journal of Psychiatry, vol 160 (5) May 2003, pp. 1019-1023. ‘Mobility Status of the Population’. Statistical Abstract of the United States: 2006, p. 29. Parsons, T., ‘Death in American Society: A Brief Working Paper’. American Behavioural Scientist 6 (9), 1963, pp. 61-65. ‘Resident Population by Age’. Statistical Abstract of the United States: 1999, p. 869. Statistical Abstract of the United States: 2006, 126th ed. Washington, D.C.: Government Printing Office, 2006. U.S. Census Bureau, ‘Expectation of Life at Birth’. Historical Statistics of the United States, Colonial Times to 1970. Washington, D.C.: Government Printing Office, p. 55. Nate Hinerman is on the faculty at the University of San Francisco where he teaches courses in death and dying as well as religious studies. He is also Chair of the San Francisco Bay Area End of Life Network. Communicating with the Dead through the Newspaper: A Quantitative and Qualitative Analysis Patricia L. Bromley and Mitte J.A. Nimocks Abstract Rituals performed immediately following a death serve important functions. Preparing the deceased for burial, creating a means for mourners to gather, and preparing for a funeral allow people to begin to grieve the loss. Obituaries simultaneously notify the public about funeral plans, and memorialise the deceased. But what purpose is served by advertisements placed in newspapers long after someone has died? Often, these notices appear to be directed to the deceased, as though the dead person subscribed to the Sunday edition and would be sure to read it. The question posed in this paper is, who writes and pays for these advertisements and why do they do it? In this study, the content of In Memoriam advertisements was analysed via qualitative and quantitative methods. Data reveal that such advertisements serve several purposes, including maintaining attachment bonds, seeking community, commemorating the deceased, and reconstructing one’s personal belief system. Key Words: In memoriam, newspaper, death, bereavement, obituary. ***** 1. Introduction Cultures have norms concerning expression of grief. A funeral, memorial service, and/or visitation are public and expected; a newspaper obituary invites mourners to attend. However, some mourners also place In Memoriam (IM) advertisements in the newspaper a year or many years later. Such advertisements are often framed as private communications to the deceased, yet are posted in a public forum. The practice is not simply a North American phenomenon; Alali1 examined such advertisements in Nigerian newspapers, identifying several common features. Though bereavement is assumed to be a private, personal experience, it is also a social one.2 Private grief work helps one come to accept the death.3 Reaching out to the outside world may facilitate this process.4 Personal advertisements and “web cemeteries”5 may allow a means to express sadness for a longer time and to a wider audience than might otherwise be possible. Roberts’6 analysis of web cemetery guest books reveals that 29% of entries were written by the memorial author, returning to visit. The memorial is a public venue; postings often refer to anonymous others, e.g., “whoever is reading this.” Almost half of visitors did not know 164 Communicating with the Dead Through the Newspaper ______________________________________________________________ the deceased, suggesting that those who post memorials and those who read them are seeking a broader community in which to discuss grief.7 In Memoriam advertisements may represent attempts to maintain bonds to attachment figures.8 Because attachment bonds are crucial to wellbeing,9 when death severs them, individuals may try to maintain them. Because most separations are temporary, our tendency is to call out for the other, to create and maintain a mental image of them10 and to fantasize about their return.11 In the absence of ongoing physical contact with the person, images may fade into oblivion unless preserved by the living. Recent bereavement research has focused on the ways bonds can be continued in adaptive ways.12 Bereaved individuals must reappraise the meaning of the loss and somehow relocate the deceased in a world in which they are no longer physically present. Coping involves changes in identity (e.g., from wife to widow) and role (e.g., mastering new skills). In a sense, the biographies of self and of the deceased are modified on an ongoing basis.13 This is done through efforts to make sense of the death.14 Because families create their own realities, narrative is the method by which reality is maintained.15 Families discuss whether the death was preventable and tell stories about the deceased, finding ways to characterize the deceased which allow them to construct meaning. For this study, the authors used both a quantitative analysis of the content of IM advertisements, and a qualitative one. The quantitative analysis consisted of frequency counts of advertisement contents. The qualitative analysis employed Burke’s16 method of dramatistic criticism. Burke17 posited that human action can be understood through the metaphor and language of drama. Rhetoric may be analysed by defining the where and when (Scene), what (Act), who (Agent), how (Agency), and why (Purpose) surrounding any particular act or genre of acts. Burke described relationships between any two of these elements as “ratios” referring to the balance between the two, or the relative emphasis of each. Human acts have very different meanings based on which of the five elements is used to define another.18 Memorials published in newspapers provide an intriguing genre for study. Regardless of one’s beliefs regarding life after death, it is odd that a person would communicate with a deceased loved one through a newspaper. Does the sender of the message believe that the newspaper provides a channel accessible to the deceased whereas other channels of communication are not? The critical question of this study is why one would choose this form of communication. Applying Burke’s pentad, the Agent in IM advertisements is the person or people who authors, submits, and pays for them. The Act is the posting of the advertisement. The Scene is the date on which the advertisement appears. The Agency is the advertisement itself. Determining the Purpose is the primary objective of this study. Focusing on the Agency- Patricia Bromley and Mittie Nimocks 165 ______________________________________________________________ Purpose ratio, the ratio that calculates the relationship of means-ends19 illuminates why presumably rational humans would choose the personal advertisements as an agency for communicating with the dead. 2. Method The Wisconsin State Journal (WSJ), a daily newspaper published in Madison, Wisconsin, USA, was used in this study. The WSJ, which mainly has a statewide readership, features IM advertisements on the Personals page in the Classifieds section. We analysed all IM advertisements placed in the WSJ in 2005. We tallied date of the advertisement, gender and age of the deceased, years since death, who placed the advertisement, the apparent audience, the occasion (e.g., anniversary of death, birthday), manner of death, and whether a photograph appeared. The form of the advertisement (e.g., poem, letter) and specific contents were also tallied. Advertisements, which appeared for several days, were only analysed once. 3. Results A. Features of IM Advertisements (Table 1) In 2005, 191 IM advertisements appeared in the WSJ. Most (61.9%) memorialised males and appeared within five years of death (55.3%). The modal number of years since death was one (M = 5.3, range 1-25); the modal age at death was 18 (M = 39.27, range 1-89). The vast majority (79.9%) of authors were relatives, usually “your family.” “Mom” was far more apt to place an advertisement than “Dad” (12.4% versus 2.1%). Advertisements apparently placed by pets comprised 4% of the sample. The deceased appeared to be the audience for the advertisement in 82% of cases. Some advertisements (4.1%) were directed to the public and some (6.2%) to both the deceased and the public. Advertisements were most commonly placed on an anniversary of the death (52.6%) or birthday of the deceased (32%). B. Content of IM Advertisements (Table 2) Ads most commonly featured a photograph of the deceased and a letter or note (57.2%) to the deceased. Poems appeared in 32% of advertisements. Mentions of loving (81.4%), missing (62.9%), and feeling the presence of the deceased (66.5%) were also common. Sadness (23%) and longing for the deceased (18.6%) were less common. Pearson correlations were computed among the variables. Age at death was negatively correlated with presence of a photograph (r = -.16, p < .05). Years since death was positively correlated with presence of an information update for the deceased (r = .156, p < .05). Age at death was negatively cor- related with mentioning the possibility of a reunion with the deceased (r = .19, p < .01). 166 Communicating with the Dead Through the Newspaper ______________________________________________________________ Authors who mentioned loving the deceased also tended to mention missing them (r = .38, p < .01). Mention of love correlated positively with mention of memory (r = .15, p < .05) and of a desire for a reunion (r = .16, p < .05). Longing was positively associated with sadness (r = .20, p <.01). Table 1. Frequencies and Number of Instances in IM Advertisements Feature Gender of Deceased Male Female Unknown Number of Instances Author of Advertisement “Your Family” Mother Both Parents Children Wife Dad Pets Husband Others (step-relatives, names of people) Audience The Deceased Deceased and Public Public Other Unspecified God Occasion Anniversary of Death Birthday of Deceased Other (Christmas, Mothers/Fathers Day, Thanksgiving, Wedding Anniversary) Form Letter or Note Poem Birthday Greeting Other (Epitaph, Bible Verse, Chant/Cheer) Note: n = 191 Frequency 120 67 4 61.9% 34.5% 2.1% 96 24 12 6 5 4 4 3 3 49.5% 12.4% 6.2% 3.1% 2.6% 2.1% 2.1% 1.5% 1.5% 159 12 8 8 3 1 82.0% 6.2% 4.1% 4.1% 1.5% 0.5% 102 62 52.6% 32.0% 11 5.6% 111 63 52.7% 32.5% 7 3.6% 3.1% 6 Patricia Bromley and Mittie Nimocks 167 ______________________________________________________________ C. Application of Burke’s Pentad Scene. The date marked by IM advertisements is significant; advertisements were most commonly placed on an anniversary of the death, publicly marking the significance of that day. Birthdays comprised the second largest category of dates, with other special occasions less frequently recognized. Recently deceased people are most commonly memorialised, suggesting that grief work provides a means of maintaining a relational bond after death but that the bond relaxes with time, for many people. It may feel strongest on the anniversary of death and at holidays. Act. The Act is to send a written and visual message. Nearly always, this message was addressed to the deceased, though a few were directed to the public. The presence of photographs in 80% of advertisements suggests a visual reminder is important. The format was commonly a letter or note to the deceased and the most common message was an expression of love for the deceased, frequently coupled with the message that the deceased was missed. Approximately half of advertisements referred to memories of the deceased. Half mentioned being conscious of time elapsing since the death. Many included wording suggesting that those placing advertisements felt the presence of the deceased, e.g., “Your spirit lives within us.” This supports the theory that the bereaved wish to maintain relationship with the dead. Table 2: Instances of Specific Features of Advertisements Feature Number of Instances Percent Loving Feeling the Deceased is Present Missing Time Passing Memories of the Deceased Making Sense of the Death Sadness Longing Imagining the Deceased Now Reunion with the Deceased Idealization of the Deceased Instructions Update on Family Events Thanks Manner of Death Warning Note: n = 191 158 129 122 98 94 52 46 36 33 30 28 28 19 16 7 6 81.4% 66.5% 62.9% 50.5% 48.5% 26.8% 23.7% 18.6% 17.0% 84.4% 14.4% 14.4% 9.8% 8.2% 3.5% 3.1% 168 Communicating with the Dead Through the Newspaper ______________________________________________________________ In more than 25% of advertisements the writer seemed to be creating a narrative to make sense of the death. A reunion was suggested by approximately 15% of authors and idealization of the deceased in about the same percentage. Thus, the Act appears to weave together words and images reflecting closeness to, and regard for, the deceased. Agency. Placing an advertisement in a daily, regional newspaper, to be posted on a specific date involves planning, time, thought, and money. Such an agency also allows for feedback regarding the message. Feedback may come from those who read the advertisements but also may come in the form of the agency/act itself. Workers at the paper read the advertisement, it is published in the newspaper, and then it is delivered to the author, who then may read it, becoming both receiver and sender of the message. Agents are most often relatives; feedback would return to them, providing additional opportunities for talking with others about the deceased. Purpose. The most frequent message communicated is that the author loves and misses the deceased. Timing of messages on significant dates suggests the wish to communicate is strongest then. Agency-Purpose Ratio. Considering the various reasons other types of messages are communicated through advertisements might offer some insight as to why a living person would choose this channel. Notices of items for sale or items that have been lost and found are placed when the author wishes to communicate with a person unknown (e.g., “I found your ring but I don’t know who you are.”) This reason would not apply to the deceased, as it is clear that this person is well-known to the author. Another reason for placing an advertisement is to communicate with a person whose whereabouts are unknown. This is a more logical rationale, in that while most people know where the physical remains of a loved one are they may feel uncertain of where the spirit or non-physical person resides. 4. Discussion People place personal advertisements as announcements to the general public. In this respect placing an IM advertisement parallels other acts that memorialise a loved one such as placing flowers at graves and erecting roadside crosses. Advertisements may be used not to reach the deceased effectively but as a means of communicating a message publicly. The question becomes not, “why the newspaper?” but, “why the public nature of this intimate communication?” Must it be public so that it may be witnessed? An IM advertisement seeks connection with those who have empathy with the loss and also declares that the relationship continues. A public declaration affirms that a person lived and was important, unique, and loved. It documents the devotion of the partner and the strength of the bond, perhaps offering an opportunity to complete unfinished business or redefine the relationship. Patricia Bromley and Mittie Nimocks 169 ______________________________________________________________ We therefore conclude that there is a dual audience for these advertisements, and that the motivations for their public nature are complex. Most IM advertisements are addressed to the deceased and serve to maintain attachment and affirm beliefs that the relationship between the author and the deceased is intact. Addressing the deceased publicly is a formal declaration of love (and of one’s belief in the afterlife) to which the readership act as witnesses. The 20% of advertisements not specifically directed to the deceased sought community, commemorated the deceased, and rewrote narratives. Notes 1 A Alali, ‘Obituary and In-Memoriam Advertisements in Nigerian Newspapers’. Omega, vol. 28, issue 2, 1993, pp. 113-124. 2 M Stroebe, H Schut, and W Stroebe, ‘Attachment in Coping with Bereavement: A Theoretical Integration’. Review of General Psychology, vol. 9, issue 1, 2005, pp. 48-66. 3 S Freud, ‘Mourning and Melancholia’, in Standard Edition of the Complete Psychological Works of Sigmund Freud, J Strachey (ed), Hogarth Press, London, 1957. 4 J Archer, ‘Broad and Narrow Perspectives in Grief Theory: Comment on Bonnano and Kaltman’. Psychological Bulletin, vol. 127, issue 4, 2001, pp. 554-560. 5 M Moss, ‘Grief on the Web’. Omega, vol. 49, issue 1, 2004, pp. 77-81. 6 P Roberts, ‘The Living and the Dead: Community in the Virtual Cemetery’. Omega, vol. 49, issue 1, 2004, pp. 57-76. 7 P Roberts, ‘Here Today and Cyberspace Tomorrow: Memorials and Bereavement Support on the Web’. Generations, vol. 28, issue 2, 2004, pp. 41-46. 8 J Archer, op. cit., p. 555 9 J Bowlby, Attachment and Loss: Vol. 3: Loss: Sadness and Depression, Basic Books, New York, 1980. 10 J Archer, op. cit., p. 556 11 M Gibson, ‘Melancholy Objects’. Mortality, vol. 9, issue 4, 2004, pp. 285299. 12 M Stroebe, H Schut, and W Stroebe, op. cit., p. 49 13 M Moss, op. cit., p. 77 14 C Davis, S Nolan-Hoeksema, and J Larson, ‘Making Sense of Loss and Benefiting from the Experience: Two Construals of Meaning’. Journal of Personality and Social Psychology, vol. 75, issue 2, 1998, pp. 561-574. 15 J Nadeau, ‘Meaning Making in Family Bereavement: A Family Systems Approach’, in Handbook of Bereavement Research: Consequences, Coping, 170 Communicating with the Dead Through the Newspaper ______________________________________________________________ and Care, M Stroebe, R Hansson, W Stroebe, and H Schut (eds), American Psychological Association, Washington, DC, 2001, pp. 329-348. 16 K Burke, A Grammar of Motives, Prentiss-Hall, New York, 1945. 17 ibid. 18 J Gusfield, Kenneth Burke on Symbols and Society, University of Chicago Press, Chicago, 1989. 19 J Gusfield, op. cit., p. 136 Bibliography Alali, A., ‘Obituary and In-memoriam Advertisements in Nigerian Newspapers’. Omega, vol. 28, issue 2, 1993, pp. 113-124. Archer, J., ‘Broad and Narrow Perspectives in Grief Theory: Comment on Bonnano and Kaltman’. Psychological Bulletin, vol. 127, issue 4, 2001, pp. 554-560. Bowlby, J., Attachment and Loss: Vol. 3: Loss: Sadness and Depression. Basic Books, New York, 1980. Burke, K., A Grammar of Motives. Prentiss-Hall, New York, 1945. Davis, C., S. Nolan-Hoeksema, and J. Larson, ‘Making Sense of Loss and Benefiting from the Experience: Two Construals of Meaning’. Journal of Personality and Social Psychology, vol. 75, issue 2, 1998, pp. 561-574. Eisenhandler, S., ‘The art of consolation: Commemoration and folkways of faith’. Generations, vol. 28, issue 2, 2004, pp. 37-40. Freud, S., ‘Mourning and Melancholia’, in Standard Edition of the Complete Psychological Works of Sigmund Freud, J. Strachey (ed), Hogarth Press, London, 1957. (Original work published 1917). Gibson, M., ‘Melancholy Objects’. Mortality, vol. 9, issue 4, 2004, pp. 285299. Gusfield, J., Kenneth Burke on Symbols and Society. University of Chicago Press, Chicago, 1989. Moss, M., ‘Grief on the Web’. Omega, vol. 49, issue 1, 2004, pp. 77-81. Patricia Bromley and Mittie Nimocks 171 ______________________________________________________________ Nadeau, J., ‘Meaning Making in Family Bereavement: A Family Systems Approach’, in Handbook of Bereavement Research: Consequences, Coping, and Care, M. Stroebe, R. Hansson, W. Stroebe, and H Schut (eds), American Psychological Association, Washington, DC, 2001, pp. 329-348. Reid, J. and C. Reid, ‘A Cross Marks the Spot: A Study of Roadside Death Memorials in Texas and Oklahoma’. Death Studies, vol. 25, issue 4, 2001, pp. 341-355. Roberts, P., ‘The Living and the Dead: Community in the Virtual Cemetery’. Omega, vol. 49, issue 1, 2004, pp. 57-76. Roberts, P., ‘Here Today and Cyberspace Tomorrow: Memorials and Bereavement Support on the Web’. Generations, vol. 28, issue 2, 2004, pp. 41-46. Rosenthal, C., ‘Kinkeeping in the Familial Division of Labour’. Journal of Marriage and the Family, vol. 47, issue 4, 1985, pp. 965-974. Stroebe, M. and H. Schut, ‘The Dual Process Model of Coping with Bereavement: Rationale and Description’. Death Studies, vol. 23, issue 3, 1997, pp. 197-224. Stroebe, M., H. Schut, and W. Stroebe, ‘Attachment in Coping with Bereavement: A Theoretical Integration’. Review of General Psychology, vol. 9, issue, 1, 2005, pp. 48-66. Patricia Bromley is professor of psychology at the University of WisconsinPlatteville. Mittie Nimocks is professor of Communication and Dean of the College of Liberal Arts and Education at the University of Wisconsin-Platteville. Agencies of the Afterlife: Weblogs and Television Shows on Death in the Netherlands Marga Altena Abstract In the Netherlands, Internet sites and television shows present intimate accounts of people dealing with death, mourning and memorialising. Personal diaries, life stories and memorial sites reveal reflections of patients, parents, spouses and friends. Television shows such as Over My Dead Body, in Dutch Over Mijn Lijk, document in detail the impact of a disease, the funeral and how the bereaved cope with their loss. Weblogs and television shows, like any other means of communications, reflect people's ideas and values, but they are also instrumental in the construction of new notions and practices. Although in the Netherlands, people are supposed to be free in the creation of funerary rites, websites and television shows take shape in accordance with traditional techniques and expressions. A close “reading” of the visual and textual expressions in the weblogs and television series of Over My Dead Body, leads to conclude that in the digital realm people find an unprecedented freedom to shape new and personal funerary rites, and that these modern media provide unexpected opportunities to express spiritual feelings. Key Words: Agency, representation, afterlife, weblogs, television shows. ***** Sometimes, scholars can hardly believe me when I tell them about Dutch television shows and weblogs featuring terminally ill people who relate how they cope with death. They ask me: “Why would anyone who is not attention craved or overly exhibitionistic, choose to expose one’s intimate history and sorrow in a public medium?” From an academic point of view scholars find the topic fascinating, but personally, they cannot appreciate these weblogs and shows. Although I can see where these reactions are coming from, (I confess, at first, I felt very much the same), I hope to show that the “Agencies of the Afterlife in Dutch Weblogs and Television Shows” represent a promising research topic that sheds light on how death and dying are perceived today. Moreover, I hope to point out that shows and weblogs on death and dying supply innovative and authentic means for expressing what is most dear and meaningful to people. 174 Agencies of the Afterlife ______________________________________________________________ In the Netherlands, on television and the Internet, diaries, life stories and memorial sites reveal reflections of patients, parents, spouses and friends. My research investigates how death and memorials are represented in these television shows and weblogs, and what meanings of afterlife and spirituality these images and texts convey. Fascinating questions arise about why people feel the need to convey such messages to an unknown audience, and what they hope to achieve by them. Here, I focus on the television series titled Over My Dead Body, a show that is closely intertwined with the Internet. In the television show and on the Internet, the protagonists address the audience: during the show as well as afterwards, they debate subjects related to the show as well as independent topics. In my analysis, I am particularly interested in A. how the new media of television shows and weblogs relate to traditional media in funerary culture, and B. how three parties involved in the making - the producers, the presenter and the protagonists - influenced the shape and content of these media. Because of the time frame, I excluded a fourth party, that of the television audience, which I will discuss elsewhere. 1. Visual Traditions in Dutch Funerary Culture It is likely that people have always needed images to remember dead loved ones. Portraits and objects of the dead not only helped people left behind to keep memories alive, but they also re-defined the relations of the deceased and bereaved. Images, things both reflected and constructed, lost and new identities, were tangible proofs of the ties between the living and the dead. Historical objects show the diversity and the continuous change of funerary imagery. In the Netherlands in 1998, some 150 drawings, prints and paintings of dead persons were accounted for in archives and museum collections.1 These portraits represent only a small part of the total amount of portraits made of dead friends and family, as most of these used to be destroyed when there were no contemporaries left to remember who they were. In Roman Antiquity, sculptured busts of deceased well-to-do citizens depicted as being alive - had a prominent place in rituals of ancestor veneration.2 In the Middle Ages, painted and sculptured death portraits shown as if alive, as a corpse and sometimes even in decay - were still an elite’s privilege. In the seventeenth century, portraits of the dead - presented living and as a corpse - became affordable for the emerging class of rich tradesmen. Although becoming unfashionable in the eighteenth century, romanticism re-introduced death portraits.3 Images of dead people, executed by the new medium of photography, became quite popular again in the nineteenth century. Post mortem photos were put into cassettes and medallions for private use, but they were also presented in photo albums and Marga Altena 175 ______________________________________________________________ exhibited in drawing rooms to be seen for visitors where they had a semipublic function.4 In the Netherlands at the turn of twentieth and twenty first century, new funerary rituals emerged that made prominent use of popular media like television and the internet. In 2008, television and the Internet have become broadly accepted means of communication about dying and death.5 In websites and weblogs people have found a platform to address delicate issues concerning death and dying and an appreciated means to express themselves. 2. Over My Dead Body The television series Over My Dead Body, follows five young terminally ill cancer patients with a life expectancy of only a few months. These people are visited by the show’s presenter over a period of one year resulting in a series of seven episodes. The first series that was aired in 2006 was proclaimed the best Dutch television show of the year. The second series, aired in 2008 equalled the success of the first. To understand why the show was so highly appreciated, we have to look at its construction, especially at the different levels of mediation, the different agents at work in the production of the television show and the website connected to it. In my method, I make a distinction between: 1. the producer, here: the production company and the broadcasting company, 2. the presenter and 3. the protagonists, the dying people who’s stories are told. A. The Producer/The Broadcasting Company Over My Dead Body is made by an independent production company called Skyhigh TV that produces television shows varying from informative political talk shows to light entertainment, and from religiously inspired documentaries to dating shows.6 Skyhigh TV classifies Over My Dead Body as a “Docusoap.”7 Indeed, being a series of stories about several people whom the viewer gets to know and identifies with, the format is not unlike a fictional soap series. Also, the trailer presentation of the protagonists and their “role” resembles that of mainstream fiction soap series. The trailer introduces five young women and men, showing their portraits, names, ages and the diseases they endure. Each 30 minutes episode begins with a voice over giving an update of previous happenings, as if revealing the development of a fiction plot. The show concludes with a preview of upcoming events. These are elements of a format the viewer knows from soap series. Despite the similarities in shape and format, the “docu” element in this “Docusoap” prevents it from having the reception of a regular soap series. The harsh realities the viewer is confronted with are such that it is impossible to watch the show with the carelessness of trivial entertainment. Although the “cliff hanger” invites the audience to “stay with the show,” web 176 Agencies of the Afterlife ______________________________________________________________ comments from the audience reveal that the emotional impact each sequel evokes, prevents people from following the stories as faithfully as they would with fiction shows. In the (still) pillarised Dutch television landscape, the noncommercial broadcasting company of BNN, which presents Over My Dead Body, regards itself a rebel. Serving a predominantly young public, the topics of BNN shows cover the work and social life of youngsters while exploring the boundaries of the acceptable. As the Dutch audience was already used to so-called real life television shows such as Big Brother - a Dutch inventionin which people live together, fight or have sex, the next taboo to be conquered was a show on how people die. Broadcasting company BNN, initiated by Bart de Graaff who himself died after a long disease, claims a particular interest in young people who despite a physical disability or a disease try to realize their ideals. In this respect, Over My Dead Body, a confronting television show about young terminally ill people making the most of life, meets the BNN aims perfectly. Next to that, BNN, declares itself particularly interested in the Internet. B. The Presenter Each episode of Over My Dead Body is a compilation of events taken from the daily life of each protagonist. To make distressing events acceptable for a large audience, the images are combined with up beat music, and difficult moments, such as a disappointing hospital visit, are alternated with happy moments like a colourful good bye party. Presenter Patrick Lodiers has several interconnected roles to play. He explains to the audience what the show is about and what can be expected from the next episode. Next to this traditional mediating role, the presenter seems to function as a friend or even a “buddy” of the protagonists. He visits them and asks intimate, even impertinent questions about their physical condition, about the disease and about how they cope with the prospect of having to die soon. The topics and the combined roles he plays make Lodiers take a more reserved attitude towards the protagonists than is customary among the self-proclaimed “forward” attitude of BNN presenters. Sometimes, when confronted with sudden emotional events, the program format offers Lodiers no structure for how to react, making improvisation necessary. Left to himself, he is forced to act, spontaneously it seems, as a “real life” friend, as when Lodiers appears to be shocked when confronted with the fact that he won’t see a protagonists alive again. The raw realism of these moments and the suggested spontaneity of the presenter’s reaction endears him to the public and contributes to the documentary quality of the show. The complexity of the show’s subject becomes clear when the show’s format is adapted to the presenter’s needs. After the sudden death of Marga Altena 177 ______________________________________________________________ one of the protagonists, the presenter makes an emotional statement for the television audience using the hand held camera usually operated by the protagonists. Also on the show’s Internet page, the presenter reflects on his personal feelings. When after the second series, Lodiers decided not to commit to the moderation of the third series, he explained himself on television shows and on the Internet, discussing the “very heavy” impact the moderation of the series has had for him. On these occasions, the role of the presenter has evolved into one not unlike that of the protagonists. C. The Protagonists A striking characteristic in Over My Dead Body is the strong agency displayed by the protagonists. Although in the first series presented as “guests,” as if they were making a short appearance in a talk show, the five terminally ill people are obviously much more than that. It’s their story that the show and the website focus on - making them protagonists - and it’s their choice of how it is performed - making them “creative consultants” or maybe even “producers.” In the series and in the Internet diaries, their choices dominate the shape and content to an extent unique for non-professionals appearing on television. The protagonists define both the range of the topics the presenter is allowed to touch upon and what can be shared with the audience. The reflections of the protagonists are given attention in a way that is unique for the sound bite driven television culture of today. Clearly, discussing the topic of death supplies ordinary people with a media power temporal and in agency - unseen before. For example, a young woman is portrayed in the process of composing and recording a love song for her husband that is also a farewell song. Both the song and the televised production of it constitute a memorial for herself and her love that would otherwise would not have been made. Through her participation in the show and her creative input, the woman is able to leave her husband and family a unique and personal memorial. The example also touches upon the question as to why people don’t make filmed memorials themselves, since handy cams have become broadly accessible. However, next to the required skill to produce a film or create a weblog, the terminally ill usually need to save their energy to cope with everyday life and to deal with the illness and its treatment. A major attraction of television shows and websites is the opportunity to contact fellow patients and others who understand the experiences of the protagonists. In their reactions, fellow sufferers and sympathizers offer much needed recognition, support and appreciation. Protagonists repeatedly confirm that they are strengthened by the weblog messages. Therefore, it’s not surprising that the website communication between the protagonists and the audience, as well as among the protagonists themselves, far exceeds the duration of the television show. 178 Agencies of the Afterlife ______________________________________________________________ A conspicuous element is that the protagonists of Over My Dead Body all show themselves strongly aware of the impact their death will have for their friends and family. Regularly, their actions and worries concern the way they will die, the preparation of their funeral and how their bereaved will remember them. All the protagonists are troubled by the prospect of causing grief. A young man declares that he does not even allow himself to fall in love because for this very reason. Another protagonist is himself relieved when his family and friends are able to “celebrate life” at his farewell party. At moments like these, the felt responsibility by the protagonist for the bereaved is very apparent. Concerns about the afterlife emerge when the protagonists and their spouses discuss how they imagine themselves after one of them will be dead. People declare that they think the dead person will “still be there” to watch over their loved ones as a guardian angel. Next to that, the protagonists advise their spouses to have a good life after they have gone, and they even discuss the possibility of a new spouse for the future widow or widower. In making public reflections like these, Over My Dead Body functions as a documented consent, a public recognition of the partner’s future choices of life. 3. Conclusion After comparing conventional expressions of Dutch funerary culture with shows and weblogs like Over My Dead Body, it is safe to argue that these new media opened up funerary imagery in providing the opportunity for individual persons – non professionals in funerary culture and media culture - to create a televised and digital memorial of themselves, a mediatised self-portrait. Instead of traditional funerary portraits of both deceased and living people as solemn remembrances, the “celebration of life” and the making of the memorial have become central. In modern television culture, the forceful agency of the participating protagonist particularly stands out. Both television series and weblogs create innovative platforms for the terminally ill and their loved ones to express heartfelt emotions and to contact fellow sufferers and others. These are media that deserve recognition as instruments of agency in obtaining (self) appreciation for individual protagonists and their audience, as well as in the creation of new, “real life” relationships. Notes 1 B Sliggers (ed.), Naar het lijk: Het Nederlandse doodsportret 1500-heden, Walburg Pers, Zutphen, 1998, p. 7. Marga Altena 179 ______________________________________________________________ 2 R Bianco Bandinelli, Die römische Kunst: Van den Anfängen bis zum Ende der Antike, CH Beck Verlag, München 1975, pp. 43-65. 3 B. Sliggers (ed.), Naar het lijk: Het Nederlandse doodsportret 1500-heden, Walburg Pers, Zutphen, 1998, p. 15. 4 J Coppens, M Altena, S Wachlin, Het licht van de negentiende eeuw: De komst van de fotografie in de provincie Noord-Brabant, Eindhoven, 1997, pp. 23, 34, 36. 5 J Enklaar, Onder de groene zoden: De persoonlijke uitvaart. Nieuwe rituelen in rouwen, begraven en cremeren, Alpha, Zutphen, 1995; M Bot, Een Laatste Groet. Uitvaart- en rouwrituelen in multicultureel Nederland, Marrie Bot, Rotterdam, 1998; R L Grimes, Deeply into the Bone: Reinventing Rites of Passage, University of California Press, Berkeley, 2000; C Wouters, ‘The quest for new rituals in dying and mourning’, Body & Society vol. 8, 2002, pp. 1-28; P van den Akker, De dode nabij. Nieuwe rituelen na overlijden, Dela, Tilburg, 2006. 6 http://skyhightv.tv/, viewed on August 21, 2008. 7 The televised ‘in memoriam show’ of I Miss You, in Dutch Ik mis je, is a Skyhigh production for the Evangelistic Broadcasting Company. Bibliography Akker, Van den, P., De dode nabij. Nieuwe rituelen na overlijden. Dela, Tilburg, 2006. Bianco Bandinelli, R., Die römische Kunst: Van den Anfängen bis zum Ende der Antike. C. H. Beck Verlag, München 1975. Bot, M., Een Laatste Groet. Uitvaart- en rouwrituelen in multicultureel Nederland. Marrie Bot, Rotterdam, 1998. Coppens, J., M. Altena, and S. Wachlin, Het licht van de negentiende eeuw: De komst van de fotografie in de provincie Noord-Braban. Eindhoven, 1997. Enklaar, J., Onder de groene zoden: De persoonlijke uitvaart. Nieuwe rituelen in rouwen, begraven en cremeren. Alpha, Zutphen, 1995. Grimes, R. L., Deeply into the Bone: Re-inventing Rites of Passage. University of California Press, Berkeley, 2000. Sliggers, B. (ed.), Naar het lijk: Het Nederlandse doodsportret 1500-heden. Walburg Pers, Zutphen, 1998. 180 Agencies of the Afterlife ______________________________________________________________ Wouters, C., ‘The Quest for New Rituals in Dying and Mourning.’ Body & Society, vol. 8, 2002, pp. 1-28. Marga Altena is a historian of visual culture at the Radboud University Nijmegen. She researches films, tv shows and weblogs on death and dying. PART III Ethical Re-Imaging Physician-Assisted Suicide and the Supreme Court: A Decade in the Life of a Constitutional Issue That’s “Not Dead Yet” Arthur G. Svenson and Susan M. Behuniak Abstract Our research examines the legal and constitutional questions underpinning the conflict over physician-assisted suicide between state and national governments in the United States, each laying claim over sovereign prerogative to decide this end-of-life issue. We advance the following thesis: informed by the Supreme Court’s ruling in Gonzales v. Raich (2005), that on constitutional grounds the Controlled Substances Act pre-empted California’s law legalizing the intrastate, non-commercial consumption of marijuana for medicinal purposes, if Congress had the legislative will to explicitly criminalize a physician’s prescription of admittedly interstate and commercial substances to assist in the suicides of others, the resulting constitutional question whether Congress had exceeded its Commerce Clause power would be resolved in favour of Congress, not state law contrary to it. Key Words: constitution, physician-assisted suicide, medical marijuana, supreme court, federalism, commerce clause ***** 1. Introduction In its landmark resolution of Washington v. Glucksberg,1 the United States Supreme Court rejected constitutional arguments to nationalize a right to physician-assisted suicide (PAS). In that case, the Court reasoned that if such a right were to be established in our federal system of government, advocates for its legalization would have to prevail in the “earnest and profound debate about the morality, legality, and practicality of physicianassisted suicide” in their respective states.2 As Justice O’Connor explained in her concurring opinion, “[s]tates are presently undertaking extensive and serious evaluations of physician-assisted suicide and other related issues [emphasis added]. In such circumstances, ‘the...challenging task of crafting appropriate procedures for safeguarding...liberty interests is entrusted in the ‘laboratory’ of the states...in the first instance.’”3 Among all state laboratories, Oregon’s produced the nation’s first voter-approved initiative legalizing PAS in 1994,4 an experiment that was successfully repeated in 1997 following a state legislature-driven effort aimed at its repeal.5 In the decade since Oregon’s Death With Dignity Act (DWDA) 184 Physician-Assisted Suicide and the Supreme Court ______________________________________________________________ became effective, 341 qualified Oregonians have died after having selfadministered a lethal dosage of physician-prescribed drugs.6 Efforts to legalize PAS in other states have occurred but none successfully. As if encouraged by the Glucksberg holding—and as if inspired to do so on O’Connor’s cue in particular—state laboratory experiments on “other related issues” continue to occur. Among those issues that most closely parallel PAS is the “profound and earnest” debate over the legalization of medical marijuana (MM). Just two years after Oregonians initially adopted their DWDA, advocates of MM scored their first legislative victory when, in 1996, a voter-approved initiative codified California’s Compassionate Use Act (CUA);7 since that time, twelve other states have adopted similar measures. Discouraged and uninspired by state initiatives legalizing PAS and MM, opponents of both have long observed that an “earnest and profound debate about the morality, legality, and practicality” of such policies has also occurred at the national government—and decades prior to the Oregon and California experiments; moreover, “extensive and serious evaluations” of the “health and general welfare of the American people” explain why Congress adopted the Controlled Substances Act (CSA) of 1970.8 Among its many provisions that aim at “drug abuse prevention and control,” PAS and MM opponents stress that the language of the CSA, accompanying administrative rules attached to it over time, and, of course, the Constitution’s Supremacy Clause of Article VI, conspire to neuter state legislative enactments contrary to it, including (1) Oregon’s DWDA, since federally-approved drugs may not be used for purposes prohibited by the CSA, and (2) California’s CUA, since drugs prohibited by the CSA may not be used for purposes other than federally-approved research. Nearly a decade after state-inspired PAS and MM movements took root, the Bush Administration navigated legal arguments to quash Oregon and California laws all the way to the Supreme Court: in 2005, Gonzales v. Raich9 sustained arguments that Congress’ Commerce Clause power, on which the CSA is based, pre-empted state laws legalizing MM; in 2006, however, Gonzales v. Oregon10 held that the Justice Department’s interpretation of the CSA, aimed at prohibiting PAS, was not authorized by the plain language of the law. Our research provides a comparative analysis of the Supreme Court’s resolution of national-state conflicts central to the PAS and MM cases. In section one, an overview of Oregon’s DWDA, California’s CUA, and Congress’ CSA is presented to isolate the core legal strategies developed in Washington to nationalize prohibitions against PAS and MM. In section two, the Court’s holdings in Raich and Oregon are vetted. Three overarching themes of constitutional interpretation generated by the Raich Court are revealed. First, even in the absence of specific statutory findings, Congress Arthur G. Svenson and Susan M. Behuniak 185 ______________________________________________________________ could have had a “reasonable basis” to conclude that California’s legalization of intrastate, non-commercial MM would have had a “significant effect” on marijuana’s illegal interstate market. Second, the “outer limits” of Congress’ Commerce Clause power were categorically not at play in sustaining the reach of the CSA to intrastate, non-commercial production and consumption of marijuana for medical purposes; with the nearly universally venerated Wickard v. Filburn11 serving as Raich’s precedential touchstone, the Court concluded that “new era” case law clearly justifies the imposition of the Government’s “final word” on MM in California. Third, not a word in Raich casts doubt on the constitutionality of the CSA in toto, which, the Court concludes, is “a concededly valid statutory scheme,”12 controlling activities “quintessentially economic” in nature.13 In section three, we argue that in the wake of Raich’s overarching themes, the life of Oregon’s DWDA is gravely imperilled, and so it is despite Oregon’s thumping of the Bush Administration over PAS. Our thesis is this: if Congress had the legislative will to amend the CSA explicitly criminalizing a physician’s prescription of admittedly interstate and commercial substances to assist in the suicides of others, the resulting constitutional question whether Congress had exceeded its Commerce Clause power would be resolved in favour of Congress, not state law contrary to it. 2. Physician-Assisted Suicide, Medical Marijuana, and the Controlled Substances Act In the early 1990’s, prohibitions against PAS and MM existed in every state; in some, however, opinion polls indicated that the legalization of such activities might be tolerated albeit on a very limited basis. Thus, for drafters of PAS and MM initiatives, narrowly crafted exceptions to existing bans emerged as central legislative strategies. In both instances, opposition forces sounded a similar theme of alarm: the “slippery slope”—and one that played out in a host of variations. For PAS opponents in Oregon, the slippery slope conjured up unimaginable images of paradise lost. Should even the most narrowly and carefully crafted exception to assisted suicide be legalized, a “parade of horribles” would follow, from physician-assisted deaths of terminally-ill patients, to physician-assisted, even physician-administered deaths of patients with debilitating not terminal conditions, and ultimately to the horror of the very real-world killing fields of Nazi Germany. For MM opponents in California, the slippery-slope argument was ubiquitously applied. Such a law would “provide new legal loopholes” negatively impacting on the state’s prosecutorial efforts of drug dealers, marijuana as a “gateway drug” would cause youth to experiment with and to grow increasingly dependent upon more powerfully addictive and deadly drugs, and fears, too, about marijuana- 186 Physician-Assisted Suicide and the Supreme Court ______________________________________________________________ prescribing physicians who would unwittingly or otherwise become practitioners against whom the “war on drugs” is waged. To counter slippery-slope theme and variations, the PAS initiative in Oregon and the MM initiative in California were written with language that proponents believed would satisfy voters without compromising their state’s respective interest in protecting the sanctity of life—drug free. In the case of Oregon’s DWDA,14 those who qualified for suicide assistance became a narrowly circumscribed group, and the means available to facilitate “a humane and dignified” death were restricted to one, the selfadministering of a prescription drug, making mercy killing of any sort still illegal. To qualify for PAS, a patient had to be an adult resident of Oregon who is “capable” of making health-care decisions, and who is dying from a terminal illness, i.e., one that is “incurable and irreversible” and will “within reasonable medical judgment, produce death within six months.” The patient’s condition needed to be confirmed by both attending and consulting physicians, and should either physician suspect that the patient suffers from any “psychiatric or psychological disorder, or depression causing impaired judgment,” professional counselling is mandatory. The patient’s decision to die had to be made voluntarily, requiring two oral requests for assisted suicide separated by no less that fifteen days, as well as a written request witnessed by two persons attesting that “the patient is capable, acting voluntarily, and is not being coerced to sign the request.” California’s CUA15 was drafted to counter “slippery-slope” arguments as well. The two purposes central to the initiative were these: first, “[t]o ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes...recommended by a physician...in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief”; and second, “[t]o ensure that patients...are not subject to criminal prosecution or sanction”—an immunity also applicable to physicians. To achieve these purposes, the CUA carved out limited exceptions to existing state law otherwise prohibitive of both marijuana possession and cultivation: neither prohibition, the CUA stipulated, would “apply to a patient...who possesses and cultivates marijuana for the personal medical purposes of the patient upon the written or oral recommendation or approval of a physician.” On November 8, 1994, Oregonians approved the state’s DWDA by a narrow 2% of the vote; and when, on November 4, 1997, the state legislature mandated that a second canvassing of voter sentiments occur, the Act was approved again, this time by a startling margin of 20%. California’s CUA was also approved, by 56% of the voters, on November 5, 1996. While proponents rejoiced, those having lost these battles sought to win the war in Washington. For this purpose, members of the congressional and executive Arthur G. Svenson and Susan M. Behuniak 187 ______________________________________________________________ branches looked approvingly—and hopefully—toward the Controlled Substances Act of 1970. The CSA was designed to consolidate existing federal drug statutes to bring a unified and comprehensive regulatory approach to the “illegal importation, manufacture, distribution and possession and improper use of controlled substances [that] have a substantial and detrimental effect on the health and general welfare of the American people.”16 Congress passed the Act pursuant to its constitutional grant of power to regulate “Commerce...among the several States.” Significantly, however, the Act’s regulatory scope included the intrastate manufacture, distribution, and possession of controlled substances, and for three primary reasons: first, “[l]ocal distribution and possession of controlled substances contribute to swelling the interstate traffic in such substances”;17 second, “it is not feasible to distinguish, in terms of controls, between controlled substances manufactured and distributed interstate and controlled substances manufactured and distributed intrastate”;18 and third, “[f]ederal control of the intrastate incidents of the traffic in controlled substances is essential to the effective control of the interstate incidents of such traffic.”19 The Act groups all controlled substances into one of five schedules: schedule I drugs are those for which no accepted medical use has been established, and with which only tightly-supervised, federally approved research is permitted; schedules II through V include drugs with proven medical benefits, arranged in descending order based upon an assessment of the substance’s relative degree of risk to “the health and general welfare of the American people.” The controlled substances “prescribed” by Oregon physicians to hasten a patient’s death, pentobarbital and secobarbital, are located in schedule II; the controlled substance “recommended” by California physicians to comfort the ill patient, marijuana, is located in schedule I. The argument to neuter PAS embraces combinations of sections of the CSA plus an administrative interpretation of a Justice Department regulation appended to the Act in 1971. The Act empowers the Attorney General to suspend or revoke a physician’s drug-prescribing license for professional behaviour deemed “inconsistent with the public interest.”20 The Act stipulates that the Attorney General’s determination of the “public interest” shall be guided by a number of factors, including “compliance with applicable State and local law” and “factors as may be relevant to and consistent with the public health and safety.”21 Most significantly, physicians can only distribute controlled substances with a “written prescription.”22 In 1971, then-Attorney General John Mitchell authored an administrative regulation intended to enhance the “efficient execution” of the prescription language of the Act: accordingly, “[a] prescription for a controlled substance to be effective must be issued for a legitimate medical purpose”.23 The ultimate piece in the CSA argument was provided by President Bush’s 188 Physician-Assisted Suicide and the Supreme Court ______________________________________________________________ Attorney General John Ashcroft, whose administrative interpretation of Mitchell’s regulation—the “Ashcroft Directive”—was announced on November 9, 2001. Wrote Ashcroft: “I hereby determine that assisting suicide is not a ‘legitimate medical purpose’...and that prescribing, dispensing, or administering federally controlled substances to assist suicide violates the CSA.”24 The statutory challenge to MM stems from fewer and seemingly less ambiguous sections of the CSA; moreover, no “administrative interpretation” of an “administrative regulation” is seized upon as Washington’s knockout weapon. The CSA classifies “marihuana” as a Schedule I drug because of its “high potential for abuse,” and the absence of any currently accepted medical use”.25 For opponents, then, the legal argument against MM rested on secure ground: although California law exempted MM from the criminal code, the CSA clearly embraced no such safe-harbour. Moreover, that Congress had stipulated in the Act to “findings and declarations” that connected “local distribution and possession of controlled substances” to interstate commerce redoubled the optimism of MM critics that their arguments would persuade even the most ardent supporters of states’ rights on the federal bench. 3. MM, PAS, and Federalism: The Supreme Court Decides Those seeking to nationalize a prohibition against PAS invoke the CSA to demonstrate not that the drug prescribed to induce death is forbidden, but that the purpose of the prescription is; those seeking to nationalize a prohibition against MM invoke the CSA to demonstrate not that the purpose of the “recommendation” is forbidden, but that the drug itself is. Of the two issues, the legal struggle between national and state governments over MM arrived at the Supreme Court first. A. Gonzales v. Raich (2005) The Drug Enforcement Administration (DEA) raid in Butte County, California, that precipitated the constitutional question in Gonzales v. Raich occurred on August 15, 2002; federal agents seized a number of marijuana plants, in compliance with authority under the CSA, cultivated and consumed by Angel McClary Raich, in compliance with the state’s CUA. Raich had “been diagnosed with more than ten serious medical conditions, including an inoperable brain tumour, life-threatening weight loss, a seizure disorder, nausea, and several chronic pain disorders.”26 Raich consumed marijuana as medication since thirty-five prior prescriptions were either ineffective or caused intolerable side effects. Her doctor’s prognosis? “[F]oregoing marijuana treatment may be fatal.”27 Having been deprived of her medical lifeline by the DEA, Raich brought suit against Attorney General Ashcroft, later Roberto Gonzales, claiming that the CSA as applied to California’s CUA was unconstitutional. Arthur G. Svenson and Susan M. Behuniak 189 ______________________________________________________________ A Federal District Court rejected Raich’s claim for a variety of reasons, including (1) explicit prohibitions in the CSA against marijuana;28 (2) congressional findings that intrastate and interstate manufacture and distribution of controlled substances were indistinguishable, making both, therefore, subject to federal control;29 and (3) “by the weight of precedent” validating the Act itself.30 To that court’s astonishment, a divided 9th Circuit reversed its judgment on appeal. The appellate court’s conceptualisation of the “class of activity” that Washington sought to extinguish served as the keystone to the resolution of the case: that class, the Court explained, was “the intrastate, non-commercial cultivation and possession of cannabis for personal medical purposes as recommended by a patient’s physician pursuant to valid California state law.”31 Governed by the specificity of this “class of activity,” the Court asserted that MM “is, in fact, different in kind from drug trafficking”: first, the marijuana Raich consumed is cultivated “us[ing] only soil, water, nutrients, growing equipment, supplies and lumber originating from or manufactured within California”;32 and second, Raich’s “medicinal marijuana...is not intended for, nor does it enter, the stream of commerce,” and no part of her consumption of it is commercial.33 Therefore, since the linkages between MM and interstate commerce “are, indeed, attenuated...we find the CSA, as applied to [Ms. Raich] is likely unconstitutional.”34 The Supreme Court announced its decision in Gonzales v. Raich on June 6, 2005. By a whopping 6-3 vote, the judgment of the 9th Circuit was reversed: intrastate and non-commercial MM, “never more than an instant from the interstate market,” observed Scalia,35 was subject to federal control. For dissenting Justices O’Connor, Thomas, and Chief Justice Rehnquist, losing the battle over medical marijuana was a bitter pill to be sure, most especially since Justices Scalia and Kennedy apparently abandoned the twin precedents of United States v. Lopez (1995)36 and United States v. Morrison (2000)37 that all five had forcefully advanced to restrict the regulatory scope of Congress’ commerce clause power. Lopez involved the constitutionality of Congress’ “Gun-Free School Zones Act of 1990,” that made it a federal crime to possess a firearm within a designated parameter surrounding public or private schools. For the Court, Chief Justice Rehnquist maintained that congressional commerce power extends to “three broad categories of activity”: first, to “regulate the use of the channels of interstate commerce”; second, “to regulate and protect the instrumentalities of interstate commerce, or persons or things in interstate commerce, even though the threat may come only from intrastate activities”; and third, “to regulate those activities having a substantial relation to interstate commerce, i.e., those activities that substantially affect interstate commerce.”38 In light of category three, Rehnquist concluded that Congress’ Act was unconstitutional since it had “nothing to do with ‘commerce’ or any sort of economic enterprise”.39 In Morrison, Congress’ “Violence Against 190 Physician-Assisted Suicide and the Supreme Court ______________________________________________________________ Women Act of 1994” was challenged, and similar tensions over the appropriate scope of congressional commerce power reappeared. With Lopez as his guide, Rehnquist clarified several “significant considerations” in determining when intrastate activities “substantially affect” interstate commerce, the third Lopez category. Among these considerations—for purposes of both PAS and MM adjudication as matters will unfold—two emerged prominently: first, whether the statute in question actually regulates commerce; and second, whether the link between the regulated activity and the significant effect on interstate commerce is “attenuated.” Guided by these considerations, Rehnquist concluded that “[g]ender-motivated crimes of violence are not, in any sense of the phrase, economic, and the link between “the cost of crime” and “national productivity” is so attenuated that if the link is not rejected “Congress might use the Commerce Clause to completely obliterate the Constitution’s distinction between national and local authority”.40 According to Justice O’Connor, then, the Raich majority of 2005 had succeeded in obliterating the nation-state distinction “without any proof that the personal cultivation, possession, and use of marijuana for medicinal purposes, if economic activity in the first place, has a substantial effect on interstate commerce and is therefore an appropriate subject of federal regulation.”41 As for dissenting Justice Thomas, if “the majority is to be taken seriously, the Federal Government may now regulate quilting bees, clothes drives, and potluck suppers throughout the 50 States...mak[ing] a mockery of Madison’s assurance...that the ‘powers delegated’ to the Federal Government are ‘few and defined,’ while those of the States are ‘numerous and indefinite.’”42 For six justices, however, the line separating enumerated national powers and those reserved to states had not been breached. Far from it, as Justice Stevens admonished: in light of the Court’s nullification of the GFSZA in Lopez, the “statutory scheme that the Government is defending in this litigation is at the opposite end of the regulatory spectrum.”43 True, admitted Stevens, the Government’s case against California’s legalization of MM lacked detailed findings establishing a meaningful nexus between intrastate, non-commercial MM, and marijuana’s illegal interstate market. But the expectation of detailed findings from Congress “is not only unprecedented, it is also impractical.”44 As a general rule, Stevens opined, “Congress cannot be expected (and certainly should not be required) to include specific findings on each and every substance contained [in the CSA] in order to satisfy the dissenters’ unfounded scepticism.”45 How, then, did Stevens manage to demonstrate that California’s legalization of intrastate, non-commercial MM had a “significant effect” on interstate commerce when Congress had not done so itself? Said Justice Stevens: “We need not determine whether respondents’ activities, taken in Arthur G. Svenson and Susan M. Behuniak 191 ______________________________________________________________ the aggregate, substantially affect interstate commerce in fact, but only whether a ‘rational basis’ exists for so concluding.”46 In this way, because the product is “fungible,”47 because the war on drugs persists despite lawenforcement efforts,48 because “care givers” will not stop the production of marijuana when a care-giver’s patient either recovers or dies,49 and because California has established no limit on the permissible amount of marijuana a patient may possess,50 the Court could fairly conclude that Congress could have had a “reasonable basis” to believe intrastate, non-commercial MM has a significant effect on that drug’s $10.5 billion illegal interstate market.51 “The notion,” Stevens reasons, “that California law has surgically excised a discrete activity that is hermetically sealed off from the larger interstate marijuana market is a dubious proposition, and, more importantly, one that Congress could have rationally rejected.”52 Finally, that Congress could have had a “rational basis” for imposing the final word on state legalization of MM does not signify that Congress has pushed its regulatory power “beyond the ‘outer limits’ of [its] Commerce Clause authority.”53 Noting that the Government has had nearly a century’s worth of experience with drug regulation,54 the Stevens majority contends that its ruling is not only consistent with Lopez and Morrison, but its similarities with Wickard v. Filburn55—the mother of all Commerce Clause cases—are “striking.”56 Justice Stevens: “In both cases, the regulation is squarely [emphasis added] within Congress’ commerce power because production of the commodity meant for home consumption, be it wheat or marijuana, has a substantial effect on supply and demand in the national market for that commodity.”57 Even Justice Scalia in his concurring, “more nuanced” opinion, presses the point that no “violation of state sovereignty of the sort that would render this regulation ‘inappropriate’ [has occurred in Raich], —except to argue that the CSA regulates an area typically left to state regulation.”58 In sum, the Raich message was quite clear: first, Congress could have had a “rational basis” to trump state law legalizing intrastate, noncommercial medical use of marijuana;59 second, the ruling squares with a century of “new era” case law60 that “firmly establishes Congress’ power to regulate purely local activities that are part of an economic ‘class of activities’ that have a substantial effect on interstate commerce”;61 and third, the CSA is “a concededly valid statutory scheme.”62 If the democratic forces at work in the creation of the CSA failed to account properly for the independent judgments of sovereign state governments, then, as Stevens concludes, the “voices of voters...may one day be heard in the halls of Congress.”63 For all that PAS and MM have in common as experiments “in the ‘laboratory’ of the states,” since state legalization of MM is pre-empted by 192 Physician-Assisted Suicide and the Supreme Court ______________________________________________________________ federal prosecutors enforcing the zero-tolerance reach of the CSA, would a similar holding apply to Oregon’s defence of PAS? B. Gonzales v. Oregon (2006) The statutory question presented to the Supreme Court in Gonzales v. Oregon was framed in this way: “[W]hether the CSA allows the United States Attorney General to prohibit doctors from prescribing regulated drugs in use in physician-assisted suicide, notwithstanding a state law permitting the procedure.”64 Unlike the conflict over MM, that the PAS question as framed raised no constitutional issues ultimately proved decisive. Oregon’s challenge to the Ashcroft Directive triumphed in Federal District Court,65 and again, in a divided Court of Appeals.66 In both cases, the Ashcroft Directive was invalided solely on statutory grounds. After a careful and pithy review of the language, legislative history, and relevant case law associated with the CSA, the District Court claimed that “Congress did not intend the CSA to override a state’s decision concerning what constitutes legitimate medical practice, at least in the absence of an express federal law prohibiting that practice [emphasis added].”67 As for the Attorney General’s role in acting to supersede Oregon’s legalization of PAS, the Judge sounded a note of astonishment: “[t]o allow an attorney general—an appointed executive whose tenure depends entirely on whatever administration occupies the White House—to determine the legitimacy of a particular medical practice without a specific grant of such authority [emphasis added] would be unprecedented and extraordinary.”68 On appeal, the Circuit Court sustained this holding and did so for virtually the same reasons. In a 6-3 ruling, the Supreme Court affirmed Oregon’s claims that the language of the CSA did not authorize the Ashcroft Directive. According to Justice Scalia, in dissent, “The question before us is not whether Congress can do this, or even whether Congress should do this; but simply whether Congress has done this in the CSA.”69 Central to the Government’s case that Congress had authorized the Attorney General to criminalize PAS involved its reliance upon a rule set down in Chevron U.S.A., Inc. v. Natural Resources Defence Council, Inc.70 As Cass Sunstein explains, Chevron is widely regarded “as a kind of counterMarbury,”71 meaning, to paraphrase Chief Justice Marshall, “[i]t is emphatically the province and duty of the [bureaucracy] to say what the law is.”72 Lawrence Tribe describes the Chevron rule in this way: “if the statute is silent or ambiguous with respect to a specific issue, the question of the Court becomes ‘whether the agency’s answer is based on a permissible construction of the statute; that is, whether the agency’s interpretation is ‘reasonable,’ or ‘rational’ and consistent with the statute.”73 For this reason, Tribe explains, “Chevron comes close to installing agencies...as mini-congresses and minijudiciaries at the same time.”74 What, then, would make the Ashcroft Arthur G. Svenson and Susan M. Behuniak 193 ______________________________________________________________ Directive “reasonable,” worthy of Chevron deference? A number of factors, the Government maintains. First, the CSA expressly grants authority to the Attorney General to “promulgate and enforce rules, regulations, and procedures...for the efficient execution of his functions under the CSA”.75 Second, the CSA authorizes the Attorney General to suspend or revoke a physician’s drug-prescribing license for professional behaviour “inconsistent with the public interest.”76 And third, according to Attorney General Mitchell’s regulation of 1971, only prescriptions for a “legitimate medical purpose” promote “the public interest.” Was it, therefore, unreasonable for Attorney General Ashcroft to conclude that PAS is not a “legitimate medical purpose” when (1) 49 states and the federal government “emphatically oppose assisted suicide”;77 when (2) “leading organizations of the medical profession, including the American Medical Association, American Nurses Association, and the American Psychiatric Association, consider PAS “fundamentally incompatible with the physician’s role as healer”;78 and when (3) as the Court made clear in Washington v. Glucksberg (1997) “in almost every western democracy–it is a crime to assist a suicide”?79 For the Court’s majority, however, the powerful Chevron rule is applicable only when the interpretation is “promulgated pursuant to authority congress has delegated to the official.”80 In Justice Kennedy’s opinion for the Court, the CSA narrowly restricts the Attorney General’s rulemaking authority to matters over “the registration and control of...listed chemicals.”81 True, the registration provisions empower the Attorney General to grant and revoke a physician’s prescriptive license, but in doing so a number of factors must be considered, among them “the State’s recommendation [and] compliance with state, federal, and local laws regarding controlled substances”.82 Since the Ashcroft Directive relied on none of these factors, and more, since its aim was not the “control” of a drug (“to add a drug...to a schedule”83) but to “define standards of medical practice,”84 Kennedy concluded that Chevron deference was not warranted. As such, “The idea that Congress gave the Attorney General such broad and unusual authority through an implicit delegation in the CSA’s registration provision is not sustainable.”85 In an enormously revealing concluding observation, we believe, Justice Kennedy opines that although “regulation of health and safety is ‘primarily, and historically, a matter of local concern, there is no question that the Federal Government can set uniform national standards in these areas.”86 And what is required of Congress if it chooses to occupy an area of “health and safety”? Simple, he explains: “[Congress] does so by explicit language in the statute.”87 194 Physician-Assisted Suicide and the Supreme Court ______________________________________________________________ 4. Physician-Assisted Suicide in the Wake of Raich Because of Raich, state law legalizing MM no longer immunizes state citizens form federal prosecutors enforcing the zero-tolerance reach of the CSA, even into the intraparcel connection between the backyard production of marijuana and the front room consumption of it to palliate pain and/or to dodge death. But Oregon’s victory only a year later seemed uncomfortably unfinished since in its journey through federal courts none of the prevailing opinions could be read to have foreclosed the possibility that Congress could act constitutionally to prohibit PAS. Assume that Congress had the legislative will to ban the use of controlled substances in PAS, and to do so Congress amended the CSA by either (1) expressly prohibiting such a use, or (2) expressly delegating to the Attorney General the necessary rulemaking authority to distinguish legitimate vis-à-vis illegitimate medical uses of controlled substances. Could Oregon prevail against Congress arguing that either amendment is situated beyond even the “outer limits” of the Commerce Clause power? We think not, and for reasons advanced in Raich. Proponents of MM and PAS assert that surgically-drafted exemptions from the regulatory scope of the CSA are justified: in California’s case because the marijuana in MM is intrastate and noncommercial, not because control over the practice of medicine is a sovereign state power; and in Oregon’s case because the control over the practice of medicine is a sovereign state power, not because controlled substances used by physicians and pharmacists to hasten death are intrastate and noncommercial. That Oregon seeks to distance itself from Raich on the grounds that “the practice of medicine” exists “at the heart of the states’ historic police powers” is, to be sure, a distinction with a difference, but that difference, we argue, only weakens Oregon’s case further. Both Lopez and Morrison invalidated laws of Congress because neither regulated economic activities that significantly affected, in an unattenuated fashion, interstate commerce. Raich involved intrastate, noncommercial activities that the High Court held Congress could have had a “reasonable basis” to believe possessed a “significant effect on interstate commerce”—and without “piling assertion upon assertion” to establish that the nexus was not attenuated. If Congress prohibited the use of a controlled substance for a purpose explicitly deemed illegitimate, or explicitly delegated that authority to the Attorney General, then the Court would be evaluating the constitutionality of an act that controls substances because they are both interstate and commercial—and Oregon agrees, having stipulated to the fact that “it is likely that the drugs in question have travelled in interstate commerce.”88 In its defence, Oregon contends that the amounts of controlled substances used in PAS are “unremarkable,”89 and “would be insignificant by any measure.”90 In this way, Oregon relies on Lopez and Morrison to Arthur G. Svenson and Susan M. Behuniak 195 ______________________________________________________________ conclude that it is just not possible that the practice of PAS could have “a significant effect on interstate commerce.” But Raich counsels otherwise: quoting from Maryland v. Wirtz,91 the Court reaffirms that where “a general regulatory statute bears a substantial relation to commerce, the de minimis character of the individual instances arising under the statute is of no consequence.”92 Wirtz to Oregon: Since the CSA regulates “quintessentially economic [activities],” the trifling amounts of controlled substances ingested in PAS are of no concern to the Supreme Court. In the wake of Raich, add one more similarity to those that exist between MM and PAS: in the end, we believe, Congress could triumph over both. And perhaps yet another similarity, too. Conceivably, a thought similar to Steven’s final comment in Raich might one day serve the Supreme Court in a concluding paragraph of a decision that validates a congressional law criminalizing PAS: if democratic forces at work in the creation of the CSA failed to carve out a sovereign role for state governments to determine for themselves what is a “legitimate medical purpose,” then “the voices of voters...may one day be heard in the halls of Congress.”93 Notes 1 Washington v. Glucksberg, 521 U.S. 702 (1997). ibid, p. 735. 3 ibid, p. 737. 4 Oregon Death With Dignity Act, Ballot Measure 16, 8 Nov. 1994. 5 Oregon Ballot Measure 51, 4 Nov. 1997. 6 Oregon Department of Human Services, Summary of Oregon’s Death with Dignity Act-2007, March, 2008, p. 2. 7 California Compassionate Use Act, 5 Nov. 1996. 8 Controlled Substances Act, 21 U.S.C. §§ 801 et seq. 9 Gonzales v. Raich, 125 S. Ct. 2195 (2005). 10 Gonzales v. Oregon, 126 S.Ct. 904 (2006). 11 Wickard v. Filburn, 317 U.S. 111 (1942). 12 125 S. Ct. 2195, 2209 (2005). 13 ibid, p. 2211. 14 Oregon Death With Dignity Act, Oregon Revised Stat. §127.800-127.995 (1994). 15 California Compassionate Use Act, Cal. Health and Safety Code, §11362.5 (1996). 16 Controlled Substances Act, 21 U.S.C. §801. 17 ibid, §801(4). 18 ibid, §801(5). 19 ibid, §801(6). 2 196 Physician-Assisted Suicide and the Supreme Court ______________________________________________________________ 20 ibid, §824. ibid, §823. 22 ibid, §829. 23 21 C.F.R. 1306.04. 24 Dispensing of Controlled Substances to Assist Suicide, 66 Fed. Reg. 56607, 9 Nov. 2001. 25 ibid, §812(b)(1). 26 Raich v. Ashcroft, 352 F. 3d 1222, 1226 (9th Cir. 2003). 27 ibid. 28 Raich v. Ashcroft, 248 F. Supp. 2d 918, 920 (N. D. Cal 2003). 29 ibid, p. 926. 30 ibid, p. 925. 31 Raich v. Ashcroft, 352 F. 3d 1222, 1228 (9th Cir. 2003). 32 ibid, p. 1226. 33 ibid, p. 1228. 34 ibid, p. 1234. 35 Gonzales v. Raich, 125 S. Ct. 2195, 2219 (2005). 36 United States v. Lopez, 514 U.S. 549 (1995). 37 United States v. Morrison, 529 U.S. 598 (2000). 38 United States v. Lopez, 514 U.S. 549, 558 (1995). 39 ibid, p. 561. 40 United States v. Morrison, 529 U.S. 598, 674 (2000). 41 United States v. Raich, 125 S. Ct. 2195, 2221 (2005). 42 ibid, p. 2236. 43 ibid, p. 2210. 44 ibid, p. 2208. 45 ibid. 46 ibid. 47 ibid, p. 2206. 48 ibid, p. 2214. 49 ibid. 50 ibid, p. 2215. 51 ibid, p. 2208. 52 ibid, p. 2213. 53 ibid, p. 2212. 54 ibid, p. 2202. 55 Wickard v. Filburn, 317 U.S. 111 (1942). 56 Gonzales v. Raich, 125 S. Ct. 2195, 2206 (2005). 57 ibid, p. 2207. 58 ibid, p. 2220. 59 ibid, p. 2208. 21 Arthur G. Svenson and Susan M. Behuniak 197 ______________________________________________________________ 60 ibid, p. 2205. ibid. 62 ibid, p. 2209. 63 ibid, p. 2215. 64 Gonzales v. Oregon, 126 S. Ct. 904, 911 (2006). 65 Oregon v. Ashcroft, 192 F. Supp. 2d 1077 (D. Or. 2002). 66 Oregon v. Ashcroft, 368 F. 3d 1118 (9th Cir. 2004). 67 Oregon v. Ashcroft, 192 F. Supp. 2d 1077, 1084 (D. Or. 2002). 68 ibid, p. 1092. 69 Gonzales v. Oregon, 126 S. Ct. 904, 939 (2006). 70 Chevron U.S.A., Inc. v. Natural Resources Defence Fund, Inc. 467 U.S. 837 (1984). 71 C R Sunstein, ‘Chevron Step Zero.’ Virginia Law Review, vol. 92, 2006, p. 190. 72 Marbury v. Madison, 5 U.S. 137, 177 (1803). 73 L Tribe, American Constitutional Law, Vol. I, Foundation Press, New York, 2000, pp. 993-994. 74 ibid, p. 997. 75 Controlled Substances Act, 21 U.S. C. §871(b). 76 ibid, §824. 77 Petition for Writ of Certiorari, United States Supreme Court, Docket No. 04-623, 9 Nov. 2004, p. 4. 78 ibid, pp. 4-5. 79 ibid, p. 7. 80 Gonzales v. Oregon, 126 S. Ct. 904, 916 (2006). 81 ibid, p. 917. 82 ibid, p. 918. 83 ibid, p. 917. 84 ibid. 85 ibid, p. 921. 86 ibid, p. 923. 87 ibid, p. 924. 88 Brief for Respondent State of Oregon, United States Supreme Court, Docket No. 04-623, 18 July 2005, p. 43. 89 ibid. 90 ibid, p. 45. 91 Maryland v. Wirtz, 392 U.S. 183 (1968). 92 Gonzales v. Raich, 125 S. Ct. 2195, 2206 (2005). 93 ibid, p. 2215. 61 198 Physician-Assisted Suicide and the Supreme Court ______________________________________________________________ Bibliography Behuniak, S. M., and A. G. Svenson, Physician-Assisted Suicide: The Anatomy of a Constitutional Law Issue. Rowman & Littlefield Publishers, Lanham, MD, 2003. California Compassionate Use Act, Cal. Health and Safety Code, §11362.5 (1996). Chevron U.S.A., Inc. v. Natural Resources Defence Fund, Inc. 467 U.S. 837 (1984). Controlled Substances Act, 21 U.S.C. §§ 801 et seq. Gonzales v. Oregon, 126 S.Ct. 904 (2006). Gonzales v. Raich, 125 S. Ct. 2195 (2005). Marbury v. Madison, 5 U.S. 137, 177 (1803). Maryland v. Wirtz, 392 U.S. 183 (1968). Oregon Death With Dignity Act, Oregon Revised Stat. §127.800-127.995 (1994). Oregon Department of Human Services, Summary of Oregon’s Death with Dignity Act-2007, March, 2008. Oregon v. Ashcroft, 192 F. Supp. 2d 1077 (D. Or. 2002). Oregon v. Ashcroft, 368 F. 3d 1118 (9th Cir. 2004). Raich v. Ashcroft, 248 F. Supp. 2d 918 (N. D. Cal 2003). Raich v. Ashcroft, 352 F. 3d 1222 (9th Cir. 2003). Sunstein, C. R., ‘Chevron Step Zero’. Virginia Law Review, vol. 92, 2006, pp. 187-249. Arthur G. Svenson and Susan M. Behuniak 199 ______________________________________________________________ Svenson, A. G., ‘The Last Rites for States’ Rights: Graveside Struggles between States and Congress Over Physician-Assisted Suicide’. The Social Science Journal, vol. 40, 2003, pp. 109-127. Tribe, L., American Constitutional Law, Vol. I. Foundation Press, New York, 2000. United States v. Lopez, 514 U.S. 549 (1995). United States v. Morrison, 529 U.S. 598 (2000). Washington v. Glucksberg, 521 U.S. 702 (1997). Wickard v. Filburn, 317 U.S. 111 (1942). Arthur G. Svenson is David Boies Professor of Government at the University of Redlands, California, and Susan M. Behuniak is Professor of Political Science at Le Moyne College, New York; they are co-authors of Physician-Assisted Suicide: The Anatomy of a Constitutional Law Issue. The Ethics of Patient Non-Treatment Lloyd Steffen Abstract That illness, disease or handicap should ordinarily receive treatment through the resources of modern medicine is not controversial. In fact, agreement can also be reached that refusal to treat such individuals constitutes a moral wrong. But this presumptive moral view for treatment is not absolute, and certain medical situations provoke refection on the possibility that nontreatment might be a morally justified, even if death is a foreseen consequence. Appealing to the ethic behind just war thinking, which lays out a justice consideration to guide moral reflection, this paper considers the justice-related criteria that would allow for possible "justified non-treatment" of severely handicapped patients. This "just war"-related way of doing ethics offers a new contribution to ethical theory while providing practical guidance on the issue of patient non-treatment. Three examples of relevant medical conditions are examined, including dystrophic epidermolysis bullosa, a disorder afflicting newborns in which touch is excruciatingly painful. The examples present medical conditions where non-treatment presents itself as a humane and caring medical option and a justifiable practice so long as certain justice conditions are met, including non-treatment in the patient’s best interest, the judgment that life is a burden, that no reasonable hope of enjoying the goods of life is possible, and others. Non-treatment is sometimes regarded as justifiable action but only if the direct intention to end life is excluded from the description. The paper supports non-treatment as justifiable in certain circumstances but questions the honesty of insisting on such a description when the foreseen and inevitable consequence of nontreatment is death. Key Words: Medical ethics, patient non-treatment, just war thinking, severely handicapped newborns, medical assistance in dying. ***** 1. Introduction Are there ever good and sufficient reasons for deciding not to provide medical treatment to persons because of the severity of their medical condition? Different ethical points of view will yield different ways of responding to this question, but that in itself raises the question for moral philosophy: What are the ethics resources available to help rational people of good will address such an issue, and how adequate are those resources for guiding us through a difficult moral controversy? 202 The Ethics of Patient Non-Treatment ______________________________________________________________ Patient non-treatment raises issues requiring ethical clarification, and I propose here to approach this medical ethics question by invoking an ethics resource that I think holds some new possibilities for thinking about practical solutions for this difficult problem. The resource to which I refer is itself related to a tradition of thinking we associate with “just war.” That tradition, I shall argue, is not itself an ethic and thus not a solution to the medical ethics issue before us—but it appeals to an ethic, and the ethic to which it appeals can be extracted and shown to be relevant to clarifying the ethics of patient non-treatment. I will extract and defend this ‘just war’ related ethic, then turn to the specific problem of patient non-treatment to see if, in fact, this ethics resource offers practical help in the moral effort to figure out what, in such a case, is the good, right, and fitting thing to do. 2. An Ethic Our traditions of ethics in the West, and I will address only Kantian deontology and utilitarianism, will often but not always lead rational persons of good will to the same ethical conclusion - and there is some comfort in that; but the approach is subject to critique due to demonstrable inadequacies. Kantian deontology, which is devised as a form of non-consequentialist thinking, can express a form of moral absolutism that yields a counterintuitive moral rigidity. And it is often asked of utilitarianism whether its focus on determining “the greatest good for the greatest number” by calculating consequences is impractical since the consequences of any action can never really be fully anticipated. By stressing consequences to the exclusion of intentions, the utilitarian fails to establish grounds for any intrinsic value beyond the calculation principle, thus jettisoning any possibility for basing ethics decisions on concerns for human rights or even the intrinsic value of persons themselves. The “just war tradition” has been handed down from Cicero, through Augustine, Aquinas and the Spanish philosophers Suarez and Vitoria and others is best known as a set of criteria to be satisfied when considering a use of military force. The suppressed premise in this “natural law” tradition is that war is an evil and as such is much to be avoided, but attendant to the theory is the other suppressed premise that war may be necessary to defend, preserve and promote important values and justice concerns that are at the core of specific conflicts. The just war tradition has identified “criteria” that must be applied to specific situations and circumstances; and these criteria must be “satisfied” if a use of military force is to be justified. Those criteria would today include the following:   Legitimate authority Just cause Lloyd Steffen 203 ______________________________________________________________     Right intention and announcement of that intention Preservation of values that could not be preserved without use of force Last resort Reasonable hope of success Two other criteria govern action within conflict itself:   a non-combatant immunity provision, and a proportionality requirement that any use of force be proportionate to the end of bringing about peace. This list of criteria identifies particular concerns related to the idea of establishing justification for uses of military force in a war, but the “theory” is sufficiently thin that it does not present any normative understanding for how these criteria are to function. An ethic that conforms to the moral point of view will take others into account and express concern for their well-being (beneficence); acknowledge universal applicability, so something good for one person to do is good for anyone similarly situated to do (universalizability); it will observe a principle of impartial justice, and also articulate a consistent set of normative principles.1 The just war criteria, despite being justice-related, do not, by this standard, constitute an ethic. That is why "just war" thinking seems so malleable and why it is so easily used to support - and justify - almost any prospective use of force. Yet this just war framework does appeal to an ethic, and what is required is the articulation of a common moral agreement, a presumption to which all rational people of good will could assent, and I would articulate it like this: ordinarily, we ought not use force to settle conflicts. This rather simple idea asserts a normative principle of universal applicability concerning the reality of conflict and the good, right and fitting action that should be undertaken when conflicts arise; furthermore it entails an implicit concern for beneficence since human well-being is reasonably advanced by not using force to settle conflicts, and it asserts the presumptive non-use of force as the just mode of settling them. Just war is, as an ethic, not a justification for war, but a justification for allowing an exception to the normative principle that force ought not ordinarily be used to settle conflicts. This underlying normative action guide is never articulated as the foundation for deliberation in classic just war thinking - yet it is the foundation for just war as an ethic. The ethical approach modelled by just war can be applied as an ethic relevant to issues beyond war and the use of force; and it is from this assertion that I am led to consider the specific 204 The Ethics of Patient Non-Treatment ______________________________________________________________ concern of this paper - patient non-treatment. What would an ethic of just non-treatment, modelled on this just war ethic, look like, and how would it function? 