William R Wood & John B Williamson. Handbook of Death and Dying. Editor: Clifton D Bryant. Volume 1: The Presence of Death. Thousand Oaks, CA: SAGE Reference, 2003.
To speak of a single death is to speak biographically. In the deaths of others and in the recognition of our own mortality, death cultivates the creation of stories that testify to the quality of life lived as well as to the relative manner of death itself. To hear that one lived a good life is to combat the nonsensical specter that haunts the modern bios.
In some sense, death has always haunted the living. Biography underscores, in particular, a modern proclivity toward individual narrative—death as the last unavoidable chapter of an otherwise fulfilling life, death as the thief of the devoted husband, death as the end of a long period of suffering, death as the accidental drowning of a child. Modern obituaries function as the briefest of biographies from which we can deduce structure and meaning. Senseless death is anathema to us.
Such individuated narratives of death stand historically in marked contrast to earlier traditions in the West. In the philosophical treatment of life as preparation for death, or the contemptus mundi of the early Christians, or even in the danse macabre of medieval and baroque Europe, death remained a question of the psyche, the nous, the soul, the species. It served not merely as an end, but also as a beginning, an illusion, a test, an immutable force of nature. Not until the rise of the natural sciences in the late 18th century did matters of life and death become fundamentally organic. In this discursive epistemological rupture, a new biomedical positivism emerged as the legitimate sentinel of life. The language of life itself, once the prerogative of theology and philosophy, became calculated, instrumental. The language of death, on the other hand, reemerged as antithetical, its only function that of nonfunction. Beginning initially with the cessation of breath (which still bore some of the ancient relation between pneuma and life), death moved in definition with advances in medicine to the stoppage of the heart, and then finally now to the cessation of brain activity. Bodies begin to fail and break down, systems begin to malfunction. We look to our stories, perhaps, for differentiation.
The historical complement to the rise of the biographical ethos has been the gradual disappearance of death from the world of the living. In the United States and Western Europe, dying is now primarily a private and often technical affair, hidden behind the closed doors of the hospital, the mortuary, and the funeral home. For most of us, the actual witnessing of death will occur quite infrequently over the course of our lives. When it does, as in the case of the death of a friend or loved one, we find ourselves in the uncomfortable position of spectator, witnessing the sublimation of dying to the auspices of professional medical and postmortem practices. With these practices, public and private rituals of dying, burial, and care for the dead common to earlier eras fade into solitary and disconnected stories.
It is this thesis, the radical transformation of attitudes and experiences of dying in the modern world, that has underscored virtually all recent critical works on the history of death in the West. Stemming largely from the work of French social historians, recent works on changing attitudes toward death evidence a shift away from the contracted analyses of funerary art, epitaphs, wills, and occidental literary sources that occupied much of late-19th- and early-20th-century writings on the topic. Historians and other scholars have begun to address the difficult task of elucidating not only what was said about death in earlier times but also the lived experience of dying, expressed not merely in words but in ritual, gesture, and even silence.
It is certainly not the case that critical analyses of literature, wills, epitaphs, and funerary art are lacking in contemporary historiographies. Such analyses continue to serve as primary resources for those concerned with the history of death and dying. Rather, the shift lies more in the posture of social historians toward already established collections of historical knowledge. It is not at all clear, for example, that epitaphs from the 14th century speak any more definitively to ritual and belief in the medieval world than modern gravestone inscriptions speak to contemporary understandings of death and dying. Although epitaphs often help to elucidate funerary customs and religious motifs, they provide less evidence for the myriad practices, beliefs, and rituals that elude or even contradict formal transcription. As such, more recent works (by social historians or others) tend to move among disparate sources and methods, often transgressing earlier disciplinary boundaries and methodologies.
Disciplinary transgressions speak to the difficulty of the task facing historians who are concerned with establishing working parameters from which to investigate changes or shifts in cultural attitudes toward death. In the introduction to his work The Hour of Our Death (1981), Philippe Aries argues his methodological imperative: “If the modern observer wishes to arrive at an understanding that eluded contemporaries, he must widen his field of vision. …The historian of death must not be afraid to embrace the centuries until they run into a millennium” (pp. xvi-xvii). Yet we might suppose that to “widen one’s field of vision” is not necessarily to engage in a millennial historiography. Indeed, among the work of his contemporaries, Aries’s work stands arguably as the most chronologically ambitious.
