It has become a common belief that death is denied in modern society. Thus according to Corr (1993: 32):

Yet, according to Simpson (1987), death is a ‘badly kept secret’; such an unmentionable topic that there are now thousands of books in print announcing that we are ignoring the subject of death.

How then do we make sense of the persistence of the view that our society is ‘death denying’ (Becker 1973), and what evidence is there to support such an assertion?

Patterns of mortality have changed as a result of demographic and epidemiological transitions leading to gains in life expectancy in developed countries and a shift from infectious diseases to degenerative diseases as causes of death (Seale 2000). Arguably, this has been a key factor shaping contemporary attitudes to death. In 1955, Gorer wrote a short article entitled the ‘Pornography of Death’. In it he argued that death could no longer be discussed openly, it had become as clandestine and secret as sex was to the Victorians. Gorer said that death as a natural process had become unmentionable and yet violent death played an increasing part in the fantasies offered to audiences by the mass media. This ‘pornography of death’ was the price that our culture paid for distancing itself from natural death.

Gorer’s article was followed by many similar arguments, most notably in the work of Aries (1981) who used his historical researches to argue that death had become hidden in contemporary society. According to Aries, the nineteenth century was the ‘beginning of the lie’ (1981: 561). Prior to this period, everyone died in public and the death of a man ‘solemnly altered the space and time of a social group’.

Aries noted with approval, the elaborate mourning rituals that accompanied ‘traditional’ death and in particular, that women in mourning were ‘invisible under their crepe and voluminous black veils’.

In contrast, according to Aries, society now ignores death and:

Aries can be criticized for his sweeping generalizations about European history and also for the fact that he writes exclusively about the ‘dying man’; and the wealthy dying man at that. Traditional society paid little attention to the death of the poor who may be treated with more dignity and respect today (Richardson 2000). Furthermore, traditional mourning practices often confined and segregated widows as Aries approvingly notes. Yet this tells us as much about the subordination of women as about attitudes to death (Hockey 1997).

Writers such as Aries, romanticized pre-modern death, seeing it as characterized by an openness and emotional accompaniment that has been contrasted with the bleakness and isolation of modern death. Walter (1994) has suggested that this romanticizing of pre-modern death resembles the romanticizing of the ‘noble savage’. Similar themes have been evident in the ‘natural childbirth’ movement.

These ideas about the ‘denial of death’ provided a rallying cry for movements such as the hospice and palliative care movement which wanted to reform the care of the dying and bereaved. In the nineteenth century, nurse reformers presented the image of the home nurse as a lower class drunkard who was incompetent and dangerous, as we saw in Chapter 9. Dickens immortalized this stereotype with the character of Sairy Gamp in his novel Martin Chuzzlewit. The reformers of the day sought to replace her with a sanitized, evangelized and disciplined workforce (Dingwall et al 1988). Thus, they harked back to a mediaeval past in which nursing was a sacred duty in order to justify their reforms. Similarly, many of the reformers that Lofland (1978) has dubbed the ‘happy death’ movement hark back to an idealized past and contrast it with the horrors of modern death. Aries’ work provided the most eloquent example of this narrative. The image of the hospital death, alone, afraid, in pain and surrounded by machinery was contrasted with a traditional and ‘natural’ death within the bosom of the family.

Contemporary historians have reassessed the myth of Sairy Gamp, arguing that it was a stereotype convenient to the reformers of the time, but not strictly accurate (Dingwall et al 1988). Perhaps the ‘denial of death’ will be similarly recognized as a myth in years to come. It is important to be aware of the existence of such myths since they can shape the directions that reform movements take.

Certainly, for a ‘taboo’ subject, death is overwhelmingly present (Walter 1991). Gorer argued that the ever-growing fantasies of death portrayed in the media were pornographic since they were devoid of humanity and emotion. Yet recently, it has become evident that, alongside the fantasy deaths offered up by the entertainment industry, much media coverage of death deals precisely with these emotional issues; offering a commentary on the grief of the dying and bereaved (Walter et al 1995). For example, the death of Diana, Princess of Wales provoked an outpouring of discussions about such feelings within the media (Kear 1999 and Walter 1999). Walter described this media coverage as ‘emotional invigilation’. When dealing with death, popular culture is preoccupied with acceptable and unacceptable expressions of suffering and grief. Emotional expression is approved, but not too much, and we must show that we care but we must also be brave. The death of Princess Diana offered enormous scope to the media in their discussions of the proper reactions of the Royal family, politicians, the public and even of their own feelings.