3. Just Non-Treatment: Criteria and Cases A. Criteria In considering the issue of patient non-treatment, end of life and beginning of life situations are not equivalent morally speaking. The possibility exists that patients at the end of life can exercise a non-treatment option by an express directive to medical care-givers, or by advance directives to withdraw or withhold medical intervention as specified physical conditions warrant, or by creating a proxy process for deciding non-treatment options (both withholding and withdrawing). Given the possibility that individual patients can opt for non-treatment as an exercise of personal autonomy, the more difficult cases worth considering are those involving beginning of life, by which I mean severely handicapped newborns. Morally speaking, rational people of good will can be expected to express common agreement on this basic moral norm, or presumptive action guide: ordinarily a newborn facing medical difficulties and even handicaps should receive “standard of care” medical treatment, including palliative care in terminal situations. Medical science can in many cases successfully intervene in neonatal medical problems to preserve life and contribute to the neonate's eventual flourishing as a member of the moral community; so ordinarily we ought not consider withholding or withdrawing treatment to medically distressed persons, though there might be good reasons to consider an exception to this common agreement. To justify an exception would require the development, articulation and application of justice-related criteria akin to those familiar in just war thinking. If, in general, the moral community acknowledges an obligation to treat rather than not treat handicapped newborns, and even Peter Singer gives evidence of supporting this view,2 the question arises: are there justified exceptions and what conditions would have to be met so that medical help could be withdrawn or withheld justifiably and the neonate patient allowed to die? This question is now my focus.3 A "just non-treatment" ethic begins with a moral presumption that distressed patients, including handicapped neonates, ought ordinarily to be treated. But several reasonable, justice-related conditions could, if satisfied, allow for consideration of non-treatment. These conditions or criteria include the following: 1. The life of the neonate patient is deemed clearly a burden to the infant itself. Lloyd Steffen 205 ______________________________________________________________ 2. The intention to withdraw or withhold treatment must be to serve the best personal, social and spiritual interests of the patient. 3. Descriptions of the patient’s medical condition must establish both severity and futility of treatment. The determination must be made that the prospects of enjoying the goods of life, including the very basic good of life itself, is negligible. No reasonable hope that the neonate will flourish as a functioning human being in relationship to others exists; and there is little hope that medical intervention will raise the medical condition to even the most minimal level required for flourishing. Medical intervention will, to the contrary, contribute to the burdens that patient must bear rather than relieve those burdens. 4. The decision to withdraw or withhold treatment is patient-centred and not determined by the burdens the patient imposes on others - the medical staff, the family or society at-large. 5. The decision must be made by those who represent the various interests of the patient including family, physicians, medical care personnel, and spiritual advisers. 6. By withdrawing (or withholding) treatment one is trying to preserve respect for the good of life rather than diminish it, and non-treatment will reasonably accomplish this end. By satisfying these criteria, the presumption that a severely handicapped newborn should be medically treated may be lifted, the accumulation of reasons amounting to this: that doing so is in the best interests of the neonate and is justified. These criteria acknowledge standard of care so that pain management, to the extent pain can be determined, is always in order, even if it hastens the death of the neonate. B. Cases Several medical conditions might allow for consideration of justified non-treatment. Individual cases must be assessed, but some medical 206 The Ethics of Patient Non-Treatment ______________________________________________________________ conditions are more likely to provoke consideration of non-treatment. Let me mention three. 1. Consider a rare skin disease called dystrophic epidermolysis bullosa of the recessive form. Newborns afflicted with this do not live past five years of age, and life is marked by intractable pain which then requires heavy sedation - that is life: pain or heavy sedation with Demerol, which puts the neonate in a stupor. Babies afflicted with this find dressing and bathing excruciating experiences, even screaming in anticipation of such activity. Here is a description from ethicist Richard C. Sparks: The quality of life open to this child is either so irremediably pained or else so doped up that should life sustainers be required or treatment become necessary for pneumonia, infections or other curable diseases, one might opt to forgo these efforts in the patient's holistic best interests, hoping for an earlier and easier rather than a belaboured and painful dying process.4 2. Next consider the condition of hydraencephaly, a birth where the newborn presents an open cranial vault, has no brain present, and only remnant tissue. According to Black’s Medical Dictionary, neonates with this condition are “born with defects of skull and absence of brain . . . the brain stem and cerebellum are atrophic. If pregnancy goes to term the infant dies rapidly.”5 A woman can know early in pregnancy that she is carrying an anencephalic baby, and if they come to term these neonates have “no cognitive activity or relational potential. Death is usually imminent within hours, days, weeks.”6 3. A third condition, the infant version of amyotropic lateral sclerosis or ALS (Lou Gehrig disease), is Werding-Hoffman disease, “a progressive, relentless and totally irreversible” condition that creates a “locked in state” of paralysis that simulates coma but normal consciousness is preserved. Werding-Hoffman can cause both extreme physical and psychological suffering. Neonates require incubation in ICUs, respirators, IV fluids, and feeding tubes. Questions arise about the pain and discomfort level of the afflicted neonate, but clearly the care givers - parents, neonatal ICU nurses and physicians - are concerned about any actions that might increase the pain and suffering of the neonate.7 Lloyd Steffen 207 ______________________________________________________________ These then are three conditions that raise the possibility of neonatal or perinatal patient non-treatment. We must take note of this commonplace reality. A serious birth defect is often accompanied by other physical anomalies, and sometimes it is the combination that is at issue even if individually one defect might not rise to the level of justifying nontreatment.8 4. Discussion If we apply the six criteria to the three cases listed above, we can see how the criteria guide making a justified exception - or not. The hydraencephelitic presents a severe and futile medical condition. No reasonable possibility exists that corrective medical intervention would ameliorate the medical situation. The neonate lacks the brain structures necessary for the possibility of relationship, identity, and becoming the subject of experience; and although the neonate is a member of the human species, the moral community rightly does not confer upon it personhood. The just non-treatment criteria could be applied and a decision not to treat made in the best interests of the patient. Non-treatment poses no reasonable issue of disrespect for the value or good of life itself.9 The dystrophic epidermolysis bullosa case as described seems to be so catastrophic, amelioration by treatment so unlikely, and futility so present, that the criteria for just non-treatment could be satisfied. The description of the disorder given above does not fit all possible cases of the disorder, but in this particular description, life itself is a burden to the neonate due to constant excruciating pain on the one hand, being doped up in a stupor on the other. Author Richard Sparks suggests that this condition begs the very question of reasonable patient non-treatment. Applying the criteria supports lifting the presumption against non-treatment - the physical condition is hopeless and futile, withholding treatment is reasonably in the patient’s best interest, and the decision to withhold treatment should be made for patient-centred reasons by those entrusted with the neonate's interests. Assessing the value of the life of the neonate provokes the non-treatment option: that life is not a gift but a terrible burden - the decision not to treat is a tragic decision, of course, but the burden of life is so great that that non-treatment seems a humane course of medical action. In a journal of clinical medical ethics, Dr. Robert Echenberg, a neonatologist, presented a case study of Werding-Hoffman in the context of a perinatal ethics committee confrontation with the disorder. Eichenberg relates how the ethics committee attempted to consider the concerns of the patient, the parents, and the community of care-givers, which included ICU nurses, whose bonding with the infant positioned the nurses to "became most qualified to assess the neonate's levels of comfort or suffering."10 Echenberg writes that much was unknown about the nature of pain or suffering being 208 The Ethics of Patient Non-Treatment ______________________________________________________________ experienced by the newborn - if the newborn could even be said to be experiencing pain; he also noted that traditional ethical theories involving "critical care decisions, logical rules, predetermined principles and commonly trusted beliefs" were not of great help. As the committee tried to figure out the how best to carry out the non-treatment decision, once that was deemed medically appropriate, consensus was sought on the timing and manner of withdrawal of treatment, and ethically, the committee needed to "be flexible and willing to explore creative, new possibilities." Echenberg writes: Through a process of careful interviews and a well-attended committee discussion, we came to a firmer accord in understanding what might be in this child's best interests, as well as in coming to terms with withdrawal of her life support. . . .[T]he critical care nurses . . . played a significant and critical role. We learned, also, that it is desirable to forge a therapeutic and healing process to ease the pain and turmoil of the survivors.11 The infant, by the way, went into cardiac arrest and no energetic resuscitative efforts were made to save her as had been done previously. The physicians and nurses in attendance "allowed the baby to die without further intervention."12 The Journal of Clinical Ethics, in which the case study appeared, published three responses to the case presentation, and respondents criticized the way the perinatal committee functioned, especially in its call for consensus among caregivers about how to proceed. Specifically criticized was the decision to allow a collective opinion of the nurses to have a huge impact on the decision-making: "We must be sceptical of the assumption that nurses and other caregivers can always be appropriate judges of the patient's best interest," wrote critic Robert Truog, arguing that coercion can be involved in consensus when someone claims authority by appeal to past experience.13 Another critic, Robert F.Weir, argued that more attention to a benefit and burden analysis might have prevented a technological intervention in the first place, since the physical condition might have deemed such intervention harmful to the patient "interfering with her future interests, impairing her psychological welfare, or as aimless cruelty?"14 And a third respondent argued that the emotional needs of health care personnel ought not be a focus of moral decision making in such a case, and that assessing the process of how judgments about the quality of life are made is the critical ethics concept, not a technical determination of pain, which can be manipulated and controlled.15 All the parties, Echenberg and his critics, paid attention in varying degrees to the centrality of the patient. The committee faced a difficulty Lloyd Steffen 209 ______________________________________________________________ determining the extent of the neonate's pain, but all were concerned with it, and none of the authors disputed the decision to withhold or withdraw treatment - the issue was when and how and who has voice in the consultation. Whereas Echenberg wanted attention paid to the caregivers because of their involvement in the case and the attendant grief, he and the committee did address primarily the patient and the patient's welfare - then in the face of unknowns about what the patient was experiencing, and having settled the justifiability of non-treatment, took a wider view about those entering into relation with the neonate as a caregiver: the decision to withdraw treatment was actually clear and demonstrate that the criteria of the just non-treatment ethic laid out above were invoked, applied and satisfied. The presumption that ordinarily even a severely handicapped newborn be treated was observed, but then attention was given to the severity and futility of treatment, then to the best interests of the neonate. Consultation with those representing the patient's interests became a focus, and the role of medical staff then became a specific issue of contention and disagreement - but disagreement did not arise, as I read the case, concerning the patient-centred decision not to treat the patient. The attention to the staff grief makes this case somewhat unusual, but in a sense, even this focus does not stray from the "just non-treatment" criterion regarding consultation, since that is what one is supposed to do with the criterion - look into how the various parties representing patient interest are to be involved. There can be disagreement about if and how particular criteria are actually satisfied, but it is the discussion and arguing in public ways that is critically important for the ethic, and that was actually done when the case was active - and then even in its aftermath, when in a professional ethics journal the case was once again presented for ethics reflection and professional discussion.16 I think the formal aspects of the “just nontreatment of neonates” ethic were observed and conscientiously so. The decision for non-treatment was made in consultation as being in the patient's best interest. I think this case, not only in its presentation, but even in the accompanying criticisms of it, demonstrates how the ethic - the just non-treatment ethic proposed here - actually works. 5. Conclusion I draw three conclusions from this discussion. First: The ethic proposed here is flexible yet patient centred and grounded in the idea that neonates, even seriously handicapped ones, should be treated. The ethic is flexible in a way a deontological ethic is not. Just non-treatment is concerned with the patient as an individual sufferer whose particular situation is deemed deserving of a presumption of care due to a principled moral directive that even handicapped newborns deserve treatment due to their status as members of the moral community. They are not ciphers in a utilitarian calculation. 210 The Ethics of Patient Non-Treatment ______________________________________________________________ Secondly, neonatal disability presents specific moral problems related to how the good of life is to be evaluated along with other goods of life. The ethic is flexible enough to suggest that the good of life must be placed in an evaluative context with other goods, which is to say that good of life is not an absolute good, but a good-in-relation with other goods like bodily integrity, and the capacity for realizing a psychological identity and thus the capacity to enjoy the other goods of life (friendship, aesthetic enjoyment, abstract reasoning). When these other goods are catastrophically compromised by physical defect or deformity in particular situations, the good of life can be called into question by applying the justice criteria of the just non-treatment ethic. The determination can be made that not all life is worth living. Moreover, rational people of good will, exercising practical reason in accord with an ethic like that suggested here, must assume responsibility for acting to advance the well-being of an individual patient whose life may be so burdensome that withdrawing medical care trumps the concern for preserving and promoting life. And third: The question arises that if the life is a burden, and further treatment is adding increased suffering, cannot the action of dispatching such an individual by means of, say, morphine injection be considered consistent with a standard of care, with the patient centred action of acting in the best interests of the patient? And should scarce, expensive medical resources continue to be expended on a futile, hopeless patient? These are questions needing further conversation, and Peter Singer is to be applauded for forcing them into the public arena. But on the ethic proposed here, I am of the view that the criterion concerning action that preserves respect for the good of life (#6) could, in this moment of societal and cultural evolution, be compromised by physicians acting as "dispatchers" - as coming to hold the role of killers rather than healers, even if ethical analysis might reveal that a morphine injection that leads to death could also be described as ultimately a healing action for a certain patient. In the United States, we are not ready for this redescription of the physician's role, and the best we can hope for is continued defence of "double-effect" pain management that brings about death as a foreseen but unintended consequence. The problem is that in more and more cases the consequence of patient death is actually intended, and any reasonable analysis would expose that interpretation. So are we allowing physicians to do what is humane and morally defensible but withholding a description we are not ready to accept - but then are we opting for a deception, even a selfdeception because the honest description is too painful for us to face? What needs to be accomplished in health education is a reorientation that supplants the anxiety of a public fearful of doctors becoming killers with the assurance that doctors will act in concert with care-givers to operate out of a patientcentred, “just non-treatment” ethic. In certain extreme medical situations, Lloyd Steffen 211 ______________________________________________________________ dying and death are made horrendously difficult by the intervention of technology, and what is needed is a practical ethic that sees good in easing off the technological interventions and commends as good, right and fitting those actions that focus on the best interests of the patients, including the possibility of a justified course of non-treatment. Death can sometimes be in the patient's best interest - and deontological ethics sometimes seems to deny this by refusing to consider direct action that would expedite death, for such would be contrary to our duty to respect persons - can you show respect to persons by acting to terminate their life?; and utilitarian ethics loses both the individual sufferer and the care-giver pain in a calculus related to distributive justice where every individual sufferer is rendered a cipher to be treated as the calculus directs. The difficult social policy issue is whether acting in a patients' best interest can, as a matter of “standard of care,” include action to directly intend the death of a patient—for the reason that that is the good, fitting and right thing to do in the patient's best interest. The just non-treatment ethic holds out this possibility. Notes 1 J Runzio, ‘Religion and Ethics in a Global World’, in Ethics in the Worlds Religions, J Runzo and N M Martin(eds), One World, Oxford, 2001, p. 23. 2 See P Singer, Practical Ethics, Cambridge University Press, Cambridge, 1979, p. 132: "Defects vary of course. Some are trivial, and have little effect on the happiness of the child or its parents; but other defects turn the normally joyful event of birth into a threat to the happiness of the parents, and any other children they may have." By this statement, I take it that a neonate may be defective even beyond “trivial” and thus should receive medical care, but some defects go to the issue of severity such that continued pain and distress raise the question, as Singer puts it, whether the neonates "life is worth living." This invokes the severity issue of the case I shall make, though not necessarily the futility feature, as will be seen below. Singer also moves beyond the “misery” factor to a broader view of utilitarian calculus, namely, the justifiability of killing a defective haemophiliac that is bound to create an aggregate disutility in relation to another newborn whom the parents of the killed neonate could create to replace it, who would not produce such disutility. I am nota utilitarian and do not agree with this position. I raise the “misery” issue related to the assessment of the neonate's condition to indicate that even Singer seems to recognize the moral presumption issue here. Singer believes a severely handicapped neonate can be aborted, but he goes further: an embryonic/fetal candidate for justified "abortion" is one who presents a defect that may not be actually discernible 212 The Ethics of Patient Non-Treatment ______________________________________________________________ until inspected at birth could, and on Singer's account such a neonate could be justifiable killed, using a utilitarian calculus that takes into account the greatest aggregate happiness. Singer provokes serious issues, but I appeal to his argument in Practical Ethics to indicate that he does not oppose the moral presumption, the action guide regarding patient non-treatment, important to my argument, and even seems to support it, as it would be reasonable to do. Admittedly he does not dwell on this feature of things because his interest is in the hard cases and he seeks to determine what utilitarianism will allow and should be done - and what is good to do - in cases of extreme defect. 3 I acknowledge that other questions press for attention, such as, “Is there a moral difference between withdrawing and withholding care,” which I think there is; and how is "allowing to die" by the decision to act in a way that foresees death not also intend death, so that letting die might be distinguished from “killing” and thus with active euthanasia. These questions, important thought they be, leads us away from the specific issue of this inquiry, so let us turn back to possible conditions that would guide justified non-treatment of neonatal patients. 4 R C Sparks, To Treat or Not to Treat, Paulist Press, New York, 1988, p. 317. 5 ‘Anencephaly’, in Black’s Medical Dictionary, 41st edition, H Marcovitch (ed), The Scarecrow Press, Lanham, MD & Oxford, 2006, p. 39. 6 Sparks, op. cit., p. 311. 7 R. J Echenberg, ‘Permanently Locked-In Syndrome in the Neurologically Impared Neonate: Report of a Case of Werdnig-Hoffman Disease’. The Journal of Clinical Ethics, vol. 48 (3), Fall 1992, pp. 206-208. This case study is followed by three critical responses. 8 The 1982 Infant Doe case in the United States involving an Indiana newborn who was born with Down's syndrome and correctable spina bifida is such a case. Infant Doe’s spina bifida was correctable by surgery, but the parents did not approve the surgery option and asked that the infant be allowed to die because they did not want the burden of a seriously retarded infant. The parents asked the attending physician to withhold food and water from the infant. This parental decision was upheld by an Indiana court. It is generally agreed that the parents would have requested the necessary surgery if the baby had not been "retarded" due to Downs, so it was not the uncorrected spina bifida that killed Infant Doe, even though spina bifida can sometimes be considered so serious a defect that it alone could provoke consideration of justified non-treatment. (See Echenberg, op. cit., p. 208.) In the Infant Doe case, the death resulted from a decision not to treat made by parents distressed by having to contend with the mental retardation accompanying the Down’s syndrome. Lloyd Steffen 213 ______________________________________________________________ 9 Dispatching a neonate with this condition using, say, a morphine injection to suppress breathing and hasten death does not seem to me to be outside the pale of justification as action addressing the best interests of the patient. Such action could be described perhaps as pain management rather than a killing, but it cannot be known for certain if pain is even at issue since there is no self to experience or integrate sensation into pain, and controversy would arise over criterion #6—diminishing respect for the good of life itself, a utilitarian-related criterion. But non-treatment itself does not seem morally controversial. 10 Echenberg, op. cit., p. 208. 11 Echenberg, ibid. 12 Echenberg, op. cit., p. 207. 13 R D Truog, ‘Locked-In Syndrome and Ethics Committee Deliberation’. The Journal of Clinical Ethics, vol. 3 (3), Fall 1992, pp. 209-10. 14 R F Weir, "Abating Treatment in the NICU". The Journal of Clinical Ethics, vol. 3 (3), Fall 1992, pp. 211-3. 15 T . Dagi, ‘Compassion, Consensus, and Conflict: Should Caregivers' Needs Influence the Ethical Dialectic?’. The Journal of Clinical Ethics, vol. 3 (3), Fall 1992, pp. 214-18. 16 For all that appears to be disagreement about the "ethics" of this case around attention to the grief reactions of staff, this case - the presentation and the respondents, actually provides a good example of how the "just nontreatment" ethics actually works. A common agreement is reached regarding a non-treatment course of action. That is determined evaluation of the patient's best interests in light of the medical situation. The other criteria are also observed, with the sticking point being the criterion that states: the determination to withdraw treatment cannot be determined by the burdens imposed on others, including care-givers. The discussion about the role of nursing staff might make it appear that concern for the caregivers trumped concern for the patient and the patient's best interests, but that is actually not the case at least as far as the non-treatment decision goes. As much as working for harmonious relations with medical staff on difficult cases is much to be lauded, the just non-treatment ethic insists that the patient must be the central focus - and I believe that was accomplished so that the dispute then turns to how to implement the best-interest decision not to treat, which then led to consideration of the role of care-givers. I do not see that the neonatal patient was in anyway short-changed ethically or that the patient's case failed to be vetted adequately through the ethical scheme I am supporting here. 214 The Ethics of Patient Non-Treatment ______________________________________________________________ Bibliography ‘Anencephaly’, in Black’s Medical Dictionary, 41st edition, H. Marcovitch (ed), The Scarecrow Press, Lanham, MD & Oxford, 2006, p. 39. Dagi, T. F., ‘Compassion, Consensus, and Conflict: Should Caregivers' Needs Influence the Ethical Dialectic?’ The Journal of Clinical Ethics, Vol. 3 (3), Fall 1992, pp. 214-18. Echenberg, R. J., ‘Permanently Locked-In Syndrome in the Neurologically Impared Neonate: Report of a Case of Werdnig-Hoffman Disease’. The Journal of Clinical Ethics, vol. 48 (3), Fall 1992, pp. 206-208. Runzio, J., ‘Religion and Ethics in a Global World’, in Ethics in the Worlds Religions, J. Runzo and N. M. Martin (eds), One World, Oxford, 2001. Sparks, R. C., To Treat or Not to Treat. Paulist Press, New York, 1988, p. 317. Singer, P., Practical Ethics. New York, Oxford, 1979. Truog, R. D., ‘Locked-In Syndrome and Ethics Committee Deliberation’. The Journal of Clinical Ethics, Vol. 3 (3), Fall 1992, pp. 209-10. Weir, R. F., "Abating Treatment in the NICU". The Journal of Clinical Ethics, vol. 3 (3), Fall 1992, pp. 211-3. Lloyd Steffen is Professor of Religion Studies and University Chaplain at Lehigh University. He is the author of several books, including Holy War, Just War: Exploring the Moral Meaning of Religious Violence, published in 2007 by Rowman and Littlefield. What's Wrong with the Brain Death Debate? Joseph Wang Abstract Since the proposal of the brain death criteria this issue has been under heavy debate. While for most physicians brain death is really the death of a human being (resp. human person), for some philosophers it is just the death of a special human organ, but surely brain death is not identical with the death of the whole human person. In this paper I argue that physicians and philosophers are at cross-purposes. The crucial question in this debate seems to be an ontological one: Who or what is dead if someone is brain dead? The physicians’ answer is “the human being,” while the philosophers’ answer is “the brain.” But if we also consider the purpose of this ontological question, then perhaps the alleged confusions can be cleared up. In my opinion brain death is not an appropriate answer for the ontological question, but rather it is a regulatory principle for actions, in particular the action of the withdrawal from therapies and the actions of making preparations for the organ transplantation. If this is accepted, then the subject of the brain death debate will not be the ontological question about human death, but rather a question within an ethic of transplantation medicine. Key Words: Brain death, organ transplantation, withholding of/withdrawal from therapy, biomedical ethics. ***** 1. Introduction Until the beginning of the 20th century death - regarded from the medical perspective - was not a subject for debate but rather a mere fact. Of course, there were philosophical and medical treatises about death, but “defining death” was not necessary, as death was an event that occurs on a certain living being at a certain time. Though people already knew that the brain had something to do with the mind and that somehow the “personality” of a human being was tightly coupled with her brain, the brain - due to epistemological difficulties - was not the main organ for physicians to determine a patient's death. The heart, on the contrary, became the obvious criterion for diagnosing the death. As far as we know, there has never been a living person without a beating heart and every dead human being has lost their heart functions. And since we can find out easily whether a heart is still functional or not, the beating heart was the crucial criterion for a living human being. 216 What's Wrong with the Brain Death Debate? _____________________________________________________________ This situation has gotten more complicated since the end of the 1950's: Physicians now have means to support or even to substitute some of the vital organ functions. Some patients who have lost their heart functions can now be kept alive for some time. Some patients in coma who would have died in the 19th century can now be nourished and kept alive until they recover from their diseases. Thanks to the advances in medical science more lives can be saved. But this means also that not having a functional heart is not sufficient anymore for the death diagnosis; the traditional heart criterion cannot hold any longer: There are now “living” human beings without a living heart. On the other hand, the downside of this development and its ethical challenge also show their faces: Some patients, though kept alive with technical means, never regain their consciousness: They will never be able to make some decisions, to laugh or to cry or to take part in discussions again. Should physicians still keep them alive as long as possible? At least our intuition today those patients can certainly be allowed to die. To deal with this intuition and the new “situation” new terms like “coma depassé” 1 and “irreversible coma” 2 were introduced. The notion “brain death” was then introduced as a medical term to describe patients who have lost their (higher) brain functions and will (probably) never be able to live a personal life again. Ever since the introduction of the terms (and perhaps the introduction of the transplantation techniques) brain death, like other bioethical issues, has been under heavy debate. Though there are different “flavours” of brain death criteria, I think we can safely suggest that proponents (P) of the brain death criteria propose that human beings who have lost their brain functions are dead, while the opponents (O) of the brain death criteria hold that brains, but not human beings, are dead when a brain death is diagnosed. In my paper I want to hold a kind of middle position. I want to emphasize the practical aspect of this debate and hope that, by doing so, I can shed a different light on this debate. And I will come to the conclusion that the (ontological) question whether a person, a human being, or a brain is dead when brain death is diagnosed is not as important as the question about (indirect) euthanasia and about the ethic of transplantation medicine. I will proceed as follows: In the first part I want to introduce the notion “brain death” as it is introduced by the physicians. In the second part I want to show that the questions in debate are explicitly or implicitly questions of ontological and/or metaphysical nature. This means that whether a certain answer is sound for a discussant depends very much on her world view. In the third part I want to approach the matter from a practical point of view by analysing people's actions when brain death occurs. And in the last section I want to compare these actions with actions, which are initiated Joseph Wang 217 _____________________________________________________________ when somebody has died. I will conclude that brain death debate is not an ethical issue itself but should rather be embedded in a debate over the ethics of transplantation medicine. 2. What is Brain Death? I have suggested that the notion “brain death” was introduced to separate patients who cannot be helped from others patients for whom physicians should do their best to save their lives. So, foremost, “brain death” seems to be a medical term used in the medical practice and science. But what is “brain death” anyway? It is understandable that I cannot provide a full analysis of the medical standard for the brain death diagnosis. What I will try to do here is to explain the so-called four-level-model of the notion “brain death” which is used by physicians to introduce this special term.3 At the beginning it should be noticed that the way a term is introduced here is applicable (and even feasible) to other medical and non-medical terms. Most medical introductions to the notion of brain death use the four-level-model (sometimes the second level is omitted, and then it is called the three-level-model)4. In this model a notion is successfully introduced when four different kinds of questions can be answered satisfyingly. The first level/question is concerned about the subject of death: Who or what can actually be dead? And who or what is dead if somebody is brain dead? It seems to us that the answer to the first question is quite simple: living beings. The second question is trickier: For P the person/the human being is dead, but for O only the brain is dead when a brain death is diagnosed. The second level concerns the definition of death. According to Moskopp “death” is (quite plausibly) the absence of life; this definition can arguably be an empty tautology. For this definition to be meaningful a definition of “life” must be provided. But since it is impossible to define life with all its different aspects, it is therefore also impossible to define death.5 Interestingly the notion “brain death,” though there are different, say, “flavours,” is well-defined in comparison. Brain death is the “irreversible loss of the integrating function of the brain,”6 the different flavours emphasize on different brain areas, which have lost their functions. The third question is the question about the symptoms/ phenomenological content of the notion “brain death.” When somebody is brain dead, how can we see this, how is this man different from the rest of us? Typical signs of brain death are fixed pupils, no higher cerebral reflexes, no spontaneous respirations, etc. To be sure, the so-called death signs cannot be applied to a brain dead person. And the last question complex is about different tests to determine or to assure the clinical diagnosis of brain death. Physicians and medical 218 What's Wrong with the Brain Death Debate? _____________________________________________________________ researches continue to improve the different methods so the results of these tests are more specific and valid. The most prominent test is probably the EEG showing flat lines; other tests include the ultrasonography of the carotid arteries and the apnea-test. To sum up, the question “what is brain death?” is answered by P in the following way: A brain death is the death of a human being who has lost her life and shows the following clinical signs; the brain death is conformed by such and such tests. The same question is answered by O in a different way: A brain death is the death of a (human) brain which has lost all its functions; the person shows the following clinical signs and the brain death can be confirmed with such and such tests. As we can see: The main debate is not about the signs and the tests, these are seldom under (philosophical) debates. We all tend to think (and I think quite rightly) that physicians who are proficient in their jobs will know best how the brain death can be diagnosed. And I think most people will agree that how brain death is diagnosed is for medical researchers to be answered; philosophers and theologians are neither capable nor suitable to answer these questions. But aren't they capable of answering the first two questions? The first and the second question seem to be more of philosophical nature than of medical nature. 3. The Metaphysical Nature of These Questions and World View In the western philosophy tradition questions concerning definitions and attributions are main field of philosophy. So the first two levels in the four-level-model are of philosophical matter. To put it in an exaggerated way one might say that regardless how advanced the medical science will be, it will never be able to answer these questions. To show this is really the case, I want to examine some of the arguments pro and against brain death criterion.7 A. Some Pro Arguments The Brain is responsible for integrating the organism. Brain - as opposed to, say, an arm - is a special organ. While loosing an arm does not mean to lose one's life, because an organism still exists, this is not true if the brain is lost, for the brain is (at least according to the findings of the medical sciences) the organ which integrates the different parts of a living being. i.e. the living being is one because the brain gathers the different parts and puts them into an organized whole. So if the integrating organ is missing, the different parts of the organism are no longer connected; and their ontological status is comparable to the ontological status of an arm cut off. And a pile of body parts is not a living entity. Therefore the death of the brain is equal to the death of the whole human being. Joseph Wang 219 _____________________________________________________________ Brain death is the death of the person. For this argument to be sound one must first distinguish between “persons” and “human beings.” 8 The notion “person” refers to the mind of someone, the part that is morally relevant; while the notion “human being” refers to the corporal part, which is morally just as relevant as any other higher animals. The person, so it seems, is coupled (solely) with the brain, since a man stays the same person even if his arm is cut off, but he is not the same person anymore if a larger part of his brain is injured. Under this premise and under the premise that the person can die at another time than her underlying human organism, obviously, brain death is the death of the person, though the death of the organism has not yet occurred. B. Some Counter Arguments On the other side, these arguments have been challenged. I want to present some of these O-arguments. Death of a part cannot be the death of a whole. When a part of a whole dies, this does not mean that the whole organism is also dead. This is obvious in case of a lost arm, so why should brain, which is also (just) a part of an organism play such a central/vital role? Actually the organism can be alive even without the brain, as can be seen in the case of the brain dead persons. When other parts of the organism (e.g. the blood circulation system, the peripheral nervous system, the endocrine system etc.) are still functional, the patient can be kept alive for a certain time. So the death of the brain alone is not the death of a whole organism. Besides, one day the medical science might be so advanced that it can repair even extensive brain damage, so people might be able to recover from the brain death (just like they can recover now from the heart death). The notion of personhood chosen by P is the wrong one. The notion “person” as defined by Locke and Singer is not the only possible one. In the Aristotelian tradition the soul cannot be separated from the body. If a notion of personhood from this tradition (e.g. that of Boethius or of Thomas Aquinas) is chosen, then persons cannot be dead on another time than their bodies. Under this premise the person is not dead (because she still has the sensitive and the vegetative functions) when her brain dies. C. A Question of World View? Which of the two views is the right one? It seems clear that they cannot be both right, and it seems that both sides are sound and not unreasonable. There are good arguments both for and against the thesis that the human being is dead when he is brain dead. How can we take position? For the first argument pair (integrating function of the brain vs. living function of the body) it seems that whether one is a P or an O depends on her personal judgment whether a human being is a composition integrated 220 What's Wrong with the Brain Death Debate? _____________________________________________________________ by some very important instance (brain), or whether she thinks that the organism is per se a whole and its parts cannot exist for themselves. And for the second argument pair (Lockean personhood vs. Aristotelian personhood) it seems that whether O appeals one by P or depends on her opinion about the notion of personhood. If one thinks that the mental capacities are essential for human personhood, then she will tend to think that brain death is a criterion for the death of a human person. If she thinks that a human person must consist of both parts, the mind and the body, then brain death will just be the death of a part of a human person, but it will not be the death of the person herself. As we can see here, whether P or O is sound depends on one's personal attitude toward some philosophical issues. Of course the opponents could shift the subject of debate from the brain death to philosophical anthropology, but this would not be a debate on ethics, but on world views.9 And we don't have clear criteria for determining which world view is better than others. Therefore we probably cannot justify our opinion in this matter universally. If this analysis is right, does it mean that we have to give up the endeavour to find out the right answer? I will suggest another approach instead. 