Such a widening of vision, however, requires an epochal familiarity with prevailing ideas, theologies, art, literary themes, and cultural rituals, as well as a questioning of the usefulness of commonly accepted historical demarcations (the classical world, the medieval world, the Renaissance, and so on) in their ability to speak to historical shifts in attitudes on death and dying. Thus Aries proposes an alternative historical scheme in which death had gradually become less familiar to the living, moving initially from what he calls the “tame death” of the ancients and the early Middle Ages to the “wild death” of the modern world. Similarly, American scholar John Stephenson has proposed in his work Death, Grief and Mourning: Individual and Social Realities (1985) the movement in American society from an age of “sacred death” in Puritan times to one of “secular death” and finally “avoided death” in the modern age. Often these alternative historical schemata parallel larger historical transformations in the West. Sometimes, however, they do not. In any case, the historian of death is faced with the question of a beginning and an end, a pericope for transformation that exceeds any one text, monograph, painting, inscription, or ritual.
Finally, to propose that many of the more recent historical works on death and dying share common threads is not to argue that these works are saying the same thing. Most emphatically, they are not. Specifically, most recent works on the history of death lack Aries’s chronological ambition. Indeed, many take exception to Aries’s (1981) insistence that “the errors [the historian] will not be able to avoid are less serious than the anachronisms to which he would be exposed by too short a chronology” (p. xvii). The examination of such a large time span has the propensity to both illuminate certain shifts and obscure others, particularly in the case of women, the poor, and the dispossessed. In this case, the history of death is no less a battlefield than other social histories, one in which both method and source are central to the histories of the dying, and ultimately to how we interpret our own death. Thus in this chapter we offer only the briefest of sketches, taking into account both the major shifts that have occurred in people’s experience of death and dying and the methodological and interpretive collaborations and disagreements central to this endeavor.
Philippe Aries’s History of Death
The work of French historian Philippe Aries stands as arguably the most visible social history of death available to date. In Western Attitudes Toward Death and Dying (1974) as well as in the better-known The Hour of Our Death(1981), Aries proposes that death itself has, from the early medieval period onward, undergone a series of gradual yet discernible changes, which he titles “tame death,” “one’s own death,” “thy death,” and “forbidden or wild death.”
This fourfold division centers directly on how people experience and understand death. As such, it stands as a peculiar history, one that often eschews more visible changes (e.g., the Reformation) in favor of less discernible shifts present in literature, art (including funerary art), liturgy, burial practices, and wills. It is characterized by the use or assumption of mentalités—attitudes that characterize particular epochs or periods of time. Michel Vovelle (1983, 1990), another French historian and contemporary of Aries, has argued that the primarily French social histories of “attitudes” (mentalités) occupy a specific location in the overall investigations into history of death. Such investigations Vovelle divides into three categories: mort subie (the burden of death), characterized by works that measure the demographic levels and effects of death in particular places and times; mort vécue (experienced death), which seeks to explain how people have understood dying and, in particular, their own mortality; and discours sur la mort (discourses on death), which seek to elucidate how philosophy, religion, art, and literature have depicted death. Within this tripartite division, the works of both Aries and Vovelle move among all three, but remain arguably focused on la mort vécue, occupied with elucidating the manner in which people have experienced and lived death (see Koslofsky 2000:5).
It was Aries’s work that, in the context of French social history, first suggested the usefulness of examining mentalités (or attitudes) for understanding long-term changes in attitudes toward death. In Aries estimation, although each attitude (or rather loose collection of attitudes) exhibited a distinct posture toward death and dying, these shifts were also part of a larger gradual movement in the West, where death had receded from the public, visible, and highly stylized rituals of late antiquity and the early Middle Ages toward an increasingly private, individuated, and ultimately socially inchoate event. Hidden from public view, and finally even from the dying person him- or herself, death had became ultimately unspeakable and unknowable. Once tame, the modern world had, in Aries’s estimation, rendered death wild.
The tame death was, for Aries, not necessarily commensurate with a tame life, especially in late antiquity and the early Middle Ages, when material conditions were unimaginably horrid and death was a common event. War, famine, pestilence, and childbirth made living a perilous endeavor. A span of 30 years often constituted a full life. The decline of the Roman Empire returned urban populations to the familiarity of towns and villages. Roads declined, and people did not travel long distances, usually living in one location for the entirety of their lives. If death was “tame,” it was because people died frequently, in plain view of their townsmen or fellow villagers; in such times, it would have been difficult to die a private death.