‘So brave, grief stricken William and Harry hold back the tears’

‘The Duchess has lost someone she has always considered a sister. There are no words to describe the pain in her heart’

‘We are a nation today in a state of shock, in mourning, in grief that is so deeply painful for us’

‘I am crying as I write this … I cannot believe Diana is dead’ (Daily Mirror 1997)

According to Walter et al, such preoccupations reflect a new uncertainty about how to act and feel in the face of suffering and death. As our society has become more secular and individualistic, prescribed mourning rituals have largely disappeared leaving us unsure of what to say and do. Their later study of front-page tabloid coverage of violent death also shows the ways in which gender stereotypes continue to dominate media representations of death. They conclude that ‘several different discourses of death are being conducted on an almost daily basis’ (Pickering et al 1997). This suggests that media representations of death are far more complex and multifaceted than Gorer had suggested.

Recent instances of public mourning, such as the events following the death of Princess Diana (Walter 1999), also suggest that modern ‘folk’ rituals have arisen to replace the more formal rituals of the past. For example, the laying of mass floral tributes and the creation of roadside shrines at the site of a traumatic death have become familiar occurrences. Thus according to Brennan (2001), the mourning for Diana was both extraordinary and paradoxically ‘quite normal after all’.

Blauner (1966) argued that death was both ‘present’ and ‘absent’ in modern society. He thus gave a more balanced account than Gorer (1955) had given. He suggested that better life expectancy meant that death in the prime of life had become the exception rather than the rule. Prior to the twentieth century, deaths from infectious diseases were prevalent and death touched the lives of everyone. Social life was threatened by the frequent deaths of younger people who still had important social roles. Thus, mourning rituals were necessary to restore social equilibrium since death regularly disrupted the social order. By contrast, nowadays most people are old when they die. The deaths of the old, according to Blauner, affect far fewer people since the old have already had to relinquish their social roles. The elderly may be dispatched at a perfunctory crematorium service, with only a handful of mourners. For them, mourning rituals have declined and their deaths pass largely unnoticed. However ‘untimely’ deaths still disrupt the social order and these deaths will be mourned more expressively.

Thus Pickering et al (1997) showed that media representations focus almost exclusively on ‘untimely’ deaths which threaten the social fabric. The deaths of the old rarely warrant media attention. Within a culture which places a high social value on modernity and change, the skills and knowledge of the old are no longer seen as a valuable resource to be handed on to a younger generation. Instead, too often the old are seen as obsolete and ‘past their sell-by date’.

Death illuminates the cultural values within a society. Arguably, the modern management of death shows just how ageist our society has become. Social death occurs when an individual is no longer an ‘active agent in the social world’ (Mulkay 1993) and comes to be treated as a non-person, someone whose life and concerns are no longer of any value or importance. The old, it is argued, are socially dead before they are biologically dead (Sudnow 1967). They are denied social participation, devalued and institutionally segregated. Even in the contemporary movement to humanize death, the old are notable by their absence. Terminal care services remain largely institutionally separate from care of the elderly and care disproportionately for the younger dying (Seale 1998).

We can conclude therefore that contemporary societal responses to death are complex and that denial is only one of a range of responses. Responses to death reflect societal inequalities and tell us much about contemporary judgements of social worth.

In a variation on the argument that we live in a ‘death-denying’ society some sociologists argue that death is hidden in contemporary society (Mellor & Schilling 1993). It is necessary for all societies to some extent to ignore death in order to commit themselves to everyday life. Death can call into question the world building activities of individuals and a failure to deal with death adequately can threaten our individual and collective sense of meaning. Many contemporary sociologists have suggested that modern societies have particular difficulties dealing with death which both threatens individuals with ‘extreme terrors of personal meaningless’ and threatens the social order with ‘a more widespread attendant loss of meaning and order’ (Mellor 1993). This concurs with Berger’s (1967) view that every human society is ‘in the last resort men (and women) banded together in the face of death’. Berger further explains:

We have seen that there are multiple discourses about death in contemporary society. A major concern for some authors is the decline in religious values, which offered a communal response to death. The absence of religious explanations and rituals is said to lead to private anxiety and anomie (however the evidence for the decline of religion is mixed as we saw in Chapter 3). Thus, according to Turner (1991) the death of God has left us ‘literally and culturally naked’ and…

Giddens (1991) has noted that a particular feature of contemporary society (an era he describes as ‘high modernity’) is a concern with self-identity (see Chapter 5 for a summary of Giddens’ major ideas). We live in a highly individualistic society obsessed with individual choice and control. A variety of therapies and self-help guides help us to create a positive self image and sense of self. An important part of the cultivation of self-identity is the cultivation of the body. Consumer culture places enormous emphasis on products to enhance the appearance and well being of the body (as we see in the endless ‘makeover’ shows on TV) and increasing importance is placed on the body as constitutive of the self (Mellor 1993). Thus, the prospect of death in such a society can threaten the most profound loss of self.