4. The Practical Approach to “Brain Death” As we have seen, the level 3 and level 4 questions are not under philosophical debate. Rather they are instructions on how to determine the brain death. They are justified through practical aspects and background theories. Though they can be subject to debates themselves, these debates are mostly debates on scientific accounts. Whether a certain test is suitable for determining brain death is not a philosophical issue, but a medical one. Based loosely on Bridgman and Muck10 we can call them operational analysis of the notion “brain death.” Are these tests then out of philosophical questions then? Not quite. In my opinion, even from a moral philosophical point of view at least three questions can be asked: 1. Can the executions of these operations for testing brain death morally accounted for? 2. What does the notion “brain death” serve for? 3. Do we really need it? As we can see, these questions do not touch the ontological debate directly. To be able to answer the first question we do not need to know what is dead if a brain death test is positive, but we should know who is involved, how the test is performed and whether the actions are morally right or not. Joseph Wang 221 _____________________________________________________________ To give an example, the cerebral angiography for the determination of brain death is controversially discussed. What is out of the question is that with this method the blood flow in the brain can be measured. There are though moral concerns: According to Rabl this test does not aim on a therapy or a treatment of a patient and may even cause brain death itself; therefore this method should not be used in the daily routine and should only be applied under special circumstances. 11 As can be easily seen, the moral philosophical debate is not on the subject of the ontological bearer of brain death but on the cost of the action and whether it will make sense or not. The second question is more interesting. The answer to the question “do we will need a certain notion?” depends - at least if we interpret the later Wittgenstein in a certain way - on what we can do with it. The “mere” description of brain death is not enough to give a full account of it. And the best way to see how a notion can be used is to analyse its usage in human actions. I think we can agree on that the medical use of this notion is the most important one. We can actually see how the actions of physicians change when “brain death” is diagnosed. For examples I want to point out three different types of actions which are initiated when the diagnosis “brain death” is for sure: Withholding of/withdrawing from therapy, psychological support for the grief of the relatives, and preparations for organ transplantations. As far as I can see, these are typical actions connected with brain death. A. Withholding of and Withdrawal from Therapy The first type concerns all kinds of withholding and withdrawing from therapy. Physicians do not try to cure the patient anymore, if they find out that she is already brain dead. Is this morally justified? As to my observation that if brain death has been diagnosed, letting the patient die is normally morally justified. If there is one condition under which the passive euthanasia is justified, then it must be in case of brain death. Physicians agree that treating a brain dead person is a futile action; therefore we can safely retreat from therapy and let the brain dead patient die. B. Psychological Support When brain death is diagnosed, physicians usually also start with the psychological support for the relatives. While only a few studies - at least to my observation - on this subject have been done, most physicians seem to suggest that, since the death has already occurred (or is inevitable), we can already provide psychological support for the bereaved. Common sense among physicians prescribes that we should give no false hope and that the family and friends of the patient should be given the right information that the patient is gone, though he is yet warm and breathes. 222 What's Wrong with the Brain Death Debate? _____________________________________________________________ I think most physicians, even when they are not P, will support the suggestion that psychological support for the grief can be started when the death is inevitable. There might be some slight differences between P and O in their own ways to provide the necessary support, but I think these differences will not be greater than the difference between two different supporters (resp. opponents) of brain death criterion. C. Preparations for the Transplantation I have not touched the subject of transplantation yet because I wanted to focus on brain death and its debate. Surely we cannot evade discussing transplantation if we are discussing brain death, but - as we saw earlier - the definition (operational analysis) of brain death does not include (and should not include) organ transplantations. Rather the opposite is the case: for the operational analysis of some organ transplantations I think the notion “brain death” is needed. Physicians exercise different tasks to fulfil the preparation of the transplantation. They must get the consent of the relatives; they must check the health conditions of the patient; and they have to prepare the operation for harvesting the organs. Are these actions morally justified? This will be the subject for the last section of this paper. 5. Shifting the Question from Ontology to Moral Philosophy In this section I want to shift the ontological question “who or what is dead when somebody is brain dead” to a debate on transplantation medicine. A. Brain Death is Nearly Practically Equivalent to Other Death Forms I have pointed out in 4 that there are three types of actions, which are initiated when brain death is diagnosed. When we compare these actions with other actions initiated when a (normal) death of a patient is diagnosed, we can find that in the first and the second case there are no practical differences. When a patient has died, physicians stop the therapy and life support mechanisms; they withdraw from therapy and naturally withhold other therapy forms. Physicians also start the psychological support for the bereaved when death occurs. And it is notable that there are no (heavy) moral objections to the actions on both sides. If this analysis is right, then the difference between death and brain death is minimal, taken aside of the organ transplantations, i.e. although the justifications of these actions are different between brain dead and dead persons, the actions themselves are nearly the same. And - in case of the withdrawal from therapy and in case of the psychological support - actions on both sides are morally justified. So with regard of these aspects we can say that death and brain death are - from a practical point of view - equal. Joseph Wang 223 _____________________________________________________________ In case of the organ transplantation, the situation is different. While organ harvesting on a dead body seems to be morally justified, the organ harvesting of a brain dead human being, especially the vital organs (hearts and lungs), are under heavy debate. The reason is the following plausible intuition: If the donor has not died, taking her organs would be an action of killing for other's benefit; and this is morally unjustified. B. An Ethic of Transplantation Medicine? If this intuition is right, it seems that we do need the answer for the ontological question, since we need to know whether a person is already dead when she is brain dead or not. If O is right, then the heart transplantation will be a merciful killing coupled with the benefit of saving the life of another person. And this is morally wrong; therefore the transplantation of vital organs should be stopped. Is this the last word? How to justify organ transplantation morally is out of the scope of this paper. But if the former analysis can be accepted, then we could perhaps shift the debate from an ontological question (“who or what is dead if somebody is brain dead?”) to the debate on organ transplantation. We need a moral justification for organ transplantation, which does not need an ontological debate. One possible justification of transplantation could be the following: In case of a patient with a valid consent for organ donation we can assume that she is willing to give up her organs, and therefore her life, in order to save other's life under the condition that her life cannot be saved. If this patient is brain dead, then saving her life will be a futile task for us, for we cannot save her life anymore. In this case, it could be allowed to take her organs to fulfil her wish of saving other's life. Arguments like this could be applied by an ethic in transplantation medicine. Professionals in this field will have to deal with hard questions like “can we give up or even take one's life under special circumstances in order to save the life of another person?” They also have to debate the subject of consent vs. dissent solution, on problems of organ allocations etc. In short, this field of ethics would have to deal with moral problems associated with actions taken in the transplanting of organs. And as we can see, the actions and the regulations of actions are under debate, not the ontological question. 6. Conclusion If my suggestion in the brain death debate can be accepted, we can (and perhaps even should) shift the debate from the heavyweight ontological questions about the bearer of (brain) death to the ethical debate on transplantation medicine. I think agreements can be made more easily in this way, because discussants can argue from the practice, and arguments out of practice can be accessed more easily for the opponents. In this way the 224 What's Wrong with the Brain Death Debate? _____________________________________________________________ consents can be achieved more quickly and there is no heavy and endless debate over ontological frameworks, the justification of which is a more difficult task. Notes 1 P Mollaret and M Goulon, ‘Le coma dépassé’, Rev Neurol, vol. 101, 1959, pp. 3-15. 2 Ad hoc Committee of the Harvard Medical School, 'A Definition of Irreversible Coma', JAMA, vol. 205 (6), August 1968, pp. 85-88. 3 I will refer mostly to D Moskopp, 'Hirntoddiagnostik', Intensivmedizin up2date, vol. 1, 2005, pp. 285-308. 4 E.g. in W F Haupt and W Höfling, ‘Die Diagnose des Hirntodes: Medizinische und juristische Aspekte unter Berücksichtigung des Transplantationsgesetzes (TPG) der BRD,’ Fortschr Neurol Psychiat, vol. 70, 2002, pp. 583-590. 5 Cf. Moskopp, op. cit., p. 295. 6 Cf. D A Jones, ‘Metaphysical Misgivings about “Brain Death”’, in Beyond Brain Death, M Potts, P A Byrne and & R G Nilges (eds), Kluwer Academic Publishers, Dordrecht, 2000, pp. 91-119, here p. 94. 7 Here I follow: Jones, op. cit.. 8 For the Lockean notion of personhood cf. J Locke, An Essay Concerning Human Understanding. Book II, Ch. 27. For Singer's notion of personhood cf. P Singer, Practical Ethics, Cambridge University Press, Cambridge, 1979, pp. 72-78. 9 Cf. Muck's explication of dialogues about world views and about religious beliefs, e.g. O Muck, ‚Zur Logik der Rede von Gott’, in Rationalität und Weltanschauung, O Muck and W Loffeler (eds), Tyrolia-Verlag, Innsbruck, 1999, pp. 14-44. 10 Cf. P W Bridgman, 'Operational Analysis', Philosophy of Science, vol 5, April 1938, pp. 114-131. Cf. also O Muck, 'Wahrheit und Verifikation', in Rationalität und Weltanschauung, Tyrolia-Verlag, Innsbruck, 1999, pp. 81100. 11 Cf. W Rabl, Gerichtliche Medizin, 5th edition. Innsbruck, 2000/2001, pp. 23. Bibliography Ad hoc Committee of the Harvard Medical School, 'A Definition of Irreversible Coma'. JAMA, vol. 205 (6), August 1968, pp. 85-88. Joseph Wang 225 _____________________________________________________________ Bridgman, P.W., 'Operational Analysis'. Philosophy of Science, vol 5, April 1938, pp. 114-131. Haupt, W.F. and W. Höfling, ‘Die Diagnose des Hirntodes: Medizinische und juristische Aspekte unter Berücksichtigung des Transplantationsgesetzes (TPG) der BRD’. Fortschr Neurol Psychiat, vol. 70, 2002, pp. 583-590. Jones, D. A., 'Metaphysical Misgivings about ‘Brain Death’', in Beyond Brain Death, M Potts, P. A. Byrne and R. G. Nilges (eds), Kluwer Academic Publishers, Dordrecht, 2000, pp. 91-119. Mollaret, P. & M. Goulon, 'Le coma dépassé'. Rev Neurol, vol. 101, 1959, pp. 3-15. Moskopp, D., 'Hirntoddiagnostik'. Intensivmedizin up2date, vol. 1, 2005, pp. 285-308. Muck, O., 'Zur Logik der Rede von Gott’, in Rationalität und Weltanschauung, O. Muck and W. Loffler (eds)., Tyrolia-Verlag, Innsbruck, 1999, pp. 14-44. Muck, O., 'Wahrheit und Verifikation', in Rationalität und Weltanschauung, O. Muck and W. Loffler (eds), Tyrolia-Verlag, Innsbruck, 1999, pp. 81-100. Rabl, W., Gerichtliche Medizin, 5th edition. Innsbruck, 2000/2001. Singer, P., Practical Ethics. Cambridge University Press, Cambridge, UK, 1979. Joseph Wang is a Ph.D. student at the Catholic Theological Faculty of the University Innsbruck. Death & Justice: An Ethical Response to Massacre Vanessa Fredericks Abstract This paper applies Derrida’s “politics of mourning” to a particular event in Polish history, namely the Katyn massacre of WWII. For Derrida, mourning is an ongoing entrusted responsibility to the Other. It is an ongoing responsibility to memory of the Other and a responsibility in the face of a heritage. This work of mourning is not to be perceived as only a responsibility to our immediate friends, but is also to be seen as a political and collective responsibility, especially when the lives we are mourning are lost as a result of politics. With a focus on ethics, responsibility and justice, this paper is a way of thinking and responding to this particular massacre. It is an attempt to break the silence that existed after the event for so long and it is a call for justice. But what exactly is justice? Is justice a necessary part of mourning? What is the most ethical way to mourn? What is an ethical response to a massacre around which there has been so much silence? We can begin to answer these questions by using Derrida’s idea of mourning as a future-oriented memory which is dedicated to an ethical responsibility to the trace of the Other. To be silent, to be non-responsive, is an unethical response to this event. Key Words: Katyn massacre, deconstruction, responsibility, justice, law, memory, genocide. mourning, ethics, ***** In this paper I will be examining an event in Polish WWII history in light of Derrida’s notion justice. This paper is part of a larger body of work, which deals primarily with Derrida’s “politics of mourning.” For Derrida, mourning is an ongoing, entrusted responsibility that we, the living, owe to the other that has passed. In instances of murder, massacre or genocide, collectively, we are forced to ask ourselves what constitutes justice and what an ethical response to such a death might entail. The event that I will be discussing is the murder of around 14,000-22,000 Polish prisoners of war by the Red Army, in what has come to be known as the Katyn massacre. The truth about who was responsible for the crimes was covered up for fifty years and to this day no one has been prosecuted for the crime; there has been no official apology or any attempt to compensate the victim’s families. In this paper I will look at how justice has not been done, how laws have been enforced in the name of justice, and how justice is related to an inherited memory. Deconstruction enables us to begin to talk about the question of justice in relation to this event. 228 Death & Justice ______________________________________________________________ For Derrida “the task of a historical and interpretative memory is at the heart of deconstruction” which he describes as a “responsibility in the face of a heritage.”1 Deconstruction makes visible our responsibility for the inheritance of the past, the inheritance of an historical memory, which informs our present, and in turn, the future to come. But with this memory also comes a responsibility to question this inheritance and to critique the implications of this memory. This is particularly important when we speak about historical injustices and crimes against humanity. We must be vigilant to what this memory entails and be aware that the truth is always an interpretation. Ultimately, this responsibility in the face of a heritage is an infinite call for justice. So what does this have to do with deconstruction then? For Derrida, deconstruction is “already engaged by this infinite demand of justice, for justice.”2 It is concerned with a “sense of responsibility without limits, and so necessarily excessive, incalculable, before memory.”3 If this responsibility is without limits, it is therefore incalculable, and there is never a moment when one can say that one has dealt with justice, or that justice has been met. In Derrida’s most explicit discussion of justice, “Force of Law” he argues that it is necessary to think deconstructively about the “force of law”, acknowledging the “performative and therefore interpretative violence” in the founding or instituting of any law.”4 To “enforce the law” alludes to the force that comes from within, which reminds us that “law is always an authorized force, a force that justifies itself or is justified in applying itself, even if this justification may be judged from elsewhere to be unjust or unjustifiable.”5 The space between law and justice must always be viewed then as anything but a naturally occurring space. It is within this space that deconstruction resides. The singularity of the other can never be responded to within this space and thus it must constantly be deconstructed in response to each singularity. Derrida argues that “each case is other, each decision is different and requires an absolutely unique interpretation, which no existing, coded rule can or ought to guarantee absolutely.”6 Following from this paradox, “there is never a moment that we can say in the present that a decision is just.”7 Deconstruction should always remain critical of legal claims to justification. Deconstruction does not set out to dismantle the ideal itself of law or justice, but to always remain suspicious of systems that claim to be right or just. Justice must be situated as “the yet to come which can never be presented.”8 For Derrida, justice is an aporia, an experience of the impossible.9 Why should we talk about something then if its very experience is one of the impossible? It is for this reason exactly; because justice is impossible that deconstruction must be dedicated to the relentless pursuit of justice. Derrida argues that is important to know that “this justice always addresses itself to singularity, to the singularity of the other, despite or even because it pretends to universality.”10 Justice is caught in this double-bind of Vanessa Fredericks 229 ______________________________________________________________ responding to the event each time, as a singularity, but also must be dedicated to the unveiling of universal injustices. Justice can never be really possible then and it is for that very reason that we must continue to think new ways through current injustices, continue to question obstructions of justice, and be critical of the ways in which justice is regulated through laws and legal systems. However impossible it may be though, justice “if such a thing exists, outside or beyond law, is not deconstructible. No more that deconstruction itself, if such a thing exists. Deconstruction is justice.”11 For Derrida, justice sits outside of anything that can be called law. Laws can be enforced, they can be interpreted. Legality is a construct, but justice exists before and outside it, it is above and beyond it, therefore it is not deconstructible. The point of insisting on the indeconstructibility of justice is not to reduce the notion of justice to an unattainable ideal, but to insist on the deconstructibility of the law and to constantly deconstruct injustices made possible by legality or political systems. It is to draw our attention to the very precarious nature of law, to be constantly open to the singularity of the other, and to the tensions between this singularity and universal claims to justice. It is important to note how Derrida’s notion of justice is derived from Levinas’ concept of justice, which he makes explicit in the following quotation: Levinas says somewhere that the definition of justice... is the relation to the other. (Totality & Infinity: 89). That is all. Once you relate to the other as other, then something incalculable comes on the scene, something which cannot be reduced to the law or to the history of legal structures. That is what gives deconstruction its movement, that is, constantly to suspect, to criticize the given determinations of culture, of institutions, of legal systems, not in order to destroy them or simply cancel them, but to be just with justice, to respect this relation to the other as justice.12 Our responsibility to the other is immeasurable, it is infinite, and it is constantly in this state of movement, of moving towards something-to-come. A deconstruction of laws, cultures or events needs to keep in mind this vigilance to the other as justice. Our ethical relation to the other stems from this justice. A law, or an institution that does not respect the otherness of the Other, that does not open itself to the possibility of the Other is not just. An ongoing deconstruction of these laws and ideals is a way of continually negotiating this justice, calling for and to justice. If justice is to be defined in relation to the other, then murder or massacre is the most extreme example of an injustice towards the other. 230 Death & Justice ______________________________________________________________ With this in mind, I will briefly outline the Katyn massacre. The word “Katyn” has recently come to represent the massacre of 14,000–22, 000 Polish men made up of generals, army officers, policemen, teachers and professionals, taken prisoner by the NKVD (Soviet secret police) in the Spring of 1939. The prisoners were kept in three separate prisoner of war camps, and were subsequently executed and buried in three separate mass graves in the Ukraine. The executions took place in 1940 under Stalin’s orders, and the first of the mass graves at Katyn were discovered by German soldiers in 1943. It is because the graves at Katyn were the first to be discovered that the word “Katyn” has now come to refer to all the massacres. Between 1940 and 1943 the whereabouts and fate of the prisoners was kept from the victim’s families. In relation to a deconstructive ethics, how are these massacres an injustice of our responsibility to the other? In one sense, murder, massacre is an injustice to the other; it is a violation of human vulnerability. War however, is an institution, which justifies killing. The detainment and execution of the Polish prisoners of war was justified through the institution of war. It was an organised crime made possible through the legal and conceptual framework of war. I must emphasise here that the prisoners of war detained and murdered in these camps were not just members of the army but also policemen, teachers, and professionals. “Civilians”, if you will. But then again, this is a distinction validated through the discourse of war, as if the worth of human life can be determined by its relationship to war. What further added to the injustice of this massacre was the continued obstruction of justice, which was supported by legal systems and political infrastructures. The first public mention of the Katyn graves was made by the German news agency Trans-Ocean on 11 April 1943. The following day this was countered by a pro-Soviet Polish language broadcast from Moscow which claimed the accusations where German propaganda. Exhumations were conducted under German supervision by both the International Red Cross (IRC) and the Polish Red Cross (PRC). Both concluded that the names of the officers who were missing from the Soviet POW camps correlated with the victims identified at Katyn. They also noted that newspapers and diaries found on the corpses dating from spring 1940 pointed to Soviet guilt. The Soviets did not accept this and on the 13th of January 1944 a special Soviet commission was set up for investigation of the site. It was chaired by chief surgeon of the Red Army, Nikolai Burdenko, so is commonly referred to as the Burdenko Commission. The Burdenko Commission focused on rejecting the conclusions and evidence cited in the 1943 report of the IMC (International Medical Commission). It argued that the Polish prisoners of war had fallen into German hands and were executed by the Germans between July and September 1941. An extract of the report was presented as evidence in the Nuremberg war Crime Trials. The Soviet charges against the Vanessa Fredericks 231 ______________________________________________________________ German Nazi leaders included the murder of the Polish officers at Katyn. The Katyn case was not listed in the final IMT verdicts, and although no one was officially cleared of responsibility for the massacres, neither was anyone officially charged for the massacres. This was enough for the Soviet government, and up until mid-April 1990, all Soviet governments and official publications claimed that the Soviet Union had won its case on Katyn at Nuremberg. From then on the Katyn report of the Burdenko Commission was always presented and cited in Soviet media, encyclopaedias and history books, until the official admission of Soviet guilt in 1990. This fabricated yet official and legal case for justice was used as a means to obstruct truth, justice, and cultural memory. Not only was the Burdenko Commission used to prevent justice being done to the memory of the deceased and to the victim’s families, but it was also an injustice to the Russian cultural memory as the inherited memory of Katyn was a lie, one which was supported by a legal document and sustained by the repetition of this lie in other mediums. In post-war communist Poland, under direct orders from the Kremlin, the very word “Katyn” was forbidden. Children of the Katyn victims were forbidden to speak publicly about the cause of their father’s deaths. To do so they risked losing their jobs, being denied access into schools or universities, or even jailed. The law in this case, was used to obstruct truth, justice and memory. Justice is not always about trial and punishment. There is an injustice in not being allowed a culture of mourning. In not being allowed to speak of the dead, the victim’s families were denied access to the language of mourning. In 1988 Mikhail Gorbachev’s glasnost [open discussion] policy led to the relaxation of censorship in Poland, resulting in growing pressure for the truth on Katyn. Gorbachev’s policy of glasnost led to the opening of some state archives to three Russian historians who had a significant impact on the uncovering of the truth of Katyn (Yuri Zoria, Valentina Parsadonova and Natalia Lebedeva). In 1989 they found previously unknown documents on the Polish prisoners of war including archival materials on the Polish POWs held in the three camps which corresponded with the names of the dead officers compiled by the Germans in 1943. The truth was finally announced on the 13th of April 1990, fifty years after the event. Derrida argues that justice, “however unpresentable it may be, doesn’t wait. It is that which must not wait.”13 A just decision “is always required immediately, ‘right away.’”14 Thus this admittance of guilt was an important step towards justice, but it had to wait. The inherited cultural memory of Katyn was a memory that was haunted by the failures of governments and laws to bring justice to the perpetrators of the crime. After fifty years of lies, denial and enforced censorship laws, an admittance of guilt is not enough, it is not justice. German President Roman Herzog apologized to the Polish nation in August 1994 for German crimes committed in Poland during WWII. There 232 Death & Justice ______________________________________________________________ was talk in Poland about the need for an official Russian apology for the Katyn massacre and of compensation for the victim’s families. Boris Yeltsin objected to both of these demands but he did agree that a memorial should be built at Katyn. A Polish-Russian agreement was signed in 1994 in which the Poles agreed to maintain Russian war graves in Poland and vice versa, and a Polish-Ukrainian agreement was signed which led to the opening of three cemeteries in 2000 at Kharkov, Katyn and Miednoye (the three burial sites of the executed officers). Although this was a significant step towards implementing a culture of mourning around this crime, it did not put an end to the Katyn question. Documentation is still lacking on Stalin’s motives and timing for the decision to execute, the whereabouts of the prisoners held in NKVD prisons of Western Ukraine and Western Belorussia are still unknown, and there has still been no official apology for the crimes committed at Katyn. Thus there are still questions unanswered, truths to be uncovered and injustices to respond to. Justice is yet to come. On the 11th of March 2005 the head of the Russian-Katyn investigation, Aleksandr Savenkov, announced that the investigation was closed and that no one would be condemned because all members of the wartime Politburo were dead. He concluded that there was no evidence that genocide had been committed against the Polish nation. Although this statement caused outrage in Poland15, it was supported by the institution of Russian law. For one thing, the concept of genocide was absent from Russian criminal legislation until January 1997. How can one respond to the singularity of an event if the language of genocide, murder, or ethics is not universal? The Russian government did update their criminal code in the late 1990s to bring it closer to international standards. The new criminal code qualified as criminal the “cruel treatment of prisoners of war or civilians” and also the “planning, preparation, unleashing or conduct of aggressive war.”16 Article 10 of the new code however, stated that punishment for these crimes did not apply to crimes committed before the code entered into force making it legally impossible for those responsible for the executions to be prosecuted. The new code also followed Russian legal tradition in not allowing the prosecution and judgement of criminals no longer living. This is another example of a legal obstruction of justice, an interpretation of what constitutes justice and how justice should be carried out. Both the new Russian code and Russian legal tradition are contrary to Article 6 of the IMT Charter as well as Article 2 of the 1968 international convention on the inapplicability of the statute of limitations to war crimes and crimes against humanity.17 However, though it may be the law within the international tribunal not to have a statute of limitations on war crimes, is there really any justice in prosecuting someone after they are dead? Do we owe justice to the memory of the perpetrators? What the Katyn case does highlight though is the urgency of justice, and what Derrida means when he says that a just decision is required Vanessa Fredericks 233 ______________________________________________________________ immediately. If justice cannot wait, then can it ever be too late for justice? Justice is related to an inherited memory and because of that there is justice in having the truth about these crimes brought to light. Justice can be done to the memory of the deceased, and to those who are left to mourn, to inherit that memory. Another obstacle to reconciliation over Katyn is that there is a conflict of historical memory between the Russian and the Polish people. Most Russians find it difficult to admit the truth about the Stalinist years as most still view him as a great war leader who liberated Eastern Europe from German occupation.18 On the 31st of December 1999 Yeltsin’s appointment of Vladimir Putin as his successor, brought with it new hopes of a PolishRussian reconciliation over Katyn. Putin however, “ejected a comparison of Stalinist repressions with Nazi German genocides.”19 Once again we have a conflict of inherited memory and of an interpretation of the concept of genocide which is obstructing justice. In Poland, the fight for justice appears to have come to a standstill. A Polish investigation, announced on 30 November 2004 is unlikely to bring closure since the Russian Main Military Prosecutors office denies the committee access to most of the documents gathered in its own investigation. Polish President Lech Kaczyński stated in July 2006, It is not the role of [the] prime minister to lead fights over the past. I want my government and myself to form a group that works for the future. We leave these fights to the historian for the time being.20 It is interesting to note here the separation of anxieties about the past from the concerns for the future. Derrida argues that we inherit the past, and with this inheritance comes responsibility. We inherit the cultural memories of the past and these memories inform the future. The Katyn question is a complicated historical blank spot in the cultural memory of both the Polish people and the Russian people. But the issue of justice is still unanswered. Derrida argues that “Justice remains, is yet, to come, à venir, it has an, it is à venir, the very dimension of events irreducibly to come.”21 And it is the case with Katyn that justice is yet to come, an apology is yet to come, the full truth about this event and other Stalinist war crimes is yet to come. The failure of legal systems and governments to respond to justice over the case of Katyn demonstrates the volatile space between law and justice. The numerous attempts to bring justice to the crime have been aided by legal structures. With the admittance of guilt in 1990 there was some justice in being able to talk about these deaths and in being allowed to visit the graves of the murdered officers. It remains to be seen whether there will ever be justice in the form of reparation or apology for the crimes committed 234 Death & Justice ______________________________________________________________ at Katyn. But If Derrida has taught us anything about justice, it is to remain vigilant to the call of justice. An injustice would be the perpetuation of silence in response to this event. Perhaps there is some justice in being allowed to talk about the event, to name the event. Perhaps there is justice in being allowed to visit the graves. Perhaps justice will continue to haunt the inherited cultural memory of Europe. “‘Perhaps’, one must always say perhaps for justice.”22 Notes 1 J Derrida, ‘Force of Law: The “Mystical Foundation of Authority’’’, in Deconstruction and the Possibility of Justice, D Cornell, M Rosenfeld and D G Carlson (eds), Routledge, New York & London, 1992, p 19. 2 ibid., p. 19. 3 ibid., p. 19. 4 ibid., p. 13. 5 ibid., p. 5. 6 ibid., p. 23. 7 ibid., p. 23. 8 C D’Cruz, ‘Responding to a Heritage: Justice, Deconstruction and Injunctions of Marx’, Social Semiotics, vol. 6 (2), 1996, p. 170 9 Derrida, op. cit., p. 16. 10 ibid., p. 20. 11 ibid., pp. 14-15. 12 J Derrida cited in J Caputo, Deconstruction in a Nutshell: A Conversation with Jacques Derrida, Fordham University Press, New York, 1997, p. 17-18. 13 Derrida, op cit., p. 26 14 ibid., p. 26. 15 A M Cienciala, N Lebedeva, and W Materski (eds), Katyn: A Crime Without Punishment, Yale University Press, New Haven & London, 2007, p. 289. 16 ibid., p. 261. 17 ibid., p. 261. 18 ibid., p. 262. 19 ibid., p. 261. 20 ibid., p. 264. 21 Derrida, op cit., p. 27 22 ibid. Vanessa Fredericks 235 ______________________________________________________________ Bibliography Caputo, J., Deconstruction in a Nutshell: A Conversation with Jacques Derrida. Fordham University Press, New York, 1997. Cienciala, A.M., N. S. Lebedeva, and W. Materski (eds), Katyn: A Crime Without Punishment. Yale University Press: New Haven & London, 2007. D’Cruz, C., ‘Responding to a Heritage: Justice, Deconstruction and Injunctions of Marx’. Social Semiotics, vol. 6 (2), 1996, pp. 159-177. Derrida, Jacques, ‘Force of Law: The “Mystical Foundation of Authority”’, in Deconstruction and the Possibility of Justice, D Cornell, M Rosenfeld and D G Carlson (eds), Routledge, New York & London, 1992, pp. 3-67. Levinas, E., Totality and Infinity: An Essay on Exteriority. A. Lingis (trans), Duquesne University Press, Pittsburg, 1969. Vanessa Fredericks is a Ph.D. candidate in the department of Critical & Cultural Studies at Macquarie University in Sydney, Australia. The focus of her research is Derrida’s politics of mourning and Polish history during and after WWII. She is currently working as an editorial assistant on a Derrida concordance and glossary to be published by Edinburgh University Press. Kantian Obligatory Suicide: Further Developments Dennis R. Cooley Abstract Although the topic causes many to feel an intuitive moral repulsion and anger, the issue of morally obligatory suicide duties for the soon to be demented needs philosophical attention, especially given new information about the number of people who will be afflicted. The Alzheimer’s Association estimates there are already 5.1 million Americans with Alzheimer’s, and predicts 7.7 million will have the disease by 2030. Given the situation’s emotive impact and the difficulty changing fundamentally held beliefs and ideologies, an objective discussion of what to do needs to begin as soon as possible. Using a modified interpretation of Kant, I defend the position that some of the soon to be demented have a moral duty to themselves to end their lives before they lose their moral agency against some of its most important actual and potential objections. Key Words: Dementia, duty, Kant, suicide. ***** 1. Introduction In “Crimina Carnis and Morally Obligatory Suicide” and “A Kantian Moral Duty for the Soon to be Demented to Commit Suicide,” I argued for the controversial position that Kant believed that some suicides are moral duties.1,2,3 The justification for such an anti-traditionalist position can be found in a suicide maxim that can be consistently willed as a law of nature by agents in certain situations and several of Kant’s examples in which he claimed that some people had a duty to kill themselves rather than surrender their humanity. The suicide obligation’s three conditions are that the agent has a moral life worth preserving, he is in a situation in which he can save his human dignity only by sacrificing his physical life, and he can perform the action with the right mental states, including primarily good intentions, motives, attitudes, and respect. In situations meeting all the conditions, the agent owes it to his moral self to die physically before his other life ends. Of course, such a controversial interpretation of Kant’s position was bound to draw fire on many different grounds, especially due to the soon to be demented component. I will leave to one side the issue of whether or not my interpretation captures the true spirit of Kant’s ethics to focus on some of the more difficult, and therefore more interesting, objections to the overall position. First, Kant’s argument is based on what a totally rational agent 238 Kantian Obligatory Suicide ______________________________________________________________ would do in the circumstances, which is antiquated at the very least, if not positively wrong. Second, a duty to commit suicide might make it less likely for the agent to perform the action because she does not want to be told what to do, especially when it comes to ending her physical life.4 I will consider and respond to each of these in turn. 2. Kant’s Cold Morality The first major criticism of a suicide duty is that Kant’s morality is based on what a purely rational agent would do in the same circumstances. The main trouble for this position is if an agent does not have emotions as part of what it is to be a person and morality, then she cannot make decisions as a person in the first place. Kant’s rational person is an entity who cannot choose between the pricking of his thumb and the destruction of the world because he does not have emotion to care about which one occurs. This oversight is a serious one because the ignored emotions are what allows us to bridge the gap between the purely descriptive “is” in order to get to the moral “ought.” The solution to this problem is not difficult to discover: although rationality plays a significant function in ethics, it is not a primary role. I contend that the same conclusion about suicide obligations can be achieved without going to the extreme of formulating an ethical theory based upon a person unable to understand ethics in any real way. A reasonable person standard combining rationality and the emotions underlying morality works better than a rational person standard. A reasonable person rationally analyses the data available to her in each particular situation she is in, and incorporates all relevant facts about the external world society’s rules, practices, and customs; rules and responsibilities associated with specific roles the agent is playing at the time; claims that others have on the agent and the agent has on others; value of all foreseeable consequences; and all other relevant factors into her decision process.5 At the same time, she is someone whose decision procedure has the belief that morality is “a creative, cooperative enterprise whose end is to better the world by trying to realize in ourselves and others nurturing goods such as caring, considerateness, compassion, sympathy, and love.”6 The reasonable person can be generally characterized as a rational, caring, considerate, compassionate, sympathetic, and loving individual who understands the internal and external moral factors involved in the situation, and makes her decisions accordingly.7 This is the person by which we should be judging actions and obligations, and I take it as a given that each moral agent is obligated to strive to be a reasonable person and act as one. It is a difficult argument to prove that reasonable people would confirm the existence of a suicide duty for every person who will become demented in his lifetime. After all, it is hard for people to agree on many trivial matters much less one of the most important actions some people must Dennis R. Cooley 239 ______________________________________________________________ take. However, I do not have to prove that all reasonable people will agree that there is a duty, only that some will and that the duty exists for at least some people, viz. individuals who do not have any extenuating circumstances that justify them staying alive without their moral life. There are many individuals who are embedded in positive relationships with others that have or should have accepted what will happen and understand the decision, although if they are caring, they will regret that it needs to be done. These are the individuals who have the suicide duty. The duty to die for dementia patients is an obligation to oneself that recognizes that morality is internal and does not rely solely on the consequences of the agent’s action. Recall that people can act in such a way that they sacrifice their humanity while still retaining their ability to make choices. Suppose that an agent, while trying to murder a good, innocent person, misses his intended target and accidentally shoots a terrorist