The tame death was more than mere familiarity with the spectacle of death, however. Aries (1981) argues that the tame death had been occurring for hundreds or even thousands of years. It was, in his estimation, the “oldest death there is” (p. 28). The rituals that surrounded an individual’s approaching death were deeply inscribed into the actions of both the dying and those present at the death. Throughout his work, Aries often juxtaposes the highly stylized and familiar rituals of the tame death against what he understands to be the social incomprehensibility of death in the modern world. In his writings, figures from earlier eras find meaning in ritual. They understand their deaths and what is expected of them in a manner that would appear highly scripted and even unemotional today. In this oldest death, an individual’s passing was usually forewarned; it was the dying person who first saw his or her own death, allowing time for preparation, contemplation, and prayer. Aries contrasts this—that the dying knew their own death when they saw it—with the modern hospital or cancer ward, where knowledge of death often comes last, or not at all, to the dying.
Not all deaths in the Middle Ages were so sanguine, however. People died suddenly, violently, or by accident. The death of children was common. Both the ancient and early medieval worlds distrusted those who had died mors repentina, in sudden death. Outside the familiar rituals of the tame death, a murky and uncertain world existed in which those who had perished suddenly were suspected, blamed, and potentially excluded from Christian burial. Such attitudes toward the victims of unexpected or violent death had existed for ages. As early as Homer, the shades of those who had been murdered or killed accidentally were understood to present trouble for the living. The specter of death haunts Achilles as the slain Patróklos visits him after his victory over Hektor. “Sleeping so?” Patróklos inquires of his friend. “Thou has forgotten me, Akhilles [sic]. Never was I uncared for in life but am in death. Accord me burial in all haste; let me pass the gates of Death” (Homer 1974:chap. 23, ll. 80-84). Virgil spoke as well of the falsely accused and murdered inhabiting the darkest part of the underworld. Their very deaths marked them as suspect and culpable. As Aries (1981) notes:
The vile and ugly death of the Middle Ages is not only the sudden and absurd death, it is also the secret death without witness or ceremony: the death of the traveler on the road, or the man who drowns in a river, or the stranger whose body is found at the edge of a field, or even the neighbor who is struck down for no reason. It makes no difference that he was innocent, his sudden death marks him with malediction. (P. 11)
By the 12th century, perceptions of innocence and culpability were shifting beyond the boundaries of the mors repentina. If for at least a millennium the living had remained “as familiar with the dead as they were … with the idea of their own death” (Aries 1974:25), small but discernible changes began to appear that placed more emphasis on the religious significance of a person’s own death. Although many of the rituals surrounding death remained familiar, the certainty with which men and women faced death was becoming increasingly individuated. Illustrations of the Parousia depicting Christ as Judge suggested that salvation was moving from a collective rite to an individual trial (Aries 1981:101). The iconography of the Book of Life (liber vitae), depicted in paintings as well as in the woodcuts of the artes moriendi, illustrated these changes. Prior to the 13th century, the Book of Life had been represented largely as a collection or list of those who were to be saved, a “formidable census of the universe” (Aries 1974:32). Between the 13th and 15th centuries, however, a shift occurred, as the (now) familiar image of the Book of Life, often draped around the neck of the judged, replaced the earlier emphasis on collective salvation. The sins and deeds of human beings emerged as the currency of the Book of Life.
Aries (1974) calls this book a “personal account book.” Presumably, this is an allusion to the bookkeeping techniques central to the rise of industrialization and capitalism, both of which play a central role in Aries’s analysis of the eventual dissolution of ritual and meaning in the West. Even if capitalism had not yet made large inroads into Europe, Aries suggests that a historical movement toward individualism (so often linked to economic processes) was under way as early as the 13th or 14th century. Unlike the Homo faber central to historical materialism, however, or even Max Weber’s emphasis on the relationship between Calvinistic salvation and capitalism, Aries (1974) suggests a precursor:
In the mirror of his own death, each man… discover[ed] the secret of his own individuality. And this relationship—which Greco-Roman Antiquity and especially Epicureanism had glimpsed briefly and had lost—has from that time on never ceased to make an impression on our Western civilization. (P. 52)
In the 17th and 18th centuries, although death remained visible in the vestiges of public ritual, the growing division between reason and madness, portrayed so well in Brueghel’s The Fight Between Carnival and Lent (1559), placed death increasingly within the auspices of the erotic, the phantasmagoric, and the forbidden. Already in Brueghel’s painting, the world of carnival (the world of the tame death) is at odds with the increasingly austere, orderly, and rational movements transpiring within the Church and society. It remains perhaps within the later romantic rejection of the Enlightenment, and its turn toward the interior world (including the emphasis on the baroque), where burgeoning relationships among madness, the erotic, and death begin to haunt an increasingly disenchanted world.