By contrast, death and bodily decay are important symbols in many religious traditions. In these cultures, transcendent values define the self. For example, in Sinhalese society, Buddhists are invited to meditate on the decay of the dead body. This is a religious duty which reminds them of the transience of their earthly existence (Obeyesekere 1989). Similarly in Mediaeval Europe ‘memento mori’ (reminders of death) were commonplace in art and artefacts. In high modernity by contrast, bodily fitness is cultivated to ward off thoughts of death and decay; for fear that such thoughts will bring with them what Berger and Luckman (1967) have called the ‘onslaught of the nightmare’.

Thus, many contemporary sociologists see European societies building a world of secular meanings in which death is distant, something that happens only to other people. This is in stark contrast to societies in which religious values still dominate. In this new secular world, the dying are isolated and have to face death alone and unsupported. Elias (1985) argues that the ‘civilizing processes’ that have shaped our society place a high value on privacy and emotional reserve. Thus, it is no longer possible to speak to the aged and dying of their death and they are condemned to extreme loneliness. For Mellor (1993), it is this ‘privatization of meaning’ which has led to the ‘sequestration’ of death. He describes the dying as hidden away in institutions and isolated from human contact.

We noted earlier the existence of multiple discourses about death in contemporary society. Thus, it is no surprise that we can find challenges to this account of death as isolated and hidden. Seale (1995a) argues that our society places a high value on emotional accompaniment at the time of death. His study of those who had died alone showed that for survivors, dying alone was seen as a threatening and untoward event for which they had to account and atone. It is common for responsibility for dying alone to be imputed to the dead person; neighbours might express regret or guilt but justify their social distance by describing the deceased as someone who ‘kept themselves to themselves’. Media accounts of dying alone universally construct these as ‘bad’ deaths (Seale 2003). This does not of course mean that such ‘bad deaths’ do not happen more frequently than we might consider desirable.

Another challenge to Mellor’s (1993) thesis is the hospice and palliative care movement which has done much to humanize death and to put care of the dying on the public policy agenda. We can argue that hospices far from ‘sequestering’ the dying, place a high value on home care. Many patients express a preference for dying at home and meeting patients’ preferences regarding place of death has been an important part of the hospice movement’s agenda (Grande 1998 and Thomas 2004). However, even within hospices, patients with particularly distressing lingering deaths may be ‘sequestered’ by staff (Lawton 1998, see also Chapter 8).

An alternative argument suggests that contemporary public discourses about death have not ceased but changed. Since the industrial revolution, we have moved from a religious to a scientific and bureaucratic treatment of death. At the same time as a decline in mourning rituals, the surveillance of death by the state became increasingly important. A new rationalist discourse of death arose leading to a new set of bureaucratic practices for the management of death such as the death certificate, the post-mortem and the coroner’s court (Armstrong 1987).

Throughout the nineteenth century, there was a vocal debate on the disposal of the dead and accounting for death became vital to the government of populations (Prior 1989 and Richardson 2000). We have noted that societies have to some extent to ignore death in order to function. Modern social institutions also need to control the impact of death by calculating its probability. For example the life insurance industry became an important part of the modern management of death (Seale 1998). An industry of death accounting has thus arisen. Accounting for death became a medico-legal discourse, which located death and disease within the human body. The discipline of pathology looked for explanations of death within the corpse. Physical and individualist explanation of death came to replace social and religious explanations (Prior 1989).

Prior’s (1989) study of the certification of death shows how the medico-legal management of death came to individualize explanations of the cause of death. Until the end of the nineteenth century, the vocabulary of causation linked the physical body to the social body. Early reports of coroners and the Registrar General had included reference to the price of food and fuel, levels of pauperism and the climate. In the nineteenth century, you could still officially die of poverty, neglect or ‘unskilful medical treatment’. Gradually, social factors and human agency were erased from accounts of death, so that by the late twentieth century, a victim of violence in Belfast was recorded as having died from ‘bruising and oedema of the brain associated with fractures of the skull’.