who would have killed many other good, innocent people the next day had he survived. Unless we are unrepentant consequentialists, the fortunate accident is still morally wrong because it was an attempt to kill someone who did not deserve it.8 What makes the agent blameworthy in this case is not merely the murder attempt, but his decision to try to kill another. This conclusion is borne out by the fact that even if he had been prevented from acting on his decision by circumstances beyond his control, we would still say that he degraded himself by being a person who would commit such an action. Granted that those with dementia causing diseases are not evil as are would be murderers, when an agent does not select suicide, she devalues herself regardless of the beneficial consequences of her position. First, her last goal as a moral person and agent cannot be to squeeze out as much time as a rational creature as one can, but to write her final narrative in a way that is consistent with the moral life that she has led.9 In addition, each moral agent has to recognize and understand the impact of her actions on all those affected by them so that she can respect each for the end he is in himself. This group of people includes not only those with whom she has caring and nurturing relationships, but others in society as well. To treat them as she should, when a moral agent is confronted with her dementia prognosis, she must ensure that her final decision is made for the right reasons. That is, her intentions, motives, attitude, and other relevant mental states must be primarily good. In the case of a person who remains alive as a sacrifice for deserving loved ones, all indications are that the person can do the right thing by ending her life or continuing her body’s existence. In other cases, the behaviour is identical but the choices are defective due to bad motives, intentions, attitude or relevant mental states, e.g., the person who knows her family will be destroyed emotionally and financially caring for her but selfishly chooses to place the burden on them anyway. For actions failing to meet the necessary mental conditions, the 240 Kantian Obligatory Suicide ______________________________________________________________ person makes herself a worse person than she otherwise would have been in matters of utmost importance. That is, she degrades herself, and the level of her degradation depends on the severity of the bad inner states. Therefore, in the absence of extenuating circumstances, each person owes it to herself to end her life to preserve who she is as a moral person and to respect all others affected by her actions. Some have raised the issue of harm caused to the suicide’s loved ones of a suicide as being sufficient to defeat any duty to kill oneself. Rabins states that “the family and friends of those who commit suicide are often permanently and grievously damaged when a loved one or close acquaintance commits suicide, whether or not there was a ‘good reason.’”10 If we respect others for the ends that they truly are, this line of reasoning suggests, then we should not cause them unnecessary, excessive harm by killing ourselves. Moreover, provided that the injuries suffered are likely to be lessened or avoided altogether, the individual would have an obligation to stay alive for as long as she can. There are three plausible arguments, which when taken together, provide an adequate response to this criticism. First, the suicide duty is not absolute because there are a number of individuals who may permissibly stay physically alive while losing their moral agency for the interests of others. Perhaps their families need more time to accept the inevitable and this inability to understand and accept is not caused by some moral defect they have, such as being self-centred or wilfully uninterested in the well-being of others. In these situations, the person sacrifices herself by losing her identity as a moral agent after the dementia sets in, but retains her human dignity while she lives as a moral agent due to the fact that her action is noble rather than venal or worse. She does not lose her dignity by trying to stay alive as long as she can and leaving the burden of taking care of her on her loved ones and society that causes her to deserve a lower moral status. Rather she stays physically alive for others because she cares for them. This exception fits in with Tong’s notion of death as a gift given to loved ones.11 Although Tong would disagree that there is a duty to die, in these rare conflict situations, there are two competing alternatives, which if they did not exist simultaneously for the agent, would be duties. In these cases, the agent may select either and still do the right thing. There are two other ways to respond to the unethical harm through grief argument. First, if there is a duty to oneself to die, then the harm caused to others is permissible. No one ever said that doing the right thing, especially in difficult situations such as these, leaves everyone with a positive or neutral outcome. Suppose two people – Person A and Person B - are stranded in a blizzard with only enough food to keep one of them alive. Furthermore, assume that the food is owned and has been brought by Person A. If Person A eats it, then what she does harms Person B by killing/allowing him to die Dennis R. Cooley 241 ______________________________________________________________ from starvation. However, Person A has done nothing wrong in preserving her life, even though she unintentionally caused B pain, suffering, and death. It might not have been her duty to stay alive, since she could have acted altruistically by sacrificing herself and given the food to Person B, but her action was morally permissible. Therefore, the mere existence of severe harm to others does not entail that anyone was treated illicitly. Second, and more importantly, the existence of a great deal of permanent and grievous damage to people as the result of some suicides does not establish that they ought or have a right to feel this way. It is the naturalistic fallacy to derive an “ought” from an “is,” as has been pointed out by many over the years. Therefore, to prove that the harm is illicit requires us to investigate the reasons why these individuals suffer these feelings. I contend that any permanent and grievous damage felt by them is the partial result of social learning. We are raised and reinforced by society to believe that death and suicide are always very bad things. There also seems to be an underlying belief that those diagnosed with a dementia causing illness are fragile victims requiring full paternalistic protection from themselves and others. Something similar is seen in Slavoj Zizek’s analysis of NATO actions in Kosovo: What we encounter here is again the paradox of victimization: the Other to be protected is good in so far as it remains a victim…the moment it no longer behaves like a victim but wants to strike back on its own, it magically turns all of a sudden into a terrorist/fundamentalist/drugtrafficking Other.12 A victim who takes control of his life and throws off others’ paternalism causes such discomfort to those wanting to help him that he is labelled as a danger. This is one of the reasons why claiming that those who will be demented have a duty to kill themselves is so controversial. By rejecting the helpless victimhood paradigm, the suicide duty challenges fundamental social beliefs about the status of those diagnosed with dementia causing diseases. However, what is socially learned can be unlearned. The ancient Greeks, for instance, did not view suicide and death in the way that many of us do. They thought it base and ignoble to place a heavy burden on society or family if doing so is only to give a short extension of life to one citizen.13 Given that social attitudes have changed, it follows that unless we are full of hubris, we cannot merely assume that our contemporary views about suicide and death are superior measures of morality. In fact, they might be unjustified if a better social belief is available to us. If we changed our society in such a way that people accepted suicide as a rational, honourable action, then much of the damage caused to those left 242 Kantian Obligatory Suicide ______________________________________________________________ behind by it would not occur. I am not arguing that there will never be painful emotions such as regret, remorse, guilt, and grief - some legitimately felt while others are not - but that understanding why the person did what she did as a right action can alleviate much of it in the same way that those emotions are reduced when families and friends are part of the process when patients refuse further treatment for their illnesses. Instead of allowing oneself to succumb to the disease, the person ends her life at the time and in the circumstances she controls, which if the family respects and cares for her, might be tragic and laudatory to them rather than causing them permanent damage. The suggested alteration to social beliefs could create a society that is much better than the one we have. Instead of people being wracked by guilt, overburdened with emotional and financial costs, or incurring other avoidable expenses, there can be a loving society in which caring support is given and the person ends her life in a right way. 3. Moral Duties, Stultification, and Comfort Although much can be made of the stultifying effect of moral obligations on people who do not like to be told what to do, especially after they are diagnosed with a dementia causing disease, having a suicide duty might be beneficial to the individual’s mental state in a variety of ways. First, it provides certainty at a chaotic time. If suicide is merely permissible or a right, people have to struggle with whether or not they will commit. Since it is permissible to go either way, then they do not know what to do. Mandatory suicide, however, takes the decision out of their hands. It is made for them, and all they have to do to remain good people is for them to perform their duty. The result is that instead of the emotional turmoil generated by suicide being merely permissible, with a proper frame of mind, there can be a sense of calm and acceptance of fate much the same way many dying from cancer and other terminal diseases finally come to acquiesce to the final outcome. They are unhappy about the situation and would change it if they could, but their tacit acceptance has given them peace of mind. A suicide duty can be a comfort in other ways as well. As Dena Davis writes, “people have a strong interest in ending their lives with a final chapter that is consonant with the narrative as a whole.”14 That is, some individuals desire to die in a way that reflects how they lived. They do not wish to be someone slowly but certainly progressing to the state of former personhood in a living body, who must rely on others for massive support, regardless of what might be in the latter’s best interests. Rather these agents want to end their physical life as a person and take a vital, in opposition to a passive, role, which allows them to remain “active and dominant.”15 This particular requirement to end one’s own life leads to an alleged problem that has been raised by some critics. There is not a clear moment when a patient progresses from full self-hood to being a former person. Dennis R. Cooley 243 ______________________________________________________________ Given this lack of clear definition and the value of being a person, it would be wrong, according to them, to end one’s life too early. Since the dignity of a person’s humanity must be preserved no matter what the cost to her physical life and to maximize her time as a person, she should passively allow the dementia to render her a different person or a former person. The objection, however, arises from a basic misunderstanding of my time-line and the internal nature of the ethical. There is not an exact right moment when the death must occur. Further diagnoses have to be sought to provide sufficient evidence of what will happen to the person so that she can make an informed decision about when to end her life. After that, the person has to settle her affairs, including bringing those who care for her into the process of her end of life. Finally, since the person does not become demented overnight, she has the opportunity to live fully as a person for as long as she can, as long as she knows there is a limitation to her time. When her disease has progressed far enough so that recovery is impossible but she is still assured of being a full person, then she has the duty to end her life. So, the suicide duty either exists or it does not for a person - that is an either/or proposition - but her window for action is limited to an acceptable range of time. 4. Conclusion The existence of a duty to commit suicide for those who will be demented is controversial. It challenges fundamental beliefs about death, suicide, and the vulnerable in ways that make many uncomfortable, and some fear the loss of hard earned respect and rights for those who have been oppressed or are especially at risk of exploitation. However, if it is understood in the proper way as a loving, caring act that respects all those affected by it, the obligation can be seen as beneficial to those who will have to perform it, their loved ones, and society in general. It might be hard to accept, but as health care resources become further stretched, many would prefer having such a duty based on the respect for themselves and others rather than becoming a statistic in a utilitarian calculation of who should die and who should live. Notes 1 D Cooley, ‘Crimina Carnis and Morally Obligatory Suicide’, Ethical Theory and Moral Practice, vol. 9 (7), 2006, and ‘A Kantian Moral Duty for the Soon to be Demented to Commit Suicide’, American Journal of Bioethics, vol. 7(6), 2007, pp. 37-44. 2 Christine Korsgaard’s work on Kant and lying served as an inspiration for this argument. C M Korsgaard, ‘The Right to Lie: Kant on Dealing with 244 Kantian Obligatory Suicide ______________________________________________________________ Evil’, in Ethical Theory, J Rachels (ed), Oxford University Press, New York, 1998, pp. 530-53. 3 Rosamond Rhodes seems to believe that my interpretation of Kant is accurate, while others do not. R Rhodes, ‘A Kantian Duty to Commit Suicide and Its Implications for Bioethics’, American Journal of Bioethics, vol. 7 (6), 2007, pp. 45-7. 4 There are four other criticisms in the unabridged paper. 5 R L Holmes, Basic Moral Philosophy, Thomson Wadsworth, Belmont, 2007, pp. 227-228. 6 ibid., pp. 228-229. 7 Given the complexity of situations and the range of reasonable people, different reasonable people can justifiably come to different conclusions in a particular situation and each is correct. In the great majority of instances, there is not one right answer, but many. 8 I am not implying that anyone deserves to be murdered. 9 Dena S. Davis’ work was very helpful in rethinking suicide as a positive action ending a life. 10 P V Rabins, ‘Can Suicide Be a Rational and Ethical Act in Persons with Early or Pre-Dementia?’, American Journal of Bioethics, vol. 7 (6), 2007, pp. 48. 11 R Tong, ‘Duty to Die’, in Is There a Duty to Die?, J M Humber and R F Almeder, (eds), Humana Press, Totowa, 2000, pp. 152. 12 S Zizwk, The Fragile Absolute, Verso, New York, 2000, p. 60. 13 G Pence, The Elements of Bioethics, McGraw Hill, Boston, 2007, p. 237. 14 D Davis, ‘Why Suicide Is Like Contraception’, in Physician Assisted Suicide: Expanding the Debate , M P Battin, R Rhodes, and A Silvers (eds), Routledge, New York, 1998, p. 115. 15 D Davis, ‘Rational Suicide and Predictive Genetic Testing’ The Journal of Clinical Ethics, Winter, 1999, p. 318 Bibliography Cooley, D., ‘Crimina Carnis and Morally Obligatory Suicide’. Ethical Theory and Moral Practice, vol. 9 (7), 2006, ISSN: 1386-2820. ____, ‘A Kantian Moral Duty for the Soon to be Demented to Commit Suicide’. American Journal of Bioethics, vol. 7(6), 2007, pp. 37-44. Davis, D., ‘Why Suicide Is Like Contraception’, in Physician Assisted Suicide: Expanding the Debate , M. P. Battin, R. Rhodes, and A. Silver (eds), Routledge, New York, 1998, pp. 113-122. Dennis R. Cooley 245 ______________________________________________________________ ____,‘Rational Suicide and Predictive Genetic Testing’. The Journal of Clinical Ethics, Winter, 1999, pp. 316-23. Holmes, R. L., Basic Moral Philosophy. Thomson Wadsworth, Belmont, 2007. Korsgaard, C. M., ‘The Right to Lie: Kant on Dealing with Evil’, in Ethical Theory, J Rachels (ed), Oxford University Press, New York, 1998, pp. 53053. Pence, G., The Elements of Bioethics. McGraw Hill, Boston, 2007. Rabins, P. V., ‘Can Suicide Be a Rational and Ethical Act in Persons with Early or Pre-Dementia?’. American Journal of Bioethics, vol. 7 (6), 2007, pp. 47-9. Rhodes, R., ‘A Kantian Duty to Commit Suicide and Its Implications for Bioethics’. American Journal of Bioethics, vol. 7 (6), 2007, pp. 45-7. Tong, R., ‘Duty to Die’, in Is There a Duty to Die?, J. M. Humber and R. F. Almeder (eds), Humana Press, Totowa, 2000, pp. 133-58. Zizwk, S., The Fragile Absolute. Verso, New York, 2000. Dennis R. Cooley is Associate Professor of Philosophy and Ethics at North Dakota State University and Associate Director of the Northern Plains Ethics Institute. PART IV Experiencing Re-Imaging “I’d Rather Be Home All My Life”: Older People and Place Care at the End of Life Eileen Sutton and Joanna Coast Abstract In the UK death is now most likely to occur at the end of a long life. The UK government has developed a National End of Life Care Strategy1, which was published in June 2008. This aims to improve the quality and equity of service provision and consider which service models are most likely to achieve these objectives. A focus of much research on end of life care originating from the UK has been the mismatch between where most people say they would like to die (at home), and the place where the majority of people actually die (in hospital). This is reflected in current government policy, where there appears to be a shift to moving care of the dying back into the community. This paper presents evidence from a qualitative research study that seeks to discover the preferences of older people for care at the end of life. Issues surrounding independence, dependency, personal identity and the meaning of home are explored and the extent to which preferences may change along the dying trajectory are considered. Key Words: Older people, death and dying, end-of-life, end of life, preferences, home, place of death. ***** 1. Introduction The population of the United Kingdom is ageing and, according to estimates based on the 2001 census, in 2005 there were more than 11 million people of state pension age and over, with over a million and a quarter over 85 years of age.2 Of the half a million people who die each year in England two thirds are over the age of 75 years.3 In 2004 the government introduced a National End of Life Care Programme, the main stated aim of which is, “To improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice”.4 Initiatives such as the Liverpool Care Pathway and the Preferred Priorities for Care were also introduced as part of the drive to improve care for the dying. Place of death has been the focus of much research originating from the UK, recent survey research revealing that a substantial amount of people say they want to die at home.5 The results of a telephone survey published in 2003 found that 56% of respondents expressed a preference to be cared for at home when they were dying, 24% preferred a hospice, 11% at hospital and 4% a nursing home.6 Nevertheless, it should be noted that older people are 250 Older People and Place of Care at the End of Life ______________________________________________________________ less likely than younger people to say they want to die at home. However, this may be connected to concerns around the availability of unpaid care to support death at home. Research evidence on place of death, however, reveals that there is a mismatch between where people say they would like to die and where they actually die. So despite around 56% preferring a home death, in reality only 18% die at home.7 The number of hospice deaths are relatively low and research has shown that older people and those from lower socio-economic backgrounds are less likely to receive specialist palliative care services, either at home or as an inpatient in a hospice.8 Home deaths in the UK are declining and Gomes and Higginson estimate that less than 1 in 10 people will die at home by 2030, and this has huge implications for service provision. 9 The growing preference for a home death is reflected in current government policy, where there appears to be a move to support death within the community. This will involve coordination of health, social care and voluntary service providers, along with those of unpaid carers. The National Council for Palliative Care has, however, noted that joint working to facilitate service provision between primary care trusts and local authorities is not always effective.10 2. Research Aims The main aim of this research study has been to discover the things that are most important to people when they are dying, and to attempt to develop distinct attributes or features of care at the end of life. These attributes are being utilised in the development of a measure for the economic evaluation of health and social care interventions at the end of life. 3. Research Methods Qualitative in-depth interviews were conducted with 23 older people living in the South-West of England from three distinct groups:    General population aged 65 and over (11) Older People living in residential care (7) Older people receiving palliative care (5) These groups were selected to facilitate comparisons and explore changing preferences along the dying trajectory. The interviews were informant-led and respondents were initially questioned on their experiences of the death of a loved one and then asked what things they thought would be most important to them when they were dying. A topic guide for use in interviews was developed following a review of current literature in the area of end of life care to aid probing of relevant issues. The interviews were Eileen Sutton and Joanna Coast 251 ______________________________________________________________ recorded and transcribed verbatim. Data was then subjected to thematic content analysis with the aid of the Software package Atlas Ti©. Following analysis of initial interview data and development of attributes, second-stage interviews were conducted with 12 of the original participants in order to refine the wording of the attributes and ensure their relevance to the population group studied. Pseudonyms for participants are used in all study reports. 4. What Is Important To Older People? Analysis of initial interviews and follow-up interviews with 12 of the original participants revealed seven main areas which older people thought would be important to them when they were dying:        Dignity – maintaining your dignity and self-respect Autonomy – having a say in decisions that affect your life and care Physical suffering – freedom from significant pain or discomfort Emotional suffering – freedom from worry or distress Affection – being with people who care about you Support – having the help and support you need Completion – having an opportunity to make the preparations you want to make 5. What Do Older People Say The older people, particularly those from the general population group, spoke about the importance of being able to remain in their own homes for as long as they possibly could. But what is it about home that makes it the preferred place of death? Frank here mentions one factor, which was the sense of achievement which some experienced from having bought and maintained their home. There was also a sense of continuity that their home represented. Perhaps they had lived there for a long time and raised a family there: Frank/72/GP: I’m staying here until I get carried away. I’ve worked hard and paid for it, and this is my abode and I’m quite happy with it. Clive/68/GP: As far as I’m concerned I’d rather be at home all my life than anywhere else. 252 Older People and Place of Care at the End of Life ______________________________________________________________ Home could also be a source of memories, perhaps of times shared with loved ones who had died: Joan/67/GP: You’ve got your memories you know. Beatrice, who lived alone at the time of the follow-up interview as her husband had recently died, had a house full of her needlecraft work and ornaments, such as a gift sent for her 50th wedding anniversary by her brother who lived in Canada, whom she would probably never see again: Beatrice/86/GP: My son said “You’ve got a load of old tat [rubbish] Mum.” I said “Yes, but it’s my tat. It means a lot to me.” In this way their home was seen to reflect their personal identity and life history. Some respondents also mentioned that they felt comfortable at home, not only with familiar environments or possessions, but also with their regular day-to-day routines: Eric/81/GP: One thing I appreciated when I got home [from hospital] I thought “Oh isn’t it lovely to get in this bed.” Joan/67/GP: It’s nice to spend the time with things around you that you’re familiar with, with a routine that you’re familiar with…with the things that you like the best. So, being at home was linked to the importance of maintaining a certain level of independence. Being able to do what they wanted to do when they wanted to do it: Beatrice/86/GP: If I want to go and dig the garden I can say: “Oh I’ll go and do ten minutes in the garden.” Whereas in a care home you’re regimented: “You sit there until we bring you a drink” or “You sit there until it’s dinner time”…I don’t want that. Being self-reliant was also linked to maintaining a sense of dignity and it was difficult for some to think about a time when they would no longer be able to complete day to day tasks, in particular looking after their personal care. Eric/81/GP: I can do everything I want to do, and I don’t have to rely on people. That’s important, not having to Eileen Sutton and Joanna Coast 253 ______________________________________________________________ rely…Well I wouldn’t like other people in my home, you know…I do like company but somebody, you know, doing all the intimate things, like doing my…cleaning the house for me, and that’s my job. Another important aspect of being at home was being able to spend time with people they cared about and who cared for them, or being able to give support their loved ones. For example, Monica was worried about how her husband, who had major health problems, would cope if she died: Monica/74/GP: I think he [husband] worries about dying. I think he, I don’t think he knows what he’s going to do without me if, you know what I mean? However, Shirley, a palliative care patient, explained that her husband had learnt to cook, wash and iron in order to care for her during her illness, but that now that she was feeling better it was important to her that she could return to her former role: Shirley/72/PC: When I came out of hospital he [husband] done everything I mean, he cooked the food and he’s never cooked in his life [laugh]…And all the washing, ironing he did. But now I do that cos I got better. Increased dependency as older people move along the dying trajectory can impact on their ability to remain at home. Consequently some of the older people interviewed had made adaptations to their homes so that they could remain there as long as possible: Beatrice/86/GP: And I had this extension built for my convenience, with no help from anybody. And there’s a shower and toilet there, you know, because I have difficulty getting upstairs. For Beatrice this had involved using a substantial amount of her personal savings to pay for adaptations. The complexities of supporting those with complex needs to remain at home to die can be prohibitive, or as Thomas found, can result in changing the nature of the home environment, making it feel more like a hospital setting, lessening feelings of comfort and normality derived from being at home: Thomas/83/GP: One of the Social Services came round, and I said, “Was there anything?” And she went away, and 254 Older People and Place of Care at the End of Life ______________________________________________________________ came back, and she said, “Yes we’ve got this gadget.”…We’d bought some odd things, like the stair lift, which is still there, and a bath lift. Because starting off we had just a frame across the bath and a little seat, and she could lower herself onto it, but then her arthritis got so bad that she couldn’t push herself out of the thing, so we got this, and this inflatable thing is made by the same firm. Some of the respondents recognised that, depending on the type of care needed, it might not be possible to remain at home to die, if specialist community care was unavailable: Joan/67/GP: If it was a question that you needed to be drained, well obviously you’ve got to go into hospital and be drained; you’ve got to go into hospital to get your medication. Others, like Rose, who attended her local hospice as a day patient, explained how she was supported to stay at home by a service providing her with oxygen supplies: Rose/81/PC: Oh I couldn’t live without it [home oxygen service]. I wouldn’t be alive without it. It does help the breathing. I mean it enables me to stay home. Clive, however, raised the issue of potential age discrimination in service provision: Clive/68/GP: I think the older you get the more dismissed you are today of all the facilities which you could expect in your life. The importance of choice is emphasised in much UK health and social care policy documentation. Nevertheless, some of the respondents in this study appeared to be resigned to a declining quality of life when they were dying: Phyllis/74/GP: Maybe that’s what the end of life is, maybe all these luxuries like these that we have during our life, we don’t have them at the very end. Eileen Sutton and Joanna Coast 255 ______________________________________________________________ Clive/68/GP: Choice is a small word with a huge meaning…and the ability to invoke it depends on so many other factors. Concerns regarding the quality and availability of out of hours support and home nursing care were also expressed: Margaret/74/GP: I feel it should be expanded [home nursing care]…but I think this is where money from the NHS should be used to enhance the house service. Another very important issue was a fear of being a burden to their loved ones if they could not maintain their independence: Peter/72/GP: I don’t want to be a burden to anybody Some expressed concerns about the availability of carers and the consequent impact on the choices open to them at the end of life: Hilda/83/PC: I’ve no daughter-in-law, my son is divorced from his wife, he’s got two teenage children. So that…there’s no females to do any helping. My sister is 74 and she lives in London so she’s not…ever so well. So…I’ve got to think ahead to think, you know, what I’ve got any choice what I want. It can be difficult for family members to provide all the care that is needed when someone is dying. Pamela, who lived at her daughter’s house with her husband and grandchildren, explained that despite supporting her mother’s wish to die at home she didn’t want to die at home herself, as she was worried about the impact upon her grandchildren: Pamela/68/GP: I would not want to die at home…when my mother died she died in the room up there, right. And we’d got all the family here, and we had the Marie Curie nurses here, and she had the hospice nurses here…we were with her all the time. But when she actually died and they took her away, my grandchildren were 13 and 11 at the time, and they were a bit worried about going past the room…it was always, [sharp intake of breath] “She died in here.” There was always that little bit of edge. 256 Older People and Place of Care at the End of Life ______________________________________________________________ For some, like Agnes, there had come a time when they recognised that they could no longer continue to live at home: Agnes/90/RC: I think for everyone it’s important to stay in your own home as long as possible, but we all know, what well at least most of us are wise enough to realise the time has come when we’re not possible to stay in our home on our own. We’re too much of a responsibility to other people and therefore we should make a decision about what it is more convenient for everyone So what about the alternatives to dying at home? Many of the study respondents related experiences of poor hospital care, experienced when their loved ones were dying, or when they had been admitted for acute care: Hilda/83/PC: In a general hospital, everybody’s always so rushed and I think when you’re coming, you know, to the end of your life you just want it to go, you just want to go out gently, not to feel that, well I mean they can’t do it in the hospitals cos they’re all so understaffed and overworked. There were concerns about lack of dignity and privacy, issues of cleanliness and hospital acquired infections, and poor staff communication skills. These experiences had convinced them that hospital was not the place that they wanted to die. However, as noted above, it is the place where most people do die. A lack of assistance to unpaid carers supporting someone dying at home often leads to unnecessary emergency admissions to hospital in a crisis situation, for example, if someone is suffering from severe breathing problems. A recent audit of care of the dying in hospitals in the UK recognised the need for substantial improvement in the care for the dying in a hospital setting.11 Similar experiences of poor nursing home care for their relatives meant that some respondents were determined not to be admitted to a nursing home: Rose/81/PC: We were talking about retirement homes, selling the house and I said “No way, I’m not selling my house to go into a retirement home where I couldn’t be happy.” I told them at [hospital] “You’d kill me in a month.” Eileen Sutton and Joanna Coast 257 ______________________________________________________________ However, other respondents were very happy living in her nursing home, like Winnie who hoped to remain in her current home until she died: Winnie/97/RC: Oh yes. I hope I’m still here when I pop off…Well I don’t think I’d want to be shifted when I was pegging out. The palliative care patients interviewed were universally complementary about the care that they received when they attended the day hospice, particularly the personal nature of the care they were given and the respect and understanding they received from staff, in addition to its pleasant surroundings, making it a “home from home.” This meant that they were all happy that they might eventually die as an inpatient there: Caroline/65/PC: If my husband can’t deal with me, come the end of this illness, cos it will get worse very quickly this illness. I said “I wouldn’t mind at all coming here [hospice].” You know I’m quite happy about it. Pamela/68/GP: Well my father died in [hospice], and that was absolutely, you couldn’t have had any better care than he had there. That was, it was absolutely superb. However, as noted above, older people and those with a non-cancer diagnosis are less likely to receive hospice care and there are also issues of geographical differences in the availability of provision, in addition to funding concerns for maintaining or expanding capacity, as a high percentage of hospice funding originates from charitable sources. 6. Conclusions Many of the people from the general population group expressed a preference to remain at home until they died, for various reasons such as a sense of continuity, comfort, familiarity, autonomy and being able to be with people they cared for and who cared about them. These factors were seen to contribute to maintaining an individual’s sense of identity and dignity at the end of life. However, the older people realised that increased levels of dependence as they become older and perhaps increasingly frail or unwell, might mean that this might not be possible. The realisation of their preference for home care was often dependent upon the availability of unpaid care or service provision to support their choice. Respondents were also worried about imposing what they considered to be an unacceptable burden upon their loved ones or carers. 258 Older People and Place of Care at the End of Life ______________________________________________________________ Poor experiences of hospital or nursing home care made them concerned about the type of care they might receive when they were dying, if they could not remain at home. A recent audit of care of the dying in hospital recognised that much work still needs to be done to improve service provision in this area and efforts to improving training for care home staff are also underway. Nevertheless, it is unclear how equality in access to service provision can be achieved. What should recognised, however, is the influence of the uncertainty of the dying trajectory and difficulties in prognostication at the end of life, which in turn have an impact on prioritisation and identification of needs. The instigation of a national End of Life Programme in the UK and the introduction of policies such as Liverpool Care Pathway for the Dying Patient and the Preferred Priorities for Care Tool, to record people’s preferences for care, are aimed at improving people’s experience of dying. Increasing funding for end of life care services and further research in this area has also been announced. It remains to be seen if policy changes, combined with increased funding for services such as hospice at home will enable more people to be able to die in the place of their choice in the future, or whether efforts to improve hospital or nursing home care will be successful and change people’s preference for care at the end of life. What is important, however, is that service provision whether institutional, or in the home should aim to help older people to maintain their own personal identity and dignity when they are dying. Notes 1 Department of Health, ‘End of Life Care Strategy: Promoting High Quality Care for All Adults at the End of Life’. Department of Health, London, 2008. 2 National Statistics, General Household Survey: Results for 2005, viewed on 1 November 2008, <www.statistics.gov.uk/downloads/themecompendia/GHS05/GeneralHouseh old Survey2005.pdf>. 3 National Audit Office, ‘End of Life Care’. London, Stationery Office, 2008. 4 National Health Service, National End of Life Care Programme, viewed on 1 November 2008, <http://www.endoflifecareforadults.nhs.uk/eolc/>. 5 I J Higginson, Priorities and Preferences for End of Life Care in England, Wales and Scotland, National Council for Palliative Care Services, London, 2003. 6 ibid. 7 ibid. Eileen Sutton and Joanna Coast 259 ______________________________________________________________ 8 GE Grande, MC Farquhar, SIG Barclay, and CJ Todd, ‘The Influence of Patient and Care Age in Access to Palliative Care Services’. Age and Ageing, vol. 35, 2006, pp. 267-273. 9 B Gomes and IJ Higginson, ‘Where people die (1974-2030): Past Trends, Future Projections and Implications for Care’. Palliative Medicine, vol. 22, 2008, pp. 33-41. 10 National Council for Palliative Care, End of Life Care: A Commissioning Perspective, Lavenham, Lavenham Press, 2007. 11 Marie Curie Palliative Care Institute Liverpool and the Royal College of Physicians, National Care of the Dying Audit – Hospitals 2007, London 2007. Bibliography Angus, J., Kontos, P., Dyck, I., McKeever, P., and Poland, B., ‘The Personal Significance of Home: Habitus and the Experience of Receiving Long-Term Home Care’. Sociology of Health and Illness, vol. 27, 2, 2005, pp. 161-187. Department of Health. ‘End of Life Care Strategy: Promoting High Quality Care for All Adults at the End of Life’. Department of Health, London, 2008. Gomes, B., and Higginson, I. J., ‘Where People Die (1974-2030): Past Trends, Future Projections and Implications for Care’. Palliative Medicine, vol. 22, 2008, pp. 33-41. Gott, M., Seymour, J., Bellamy, G., Clark, D., and Ahmedzai, S., ‘Older People’s Views About Home As a Place of Care at the End of Life’. Palliative Medicine, vol. 18, 2004, pp. 460-467. Grande, G. E., Farquhar, M. C., Barclay, S. I. G., and Todd, C. J., ‘The Influence of Patient and Care Age in Access to Palliative Care Services’. Age and Ageing. vol. 35,2006 pp. 267-273. Higginson, I. J., Priorities and Preferences for End of Life Care in England, Wales and Scotland. National Council for Palliative Care Services, London, 2003. Marie Curie Palliative Care Institute, Liverpool and the Royal College of Physicians, National Care of the Dying, Audit – Hospitals, 2007. 260 Older People and Place of Care at the End of Life ______________________________________________________________ National Audit Office, End of Life Care. London, Stationery Office, 2008. National Council for Palliative Care, End of Life Care: A Commissioning Perspective. Lavenham Press, Lavenham, 2007. National Health Service, National End of Life Care Programme, viewed on 1 November 2008, <http://www.endoflifecareforadults.nhs.uk/eolc/>. National Statistics, General Household Survey: Results for 2005, viewed on 1st November 2008, <http://www.statistics.gov.uk/downloads/themecompendia/GHS05/GeneralH ousehold Survey2005.pdf.> Eileen Sutton is a Research Associate at the University of Bristol, Department of Social Medicine. Her research interests focus on end of life care and the provision of complementary therapies in state cancer care. Joanna Coast is Professor of Health Economics at the University of Birmingham. Her research interests include decision-making in health care, with particular focus on rationing and care for older people. Waiting for Death: An Exploration of Suicide and Old Age in Ireland Christine De Largy Abstract For some older adults, later life is a time of physical pain, psychological distress and dissatisfaction with present and, in some cases, past aspects of life. Increasingly there is evidence that suicide is one of the methods of escape for older adults. Suicide is rarely, if ever, caused by any single event or reason. It results from many factors working in combination, which produce feelings of hopelessness and depression. Thus the aim of this paper is to explore the prevalence of older adult suicide in Ireland and the factors that are associated with older adult suicide in Ireland, and also to examine the adequacy of prevention programmes specifically designed for older adults. Key Words: Older adults, suicide, risk factors. ***** 1. Introduction It may be that the gods are merciful when they make our lives more unpleasant as we grow old. In the end, death seems less intolerable than the many burdens we have to bear. (Sigmund Freud) Suicide has been glorified or condemned through the ages and the debate continues even today. Meanings attributed to suicide and notions of what to do about it have varied with time and place.1 The majority of older people have a lifetime’s experience with which to face, in a positive way, the various changes that occur at this stage of their lives. For some older people these challenges can be immense and tremendous strain is placed on their ability to cope effectively. So why do some people confront the conflicts that are posed by ageing, while others choose to escape? For some, escape is the preferred alternative from what maybe a time of physical pain, psychological distress and dissatisfaction with present, and or past experience in life. Some older adults experience ageing as a time of loss, loss of social status and selfesteem, loss of physical abilities and death of friends and loved ones. Nevertheless, in the face of loss, some older people have the capacity to develop new adaptive strategies while others may feel hopeless about making changes to improve their lives and so engage in a variety of self-destructive 262 Waiting for Death ______________________________________________________________ behaviour such as isolating themselves, alcohol abuse, drug abuse or suicide. Some perceive their issues and conflicts as too great to be coped with. They see what could be termed as a “solution” with respect to medication and treatment as an insufferable compromise.2 In this research paper I intend to investigate the factors that motivate older adults to die by suicide and what if any, would be the advantages of prevention programmes designed specifically for older adults. I will also explore Physician Assisted Suicide which has been legalised in some European countries and examine whether this is an acceptable option for older adults. 