A growing fascination with death transpired in the larger context of the removal of the dead from churchyard cemeteries located within cities. The public and visible death, including the daily reminders provided by such town cemeteries, gave way in one sense as the burial places of the dead became themselves casualties of an emerging discourse of concern over public hygiene, disease, and general disregard for the treatment of the body. In both Britain and France, from about 1750 to 1850, the dead were relocated to burial locations outside city walls. This move, however, was coupled with a less visible but nevertheless present emerging cult of the dead (e.g., involving secular cemeteries and familial tombs where one could visit the dead), as well as increasingly erotic depictions of the bodies of the dead (especially the saints), depictions that Aries (1981) calls “the confusion between death and pleasure” (p. 373).
The Contested Movement of Death
For Philippe Aries, within the scope of perhaps the past hundred years, death had become wild, forbidden, excluded. Much of Aries’s work on death from the 18th century onward (and perhaps the impetus for his work on death as a whole) details the movement away from death as a collective ritual and toward something unmentionable, unspeakable. From the baroque fascination with death in the 17th and 18th centuries, and the later removal of the dead from urban cemeteries in the 19th century, the dying were increasingly disappearing from the world of the living. With both the act and evidence of death removed from public view, it was not long before the dying themselves were repositioned behind the opaque veneer of hospitals, nursing homes, and mortuaries. According to Aries, by the middle of the 20th century death had become invisible, or worse. In the words of English anthropologist Geoffrey Gorer ( 1965), it had become pornographic.
This thesis of Aries, this “forbidden death,” is arguably at the center of the resurgence in the scholarship and debate surrounding the history of death and dying. Virtually no contemporary work on the social history of death in the West does not reference the work of Aries, if not directly address his arguments. Perhaps because of this, or in spite of it, the dearth of scholarship is least evident in historical studies of death from the 18th century to the present. Yet within this scope, many scholars have taken exception to Aries’s use of mentalités. They have also taken exception to his lack of geographic specificity and class analysis. Perhaps most important, although it is clear that changes have taken place in people’s attitudes toward death and dying over the previous three centuries, whether these changes constitute a “rupture,” in Aries’s terms, and whether such a rupture denotes the radical exclusion of death and aging from contemporary life, is not at all certain.
What is clear is that, from the 17th century onward, death was already receding from its more traditional religious and social roles. The way in which people experienced death was changing. Part of the explanation for this is demographic. Increasing urbanization in Britain and Western Europe underscored growing anonymity, both in life and in death. It also allowed for a degree of freedom not common to provincial and rural ecclesiastical parishes. The recurring appearance of the plague, smallpox, and influenza in Britain and continental Europe between the 15th and 17th centuries ensured that death remained visible in and central to the lives of both urbanites and those living in provincial areas. But this visibility, as Aries notes, was already moving toward an increasingly individualized perception of death, if not yet in Puritan America, then certainly in both Britain and France, where the convergence of medicine, commerce, and incipit industrialization provided further discursive impetus toward a view of the individual as the emerging locus of truth in an increasingly secular world.