Modern techniques of surveillance of the corpse arose as a result of the change in the medical ‘gaze’ from the whole person to the bodily organs (Foucault 1973 and Jewson 1976). The expansion of anatomical dissections and post-mortem examinations was not achieved without resistance. A belief in the resurrection of the dead led many to oppose the dissection of corpses. Before the 1832 Anatomy Act, dissection was part of the punishment reserved for convicted felons. The rise of modern medicine in the early nineteenth century led to a lucrative trade in corpses. The corpse became a commodity and grave robbers emerged to supply the expanding medical schools with bodies for dissection, since demand outstripped the legal supply of corpses. In order to stamp out grave robbery, the 1832 Anatomy Act created a new supply of corpses by permitting the bodies of paupers to be used for dissection. Thus, it seemed to many that hereafter, poverty rather than crime, was to be punished by dismemberment (Richardson 2000). It is important not to sentimentalize the past. Writers such as Aries (1981) have noted with approval that in Victorian times the corpse remained at home in the front parlour until the funeral. Yet Richardson’s (2000) study of the history of dissection showed that the poor often kept the corpse at home until it began to rot in order to ensure that their loved one was in an unfit state for the pathologist’s scalpel. Paupers who escaped the pathologist’s scalpel were buried with little ceremony in unmarked mass graves.

Richardson has argued that there is a ‘fearful symmetry’ about past and present and that there are ‘alarming parallels’ between the procurement of bodies for dissection in the past and the contemporary procurement of organs for transplantation and scientific research. In contemporary society, human organs have a commodity value not unlike the commodity value of the nineteenth-century corpse. Demand continues to outstrip supply. The nineteenth-century market in the dead ‘graduated through compulsion, theft, secrecy and dishonesty to burking’ (Richardson 2000: 422). (The term ‘burking’ derives from the nineteenth-century ‘body-snatchers’ Burke and Hare who murdered their victims and sold their bodies to medical schools). What the nineteenth-century trade in corpses showed most starkly was the inequalities of a society in which the poor were worth more dead than alive. Richardson cites a study of the global traffic in organs by the anthropologist Scheper-Hughes (2000) to argue that global inequalities raise the same fears amongst the poor in some countries today.

Richardson’s distrust of the medical management of death reflects a persistent cultural theme. The Western, rationalist ideas, which underpin organ transplantation, are not universally accepted. The concept of ‘brain death’ marks a radical shift in cultural understandings of death (Ohnuki-Tierney 1994). The idea of ‘brain death’ causes continued unease and uncertainty about the borderline between life and death in some cultures, since it is a measure of prognosis rather than actual death (Seale 1998). The concept of ‘brain death’ redefines biological death to bring it in line with social death. In Japan, this concept remains very controversial. For example only one heart transplant had been carried out prior to 1995 and the doctor involved was prosecuted for murder (Lock 1995).

Controversy surrounding the boundaries of life and death is not unique to Japan. In the UK, the recent public outcry about the procurement of organs for research at Alder Hey children’s hospital demonstrated the depth of public unease and distrust surrounding the care of the dead. In particular, bereaved parents accused medical institutions of a ‘lack of respect’ for the dead (Royal Liverpool Children’s Inquiry 2001). Such fears are not without foundation. According to Hafferty (1988) the informal culture of medical students abounds with tales in which medical students play pranks with body parts in order to shock outsiders. According to Hafferty (1988) this oral culture reinforces a professional culture which values emotional detachment and may lead to the depersonalized treatment of patients. Interestingly, contemporary artistic representations of death such as the work of Damien Hirst reproduce this dehumanized discourse showing its wider cultural influence on contemporary images of death.

Some sociologists have been highly critical of these dehumanizing discourses about death. For them, such discourse is morally bankrupt. For example both Baumann 1987 and Ritzer 1996 have argued that the scientific rationalist discourse about death found its most complete expression in the Nazi Holocaust. The Nazi death camps were in some ways the most extreme expression of a rationalistic and utilitarian approach to life and death. Death and killing were bureaucratized and medicalized. Doctors and nurses attended the railway sidings at Auschwitz to sort the inmates of incoming trains into those fit to survive and those for disposal in the gas chambers (Seidelman 1991). For them, the Jews had already attained ‘thing-like’ status; they were socially dead. Thus according to Bauman 1987, the success of the Holocaust was due in part to the ‘skilful utilization of “moral sleeping pills” made possible by the Nazis’ use of modern technologies and bureaucratic techniques.