2. Settings A. International Setting The World Health Organization3 estimated in 2002, in the year 2020 there will be approximately 1.53 million people who will die by suicide, according to current trends. Suicides by age globally are as follows: 55% from age 5 to 44 years and 45% from age 45 years and over. Whenever figures on suicide are presented or discussed, there is always someone to question their reliability, insisting that in many places and due to several reasons that suicide is hidden and that the real figures must be much higher. The prevalence of hopelessness or suicidal ideation in elderly people varies from 0.7 up to 17% in different studies (depending on the strictness of criteria used worldwide). Suicide rates have increased by 60% over the last 50 years, and the increase has been particularly marked in developing countries.4 Although reported suicide is now among the three leading global causes of death among young people aged 15-34 years, the majority of suicides are reported in adults aged 60 years and over.5 Fig 1 Distribution of suicides rates (per 100 000) by gender and age, 2000 Christine De Largy 263 ______________________________________________________________ B. Irish Setting In Ireland, the population profile is currently changing, albeit at a relatively slow pace, from a young, low dependency population to an ageing one. Currently 45.3% of people over 65 years live in rural areas and approximately 27% of people aged 65 years and older live alone.6 In a short space of time, Ireland moved from being a highly integrated society with shared values which regulated the way of life to a more consumer orientated society; where communities have become less integrated and traditional values are no longer deeply held or widely shared.7 This reduced integration has coincided with increased urbanisation as reflected in the 2002 census figures which report that 60% of the total population is now living in urban areas, representing an urban population increase of 10% since 1996.8 As in all other European countries, suicide in Ireland is more common in men than in women. The specific types of life events most pertinent to suicide in later life differ from those of younger victims. 9, 10, 11 Interpersonal discord, financial and job problems, and legal difficulties are more typical of suicides in young and middle adulthood, while isolation, loneliness and chronic illness are typical in suicides in later life. In Ireland, 450 people over the age of 65 died by suicide between 1991 and 2001, of this figure 73% were male and 27% were female. Psychiatric illness is present in over 71% of older people who die by suicide with many of these individuals suffering from depression.12 In 1995 12% of all deaths from suicide occurred in people over 65. Among older people a higher incidence of suicide is evident among males, people living alone, who are either widowed or single and therefore who may be lonely and socially isolated, people in low socioeconomic groups, the ill (either physically or mentally), and the bereaved. Figure 2. Annual Male and Female Suicide Rate, by age, per 100,000 population (2000-2002 average) 264 Waiting for Death ______________________________________________________________ 3. Methodology I chose to interview individuals who work closely with older people in distress. This provided me with an opportunity to gain insight into the points of view of the participants. A qualitative interview approach allows for an exploration of a sensitive topic and for the meaning, value and interpretation of that topic to be fully explored by the interviewee as well the interviewer. Following a review of the Irish context with respect to suicide in later life, the following interviewees were desirable:   A Suicide Prevention Officer – because of experience with the topic. A Director of a support organisation i.e. Samaritans. Although this is a very small sample within qualitative interviewing it is about depth of understanding. The interviews were semi-structured and informed consent was received for audio recording In addition an extensive literature review was conducted to inform the topic guide and to provide a representative context for suicide in later life. The data from the interviews was transcribed verbatim. From a content analysis of the transcriptions, several common themes emerged.     Isolation/Loneliness Financial Strain Depression Chronic Illness The findings of the interviews will be discussed with reference to the international and national literature in the following section. 4. Findings and Discussion Ethnographic studies13, 14 have indicated that in pre-industrial societies suicide was a form of death-hastening treatment especially when it resulted from direct social manipulation. Previous research suggests that suicide is rarely, if ever, caused by any single event or reason. Rather, it results from many factors working in combination, which produce feelings of hopelessness and depression. Eleven per cent of the Irish population are over the age of 65 and 3.5% of suicide rates in Ireland occur in the over 65-age bracket. It is difficult to determine whether the number of suicide rates have increased in Ireland in recent years due to previous under-reporting. According to a recent report by the Health Research Board, older adult suicide rates in Ireland are now among the lowest worldwide.15 Christine De Largy 265 ______________________________________________________________ A Finish study conducted by Heikkinen and Lönnqvist found that although the rate of suicide was higher among the elderly than the nonelderly, living alone was not peculiar for the elderly; nor were elders living alone at any more significantly higher risk for suicide than their counterparts living with others. While personality factors in suicide in older people have received limited research attention, they seem to be less frequent in older suicide victims than in younger age groups. There also still exists a negative stigma associated with depression in many rural communities, where it is seen as weak to admit that you can't cope or are finding things hard. It's particularly difficult for men to admit that they need help, and when they do the services just aren't available to them.16 There has been very little research conducted on suicide in later life, Physician Assisted Suicide or Euthanasia in Ireland and while this paper represents exploratory research, it may help to provide a little insight into the area of older adult suicide. We assume that there is under-reporting of suicide in Ireland. The republic of Ireland was the last country in western Europe to decriminalise suicide in 1993. We could speculate that this was due to the close links between the Church and State and the perceived stigma associated with suicide. Acceptance levels for both Euthanasia and Suicide are relatively low in Ireland but support for Euthanasia has moved slowly but steadily upwards over time. There have been rapid evolutions internationally in attitudes and practices about death and dying over the last decade. Physician Assisted suicide was legalized in Oregon, USA in 1997 and in the Netherlands, voluntary active and physician-assisted suicide are available solutions to end-of-life situations. One quarter of Irish people would choose euthanasia to allow them to die, according to the findings of a poll by irishhealth.com: “If I was told I had cancer or some other serious illness, I would like to have the option to go for euthanasia”. (Quote from poll) “Euthanasia, if I'm displaying any sign of dementia and I guess suicide when I don't want to live any more and my family is grown”. (Quote from poll) Life events commonly associated with elderly suicide can be the death of a loved one, physical illness, pain, social isolation, loneliness and major changes in social roles such as retirement. In older people, particularly among older men, psychiatric illness (most notably depression), certain personality traits and physical illnesses are associated with an increased risk of suicide. Social isolation, loneliness and being divorced, widowed or single 266 Waiting for Death ______________________________________________________________ also increase the risk of suicide for older men. Reduced help seeking and remoteness from services can put older people further at risk, although it must be noted that isolation is not simply just a matter of distance and can occur in the context of many living arrangements. The findings from risk factor research have significant implications for the design and implementation of effective suicide prevention strategies, as the elimination of risk factors should lead to a reduction in suicide rates. Risk factors for suicide among older adults differ from those among the young. Several factors relative to those over 65 years will play a role in future suicide rates among the elderly, including growth in the size of the population; health status; availability of services, and attitudes about ageing and suicide. From 2000 to 2005, suicide rates among isolated Irish elderly living in rural areas have increased by 30 percent. The Samaritans reported a corresponding increase in calls to their hotline from elderly isolated from friends and family who have little time for their older relatives.17 “The future tends to be on the decline for older people, more hope for a young person” (Director of Services). The Report of the National Task Force on Suicide,18 which informs the direction of suicide prevention activities in Ireland, identified older adults as a high-risk group. A recommendation of the report was to improve recognition of the risk of suicide in older people, improve treatment of depression, and to address the psychological needs of older people by counselling and social intervention. Current prevention endeavours focus mostly on detecting or treating the acutely suicidal individual however they may not impact significantly on public health or lower elderly suicide rates.19 While there has been some encouraging preventative initiatives considered in the literature, due to the lack of controlled studies, small sample sizes, and weak design and evaluation methods, it has been difficult to evaluate the impact of these initiatives.20 In the context of Ireland there have been several key milestones in suicide initiatives. 1993 1995 1996 1998 2000 The passing of the Criminal Law (Suicide) Act resulting in the decriminalisation of suicidal behaviour. The National Suicide Research Foundation (NSRF) was established. The National Task Force on Suicide was established. The Irish Association of Suicidology (IAS) was set up. The National Task Force on Suicide Report was published and the National Suicide Review Group was set up. The National Parasuicide Registry (to be known as the National Register of Deliberate Self Harm) was established. Department of Justice, Equality & Law Reform published the Review of the Coroner Service that expanded the role of the Coroner to include investigation of the circumstances of death. Christine De Largy 267 ______________________________________________________________ 2005 Reach Out: National Strategy for Action on Suicide Prevention (2005-2014) was published and the National Office for Suicide Prevention (NOSP) was established.21 Any strategy that promotes a community response to suicide amongst any group young or old would be very welcome (Director of Services). Of course, developing a strategy is only the first step. Effectively implementing this Strategy is the real challenge. At the third annual Suicide Prevention Forum held recently, Dr Jimmy Devins TD, Minister for Disability and Mental Health, said: We as policy makers working in the area of suicide prevention need to foster a culture where people in distress, at whatever stage in their lives, won't hesitate to seek help, a culture that recognises the signs and signals of distress and is willing to help, and that focuses early in life on developing good coping skills and avoiding harmful practices.22 This is quite evident in the research findings on suicide prevention outlined by the Suicide Prevention Officer. [S]o the chance then is through our work in suicide prevention to create learning environments and education and information where people can identify those signs in older people and respond (Suicide Prevention Officer, HSE) As yet there is no universally accepted model or conceptual framework of how to define and apply prevention measures for reducing suicide, and attempted suicide, in the elderly.23 Those best equipped to inform the global communities and have a more positive impact on those who will suffer in the future, are survivors of suicide. The development of effective prevention strategies, and ultimately the reduction of suicide morbidity and mortality in later life, will result from an improved understanding of risk factors and their interactions. Greater integration and co-ordination are required in the area of research so that we can understand more deeply the personal and social circumstances that lead to suicidal behaviour in this country. There is often difficulty moving from awareness and knowledge to implementation of practices that have been shown to be helpful. In recent years however, there have been many local, regional, national and international efforts to promote positive attitudes towards mental 268 Waiting for Death ______________________________________________________________ health issues. These efforts have been developed in the context of anti-stigma campaigns, health promotion strategies and mental health awareness campaigns. However there is no single intervention or approach that will, in itself, adequately challenge the problem of suicide in Ireland. A strategic framework is required to assist all of us in identifying actions we can undertake in a coordinated way, through partnership working between statutory, voluntary and community groups and individuals, supported by Government. Everyone has a role to play in suicide prevention. In Ireland, recent years have seen the development of important policy documents on suicide prevention – Reach Out, 2005 and on mental health – A Vision for Change, 2006. A fundamental principle underlying both of these policies is the development of whole population approaches to mental health. If these policies are to be successfully implemented in full, then ongoing improvement at every level of Irish society is needed in relation to awareness of, and attitudes to, mental health. The stronger and broader the support and collaboration on suicide prevention, the greater the chance for the success of a public health initiative. Arising from the interviews and a review of the literature, it may be helpful to consider the following when developing a suicide prevention strategy for older people:        Promotion of efforts to reduce access to lethal means and methods of self-harm. Eliminate stigma and discrimination Promote and support recovery Promote Awareness that Suicide is a Public Health Problem that is preventable by increasing the degree of cooperation and collaboration between and among public and private entities that have made a commitment to public awareness of suicide and suicide prevention. Develop and implement strategies to reduce the stigma associated with being a consumer of Mental Health, Substance Abuse, and Suicide Prevention Services. Implement training for recognition of at-risk behaviour and delivery of effective treatment. Promote and support research on suicide and suicide prevention as enhanced understanding taken from this research will lead to better assessment tools, treatments, and preventive interventions. Christine De Largy 269 ______________________________________________________________ We have talked so far about prevention strategies but what about the individuals for whom prevention is not an option. Is the next step in a strategy for suicide prevention for older adults in Ireland to investigate whether Physician Assisted Suicide or Euthanasia would be a viable option for older adults who want to “die with dignity”? However, this is beyond the scope of this paper and requires careful consideration and future research. 5. Conclusions The ageing of populations worldwide means that the absolute number of suicides in elderly people is likely to increase. Society has long held the view that growing old is equated with misery and this has been reflected in literature, mythology and societal attitudes.24 Despite progress resulting in improved conditions of environment and length of life, old age remains the poorest phase of life. Elderly people have a higher risk of completed suicide than any other age group worldwide. Despite this, suicide in elderly people receives relatively little attention, with public health measures, medical research, and media attention focusing on younger age groups.25 Suicide in elderly people is a complex and multifaceted phenomenon. Suicide and suicidal behaviour are societal problems and society needs as a consequence to alter social policies to deal with the risk factors for suicide. Effective action to prevent suicidal behaviour requires the cooperation of the whole community. Suicide in the elderly remains a neglected subject receiving little interest and research attention. The role of primary care services in suicide prevention is of considerable interest. Most studies report substantial levels of contact: 40–70% of elderly suicides seeing their general practitioner (GP) in the 30 days preceding their death, and between 20 and 50% attending in the preceding week. This raises the important issue of effective intervention at a time when the individual is particularly vulnerable. The importance of training and education programmes for GPs in the recognition and treatment of depression as a means of reducing the suicide rate. Prevention of elderly suicides requires a number of approaches ranging from social assistance and improved training of care providers to more acceptance and valuing of older persons by society. I think suicide prevention is really probably in its infancy in Ireland but at the same time a lot of these steps are being taken by communities now to respond and not feel powerless (Director of Services) It has been documented that older people are rarely consulted with respect to policy development in the Health and Social Care sector. This also appears to be the case in terms of discussions on suicide. While there has been a conscious effort to develop and enhance prevention strategies, there are no strategies specifically targeted at older adults. However one must ask is this necessary, do the figures necessitate a prevention strategy specifically designed for older adults? Is a suicide prevention strategy that incorporates 270 Waiting for Death ______________________________________________________________ all ages sufficient? Clearly, the view of the future in old age differs from that in younger persons. Older persons have lived a long time, and compared to younger persons have less time facing them. Death is closer. The uncertainty and fear of death, the oft-felt inability to influence their own dying, a certain weariness of life, confront the older adult. There is only one obligatory in life from which there is no escape and that is to die, is to die by suicide, to die before one’s time? The Roman philosopher Seneca tells us we make many mistakes about death:     we assume death is bad, we assume death later is better, that a longer life is better than a shorter life that death is something that happens to us rather than something we control. Seneca argues that a self embraced death like suicide is not a premature end to a complete life. However in 1897, Emile Durkheim, the French sociologist, published the influential text, “Suicide.” His central hypothesis is that when social conditions fail to provide people with the necessary social goals and rules, at the appropriate levels of intensity, the most vulnerable individuals will consider suicide. These ideas have been examined and supported, thus the role of social integration in the prevention of suicide has been purported for over one hundred years. Suicide is due to a complex interaction of social, environmental, biological and cultural factors operating in an individual’s life. Cultural beliefs, social standards, gender bias, educational problems, income levels, living status, growing aspirations, pressures of modern life, the need to excel and compete in the modern world, employment issues, marriage-related factors, interpersonal conflict due to disturbed family relations, breakdown of family values and systems, terminal or serious illness, social isolation and death of a loved one, are all capable of initiating suicidal thoughts. Some of the factors that were highlighted during the course of the research were that factors for suicide among older persons may differ from those among the young. The great medical discoveries of our time have benefited mainly the younger age groups. While I started this paper to investigate the motivations of older adult suicide I have found that there is no easy answer to the enigma associated with suicide. This was evident in my findings, suicide is a multifaceted phenomenon. However, Seneca does makes the point that a self embraced death like suicide is not a premature end to a complete life; therefore are we programmed to believe that death is bad, is there such a Christine De Largy 271 ______________________________________________________________ thing as a good death and is to die by suicide a good death? Human beings are unique, as are their reasons for suicide. Suicide will become the preferred mode of dying because it enables a person to control the time, place, and circumstances of doing so.26 Notes 1 The Substance Abuse and Mental Health Services Administration's (SAMHSA) http://mentalhealth.samhsa.gov/ accessed April 2008. 2 R C Atchley and A S Barusch, Social Forces & Aging: An Introduction to Social Gerontology, 10th edition, Thomson/Wadsworth Publishers, Belmont, CA, 2004. 3 WHO, http://www.who.int/mediacentre/news/statements/2007 (accessed on 21st January 2007). 4 H O'Connell, et al, “Recent developments: Suicide in older people”. British Medical Journal, 329(7471), 2004, pp. 895-899. 5 WHO, op. cit. 6 National Strategy for Action on Suicide Prevention 2005-2014. Reach Out, HSE, Dublin, 2005. Published by the Health Service Executive 2005, ISBN 0-9551181-0-7. 7 ibid. 8 Central Statistics Office. 9 S S Carney, C L Rich, P A Burke, and R C Fowler, ‘Suicide over 60: The San Diego study’. Journal of the American Geriatrics Society, 42, 1994, pp. 174–180. 10 Y Conwell, M Rotenberg, and E D Caine, ‘Completed suicide at age 50 and over’. Journal of the American Geriatrics Society, 38, 1994, pp. 640– 644. 11 M E Heikkinen and J K Lonnqvist, ‘Recent life events in elderly suicide: A nationwide study in Finland’. International Psychogeriatrics, 7, 1995, pp. 287–300. 12 National Office for Suicide Prevention (Annual Report 2006) Health Service Executive, Published September 2007, ISSN: 1649-881X http://www.nosp.ie/annual_report_2006.pdf. 13 A P Glascock, and S L Feinman, ‘Social Assert or Social Burden: Treatment of the Aged in Non-Industrial Societies’, in Dimensions: Ageing, Culture, and Health, C L Fry (ed), Praeger, New York, 1981. 14 L W Simmons, The Role of the Aged in Primitive Society, Yale University Press, New Haven, CT, 1945. 272 Waiting for Death ______________________________________________________________ 15 HRB Overview Series, ‘Suicide, Attempted Suicide and Prevention in Ireland and Elsewhere’. Health Research Board, Dublin, Ireland, 2008, ISSN Number: 20090161 16 M M Henriksson, M J Marttunen, E T IsometsaÈ, M E Heikki-nen, H M Aro, K I Kuoppasalmi, and J K Lonnqvist, ‘Mental disorders in elderly suicide?’. International Psychgeriatrics, 7, 1995, pp. 275 and 286. 17 Global Action on Aging, http://www.globalaging.org/ruralaging/world/index.htm. ‘‘Isolation’ Blamed for 30 Percent Jump in Suicides by Elderly’, Shane Hickey, Independent, Ireland, November 12, 2007. 18 Report of National Task Force on Suicide, Department of Health and Children, Dublin, Ireland, 1998. 19 E D Caine and Y Conwell, ‘Suicide in the elderly’. International Clinical Psychopharmacology, 16 (Suppl. 2), 2001, pp. 25-30. 20 ibid. 21 Houses of the Oireachtas, Joint Committee on Health & Children, Seventh Report. The High Level of Suicide in Irish Society, July 2006. 22 Department of Health and Children www.dohc.ie. 23 Caine and Conwell, op. cit. 24 Aware www.aware.ie (accessed on 22nd January 2008). 25 H O'Connell, et al., op. cit. 26 M Battin, ‘Voluntary Euthanasia and the Risks of Abuse: Can We Learn Anything from the Netherlands?’. The Journal of Law, Medicine & Ethics, Volume 20, Issue 1-2, 1992, pp.133-143 Bibliography Atchley, R. C. and A. S. Barusch, Social Forces & Aging: An Introduction to Social Gerontology, 10th edition, Thomson/Wadsworth Publishers, Belmont, CA, 2004. Aware, accessed on 22nd January 2008, www.aware.ie. Battin, M. ‘Voluntary Euthanasia and the Risks of Abuse: Can We Learn Anything from the Netherlands?’. The Journal of Law, Medicine & Ethics, Volume 20, Issue 1-2, 1992, pp.133-143. Bryant, C., Handbook of Death and Dying, Sage, London, 2003. Caine, E. D. and Y. Conwell, ‘Suicide in the elderly’. International Clinical Psychopharmacology, 16 (Suppl. 2), 2001, pp. 25-30. Christine De Largy 273 ______________________________________________________________ Carney S. S., C. L. Rich, P. A. Burke, and R. C. Fowler, ‘Suicide over 60: The San Diego study’. Journal of the American Geriatrics Society, 42, 1994, pp. 174–180. Cattell, H., ‘Suicide in the elderly, Advances in Psychiatric Treatment’. The Royal College of Psychiatrists, 6, 2000, pp. 102-108. Conwell Y., M. Rotenberg, and E. D. Caine, ‘Completed suicide at age 50 and over’. Journal of the American Geriatrics Society, 38, 1990, pp. 640– 644. Crisis, The Journal of Crisis Intervention and Suicide Prevention (2/07) Vol 28/Number 2/2007. Central Statistics Office. De Leo, D., G. Carollo, and M. Dello Buono, ‘Lower suicide rates associated with a Tele-Help/Tele-Check service for the elderly’. American Journal of Psychiatry, 1995, pp. 632-634. Department of Health and Children, www.dohc.ie. Glascock, A. P., and S. L. Feinman, ‘Social Assert or Social Burden: Treatment of the Aged in Non-Industrial Societies’, in Dimensions: Ageing, Culture, and Health, C. L. Fry (ed), Praeger, New York, 1981. Global Action on Aging, http://www.globalaging.org/ruralaging/world/index.htm ‘‘Isolation’ Blamed for 30 Percent Jump in Suicides by Elderly’, Shane Hickey, Independent, Ireland, November 12, 2007. Heikkinen M. E., and J. K. Lonnqvist, ‘Recent life events in elderly suicide: A nationwide study in Finland’. International Psychogeriatrics, 7, 1995, pp. 287–300. Henriksson M. M., M. J. Marttunen, E T IsometsaÈ, M E Heikki-nen, H M Aro, K I Kuoppasalmi, and J K Lonnqvist, ‘Mental disorders in elderly suicide?’. International Psychogeriatrics, 7, 1995, pp. 275 and 286. Houses of the Oireachtas, Joint Committee on Health & Children, Seventh Report. The High Level of Suicide in Irish Society, July 2006. 274 Waiting for Death ______________________________________________________________ HRB Overview Series, ‘Suicide, Attempted Suicide and Prevention in Ireland and Elsewhere’. Health Research Board, Dublin, Ireland, 2008, ISSN Number: 20090161. http://www.healthyplace.com/communities/depression/related/suicide_3.asp http://www.irishhealth.com/poll, accessed 5th May 2008. Ilinka, H., B. D. Onwuteaka-Philipsen, A. van der Heide, P. J. Kostense, G. van der Wal, and P. J. van der Maas, ‘Refused and Granted Requests for Euthanasia and Assisted Suicide in the Netherlands: Interview Study with Structured Questionnaire’. British Medical Journal, 321(7265), 2000, pp. 865–866. Irish Association of Suicidology, accessed January 2008, www.ias.ie,. Karatu, K., ‘Towards A Socio-Economic and Demographic Theory of Elderly Suicide’, Uppsala University, 2004, http://www.soc.uu.se/research/gerontology/abstracts/diss_2004-3.html. Kennelly, B., ‘The Economic Cost of Suicide in Ireland’. Crisis, Vol. 28(2), 2007, pp. 89-94. National Office for Suicide Prevention, (Annual Report 2006), Health Service Executive, September 2007, ISSN: 1649-881X http://www.nosp.ie/annual_report_2006.pdf. National Strategy for Action on Suicide Prevention 2005-2014. Reach Out, HSE, Dublin, Published by the Health Service Executive, 2005, ISBN 09551181-0-7. National Suicide Research Foundation of Ireland, www.nsrf.ie, accessed in November 2007. O'Connell H. et al, ‘Recent developments: Suicide in older people’. British Medical Journal, 329(7471), 2004, pp. 895-899. Report of National Task Force on Suicide. Department of Health and Children. Dublin, Ireland, 1998. Christine De Largy 275 ______________________________________________________________ Roscoe, L. A., ‘The Many Faces of Physician-Assisted Suicide’. Journal of Ageing and Identity, 3, 1998, pp. 35-48. Schmitz-Scherzer, R., ‘International Perspectives Reflections on Cultural Influences on Aging and Old-Age Suicide in Germany’. International Psychogeriatrics, Vol. 7, No. 2, 1995, pp. 231-238. Simmons, L. W., The Role of the Aged in Primitive Society. Yale University Press, New Haven, CT, 1945. The Substance Abuse and Mental Health Services Administration (SAMHSA), accessed April 2008, http://mentalhealth.samhsa.gov/. World Health Organization (WHO), accessed on 21st January 2007, http://www.who.int/mediacentre/news/statements/2007 . Christine De Largy is a Development Officer at the Irish Centre for Social Gerontology at the National University of Ireland Galway. To Worship God or Celebrate a Life: Conflicting Scottish Perspectives on Funerals Glenys Caswell Abstract From a staunch Presbyterian standpoint, the purpose of a funeral is the worship of God; there is nothing useful to be said about the deceased because her fate is already decided. From a secularist point of view the only approach to a funeral that seems rational is to treat it as a celebration of the life of the deceased. For the majority of Scots today, the Presbyterian perspective has come to seem too limiting and even, perhaps, uncaring. Increasing numbers are making the decision to have a secularist funeral, which often precludes any reference to religious beliefs. However, for many both the Presbyterian and the secularist positions are too extreme, and they are seeking something that combines elements of both. In Scotland today a growing number of practitioners, many of who are Church of Scotland ministers, are seeking a middle ground. They are endeavouring to conduct funerals that simultaneously recognise the individuality of the deceased, while also allowing the minister to maintain his own integrity of belief. This sometimes makes for an uneasy balance between the elements that compose a funeral, and can require sensitive or complex negotiation between the parties involved. It appears the traditional authority of the Christian religion is being eroded, while the importance of the reflexive individual increases. This paper suggests that this is an example of the coexistence thesis, in which traditional practices continue alongside, and inform, new ways of doing things, thus producing a bricolage of old and new ways. Key Words: Funerals, games model, secularisation, Christianity, humanism, coexistence thesis. ***** Since the Reformation, Scotland has been a protestant country with the Church of Scotland, a Presbyterian denomination, as the established church.1 This does not mean, of course, that other religions and other Christian denominations have not been represented among Scotland’s population, and different regions of the country have differing religious histories. However, Presbyterianism has been dominant for the last four centuries, represented by several churches, such as the Free Presbyterian 278 To Worship God or Celebrate a Life ______________________________________________________________ Church of Scotland and the Free Church of Scotland, as well as the established Church of Scotland. The religious picture is beginning to change in the twenty-first century, however. In the United Kingdom census taken in 2001, which is a compulsory survey of all people resident in the country on a specific night, in Scotland as a whole, 27.5 percent of respondents claimed to have no religious beliefs. This figure increased to almost 37 percent in the capital Edinburgh, and reduced to less than 12 percent in Stornoway on the Isle of Lewis.2 A survey carried out in 2005 for a Glasgow based newspaper supports the view that church membership and attendance is dropping in Scotland, but also suggests that this does not necessarily mean that the population no longer has any form of spiritual or religious beliefs.3 The question this picture raises for this paper is this: how does such a changing pattern of practices translate into action when it comes to funerals? For adherents of faith groups, the decision, when it comes to what kind of funeral to have, is straightforward. The Free Presbyterian Church of Scotland, for example, conducts funerals on the basis that their purpose is the worship of God, and all the elements of the worship are based on that premise. Free Presbyterian funerals, therefore, do not talk about the deceased and contain only prayers, scriptural readings and psalms. The Humanist Society of Scotland, on the other hand, founded in 1989, provides secular funerals for those of no religious faith. These start from the assumption that a funeral should be a celebration of the life lost, and have as their only rule that there should be no reference to religion in terms of words, music or symbols.4 But what about the high percentage of individuals in Scotland today who do not belong to a religious group, but would not necessarily count themselves as secular humanists either: to whom do they turn? I have chosen to focus this paper on one particular aspect of this issue, so that by drawing on data from a sociological research project, this paper explores one possible answer to the question of where people turn for help when it comes to the conduct of a funeral. Qualitative interviews were carried out during 2007 in three different locations in Scotland, with professional informants involved in the arrangement and conduct of funerals. A typical Church of Scotland funeral today is a blend of religious elements such as scriptural readings, prayers and hymns, with secular facets such as a tribute or eulogy to the deceased, the playing of secular music and sometimes-secular readings such as poems. Despite what the figures might suggest, and the apparent secularising of Scotland, the Church of Scotland, as an institution, conducts more funerals in Scotland today than any other group. Ministers in the church conduct two different kinds of funeral. Firstly they take funerals for their church members, whom they can assume had a certain level of religious faith. Glenys Caswell 279 ______________________________________________________________ The second kind of funerals the ministers take are what they tend to call parish funerals. These are for people who are not members of the institutional church, but who live in the geographical parish served by a particular minister. Sometimes the minister will not know the people involved at all, and he can make no assumptions about their levels of religious belief or knowledge. As representatives of the national church, Church of Scotland ministers have a duty to conduct a funeral for anyone living in their parish that makes such a request of them, unless they have a good and sufficient reason to refuse such a request.5 During the course of interviews it became apparent that, particularly for ministers of the Church of Scotland, the planning of a funeral can sometimes be a complex negotiation between the minister’s own faith and sense of religious integrity and the expectations of an increasingly secularised society as represented by the bereaved. Although played out in individual funerals and the relationships that develop between ministers and the bereaved, the current state of Scottish funerals is also a manifestation of the broader social forces that are at work today. Twenty or thirty years ago, in the context of a funeral, the minister made all the decisions and all the content was religious in nature. Today, however, according to one Church of Scotland minister who was interviewed as part of the study, “you’ve still got families who want to leave everything to the minister, but a lot of families now want some sort of participation” and, in addition to this, the expectation on the part of ministers themselves is that they will meet with the bereaved in order to plan together for the funeral. One way of beginning to tease out the various factors at work when ministers and the bereaved plan a funeral together is to make use of Elias’s games model as an analytic tool. In its simplest form, Elias’s model describes a situation where a strong player in a game plays against a weaker player. The game has rules by which both players must abide, and the weakness of his opponent gives the strong player a distinct advantage; so much so that he can even force his opponent to behave in certain ways. Most games, however, are played between opponents who are more equal in strength as players, or between groups rather than individuals. Elias suggests that his games model provides a way of making relations between individuals and groups simpler, so that it is possible to observe where the power in a given situation lies, and how this influences people’s actions. Power, according to Elias, is not a static thing that a person either has or does not have, it is a process and access to it in a particular relationship can ebb and flow between participants.6 At first sight it might seem as if the minister, as an educated man or woman and a representative of the established church backed up by centuries of respect held by the population for the ministry, would be in control of the 280 To Worship God or Celebrate a Life ______________________________________________________________ situation. However, as so often is the case with appearances, this is inaccurate and the situation is a great deal more complex than this. In virtually all cases, the minister will visit the bereaved in their own home; as this research respondent expressed it, “I make an arrangement to see the next of kin, almost always I go round to the house that they're in, rather than them coming here, so they're comfortable.” In this meeting between minister and bereaved there are social rules at play, and these rules are intensified by two factors. Firstly, the general expectation is that the bereaved will be treated sensitively by all professionals with whom they have dealings in the process of arranging and carrying out the funeral. They have suffered a loss and other people should hold this in mind when interacting with them. Following on from this, expectations about the behaviour of a minister of religion are high under normal circumstances, but when in a bereavement situation they are even higher. The minister is expected to listen to what the bereaved have to say, to be sympathetic and sensitive to their situation.7 The bereaved, that is, have the power, which their particular circumstance confers upon them, and the normal social rules of interaction are adjusted accordingly. An individual who is grieving may express that grief in a restrained way, for the Scot is not expected to weep and wail, and the minister is expected to be able to deal with that and not exacerbate the situation. So the rules of interaction are such that in this encounter the minister is constrained to a greater extent than usual, while the bereaved are less constrained than usual in what is considered to be acceptable behaviour. It is often the case for a parish funeral that the bereaved will come into contact with the minister through the funeral director. Funerals in Scotland usually take place within a week of death, and sometimes within three or four days, so there is a certain pressure to make the necessary arrangements. Funeral directors, therefore, are usually keen to get in touch with whoever is going to conduct the service, and will offer to do this on behalf of the family. Where the family has no strong idea about whom this should be, the funeral director will often suggest, and contact, the parish minister. The bereaved family, therefore, does not necessarily have a great investment in having this particular minister, or even perhaps this particular denomination, involved in the funeral. This gives them the power of being able to go elsewhere if they dislike how the minister relates to them or the things he suggests for the funeral. This does put the family in quite a strong position, although many probably do not realise this, and would not even consider going elsewhere once first contact is made, as their grief can make them feel bewildered. For many ministers, however, funerals represent the one point of contact they have with many parishioners and their only opportunity to present the church to those who do not attend religious worship. One minister Glenys Caswell 281 ______________________________________________________________ interviewed described his intention of leaving mourners with “a wee bit more of a sense of otherness to help them cope, not to be evangelical, but maybe in time to enable folk to think beyond themselves.” This is a contact with wider society that the Church would be reluctant to lose. One arena in which the minister is in a stronger position than the bereaved is when it comes to his or her power as the holder of expert knowledge, and as an expert in the conduct of funerals. While bereaved families may require more than one funeral over the course of time, the likelihood is that they will not be doing it very often. The minister, on the other hand, plans and conducts funerals as part of his employment. Parishes differ, of course, in the number of deaths, and ministers differ in the number of funerals they conduct, but the probability is that a Church of Scotland minister will conduct funerals regularly. This means that he knows from experience what makes a good funeral, what is effective and what is not; he knows the kinds of choices that other bereaved families have made; and he can offer this expertise to bereaved families who call on his services. Often when a minister meets with a bereaved family there will be a number of family members present, it is rare although not unknown for one person alone to be planning a funeral. For the family, if they are united they can provide a source of support for each other and an increase in their power as compared to that of the minister. If, however, as sometimes happens, the family are divided amongst themselves, then this can provide an advantage to the minister, in terms of control of the situation.8 The minister has a further advantage in that he has a clear idea of his religious beliefs and what is required to maintain his integrity. There is, however, a distinct possibility that disparate members of the grieving family will have differing beliefs, and that some of the beliefs they hold will be sketchy and vaguely formed. The holder of a clear focus is a game player with more power than a player with a hazy focus. This paper is not suggesting that ministers and bereaved families approach the planning of a funeral service as if it were a power game. What it is suggesting, however, is that Elias’s game model can aid in separating out the strands of the interaction during which a funeral is organised.9 That the balance of power shifts between minister and the bereaved suggests that there will be dialogue between them, and this dialogue can be the harbinger of change. Ministers may carry forward to their next funeral something that one bereaved family has requested or suggested, thus gradually changing his practice, while members of the family may find themselves induced to think more deeply of spiritual matters. Families often turn to the church at a time of bereavement because the funeral director suggests it, and they do not know where else to turn. Historically, the Church of Scotland has held the dominant position in the conduct of funerals, and its ministers are still the experts in the field. That 282 To Worship God or Celebrate a Life ______________________________________________________________ dominant position, however, may be considered under threat, given the decrease in church membership and attendances, and the increase in the number of secular humanist funerals, which grew by 618 per cent between 1998 and 2003 to approximately 2 per cent of the total number of funerals carried out in Scotland.10 Some bereaved people who approach their parish minister have clear ideas about what they wish to be included in the funeral, and sometimes this leaves little room for religious expression. Ministers interviewed expressed different views on this. Some have a baseline from which they do not deviate; their funerals will always include at least a prayer or a Bible reading. Other ministers, however, said that they would never refuse a funeral and are content to conduct one without any overt religious references at all; they believe they are able to maintain the integrity of their faith without saying the words aloud. What the games model analysis has illustrated, I hope, is that the negotiation of a funeral context and content is no longer a matter of a minister of religion saying, “this is how it is going to be.” The traditional authority of the church has been eroded, and people no longer necessarily accept the meta-narrative represented by it, so that it no longer controls funerals. But if the church does not control funerals, neither does the family. Contemporary Scottish funerals are conducted in a social atmosphere that prioritises the individual and today; the Church of Scotland minister must be more sensitive to the social norms of the society in which he or she lives, and be prepared to enter into negotiations with the families who come to him for help. At times of what sociologist Anthony Giddens calls “fateful moments”, such as a death, individuals still call on the traditional authorities of the past to help them deal with the event.11 The Church of Scotland, therefore, still has a significant role in the conduct of funerals, alongside bereaved families, who are expected to be involved in the planning of the funeral if not its conduct. This current way of arranging funerals is an amalgam of past, traditional religious practices, and new ways based upon the acceptance of the deceased as a unique individual. Sometimes this works well and produces a funeral that both the bereaved and the minister feel comfortable with, but occasionally it makes for an unhappy blend of religion and secular elements. It comes about through negotiation and represents an example of the coexistence thesis, whereby the demands of tradition and the desires of the individual find a possibly restless home together.12 Glenys Caswell 283 ______________________________________________________________ Notes 1 C G Brown, Religion and Society in Scotland since 1707, Edinburgh University Press, Edinburgh, 1997, p. 17. 