If death was becoming increasingly individualized, so was the fate of the body and its location after death. As Aries (1974) notes, “In the second half of the eighteenth century … the accumulation of the death within the churches or in small churchyards suddenly became intolerable” (p. 70). On the surface, the impetus for this newfound concern came largely in the form of newly perceived health dangers involving the close proximity of the living and the dead. In response to this health crisis, the dead, who had for so long been buried within the city walls and churches, were increasingly moved to outlying cemeteries or familial plots. Beginning in the middle of the 18th century, a massive displacement of cemeteries, particularly urban cemeteries, to outlying regions was undertaken; this displacement continued for almost a century in France. This was the case in Britain as well, where as early as 1726, Thomas Lewis had published Churches to Charnel Houses; Being an Enquiry Into the Profaneness, Indecency and Pernicious Consequences to the Living, of Burying the Dead in Churches and Churchyards (Houlbrooke 2000:193). In 1839, George Alfred Walker’s Gatherings From the Graveyards painted for its audience an alarming picture of the putrescence and visible gore present in graveyards (Rugg 2000:220).
The communicability of death and decay reached a peak in the middle of the 19th century. By that time, a large number of private and commercial burial sites had emerged in both Britain and France. Such sites were located almost uniformly on the outskirts of towns or cities, away from the traditional churchyard sites (Houlbrooke 2000:193). By 1850, in Britain, private cemetery companies in effect had begun to take over from the Church the role of caretakers of the dead. As Rugg (2000) explains: “A series of Burial Acts…built on the success of cemetery companies by permitting the establishment of Burial Boards … The Church’s virtual monopoly on provision for the dead had been irredeemably shattered” (p. 221). In place of the Church arose the first professional organizations concerned solely with the disposal of the dead.
Yet within the emerging discourses on hygiene and health, more than one impetus was at work in the drive to relocate cemeteries and burial plots outside of city centers. Hygienic arguments alone do not adequately explain the transfer of cemeteries to outlying regions (Kselman 1993:167). A new relationship between the living and the dead was emerging as well, a relationship appropriate not only to health but to the individuality required of both parties. Such a relationship, contrary to the concerns of the hygienists, was evidenced not in the increased removal of the dead from the world of the living, but rather in the movement of the living to these newly relocated places of the dead. Cemeteries, for so long the anonymous grave sites of the faithful, were over time replaced with individual burial sites or plots. In and around Paris and other urban centers, such plots began to appear in number for those who could afford them. Some plots were quite exquisite or even ostentatious, but many bore nothing more than names and brief inscriptions, particularly in more urban areas (Aries 1974:49). The coffin, as well, came to be seen as “an essential element of the decent funeral, even for the poor” (Houlbrooke 2000:193). Easily accessible to the living—not for purposes of prayer or devotion, but for purposes of visitation—such plots evidenced individual characteristics almost unknown since antiquity. The acceptability of the mass grave and the anonymous burial was replaced with an emphasis on individuality, even in death. A secular sentimentality for the dead was emerging.
This sentimentality played out along several vectors. On one hand was the emerging personal relationship between the living and the deceased. By the end of the 18th century, the visitation of the dead was becoming increasingly common. Those with money could afford to bury their family members at home, on family property. Those not inclined to do so were still able to visit the deceased, buried as they were in public cemeteries. However, as Aries (1974) notes, “in order to be able to visit them, the dead had to be ‘at home,’ which was not the case in the traditional funeral procedure, in which they were in the church” (p. 72). The dead required homes of their own. On quite another level was the emergence of civic and national sentiment surrounding the places of the dead:
The use of mausolea shifted memorialism of the dead to areas outside the confines of the church building. In France from the 1770s there was considerable discussion of the need for new places in which to bury the dead which would celebrate civic virtue rather than spiritual worth….In England a shift away from the spiritual worth of the deceased is best reflected in the neoclassical treatment of civic and military heroes. (Rugg 2000:208)
Although the hygiene-related arguments of health officials kept the spaces of the dead at bay for perhaps a hundred years, the growing movement toward memorials—both private and public—slowly returned the dead to the inner sanctuary of the city. Devoid of either their posthumous relationship with the Church or their propensity for disease and sickness, the cemeteries, memorials, and mausoleums became in essence secularized cults of the dead. In this manner, it was the “unbelievers [who became] the most assiduous visitors to the tombs of their relatives” (Aries 1974:72).