2 Registrar General for Scotland, Scotland’s Census for 2001: Key Statistics for Settlements and Localities Scotland, General Register Office for Scotland, Edinburgh, 2003. 3 J Cunningham, ‘Scotland’s Religious Revolution Revealed’, The Herald (Glasgow), June 6, 2005, p. 6. 4 Humanist Society of Scotland, ‘To Celebrate a Life’, in Humanist Society of Scotland Leaflets, 4 March 2008, viewed on 9 October 2008, http://www.humanismscotland.org.uk/index2.php?option=com_docman&gid =8&task=doc_view&Itemid=126 5 A G McGillivray, Introduction to Practice and Procedure in the Church of Scotland, 2nd Edition, Church of Scotland, Edinburgh, 2001. 6 N Elias, What is Sociology?, Columbia University Press, New York, 1970, pp. 80-103. 7 E Goffman, Behaviour in Public Places, The Free Press, New York, 1963. 8 Elias, op. cit., p. 83. 9 ibid., pp. 80-103. 10 C G Brown, Religion and Society in Twentieth-Century Britain, Pearson Education Limited, Harlow, 2006, p. 317. 11 A Giddens, Modernity and Self-Identity, Stanford University Press, Stanford, 1991, p. 202. 12 P Heelas, ‘Introduction: Detraditionalisation and its Rivals’, in Detraditionalization, P Heelas, S Lash and P Morris (eds), Blackwell, Oxford, 1996, p. 7. Bibliography Brown, C. G., Religion and Society in Scotland since 1707. Edinburgh University Press, Edinburgh, 1997. _____, Religion and Society in Twentieth-Century Britain. Pearson Education Limited, Harlow, 2006. Cunningham, J., ‘Scotland’s Religious Revolution Revealed’. The Herald (Glasgow), June 6 2005, p. 6. Elias, N., What is Sociology? Columbia University Press, New York, 1970. 284 To Worship God or Celebrate a Life ______________________________________________________________ Giddens, A., Modernity and Self-Identity. Stanford University Press, Stanford, 1991. Goffman, E., Behavior in Public Places. The Free Press, New York, 1963. Heelas, P., ‘Introduction: Detraditionalization and its Rivals’, in Detraditionalization, P. Heelas, S. Lash, and P. Morris (eds), Blackwell, Oxford, 1996. Humanist Society of Scotland, ‘To Celebrate a Life’, in Humanist Society of Scotland Leaflets, 4 March 2008, viewed on 9 October 2008, http://www.humanismscotland.org.uk/index2.php?option=com_docman&gid =8&task=doc_view&Itemid=126 McGillivray, A.G., Introduction to Practice and Procedure in the Church of Scotland, 2nd Edition. Church of Scotland, Edinburgh, 2001. Registrar General for Scotland, Scotland’s Census for 2001: Key Statistics for Settlements and Localities Scotland. General Register Office for Scotland, Edinburgh, 2003. Glenys Caswell is a final year doctoral student in the Department of Sociology at the University of Aberdeen in Scotland. Her research is an exploration of contemporary Scottish funeral practices. Quasi-Widowhood: Crossing Boundaries of Marriage, Divorce, and Death Jacque Lynn Foltyn Abstract I use myself as a source of data to examine social boundaries traditionally erected around the dying, the dead, and the bereaved - and marriage and divorce. In 2005, for a six month period, I, a married woman became the primary support and sometimes sole caretaker of my dying ex-husband. I went through inpatient hospice with him and he died in my arms. Treated as “the wife” by hospice staff and his medical colleagues (he was a surgeon), I was referred to as “the wife,” and made decisions like a wife, i.e., Last Rites, cremation, disposal of property, and dispersal of his cremains. People insisted, “You do not need to do this. Most people would not.” While socially I had the choice to stay away, morally and emotionally I did not. His family were deceased or not available, he had no children, and he was single, divorced a second time. While my ex had many friends, he viewed me as his primary relationship. First love, first wife, and first ex-wife, I was transformed into something more than all of these statuses. I became a quasiwife and a quasi-widow, a person with a difficult to articulate social status/position in a society where too often social relations are so fragile that people die alone. As ex-wife and a married woman, I violated many social norms that are well-patrolled in contemporary western culture. For a time, I found myself the “wife” of two men. My current husband, also a physician, supported me through the caretaking journey, which was also considered “remarkable.” While a death researcher, before my ex’s death I had experienced death only as an abstract problem not a part of life. This paper is an exploration of caretaking and bereavement that cross social and institutional boundaries and its focus is personal transformation.1 Key Words: bereavement, cancer, caretaker, death, disenfranchised grief, divorce, ex-spouse, grief, quasi-widow, quasi-wife. ***** 1. Introduction As a death researcher, my usual work is as a social theorist studying representations of death in art and popular culture. This is a very different paper for me, opening up research, as well as personal, possibilities. When a couple divorces, they dissolve their marriage but not necessarily their emotional attachment. The bonds that connected them as a couple are not easily left behind; common children, personal histories, 286 Quasi-Widowhood ______________________________________________________________ unresolved issues, and memories can tie a couple emotionally decades past their divorce.2 As the divorce rate has climbed over the past several decades, there has been a gradual recognition by grief counsellors, clinicians, death educators, and academics that the divorced are likely to feel bereft when an ex-spouse dies and may need help dealing with their grief.3 Described in the death studies literature as a “double-loss,” “loss within a loss,” or “hidden sorrow,” grieving an ex-spouse is classified under “unusual bereavement situations”4or, more commonly, “disenfranchised grief.” Disenfranchised grief is marginalized or culturally unacceptable grief that is not socially legitimised or supported, and that may not be openly acknowledged or publicly mourned. Every society has conventions about socially permissible grief, including some grievers and excluding others.5 The literature about how an ex-spouse reacts to the deaths of a former mate is extraordinarily small, a seeming confirmation of their disenfranchisement.6 Articles and self-help advice published by death educators, clergy, therapists, journalists, and bloggers have focused on topics such as: (1) their complicated grief and their ambivalent relationship to the deceased;7 (2) reasons for mourning;8 (3) how their grief differs from that of the widowed9 or the divorced;10 (4) their substance abuse;11 (5) how they are barred from visiting and from caretaking roles;12(6) their lack of access to medical information about the dying ex;13 (7) exclusion from funerals, headstones, or obituaries;14 (8) the closure some feel when an ex-spouse dies;15 (9) alternative ways to “pay respect”;16 (10) proper etiquette when extending condolences toward former in-laws;17 (11) current spouse reactions to their mourning;18 (12) discussing the death with offspring from the dissolved union;19 (13) financial implications;20 (14) lack of social support from clergy, therapists, and/or work environments;21 and (15) ways that death counsellors and educators and the community can assist with grief management, validate emotions, and allow the disenfranchised griever a public place in the community of mourners.22 In this exploratory study, I take a different tact. I use myself as a source of data to examine how the social boundaries traditionally erected around the dying, the dead, and the bereaved - and around marriage and divorce - can be surprisingly fluid in an era in which divorce rates are high, family relations are less rigidly defined, and people through no fault of their own find themselves dying alone. I focus not on my grief—which is real, but on my social roles as a divorced and remarried woman attending to her dying and then dead former husband. . 2. Relevant History “Jacque, this is Matt, and I have really bad news. I have cancer and it’s a really bad one.” The day was March 19, 2005, and Matt, my former husband, a physician himself, was telling me that he had advanced metastatic Jacque Lynn Foltyn 287 ______________________________________________________________ neuroendocrine pancreatic cancer. After my stunned disbelief that Matt, a man in vibrant mid-life, at the height of his career as a reconstructive and plastic surgeon, had been diagnosed with a cancer that would very likely kill him, I replied, “I will help you through this. I promise. I will not abandon you. You are family.” Matt and I were 18 years olds, living away from home in university dormitories when we met. Inseparable from the start, we married at age 20. While we were married, we completed undergraduate degrees and entered graduate school - Matt medical school and residency, and I a Ph.D. program in sociology. Teenagers when we fell in love, by the time we parted 12 years later, we were casualties of marrying “too young” and growing apart as we constructed individual adult identities and value systems.23 Our post divorce years were relatively - but not always - friendly, and we each eventually remarried. Since we had no children together, were geographically separated after Matt moved to another state, and were busy with our new families and respective careers, our contact became less frequent. In the autumn of 2002, Matt called to tell me that his second marriage had ended. We resumed a closer friendship, and I became Matt’s confident during his acrimonious second divorce. I felt compassion for Matt and was still fond of him. After all, we had a shared history and had literally “grown up together,” each growing an inch in height during our marriage. The fact that Matt had almost no family support influenced me, as well. His father had died the previous year, his mother was hospitalised with organic brain disease, and his sister and he were estranged. Matt’s brother had a busy career, lived a great distance away, and was going through his own marital difficulties; they were not always, as Matt put it, simpatico. Henry, my husband, a Swedish national, did not contest our renewed contact. We talked of it often, discussing how fortunate we both were to be on such good terms with our ex-partners. Henry noted that we were folding Matt into “the family constellation.” 3. The Dying, Death, and Posthumous Journeys Matt was hospitalised several times in the next six months. I was in the recovery room when he opened his eyes after an eleven-hour surgery and visited him nearly daily through those first and subsequent hospitalisations. I was on his family visitor list, and he squeezed my hand tightly when sutures and drains were removed painfully from his abdomen. When Matt was not hospitalised, he stayed in the guest house of a friend, for his surgery and treatment were in a city and state different from where his own home was located. We were in contact each day by phone or in person, and I accompanied him to pre-op and post-op medical appointments, progress checkups, and chemotherapy sessions. For a period of several weeks, I lived with Matt in his guest house accommodations, 288 Quasi-Widowhood ______________________________________________________________ assisting him and his professional care and nursing teams. When it became nearly impossible for him to eat, I prepared special foods for him and learned to administer IV Total Parenteral Nutrition (TPN). I massaged his back and feet, trying to take his focus away from his pain. I also took care of his beloved dogs, a constant source of concern for him. Later, I worked with a hospital social worker, working to have Matt admitted to a skilled nursing facility (SNF) near my marital home. With Matt’s knowledge, I consulted with his medical team about all aspects of his medical care. Behind the scenes, I demanded—and obtained— an immediate appointment with another oncologist, when the SNF physician told me that Matt was dying, belonged in a hospice, and that the three chemo regimens he had endured had not made a dent. When the new oncologist examined him and told him forthrightly that that he was entering the last weeks of his life, I cradled Matt in my arms and wept with him. Straight from the oncologist’s office, he was driven by ambulance to a world-class hospice. Before I arrived, he had designated me as his family and “gatekeeper.” I was with Matt when he signed, “do not resuscitate” papers and when his physicians explained his pain management regimen and what to expect in the dying process. I spent the last weeks of Matt’s life with him, 12-24 hours a day, supporting him emotionally and offering him companionship. We pondered the mysteries of human suffering, dying, and death. Throughout, I had the full support of not only my husband, but my university dean, who allowed me additional leave time. As Matt’s hospice gatekeeper, I honoured his wishes about who should be allowed to visit or call him. (His brother would later say that I protected him like a lioness protects its cubs). The hospice gave my telephone number to sometimes a dozen people a day, who called me at home, seeking information - and consolation. Matt’s step-mother, the widow of his father, was an overnight guest in our house for a week. I had long talks with his estranged sister and second ex-wife, two people that Matt did not want to see. I was delivery person for documents that needed Matt’s signature, served as scribe for his final bequests, and met with his lawyer. Though Matt was not a Catholic, I arranged for him to receive Last Rites when he asked a chaplain to tell me that he wanted them. I stood by his hospice bed as the priest anointed him with oil and sang to him, in this ancient ritual now known as Sacrament of the Anointing of the Sick. In the final days of his life, Matt collapsed his visitor list to one name, mine. “You know me better than anyone does,” he told me, noting that my presence was soothing rather than a burden, unlike that of some well-meaning visitors. “I’m the one who is dying and I’m the one who is comforting them. I can just be myself with you.” “I’m sorry to put you through this,” he apologized on several occasions. “Don’t worry about me. I’m a “death researcher.” I can handle it. If I can’t handle it, who can?” I would retort, making him smile. Jacque Lynn Foltyn 289 ______________________________________________________________ Several hours before he died, Matt slipped into a coma. In those hours, I moistened his mouth with a sponge; read him poetry, humorous essays, and psalms; played his favourite music; and told him how much I loved him and that it was okay for him let go and leave me. When the hospice nurse explained that his brain was shutting down and that he no longer needed the oxygen feed, I gave her permission to take the tubes away. My parents, his former in-laws, and I were the only individuals present when Matt took his final breath on September 4, 2005, five-and-one-half months after he had been diagnosed with cancer. He died in my arms, and I felt his last heartbeat against my chest. I, not the hospice, informed his brother of his death. Soon after Matt died, my sister, his former sister-in-law, arrived. Crying, we arranged his body in a position of peaceful repose and gathered up his belongings to take home. We left before Matt was put in a body bag, a visual memory I did not want to have. Days before, working with hospice staff, I had selected the crematorium where Matt’s corpse would be burned. Ten days after his death, I picked up his cremains and drove him home. In an addendum to his living trust, Matt had requested that I keep his ashes until a time when his brother, his stepmothers, and I could meet to scatter his ashes. He asked me to be one of three speakers at his large memorial service and requested that I go through, distribute, and dispense with his personal property, together with his brother and father’s widow. Listed as Matt’s former wife, I appeared in newspaper obituaries as one of his survivors. I wrote the obituary for his alma mater, and the hospice sent me notifications of monetary gifts to the hospice made in Matt’s name, to which I responded with thank-you letters. My opinion was sought by school of medicine trustees who wished to rename a major medical scholarship after him. To mark the first anniversary of Matt’s death, my sister and I drove his cremains 400 miles to Big Sur, on the beautiful California central coast, the location where he wanted his ashes dispensed. There, I led his brother and two stepmothers in a ritual ceremony commemorating his life, before we took handfuls of what remained of him and released him into the sea. 4. Quasi-Wife and Quasi-Widow As Matt’s ex-wife, I was enfranchised, rather than disenfranchised on all levels of his dying, death, and posthumous journeys, an atypical finding in the death studies literature. Divorce changes rather than ends many relationships,24 and my involvement in Matt’s dying changed our relationship yet again. I found myself functioning as a “quasi-wife” and as a “quasiwidow,” fulfilling caretaking, social, cultural, and institutional roles traditionally associated with a wife. As I performed these roles, a remark I frequently heard from friends, colleagues, death educators, and hospital and hospice staff, was “you don’t have to do this. Most people wouldn’t,” to 290 Quasi-Widowhood ______________________________________________________________ which I would respond, “of course, I have to do this. It makes me sad to think that you think that most people would not.” Such remarks, conveyed with wondering praise rather than disapproval, were not meant to marginalize me but rather to socially locate me, for there was no word or conceptual frame to describe this unfamiliar role. No wonder some hospice workers started to refer to me as Matt’s wife, even when they knew I was his “ex” and I reminded them of my marital status. While they were correct that I was not socially or legally obligated to assist Matt, not doing so was not a morally or emotionally viable option for me. I was unwilling to disenfranchise myself, for Matt needed a family member and that family member was me. First love, first wife, and first exwife, I was transformed into something more than all of these statuses when I became Matt’s quasi-wife and quasi-widow, a person with a difficult to articulate social status in a society where social relations are so fragile that people too often die alone. As a married person I violated well-patrolled social norms about marriage in contemporary western culture. So did Henry, my husband, who supported me through the caretaking journey, which was frequently referred to by others as “remarkable.” A physician who has experienced all matter of deaths and complicated family relations in Sweden, Henry attempted to help Matt, too, by reviewing his case and researching other possible medical regimens. His compassion is illustrated by his response when I asked him whether he was bothered by the amount of time I was spending with Matt. “He needs you now. He is dying. There is plenty of time for us. You have two husbands now.” As a caretaker of my dying ex-spouse I am part of a larger, little documented or understood social trend, increasingly seen by hospice workers and medical personnel, of divorced individuals returning as caregivers of their dying ex-spouses.25 As the family institution grows more fragile, people have fewer or no children, and as families geographically disperse and grow smaller, divorced people may fine themselves not only single at the time of death but alone as well. Had I not stepped in, Matt would have died without people present he thought of as family. In response to the increasing numbers of people dying without family, there is a growing social movement in which volunteers are trained by hospice personnel to comfort individuals who might otherwise die alone.26 The fact that hospice counsellors reached out to me while Matt was dying and called me for weeks after his death, urging me to avail myself to their bereavement services (which I did) demonstrates that some death educators are heeding the recommendations Doka made back in 1986, that they “be attentive to the difficulties of the ex-spouse.”27 Although there are obvious limitations posed by using myself as a source of data, my experience highlights the need for more research into this Jacque Lynn Foltyn 291 ______________________________________________________________ subject. From my story, we can conclude that individual circumstances matter extremely in such cases, enfranchising some while disenfranchising others. I am expanding this exploratory study, and have already conducted one in-depth interview with a divorced single woman who, like me, became involved in end-of-life care of her ex-husband. Before Matt’s dying and death, death for me was an abstract problem not a part of life. For both of us, his dying was a time of grieving, healing, and working through of complicated emotions. It was a period of reconciliation, of revisiting our youths and establishing a satisfying mid-life relationship. During Matt’s final journey, we honoured a bond that would not be broken, no matter what social mores dictate. We were united even after death did us part.28 Notes 1 For Matthew and Henry. S Moss and M Moss, ‘Remarriage: A Triadic Relationship’. Conciliation Courts Review, vol. 4, 1980, pp. 15-20. 3 K J Doka, ‘Loss upon Loss: The Impact of Death after Divorce’. Death Studies, vol. 10, 1986, pp. 441-449. S Scott, ‘Grief Reactions to the Death of A Divorced Spouse’, in Death: Completion and Discovery, C. Corre and R. Pacholski (eds), Association for Death Education and Counselling, Lakewood, 1987, pp. 107-116. 4 J Beder, Voices of Bereavement: A Casebook for Grief Counselors, BrunnerRoutledge, New York, 2004. 5 K J Doka (ed), Disenfranchised Grief: New Directions, Challenges, and Strategies for Practice, Research Press, Champaign, 2002. 6 S Scott, ‘Grief Reactions to the Death of a Divorced Spouse Revisited’. Omega, vol. 41, 2000, pp. 207-219. 7 Beder, op.cit. Doka, ‘Loss upon Loss’, op. cit. K J Doka, Disenfranchised Grief: Recognizing Hidden Sorrow, Lexington Books, Lexington, 1989. Scott, ‘Grief Reactions to the Death of A Divorced Spouse’, op. cit. S Scott, ‘Death of a Divorced Spouse: The Survivor’s Dilemma’, in Divorce Shock: Perspectives on Counseling and Therapy, A Tiemann, B Danto, and S Gullo (eds), The Charles Press, Philadelphia, 1992, pp. 59-67. 8 Scott, ‘Grief Reactions to the Death of a Divorced Spouse Revisited’, op.cit. 9 Doka, ‘Loss upon Loss’, op.cit. 10 Beder, op. cit. 11 Scott, ‘Grief Reactions to the Death of a Divorced Spouse Revisited’, op. cit. 2 292 Quasi-Widowhood ______________________________________________________________ 12 Doka, Disenfranchised Grief: New Directions, op. cit. Hospice of the Valley, in Grief Healing Discussion Groups, 20 March 2004, viewed on 3 October 2008, <http://hovforum.ipbhost.com/index.php?showtopic=175>. 14 Doka, Disenfranchised Grief: Recognizing Hidden Sorrow, op.cit. Doka, Disenfranchised Grief: New Directions, op. cit. E Seymour, ‘The Two Words Missing from Robin Cook’s Headstone’, in Elleeseymour.com, 9 January 2007, viewed 2 September 2008, <http://elleeseymour.com/2007/01/09the-two-words-missing-from-robincooks-headstone/>. 15 Beder, op. cit. M Glazer, ‘How Do You Mourn an Ex-Spouse? Self-Improvement/GriefLoss’, in Ezine Articles, February 18, 2007, viewed on 4 October 2008, <http://ezinearticles.com/?How-Do-You-Mourn-An-ExSpouse?&id=459347>. 16 H I Smith, ‘Does My Grief Count? When Ex-Family Grieve’. Illness, Crisis, & Loss, vol. 14, 2006, pp. 355-372. 17 J S Holder and J Aldredge-Clanton, Parting: A Handbook for Spiritual Care Near the End of Life, University of North Carolina Press, Chapel Hill, 2004. ‘Social Etiquette and Good Manners. Death of an Ex-Spouse’s Mother’, in AllExperts.com, 10 August 2007, viewed on 20 August 2008, <http://en.allexperts.com/q/Social-Etiquette-Good570/indexExp_25849.htm 18 Hospice of the Valley, op. cit. Scott, ‘Grief Reactions,’op. cit. Smith, op. cit. 19 Glazer, op. cit. 20 Doka, Disenfranchised Grief: New Directions, op. cit. 21 Doka, ibid. Hospice of the Valley, op. cit. J Kamerman, ‘Latent Functions of Enfranchising the Disenfranchised Griever’. Death Studies, vol. 17, 1993, pp. 281-287. 22 Beder, op. cit. Doka, Disenfranchised Grief: Recognizing Hidden Sorrow, op. cit. Kamerman, 1993, op. cit. Smith, op. cit. 23 BR Karney and TN Bradbury, ‘The Longitudinal Course of Marital Quality and Stability: A review of Theory, Method and Research’. Psychological Bulletin, 1995, vol. 118, pp. 3-34. S P Morgan and R Rindfuss, ‘Marital Disruption: Structural and Temporal Dimensions’. American Journal of Sociology, vol. 90, 1985, pp.1055-1077. 13 Jacque Lynn Foltyn 293 ______________________________________________________________ L White, ‘Determinants of Divorce: A Review of Research in the Eighties’. Journal of Marriage and the Family, vol. 52, 1990, pp. 904-912. 24 Smith, op. cit. 25 M Richtel, ‘When an ex-spouse returns as caregiver’. NYTimes.com, 19 May 2005, viewed 19 July 2005, <http://www.nytimes.com/2005/05/19/fashion/thursdaystyles/19DIVORCE.h tml?_r=1&pagewanted=print&oref=slogin>. 26 S Roan ‘So They don't Die Alone: Some Dying Patients Have Neither Friends Nor Family. Increasingly, Volunteers are Filling In’. The Los Angeles Times, 4 June 2007, viewed on 4 May 2008, <http://articles.latimes.com/2007/jun/04/health/he-dyingalone4>. 27 Doka, ‘Loss upon Loss,’ op. cit., p. 449. Bibliography Beder, J., Voices of Bereavement: A Casebook for Grief Counselors. Brunner-Routledge, New York, 2004. Doka, K. J., ‘Loss upon Loss: The Impact of Death after Divorce’. Death Studies, vol. 10, 1986, pp. 441-449. _____, Disenfranchised Grief: Recognizing Hidden Sorrow. Books, Lexington, 1989. Lexington ______, (ed), Disenfranchised grief: New Directions, Challenges, and Strategies for Practice. Research Press, Champaign, 2002. Glazer, M., ‘How Do You Mourn an Ex-Spouse? Self-Improvement/GriefLoss’, in Ezine Articles, February 18, 2007, viewed on 4 October 2008, <http://ezinearticles.com/?How-Do-You-Mourn-An-ExSpouse?&id=459347>. Holder, J. S. and J. Aldredge-Clanton, Parting: A Handbook for Spiritual Care Near the End of Life. University of North Carolina Press, Chapel Hill, 2004. Hospice of the Valley, in Grief Healing Discussion Groups, 20 March 2004, viewed on 3 October 2008, <http://hovforum.ipbhost.com/index.php?showtopic=175>. 294 Quasi-Widowhood ______________________________________________________________ Kamerman, J., ‘Latent Functions of Enfranchising the Disenfranchised Griever’. Death Studies, vol. 17, 1993, pp. 281-287. Karney, B.R. and T.N. Bradbury, ‘The Longitudinal Course of Marital Quality and Stability: A Review of Theory, Method and Research’. Psychological Bulletin, 1995, vol. 118, pp. 3-34. Morgan, S. P and R. Rindfuss, ‘Marital Disruption: Structural and Temporal Dimensions’. American Journal of Sociology, vol. 90, 1985, pp.1055-1077. Moss S. and M. Moss, ‘Remarriage: A Triadic Relationship’. Conciliation Courts Review, vol. 4, 1980, pp. 15-20. Richtel, M., ‘When an Ex-Spouse Returns as Caregiver’. NYTimes.com, 19 May 2005, viewed on 19 July 2005, <http://www.nytimes.com/2005/05/19/fashion/thursdaystyles /19DIVORCE.html?_r=1&pagewanted=print&oref=slogin>. Roan, S., ‘So They don't Die Alone: Some Dying Patients Have Neither Friends Nor Family. Increasingly, Volunteers Are Filling In’. The Los Angeles Times, 4 June 2007, viewed on 4 May 2008, <http://articles.latimes.com/2007/jun/04/health/he-dyingalone4>. Scott, S., ‘Grief Reactions to the Death Of A Divorced Spouse’, in Death: Completion and Discovery. C. Corre and R. Pacholski (eds), Association for Death Education and Counseling, Lakewood, 1987, pp. 107-116. _____, ‘Death of a Divorced Spouse: The Survivor’s Dilemma’, in Divorce Shock: Perspectives on Counseling and Therapy. A. Tiemann, B. Danto, and S. Gullo (eds), The Charles Press, Philadelphia, 1992, pp. 59-67. _____, ‘Grief Reactions to the Death of a Divorced Spouse Revisited’. Omega, vol. 41, 2000, pp. 207-219. Seymour, E., ‘The Two Words Missing from Robin Cook’s Headstone’, in Elleeseymour.com, 9 January 2007, viewed 2 September 2008, <http://elleeseymour.com/2007/01/09the-two-words-missing-from-robincooks-headstone/>. Smith, H.I., ‘Does My Grief Count? When Ex-Family Grieve’. Illness, Crisis, & Loss, vol. 14, 2006, pp. 355-372. Jacque Lynn Foltyn 295 ______________________________________________________________ ‘Social Etiquette and Good Manners. Death of an Ex-Spouse’s Mother’, in AllExperts.com, 10 August 2007, viewed on 20 August 2008, <http://en.allexperts.com/q/Social-Etiquette-Good570/indexExp_25849.htm> White, L., ‘Determinants of Divorce: A Review of Research in the Eighties’. Journal of Marriage and the Family, vol. 52, 1990, pp. 904-912. Jacque Lynn Foltyn is Associate Professor of Sociology and Department Chair of Social Sciences in the College of Letters and Sciences, National University in La Jolla, California. She researches issues in death and beauty, and authored the Importance of Being Beautiful and edited The Corpse in Contemporary Culture, a special issue of Mortality. The Survivor’s Guilt: The Case of Cancer Shulamith Kreitler, Frida Barak, and Nava Siegelman-Danieli Abstract The paper deals with survivor’s guilt. Survivor’s guilt is a common phenomenon, defined as the guilt that individuals may experience if they have emerged unharmed following natural, human or social disasters in which others have been harmed. The purpose was to describe the phenomenon and to study some of its correlates and consequences in the context of the caretakers of cancer patients. The first part presents a brief review of what is known about survivor’s guilt, and the second part presents some findings of an empirical study the authors have done about survivor’s guilt. The participants were 195 caretakers of cancer patients; most of whom were interviewed and presented tests both pre- and post the patient’s death. The study showed that survivor’s guilt is prevalent among the caretakers of cancer patients and is related to remorse and somewhat less to depression. It is unrelated to variables, such as the duration of having taken care of the patient, number of deaths in the family, marital status, number of children and religiosity but is related to intensity of care for the patient and relation to the patient, and hence may be assumed to be rooted in deeper affective layers of the individual’s personality. Observations about the correlates of survivor’s guilt six months following the patient’s death support the thesis that survivor’s guilt exerts a pro-social impact on the person’s behaviour. Key Words: Survivor’s guilt, guilt, cancer, caretakers. ***** 1. Review of the Literature about Survivor’s Guilt. A. What is Survivor’s Guilt? Survivor’s guilt or survivor’s syndrome is generally defined as the mental condition resulting from the appraisal that a person is guilty by the mere fact of having survived a traumatic event whereas others did not.1 It was first diagnosed in the 1960s when several therapists identified a set of symptoms including survivor’s guilt in holocaust survivors.2 The traumatic events that may engender survivor’s guilt usually refer to combat, natural disasters and significant job lay-offs, but includes also political concentration camps, automobile accidents, wartime bombing attacks, and deaths from disease. The others in regard to whom survivor’s guilt is felt may include family members, friends, colleagues but also unknown strangers. There has been some unclarity about the differential diagnosis between survivor’s guilt 298 The Survivor's Guilt ______________________________________________________________ and post-traumatic stress disorder, with the result that the latter but not the former was included in the DSM-IV. It should however be emphasized that the two conditions differ although both may develop following a trauma. Similarly, survivor’s guilt differs from the guilt sometimes felt by rescuers who blame themselves for not having done enough to help others in emergencies or the guilt that therapist may feel for their patients’ suffering. In both of the latter cases the guilt refers to not having done something for saving the others or alleviating their suffering whereas in survivor’s guilt the guilt is based solely on the survival per se. B. In which Contexts or Circumstances Survivor’s Guilt Arises? Some investigators emphasize that survivor’s guilt hits people who have not done anything wrong or have not done much of anything at all. In order to better characterize the phenomenon, it is necessary to focus on the original circumstances in which it occurs. As noted, survivor’s guilt appears after a disaster or a trauma. The person who feels the guilt has not been hit or affected by the trauma but there was a fair probability that he or she could have been a victim. Further, survivor’s guilt is more frequent in people who have suffered themselves in the circumstances in which the disaster occurred than in those who did not. Again, it is more frequent in people who have been somehow involved in the disaster than in those who observed it from a safe distance. The suffering of those who feel the survivor’s guilt may have been serious, for example, it may have involved death risk, hunger, oppression, severe worries but in any case it was more moderate or at least ended better than in the case of the other victims, who may have died, or undergone imprisonment, torture or lay-off from work. An interesting case of survivor’s guilt is described in Kurt Vonnegut’s novel Bluebird. The protagonist Rabo Karabekian's father had survivor guilt from witnessing some parts of the Armenian genocide by hiding in a deserted village. In contrast, his wife who actually witnessed the killings and pretended to be dead while hiding under corpses did not feel any survivor’s guilt. In regard to rescuers, the survivor’s sense of guilt may be enhanced if the rescuer died while saving one’s life. Another example of a similar effect would be when a soldier switches a patrol with a friend, and the friend dies during that particular patrol. The surviving friend thinks that it should have been him and is left with survivor’s guilt. Further, survivor's guilt has been observed in situations that involve being put in a place where one wasn't able to revive or otherwise prevent the death of someone one may have loved, in short, situations where nothing can be done for the victim. Shulamith Kreitler, Frida Barak, and Nava Siegelman-Danieli 299 ______________________________________________________________ C. What are the Symptoms or Manifestations of Survivor’s Guilt? The characteristic symptoms of survivor’s guilt include primarily guilt and self-blame, as well as anxiety, depression, sleep disturbances, emotional liability, loss of drive, lower motivation and morale (e.g., increased absences from work if the trauma was lay-offs), and sometimes physical complaints. In general, survivor’s guilt has been related to longer mourning periods and complicated bereavement. D. How Common is Survivor’s Guilt? Studies have detected survivor’s guilt in a great variety of contexts. According to a literature review survivor’s guilt occurs in: patients after a death takes place within a treatment setting for chronic illness;3 people who keep their job when others are fired; homosexual men who have tested negative for the human immunodeficiency virus whereas their friends tested positive (“spared at random”); survivors of the Vietnam war; “survivorfriends” (bereaved friends) who have experienced the death of a close friend;4 individuals faced with the sudden death of a partner in an extramarital relationship (secret survivors);5 after death in the family, more survivor’s guilt in widows if the death was by suicide than by accident;6 mothers of children who died of leukaemia; psychotherapists working with the unique group of patients of holocaust survivors;7 in a surviving twin, or siblings of a cancer patient child who died;8 in survivors who suffer increased guilt due to not having completed certain courses of action prior to death of loved one and may blame themselves for failure to achieve an appropriate death for their loved one, or for not having perceived clues of impending death;9 in survivors of beloved ones, more so when death has been sudden than if not. E. What are the Reasons for or Causes of Survivor’s Guilt? There are various theoretical approaches to survivor’s guilt that will be briefly presented. According to Freud,10 guilt in general is the product of intra-psychic conflicts between the superego and the ego, and can be considered as a kind of weapon used by the superego to influence the ego's decisions in cases that involve prohibited or tabooed id impulses. Accordingly, survivor’s guilt would be the result of repressed impulses that the survivor has had in regard to the deceased, such as aggressiveness, wishes of death or tabooed sexuality (e.g., incest). Rank,11 another proponent of psychoanalysis, considered guilt as a function of the individuation process, originating in the infantile attachment to mother and in the fear and anxiety over breaking that attachment. Accordingly, guilt operates as a force that perpetuates that relationship. Survivor’s guilt reflects the guilt over enhanced individuation resulting inevitably from the deceased death. Hence, the ubiquity of survivor’s guilt. According to evolutionary theorists (e.g., Trivers12) the preservation of 300 The Survivor's Guilt ______________________________________________________________ relationships is vital for survival and reproduction. Hence, human guilt emerged from natural selection because it prevented human beings from performing destructive actions that might damage their relationships with others. Similarly, Ausubel13 focused on the importance of maintaining the group, and claimed that guilt always reflects an offence against the group. According to the existential approach guilt is a normal part of grieving, and the regressive period of mourning may revive guilty affects from the past among predisposed vulnerable individuals. A further possibility is that the guilt reflects the decreased sense of vitality the grievers may feel because of their “embracing” of death, for example, by their previous readiness to give up their own life for the deceased, their identification with the dead one or their decreased motivation for life now that the beloved deceased is no longer with them. The social interpersonal approach considers guilt from the perspective of its role in communal relatedness, supported by its biological importance for survival and reflected in the affective responses of empathy, belongingness and attachment. Guilt serves three broad functions for relationships. First, it motivates relationship-enhancing patterns of behaviour, by helping to enforce the communal norms prescribing mutual concern, respect, and positive treatment in the absence of self-interested return. Secondly, it may operate as an interpersonal influence technique that allows even a relatively powerless person to get his or her way. Thirdly, guilt helps to redistribute emotional distress within the dyad following a transgression. If the transgressor feels guilty his or her enjoyment is diminished, and the victim may feel better. Accordingly, survivor’s guilt helps to restore emotional equity experienced by family members, friends, and co-workers in regard to significant others. In this way survivor’s guilt contributes to promoting fair, equitable, and durable relationships. F. The Paradox of Survivor’s Guilt Since survivor’s guilt is such a strong and clear experience, it should lead to the commonly expected results following guilt in general. Major among these is the tendency to be punished, or in the very least to confess to one’s “sin,” apologize and make some kind of reparation. Acts of this kind are assumed to alleviate the guilt. However, empirical studies have failed to demonstrate that survivor’s guilt stimulates a wish for punishment.14 15 16 17 18 2. The Study This second part of the paper reports some of the findings of a study of survivor guilt in the caretakers and family members of cancer patients. Shulamith Kreitler, Frida Barak, and Nava Siegelman-Danieli 301 ______________________________________________________________ A. Purpose The objectives were (a) to check the frequency of survivor’s guilt in the family members ad caretakers of cancer patients; (b) to identify emotional and cognitive correlates of survivor’s guilt; and (c) to explore the consequences of survivor’s guilt, i.e., whether they were punitive or prosocial. B. Method: Participants The participants in the study were 195 family members of cancer patients who had been involved in taking care of the patients and had a continuous relationship with them. The sample of caretakers was chosen for the following reasons: (a) the sample is potentially large and fairly homogenous in the circumstances of contact with the deceased; (b) the sample enables testing the participants prior to the death of the patient and following it, so as to determine the impact of the death itself on survivor’s guilt and also to explore the immediate as well as long-term effects of survivor’s guilt. C. Method: Procedure A part of the participants (n=82) were studied only prior to the patient’s death (2-3 weeks), and the rest (n=113) both prior and after the patient’s death (2-3 weeks) and 42 out of these also 6 months later. All participants were recruited in oncology wards in different hospitals and clinics in Israel. D. Method: Tools The participants were administered two questionnaires: (a) a questionnaire that referred to the relationship of the participant with the patient and the nature and reasons for possible reactions of guilt and remorse, and reactions to it; (b) and the Profile of Mood States which assessed the participants’ current levels of different emotions, such as depression and anxiety, to which guilt and remorse were added.19 E. Results The results showed that the major emotions reported by the participants prior to the patient’s death were remorse, guilt, anger and confusion, and following the death the major emotions were remorse, guilt, fatigue and confusion. Hence, following the death, anger was replaced by fatigue. Sixty two percent of the sample reported guilt above the medium level after the patient’s death. Guilt was higher post-death than pre-death. Further, comparing the means of the emotional response prior and after the patient’s death shows that that there were declines in anger, anxiety 302 The Survivor's Guilt ______________________________________________________________ and energy, and increases in depression, fatigue, confusion, guilt and remorse. Comparing the results in the first months after the death with those six months later showed that there were significant declines in depression, anger, confusion, anxiety and fatigue, and a slight increase in energy. Guilt persisted as a reported emotion, but its level was lower than before. In all stages of testing, guilt and remorse were correlated positively and significantly (r=. 75-.82). Guilt was also correlated with depression, but to a lower degree (r=. 61-.64). The participants who were highest in guilt prior to the death had the highest levels of depression both before the death and following it. As noted, the participants were asked about the reasons for their feelings of guilt. More than 50% referred to the following reasons for their feelings of guilt and remorse: (a) Things they have not done in regard to the patient but should have done; (b) Things they have done in regard to the patient but should not have done; (c) Death wishes they have had in regard to the patient or feeling glad/relieved at patient’s death; (d) Being/staying alive whereas the patient is dying/dead. Notably, most of the actions reported as done referred to the patient’s treatment and to the period of the patient’s disease. Most of the things reported as not done referred to the relationship with the patient, mostly in the period preceding the time during which the participant engaged in taking care of the patient. The study also provided information about various correlates of survivor’s guilt. It was found that survivor’s guilt is not related to the duration of having taken care of the patient; having come from a holocaust family; the number of deaths in the family in the previous five years; the participant’s marital status and number of children; and the participant’s religiosity (or observance of religious habits/procedures). The following variables were found to be positively related to survivor’s guilt: being female; being older than 60 years of age; intensity of care provided to the patient; being a relative or friend of the deceased rather than a paid caretaker; and closeness of emotional bond with the deceased. As noted, 42 of the participants were available for interviewing also six months after the patient’s death. The obtained information made it possible to explore the long-term effects of survivor’s guilt, particularly in regard to pro-social behaviour. Out of the 42, 30 participants had post-death a guilt level above the medium, whereas 12 scored in guilt below the medium. A comparison of these two subgroups showed that 76.7% of the participants with an above-medium guilt score (i.e., 23 out of the 30) were engaged six months after the death in pro-social voluntary work, such as collecting food for the needy, helping victims of burglaries and robberies or taking care of hospitalised patients. Only two participants with a below-medium guilt score (namely, 16.7%) engaged in similar voluntary activities. Shulamith Kreitler, Frida Barak, and Nava Siegelman-Danieli 303 ______________________________________________________________ F. Some Conclusions The findings of the study are to be considered as preliminary. The results found so far show that survivor’s guilt is prevalent among the caretakers of cancer patients. It is related to remorse and somewhat less to depression, but is distinct from these two emotions. Further, the findings that survivor’s guilt is unrelated to variables, such as the duration of having taken care of the patient, number of deaths in the family, marital status, number of children and religiosity but is related to intensity of care for the patient and relation to the patient suggest that survivor’s guilt is an affective response rooted in deeper layers of the personality. Most importantly, the observations about the correlates of survivor’s guilt six months following the patient’s death support the thesis that survivor’s guilt exerts a pro-social impact on the person’s behaviour. The more general implication of these findings is that survivor’s guilt should not be treated as a pathological phenomenon to be reduced, alleviated and mitigated at all costs. Rather it may be an intrinsically human response to the occurrence of death which leads to pro-social behaviours designed to strengthen the human bond and thereby to transcend the existential plight of limited existence. Notes 1 R J Lifton, Death in Life, Simon & Schuster, New York, 1967. W G Niederland, ‘The Problem of the Survivor’, Journal of the Hillside Hospital, 10, 1961, pp. 233-247. 3 M Vamos, ‘Survivor Guilt and Chronic Illness’, Australian and New Zealand Journal of Psychiatry, vol 31 (4), August 1997, pp. 592-596. 4 F. Sklar and S F Hartley, ‘Close Friends as Survivors: Bereavement Patterns in a "Hidden" Population’, Omega: Journal of Death and Dying, vol. 21 (2), 1990, pp. 103-112. 5 R W Weinbach, ‘Sudden Death and Secret Survivors: Helping Those who Grieve Alone’, Social Work, vol 34 (1), January 1989, pp. 57-60. 6 D E McNeil, C Hatcher, and R Reubin, ‘Family Survivors of Suicide and Accidental Death: Consequences for Widows’, Suicide and Life-Threatening Behavior, vol 18 (2), Summer 1988, pp. 137-148. 7 Y Danieli, ‘Confronting the Unimaginable: Psychotherapists' Reactions to Victims of the Nazi Holocaust’, in Human Adaptation to Extreme Stress: From the Holocaust to Vietnam, J P Wilson, Z Harel, and B Kahana (eds), The Plenum Series on Stress and Coping, Plenum Press, New York, 1988, pp. 219-238. 2 304 The Survivor's Guilt ______________________________________________________________ 8 J Woodward, ‘The Bereaved Twin’, Acta Geneticae Medicae et Gemellologiae: Twin Research, vol. 37 (2), 1988, pp. 173-180. 9 M Porot, A Couadau, M Plenat, ‘Le Syndrome de Culpabilité du Survivant/ The Survivor's Guilt Syndrome’, Annales Médico-Psychologiques, vol. 143 (3), March 1985, pp. 256-262. 10 S Freud, New Introductory Lectures on Psycho-Analysis (J. Strachey trans.), Norton, New York, 1964 (Original work published 1933). 11 O Rank, The Trauma of Birth, Harcourt, Brace, New York, 1929. 12 R L Trivers, Social Evolution, Benjamin-Cummings, Redwood City, CA, 1985. 13 D P Ausubel, ‘Relationships between Shame and Guilt in the Socializing Process’, Psychological Review, 62, 1955, pp. 378-390. 14 M Friedman, ‘Toward a Reconceptualization of Guilt’, Contemporary Psychoanalysis, vol. 21, 1985, pp. 501-547. 15 M L Hoffman,’Development of Prosocial Motivation: Empathy and Guilt’, in The Development of Prosocial Behavior, N Eisenberg (ed), Academic Press, San Diego, CA, 1982, pp. 281-313. 16 H B Lewis, Shame and Guilt in Neurosis, International Universities Press, Madison, CT, 1971. 17 C Zahn-Waxier and G Kochanska, The Origins of Guilt’, in The Nebraska Symposium on Motivation 1988: Socioemotional Development, R A Thompson (ed), University of Nebraska Press, Lincoln, NE, 1990, vol. 36, pp. 182-258. 18 R F Baumeister, A M Stillwell, and T F Heatherton, ‘Guilt: An Interpersonal Approach’, Psychological Bulletin, 1994, vol. 115 (2), pp. 243267. 19 D M McNair, M Lorr, and L F Droppleman, Manual for the Profile of Moods States, Educational and Industrial Testing Service, San Diego, CA, 1971. Bibliography Ausubel, D. P., ‘Relationships between Shame and Guilt in the Socializing Process’. Psychological Review, 1955, 62, 378-390. Baumeister, R. F., A. M. Stillwell, and T. F. Heatherton, ‘Guilt: An Interpersonal Approach’. Psychological Bulletin, 1994, vol. 115 (2), pp. 243267. Shulamith Kreitler, Frida Barak, and Nava Siegelman-Danieli 305 ______________________________________________________________ Danieli, Y. ‘Confronting the Unimaginable: Psychotherapists' Reactions to Victims of the Nazi Holocaust’, in Human Adaptation to Extreme Stress: From the Holocaust to Vietnam, J. P. Wilson, Z. Harel, B. Kahana (eds), The Plenum Series on Stress and Coping, Plenum Press, New York, 1988, pp. 219-238. Freud, S., ‘New Introductory Lectures on Psycho-Analysis’. J. Strachey (trans), Norton, New York, 1964 (Original work published 1933). Friedman, M., ‘Toward a Reconceptualization of Guilt’. Contemporary Psychoanalysis, vol. 21, 1985, pp. 501-547. Hoffman, M. L., ‘Development of Prosocial Motivation: Empathy and Guilt’, in The Development of Prosocial Behavior, N. Eisenberg (ed), Academic Press, San Diego, CA, 1982, pp. 281-313. Lewis, H. B.,Shame and Guilt in Neurosis. International Universities Press, Madison, CT, 1971. Lifton, R. J., Death in Life. Simon & Schuster, New York, 1967. McNair, D. M., Lorr, M., Droppleman, L. F., Manual for the Profile of Moods States. Educational and Industrial Testing Service, San Diego, CA, 1971. McNeil, D. E., Hatcher, C., Reubin, R., ‘Family Survivors of Suicide and Accidental Death: Consequences for Widows’. Suicide and Life-Threatening Behavior, vol. 18 (2), Summer 1988, pp. 137-148. Niederland, W. G., ‘The Problem of the Survivor’. Journal of the Hillside Hospital, 10, 1961, pp. 233-247. Porot, M., Couadau, A., Plenat, M., ‘Le Syndrome de Culpabilité du Survivant/ The Survivor's Guilt Syndrome’. Annales Médico-Psychologiques, vol. 143 (3), March 1985, 256-262. Rank, O., The Trauma of Birth. Harcourt, Brace, New York, 1929. Sklar, F., Hartley, S. F., ‘Close friends as Survivors: Bereavement Patterns in a "Hidden" Population’. Omega: Journal of Death and Dying, vol. 21 (2), 1990, pp. 103-112. 306 The Survivor's Guilt ______________________________________________________________ Trivers, R. L., Social Evolution. Benjamin-Cummings, Redwood City, CA, 1985. Vamos,M., ‘Survivor Guilt and Chronic Illness’. Australian and New Zealand Journal of Psychiatry, vol. 31 (4), August 1997, pp. 592-596. Weinbach, R. W., ‘Sudden Death and Secret Survivors: Helping Those who Grieve Alone’. Social Work, vol. 34 (1), Jan 1989, pp. 57-60. Woodward, J., ‘The Bereaved Twin’. Acta Geneticae Medicae et Gemellologiae: Twin Research, vol. 37 (2), 1988, pp. 173-180. Zahn-Waxier, C., G. Kochanska, ‘The Origins of Guilt’, in The Nebraska Symposium on Motivation 1988: Socioemotional Development, R. A. Thompson (ed), University of Nebraska Press, Lincoln, NE, 1990, vol. 36, pp. 182-258. Shulamith Kreitler, a psychologist, from the Department of psychology at Tel-Aviv University, is head of Psychooncology Research Center at the Sheba Medical Center in Israel. Frida Barak is a medical doctor, a specialist in oncology, and head of the oncology unit in the Barzilai Medical Center in Ashkelon, Israel. Nava Siegelman-Danieli is a medical doctor, a specialist in oncology, and head of oncology services in the Maccabi health services in Israel. Bereaved Employees, Professional Activity and Pain of Loss Marc-Antoine Berthod Abstract When a close relative dies, what kind of relations do individuals professionally active have with their colleagues at the workplace? How do they live their return at work? Based on a research carried out with various actors (directors, heads of human resources, employees, trade unionists, work inspectors, psychologists and social workers) in about twenty medium-sized and big companies of the French-speaking part of the canton of Valais, Switzerland, this paper tries to answer these questions following an anthropological approach. It presents how the bereaved employees perceive the way their firms rationalize - or do not rationalize - the announcement of death; organize their participation to the funerary rituals; welcome them after their bereavement leave; manage the temporality of bereavement in their structure. It focuses on the experiences of the bereaved employees in order to better understand the influence of the social and professional context on the grieving process at the workplace. Key Words: Bereavement, workplace, professional activity, sense of loss, intimacy, anthropology. ***** 1. Bereavement at the Workplace Literature on bereavement at the workplace is scarce. There is yet a basic premise appearing regularly in the few texts that deal with this issue: employees have neither place nor time to express grief while they are on duty. Marcia Lattanzi-Licht assumes, for example, that: in the workplace, the traditional standard of leaving personal concerns at home is one that can create a sense of disconnection or isolation for employees experiencing a major loss.1 This educator, counsellor and consultant, refers here specifically to the American work ethic, namely a set of values that would impose a quite frank separation between the personal and the professional sphere on the employees. A similar view is defended by Regina Bento, distinguished professor of Management at the Merrick School of Business, University of Baltimore. 308 Bereaved Employees, Professional Activity and Pain of Loss ______________________________________________________________ In an article dedicated to grief in organizations, she sustains that a common norm within business companies is that “sadness and grief…should be checked at the door; they are too heavy for the rarefied emotional atmosphere of the workplace.”2 She draws her argument from narrations given by bereaved individuals to show how grieving at work may be deemed inappropriate; how grief may be refused to these employees. This happens because firms and businesses, epitomized by hierarchical superiors and colleagues, expect generally that the bereaved workers will get over their grief in a relatively short - though unspecified - period of time. As Bento reminds us, the social system simply does not always permit individuals who want and need to grieve to do it: grief is disenfranchised, a much-celebrated notion coined by Kenneth Doka in the late eighties.3 At the first glance, we can easily admit the existence of such a pervasive constraint upon intimate suffering and pain in the professional realm. Numerous persons who have coped with the loss of a close relative while they were employed would indeed share this point of view. At peculiar moments of their grieving process, bereaved workers have usually felt the weight of a limit that delineates the workplace as a non-emotional arena; moreover, this place is thought to be exempted from personal affairs. This seems particularly true for those who resume their job after an unexpected and sometimes brutal loss. The following short quote illustrates this feeling; it comes from a thirty-year-old woman who suddenly lost her husband. Six months after an accidental death, the young widow, working for an insurance company, recalled during our research interview she had had that altercation a few weeks ago with one of her colleagues who had complained to her about delay in delivering statistical data for his administrative sector: This person does not understand that my “very little problem” - even though we are very professional - cannot be left at the door when we arrive at the workplace. We cannot just say: “when I am at the office, I am at the office; and when I am at home, I am at home”. Grief is not a thing we can put under the doormat.4 Through this comment, the grieving person laments the insensibility she perceives in her colleague’s reaction to her personal and dramatic situation. Reducing ironically her bereavement to a “very little problem”, she stresses out the apparent lack of usual consideration generally due and expected in these circumstances. From this brief example, one could be prompt to say that grief is disenfranchised and to conclude that death is taboo, as it is too often highlighted in the literature and relayed by a large public.5 Marc-Antoine Berthod 309 ______________________________________________________________ However, we have to be cautious with this kind of conclusion. To my view, the above cited person is calling attention first and foremost to the fact that the divide between the professional and the personal registers is purely utopian: it is just an artifice we cannot believe in.6 This appears clearly in her discourse as she caricatures such an opposition to better say that grief is precisely at work, fully present and intertwined with her colleagues’ professional activities. As a given, her bereavement is at the heart of a new set of behaviours which goes from avoidance to complicity; from ignorance to overprotection. It serves to explain awkward attitudes, lacks of concentration, extended deadlines and potential mistakes made in the fulfilment of professional duties. There is no urge here to express more freely or to talk about grief more openly, but a serious need to embed it in a wide range of situations that may entangle the most unpredictable and the sheer conventional act or word. In writing this, I do not aim to minimize the pressure a bereaved worker may feel at work. The point I want to address is the following: displaying and welcoming grief and emotions are not and,7 more important, should not be publicized anywhere, anyhow or with anybody. This is true for the family circles or the public space as well as for any professional context. In other words, the recognition of grief and the facilitation of its “normal” process will constantly depend on multiple factors largely exceeding the idea following which the social system hinders the psychological work of grief on the motive that personal affairs are kept in the cloakroom. From the precedent example, we could thus say that the separation between the personal and the professional, and in a similar manner between the public and the intimate, is discursively used - by all actors within the same firm, not only the bereaved - to recast many sets of interactions; these are subtly modelled by the appreciation the colleagues make about their co-worker’s grieving process and by the way information circulates within a structure. Following this perspective, we tried to understand how grief is concretely configured at the workplace. We carried out a research with more than twenty medium-sized and big companies in the French-speaking part of the canton of Valais, Switzerland. A series of formal and informal interviews were made with directors, head of human resources, social workers, psychologists, psychiatrists, trade unionists, company doctors and bereaved employees. The objective was to compare and cross conceptions, practices and experiences of bereavement in various professional sectors.8 In this article though, I limit my presentation to a few ideas based on employees’ perceptions of their own bereavement within their professional environments. My purpose is more specifically centred on the ways the professional and the personal references are combined to think about disenfranchisement of grief at the workplace. 310 Bereaved Employees, Professional Activity and Pain of Loss ______________________________________________________________ 2. Acute Grief and Intimacy within the Companies There is no complete rupture with the professional world since an employee learns about the death of a close relative until he returns to work. Some individuals are even called by a parent to be told of a dramatic event as they are precisely at their workplace. In that case, they are led to share this harsh information directly with the colleagues present at this specific moment. Catherine, who tragically lost three close relatives during the last decade, remembers how she heard of a new drama that occurred within her family just a few months before our encounter: I learned about it as I went up to the cafeteria, situated in the last storey of the office building. My mother called: “Catherine, you need to sit down.” This is our peculiar formulation to announce bad news. And I said to myself: “no, not that”…I went up and said to my colleague: “my aunt has committed suicide”. I wasn’t able to take my lunch break; I went back downstairs. I couldn’t even say: “I must leave! I must go away!” I stayed behind a cupboard and cried all my tears down. And I finished my workday. Before Catherine could share her first emotions with her family members, she had to express them with a couple of colleagues in her daily professional environment. Her situation was thus instantly known and publicized by the few secretaries - but not necessarily the whole staff - she was working with. So the psychological shock and the intense intimate feelings - she sought a bit of privacy behind a cupboard - this employee was suddenly going through took place in her office. At this very early period of grief however, nobody, as Catherine remembers, knew what to do and how to behave. In this specific case, the death of an aunt might have appeared as not close enough in terms of kinship to anybody to officialise the death and ask a superior permission to leave: Catherine stayed the rest of the afternoon at her desk. Within the firms contacted, no procedures and no policies exist to anticipate this kind of situations when grief starts at the workplace. Its regulation is left to the sole appreciation of the people who are living hic et nunc this acute moment during which the “professional” and the “personal” patently show their indivisibility. Exceptions are to be found nevertheless when an employee’s close relative is terminally ill: the superior and the immediate colleagues may have been alerted to the fact that in case of emergency or death, the employee will have to give up his task at once. In general, this is orally agreed. In many other situations, one learns that a death has occurred while he is at home, on leave or on vacation. Rapidly, he tries to make sure his Marc-Antoine Berthod 311 ______________________________________________________________ company will be notified; but the way the information circulates is quite sinuous. Andrea for example, who gave birth to a stillborn, sent out an SMS from the hospital on a Saturday; among the six to ten receivers, mainly friends, there were co-workers close to the bereaved couple. Afterwards, the sad news quickly spread in her office - a public service - since one of them was on duty that same day. On her side, Julia asked one of her preferred colleagues to tell her boss about the death of her husband. The communication followed then a snowball effect: “The head of human resources called me as soon as possible, and I received a lot of messages of sympathy from the direction board.” Moreover, various social practices are linked to the professional realm during the bereavement leave. Without going into details, I can simply mention here mortuary visits; attendance to the funeral; sending of a letter of condolence signed by the staff and/or the directors; announcement in the local press. These practices are quite always codified in a more or less formal document besides the internal policy or the collective agreement that clearly indicates how many days an employee can take off according to his degree of kinship with the defunct.9 Such attentions are recognized and appreciated, even more if they appear “spontaneous” and “natural.” Julia puts it this way: During the funeral, I was impressed by the attendance. Many had driven from far to come in this small village. And I couldn’t even count the people, it was so impressive. And I saw the number two of the direction; the number one couldn’t come as he was on vacation; the whole direction was there, and that touched me because we are more than 1’500 employees…I think it was everybody’s will to come to show their sympathy. That was not really “let’s organize us and go by coach” to show that “we are there!” I really felt that everybody followed his own approach to sustain me. If these aspects show that a link – even tight – is often kept between the personal and the professional, another feature has to be noted that goes in the same direction: the return at work is almost never totally frank. This is especially true for those employees who have suffered a sudden and tragic loss, that is to say the main cases I am referring to in this article. Concretely, bereaved persons try to negotiate a “smooth” return to the workplace. For example, one may want to see his superior outside the company building, in a restaurant, sometimes at home, to talk about the work environment before his comeback; another will go to the office for a short period of time, in order to see some colleagues and prepare the “official” return. From these various insights and short descriptions pointing to the fact that professional concerns are continuously running across intimate pain 312 Bereaved Employees, Professional Activity and Pain of Loss ______________________________________________________________ as soon as an employee learns about the death of a close relative, I would like to make three main observations. First, if informed, companies try to respond to the flexibility the bereaved may explicitly need or ask for. They seek for arrangements - and sometimes they are forced to make them because a certificate of incapacity has just been delivered by a doctor or a psychiatrist in scheduling the presence of the grieving employees. They tolerate short absences and sudden changes in their work planning; or more precisely, superiors will not blame them. If such a tolerance is currently asserted by the directors and head of human resources we interviewed, it is perceived the same way by most of the employees who had to diminish temporarily their activity rate because of their bereavement. The latter perceive that a reel effort is made in terms of management towards them, at least during the first weeks of grief. Second, the circulation of information - about the death, the bereaved, the bereavement leave, the social practices related to the funeral, the exact date of return, the potential change in work conditions - is rather laconic and unpredictable within a firm. It is above all regulated by interpersonal affinities: a bereaved employee may indeed choose to contact his preferred colleague to diffuse the news; one may call a superior that he “personally” knows or likes. Everything goes as if those colleagues function as a rampart against unwanted, uncontrollable, and too emotional relationships the grieving employees might have to engage with individuals they don’t know well or appreciate. At the same time, “official” measures are almost never taken; nothing is organized for the return at work by the superiors, who globally confirm that point.10 Consequently, many employees assume that the others are supposed to know about the grief situation. But nothing is really clear, all the more so since agreements with the direction or the human resources are mostly made on an informal and oral basis, if not on a tacit one. Such partial view is not without blurring the co-workers’ appreciation of the grieving process. Furthermore, the initiative of talking about grief is often left to the bereaved. Andrea reports here what her boss told her: She said to me: “listen, I apologize in front of you. That’s true, I couldn’t think about going out of my office and shout: ‘Hey, everybody, stop for a while, I have sad news to communicate’.” And as I haven’t told her to spread the news, she didn’t know if she had to tell or not. That leads to my third observation: in these contexts of fragmented communication, everybody is on the qui vive, not knowing exactly what to do or what to say. And this is not only true for interpersonal relationships, but also for the legal frame and the rights a bereaved employee is entitled to. Marc-Antoine Berthod 313 ______________________________________________________________ Grieving persons feel this embarrassment that finds expression, at times, in a deafening silence; nonetheless, they say they understand this ill-at-ease because they would not know themselves how to behave if they were in the same situation. In this perspective, the intimate pain of grief is - en creux present at the workplace for an indefinite period of time. And even if some collaborators forget rapidly about their colleague’s bereavement, grief may stand out at specific moments, at specific places, with specific persons, for the best as for the worst professional interactions. 3. To Approach the Pain of Loss Needs “Tact” Directors, head of human resources, colleagues and bereaved employees at the same time usually hope that behaviours regarding grief at work will be as “natural” and “spontaneous” as possible. If everybody agrees on this principle, such a “normal” attitude is rarely adopted. A brief comment made by a postal officer about the situation of one of her colleagues who just lost her mother-in-law summarizes this point: “behind the scene, there is a fair amount of chatter, but in front of the bereaved, the behaviour is not very natural.” This remark simply shows that expression of grief - and not necessarily its recognition - is socially controlled. Obviously, this control is not always done by individuals who may stay mute when confronted to their colleague’s grief: bereaved employees themselves are indeed reluctant to talk about their own feelings and pain. The reason for unexpressed grief at work is then twofold. First, the bereaved may fear too much exposure in their professional relationships; they may be put under the pressure of production and feel a potential risk of dismissal if they cannot get through the same amount of work as before. This argument - sometimes set forth by interviewed employees - is important for sure. But a more crucial aspect is the inappropriateness of work conditions to express pain: time to talk properly about grief and the defunct with a client or a colleague is generally too short; interlocutors are not always the “good” ones; work locations - behind a window, in an open space office or a noisy environment - do not stimulate an outpouring. On this particular point, Bento remarks rightly “the expression of grief in the workplace is more easily tolerated if it does not take place in public. If one is crying in one’s closed office, or in the bathroom, that is acceptable”.11 Moreover, grief generates trouble of concentration, a sense of vacuity and uselessness, fatigue, as it is well described in the literature.12 All this elements contribute assuredly to the confinement of the employee. Paul, a thirty-one year old man who lost his father and eight months later his mother, comments his return to work in a school office in those terms: I was very withdrawn. I guess I didn’t have much contact; this period was so dark…Anyway I didn’t want to expose 314 Bereaved Employees, Professional Activity and Pain of Loss ______________________________________________________________ all I have lived to certain individuals if we were not very close. At the same time, I have tried to talk about my grief with some other colleagues, but after a while I felt that it was too straight; they were switching conversation…I discovered that if we are not prepared for this kind of experience, people are mostly ill-at-ease. So the second reason comes from the co-workers’ expectations; they wait on the bereaved making the first step. Such attitude is not without provoking a sense of isolation; of stigmatisation even as Paul - and many others - stresses: “I had the impression I was not really a freak, but a curiosity; an extraordinary thing happened to me that happens usually to others”. If this generates the feeling of being left by the wayside, it is mainly linked to the need of privacy and to the conceptions of intimacy that determine the expression of pain; it is not particularly specific to grief at work, but to this fundamental inability to be “normal”, “natural” and completely at ease when two persons exchange on grief. As the French sociologist Patrick Baudry accurately noted: Shall we want the people to talk about their dead as they talk about the cars they had; the vacation sites they visited or the good bottles they drunk? This is precisely that - this succession of commentaries, this pose, this affectation of learning - the denial of death.13 At the workplace, this mutual social control is framed by business temporal norms, practical conditions in which the professional activity takes place, and organizational opportunities to be flexible with the employees; at least with those who suffer grief complication, knowing that such a notion defies any easy definition.14 During an indeterminate period of time, grief is thus potentially structuring the work interactions in the background. At certain moments, often considered as tensed and problematic, the merging of the intimate and of the professional is explicitly displayed, even months after a death. In this sense, neither the colleagues nor the bereaved dare being too familiar, too humoristic, or too ironic; this is particularly true during the first weeks of the bereavement process. For example, Julia remembers she tried a line of humour related to a professional imbroglio four months after her husband died; as she says, some were pleased to see that she “had come back” while others considered her comments as a personal attack and as a mark of her lasting incapacity to be fully at work. Furthermore, the interpretation one can make about such an anecdote may lead the colleagues to ask more from a bereaved employee, professionally speaking. Marc-Antoine Berthod 315 ______________________________________________________________ In reverse, some grieving persons affirmed they couldn’t support seeing other people being too expressive, too joyous, or too expansive. Paul and Catherine notably, if they do not deem such behaviours as inappropriate, simply reckon that they were not ready to be confronted daily to such emotional easiness. So, once again, we see here that being “ordinary”, “natural”, or “spontaneous” is ambiguous when it is related to grief: everyone must guess what is the “good” moment, the “good” place, or the “good” word to communicate: this is always challenging and demanding.15 At the workplace, people need to find a constant balance between the essential proximity a co-worker must show to the bereaved person, and the companies’ rules and procedures that are the same - on the paper - for all. A useful parallel may be finally drawn here with the ideas the sociologist Marc Breviglieri developed regarding the new requirements of a social work system based on a contractualist management. Breviglieri sustains indeed that one of the main difficulties a social worker is confronted to today rests on the necessity to show his skilfulness at being within the personal and particular story of his interlocutor without discrediting the general rule. And that requires a sense of tact: Tact supposes indeed the implementation of a know-how that enables to connect a close attention to the person with its treatment as a general case. In other words, it enables the preservation of the accurate distance towards the beneficiary and its support seized between two antagonistic registers of investment and move: the one gets closer to it, the other goes away from him by a generalization of his case.16 Concerning bereavement at work, similar modes of interactions and commitments seem to be in progress. The co-workers and the hierarchical superiors for instance try to be as flexible as possible. They may well go beyond the rules and policies - in granting a longer bereavement leave; in asking some of the colleagues to care temporarily for the grieving employee; in arranging his schedule - but they never ought to go below them: misinformation or negligence regarding rules, rights and procedures will thus appear as a frustrating discredit within the professional realm. At the same time, there is a need to acknowledge the personal and intimate pain of grief an employee is going through. But, as I said before, it is always difficult to perform the helpful proximity with the grieving person, due maybe to a principle of decency. We could then think that - in the image of the social worker and his beneficiary - the appropriate way to talk about grief and act with it at work will be found when rules and rights are clearly known and communicated to the bereaved employees; when the firm 316 Bereaved Employees, Professional Activity and Pain of Loss ______________________________________________________________ rationalizes the frame within which the pain of a loss is going to be lived. This could stimulate a series of informal conversations between chosen colleagues and superiors that is generally thought to be governed by a sense of “spontaneity” or “normality.” This kind of generalization associated to a very personal pain may thus help to be tactful; it may prevent disenfranchisement of grief without necessarily asking for its public expression or its collective treatment at the workplace. Notes 1 M Lattanzi-Licht, ‘Grief and the Workplace : Positive Approaches’, in Disenfranchised Grief. New Directions, Challenges, and Strategies for Practice, K Doka (ed), Research Press, Champaign, 2002, p. 167. 2 R F Bento, ‘When the Show Must Go On. Disenfranchised Grief in Organizations’. Journal of Managerial Psychology, vol. 9(6), 1994, p. 35. 3 K Doka, Disenfranchised Grief. New Directions, Challenges, and Strategies for Practice, Research Press, Champaign, 2002. 4 All the bereaved’ names have been changed. I translated their quotes from French. 5 See in particular D Charles-Edwards, Handling Death and Bereavement at Work, Routledge, London, 2005. R F Bento, op. cit., postulates also the same idea. 6 Some years ago, Agnès Pitrou has shown that the classical separation between sociology of work and sociology of the family is not accurate. It is more than necessary to study mutual influences between these two spheres; see A Pitrou, ‘L’interaction entre la sphere du travail et la sphere de la vie familiale’. Sociologie et Sociétés, vol. XIX(2), 1987, pp. 103-113. 7 This insight was very well exposed in the pioneering work of the French anthropologist Robert Hertz in his classical ‘Contribution à une étude sur la représentation collective de la mort’, published in L’Année sociologique at the beginning of the twentieth century. 8 The research, a two year-long study, was realized with António Magalhães de Almeida, research assistant, and with the collaboration of Corinne Bonvin, psychologist at the Center François Xavier Bagnoud that offers grief counselling. It was financially supported by the ‘Résar’ - Réseau d’études appliquées des pratiques de santé, de réadaption/(ré)insertion - from the University of Applied Sciences Western Switzerland; see M A Berthod and A Magalhães de Almeida, Le deuil au travail. Les modalités de soutien au deuil en entreprise et leur impact sur le vécu des employés endeuillés, research report, Sion, 2009. 9 For further details on these administrative aspects and policies, see M A Berthod and A Magalhães de Almeida, ‘Les entreprises face au deuil de leurs Marc-Antoine Berthod 317 ______________________________________________________________ collaborateurs’, communication présentée lors de la 2ième conférence internationale sur le temps Rupture, finitude, mort et management, Université de Bretagne occidentale, Brest, 25 et 26 juin 2008, to be published. See also Pratt L, ‘Business Temporal Norms and Bereavement Behaviour’. American Sociological Review, vol. 46(3), 1981, pp. 317-333. 10 On rare occasions, it happens that a superior sends an email to all the colleagues or announces the death - mostly when it concerns a parent, a spouse or a child - during a team reunion. To my knowledge, this is never formalized in firms; it rather comes from sporadic initiatives. 11 R F Bento, op. cit., 42. 12 M S Stroebe, R O Hansson, W Stroebe, and H Schut (eds), Handbook of Bereavement Research. Consequences, Coping and Care, American Psychological Association, Washington, 2001. For anthropological reflexions on bereavement at work, see M A Berthod, ‘Entre psychologie des rites et anthropologie de la perte : notes pour l’étude du deuil’. Journal des anthropologues, vol. 116-117, 2009. 13 P Baudry, La place des morts. Enjeux et rites, Armand Colin, Paris, p. 187. [My translation]. 14 M-L Bourgeois, Deuil normal, deuil pathologique. Clinique et psychopathologie, Rueil-Malmaison, Doin , 2003. 15 On the difficulty and the complexity of doing ‘being ordinary’, see H Sacks, ‘Faire « être comme tout le monde »’ in J-P Thibaud (éd.), Regards en action, Ethnométhodologie des espaces publics, A la croisée, Bernin, 2002, pp. 201-209. I would like to thank António Magalhães de Almeida for calling my attention to this text based on lectures given by Sacks in 1970 and 1971. 16 M Breviglieri, ‘Bienfaits et méfaits de la proximité dans le travail social’ in Le travail social en débat(s), J Ion (dir), La Découverte, Paris, 2005, p. 227. [My translation]. Bibliography Baudry, P., La place des morts. Enjeux et rites. Armand Colin, Paris, 1999. Bento, R. F., ‘When the Show Must Go on. Disenfranchised Grief in Organizations’. Journal of Managerial Psychology, vol. 9(6), 1994, pp. 3544. Berthod, M. A., ‘Entre psychologie des rites et anthropologie de la perte : notes pour l’étude du deuil’. Journal des anthropologues, vol. 116-117, 2009. 318 Bereaved Employees, Professional Activity and Pain of Loss ______________________________________________________________ Berthod, M. A., Magalhães de Almeida, A., Le deuil au travail. Les modalités de soutien au deuil en entreprise et leur impact sur le vécu des employés endeuillés, research report, Sion, 2009. –––, ‘Les entreprises face au deuil de leurs collaborateurs’, communication présentée lors de la 2ième conférence internationale sur le temps Rupture, finitude, mort et management, Université de Bretagne occidentale, Brest, 25 et 26 juin 2008. Bourgeois, M.-L., Deuil normal, deuil pathologique. psychopathologie. Doin, Rueil-Malmaison, 2003. Clinique et Breviglieri, M., ‘Bienfaits et méfaits de la proximité dans le travail social’, in Le travail social en débat(s), J. Ion (dir), La Découverte, Paris, 2005, pp. 219-234. Charles-Edwards, D., Handling Death and Bereavement at Work. Routledge, London, 2005. Doka, K. (ed.), Disenfranchised Grief. New Directions, Challenges, and Strategies for Practice. Champaign, Research Press, 2002. Hertz, R., ‘Contribution à une étude sur la représentation collective de la mort’. L’Année sociologique, vol. 10, 1905-1906, pp. 49-137. Lattanzi-Licht, M., ‘Grief and the Workplace : Positive Approaches’, in Disenfranchised Grief. New Directions, Challenges, and Strategies for Practice. K. Doka (ed.), Research Press, Champaign, 2002, pp. 167-180. Pitrou, A., ‘L’interaction entre la sphère du travail et la sphère de la vie familiale’. Sociologie et Sociétés, vol. XIX(2), 1987, pp. 103-113 Pratt, L., ‘Business Temporal Norms and Bereavement Behavior’. American Sociological Review, vol. 46(3), 1981, pp. 317-333. Sacks, H., ‘Faire « être comme tout le monde »’, in Regards en action, Ethnométhodologie des espaces publics. J.-P. Thibaud (éd), A la croisée, Bernin, 2002, pp. 201-209. Marc-Antoine Berthod 319 ______________________________________________________________ Stroebe, M.S., Hansson R.O., Stroebe, W., and Schut, H., (eds), Handbook of Bereavement Research. Consequences, Coping and Care. Washington, American Psychological Association, 2001. Marc-Antoine Berthod is professor at the University of Applied Sciences Western Switzerland. He has conducted extensive fieldwork in the United States, Puerto Rico and Switzerland; his publications are related to dying, death and bereavement.