This secularization occurred throughout Western Europe as well as in the United States. In the United States, however, there were marked differences stemming from the geographic insularity of America—what David Stannard (1977) has called the prevalence of a “Puritan way of death” (we discuss this topic below). In the case of Europe, however, the work of another scholar, Barbara Ann Day (1992), provides a useful longitudinal index for understanding the changing expectations of life and attitudes toward death in early-modern Europe. In analyzing various common prints depicting the “stages of life,” Day found that in the earliest known prints from 16th-century Amsterdam “for the most part, death was central to the Stages of Life. The very placement in [the] sixteenth century Dutch version of that theme demonstrates its function as arbiter standing on the axis of a rotating universe” (p. 694). By the 17th century, however, the centrality of death had been altered. Death had been relegated to its position under the bridge of life, instead of at the center of it. According to Day, death’s descent from a superior to an inferior location, the fundamental change of both the trajectory of life and the role of death, represented a radical shift. As death sank slowly to a position below the bridge of life, the bridge itself came to act as a shield for those “privileged figures located on the rising scale of status and age” (p. 695).
Yet the figures are not privileged merely because they are shielded from death. Rather, as the prints changed from the 16th to the 17th and 18th centuries, the depiction of exactly who was walking across the bridge of life shifted as well:
The concurrent displacement of the gleaner from earth to an underground domain and the ascendance of the bourgeoisie to the top of the pyramid function as a historical telltale that marks a major transformation in cultural attitudes. Such shifts in priority register not only separation from death, but also changes in power relations that favor the prerogative of the French bourgeoisie. (Day 1992:696)
Thus, for Day, the gradual displacement of death, first from the cosmic center to under the bridge of life and then finally disappearing altogether from prints in the late 18th century, represents the larger historical movement toward the exclusion of death. It also suggests a class distinction that was already playing out both before and after 1789; the rising bourgeoisie were growing into expectations of a longer life, a complete life with its various stages, that moved progressively through the world over the specter of death (Day 1992:697).
By the early 19th century the expectation of longer life was becoming more realistic, particularly for those living in urban centers. The appearance of public health offices, as well as advances in medical science, made the understanding, anticipation, and prevention of mortality an increasing reality (Rugg 2000:203). Within this movement toward an understanding of life and death as a natural phenomenon, Michel Foucault has proposed, it is in fact with the natural sciences, at the end of the 18th century, where the greatest shift in the understanding of life and death emerged. In his work The Order of Things (1973), Foucault argues that by 1795, a transformation occurred (largely in the work of Cuvier) that allowed the natural sciences to introduce a precise and technical definition of life. In what Foucault terms the “era of biology,” the natural sciences reorganized not around the language of the visible (Aristotelian) systems of classification, but rather around the principle of the “organic,” the deduction of the living and the nonliving through the classification of biological function.
From the moment when organic structure becomes a basic concept of natural characterization, and makes possible the transition from visible structure to designation, it must of course cease to be no more than a character itself….This being so, the opposition between organic and inorganic becomes fundamental. (Pp. 231-32)
It is this fundamental shift, Foucault notes, that allowed Vicq d’Azry to exclaim in 1786, “There are only two kingdoms in nature, one enjoys life and the other is deprived of it” (p. 232).
The recognition of the difference between living and nonliving had of course existed before this rupture. Foucault’s (1973) point, rather, is that the shift represented a reorganization of classifications schemes within the natural sciences that allowed for the distinctly scientific distinction between life as “that which produces, grows and reproduces” and the nonliving as “that which neither develops nor reproduces … the unfruitful—dead” (p. 232). The shift that allowed Cuvier to relate functions, as opposed to appearances, enjoined life as a function unto itself. Whereas “life” and, with it, death had before been inexorably enjoined with religion, and then later philosophy and even humanism, the organic definition of life rejoined nothing but the beginning of a purely technical and operational functionality. In a short time, through discursive and often unconnected processes, the idea of the natural or normal life began to replace (if it had not already) the fear and trembling of the Christian tradition. The good life, as depicted in Day’s work on the stages of life, was slowly evolving into the expectations of a bourgeois class nurtured on the positivism of 19th-century life—increased life expectancy, decreased illness, urban growth, and industrialization. The belief in the movement forward in history was perhaps nowhere better expressed than in the redefinition of life itself, which, given its natural course, had nothing but death to fear.
The implication of Foucault’s proposal finds the physician, rather than the priest, at the bed of the dying. Whereas the Church had, with little regard for the body, attended (perhaps not always sufficiently) to the needs of the soul, it was the state and its relation to the emerging bureaucratic organization of hospitals, clinics, health boards, and public hygiene that found the greatest interest in the body itself. Keeping track of the dead and dying, along with disease and famine, “was the beginning of a process that would eventually re-create dealing with death as a municipal and medical function, increasingly hidden from the general population” (Rugg 2000:216). Not only the act of dying, but the management of illness, disease, pestilence, and death became functions for public or semipublic bureaucratic institutions, hidden behind the veneer of daily life.
If it is true that by the 19th century “death could be viewed as a natural phenomenon, over which man appeared to have increasing control” (Rugg 2000:203), it is in this context of control where death was largely redefined through the languages of management (public hygiene and disposal of the dead) and pathology (medicine and illness). Medical inventions such as inoculation and immunization, improvements in diet and hygiene, and public health projects all contributed in the latter half of the 19th century to advances in life expectancy, decreases in infant mortality, and a general improvement in health for those lucky enough to escape class warfare, genocide, and slavery. But control over death was effected in another important way as well. Quite simply, the dying were themselves beginning to disappear from the world of the living. If the deceased had returned in their civic cemeteries and public monuments to the center of urban life, it was the dying who were, by the end of the 19th century, becoming increasingly removed from view. With the advent of the 20th century, the rise of institutions responsible for the dying and the dead would prohibit all but the most cursory of interactions between the two worlds.
To argue, as John Stephenson (1985) does, that by the end of the 19th century Europe and the United States had moved in large part to a “secular death” is to admit that such a term serves, at best, as a general indicator. To be sure, religious considerations of the fate of the soul waxed and waned—as they do today in both Europe and the United States. It is clear, however, that by the dawn of the 20th century the epiphanies of the deathbed scene, as well as the anguish of the Puritan struggle with salvation, had all but disappeared. The place of the confessor at the bedside was increasingly filled by that of the medical practitioner. The state had taken over, either directly or through the licensing of professionals, the role of the care of the dead. Death was becoming, in most aspects, impersonal, managed increasingly through bureaucratic and professionalized institutions.
The Short 20th Century
In an essay originally published in 1955, anthropologist Geoffrey Gorer ( 1965) argued that the treatment of death in the 20th century bore many similarities to the treatment of sex in the previous one. In the Victorian era death was openly discussed, but sex had become increasingly taboo, kept from children, performed only behind closed doors with the lights low. In Gorer’s estimation, the situation had reversed itself some 100 years later. Sex was now discussed more freely, whereas death had become taboo, dirty, hidden—pornographic.
It is the contention of both Gorer and Aries that this change occurred over a short period of time, somewhere between the end of the 19th century and the middle of the 20th century. Similar to Aries, who argues that death had become shameful and forbidden, Stephenson (1985) has written of the movement in the 20th century toward “avoided death.” He notes:
The lack of open observance of mourning and the individualization of grief have aided in banishing references to death in everyday living. No longer are those who are grieving easily identified. Any public display of strong feelings is considered inappropriate today…. [T]he relegating of death to institutions has removed death from the home, and hidden it behind institutional walls. (P. 41)
The difference in the terms that Stephenson and Aries use is negligible. The main facets of the argument that a radical change occurred, particularly in the case of the United States, center on the following observations of historians and social scientists: a growing fear and anxiety surrounding death and aging (Becker 1973); the refusal to discuss death, particularly with the elderly, the infirm, or the dying themselves (Glaser and Strauss 1968, 1978); the removal of the elderly and the dying to nursing homes, hospitals, and hospices (Stephenson 1985); the increasing medicalization of death (Illich  1982; Aries 1981: 563-88); and the beautification and cosmetic enhancement of the dead and the professionalization of the funeral industry (Mitford 1963, 1998).
If, in the above-mentioned processes, death had indeed become excluded and pornographic, it is also Aries’s contention that this exclusion of death—far above its mere secularization and increased individualization—began in earnest in the United States. Exactly why Aries believes this impetus came from America is unclear. In many ways American changes in attitudes toward death and dying in the late 18th and early 19th centuries parallel those that took place in Western Europe. In some important ways, however, they do not. In his well-known work The Puritan Way of Death (1977), David Stannard addresses the unique context from which American attitudes toward death emerged. According to Stannard, the Puritan tradition of death in America is important, as it led Americans to resist much of the secularization and individualization surrounding death in 18th-century Europe. Even as Enlightenment ideas took hold in urban centers toward the end of the century, the intensely individual death of the Puritans, even in vestiges, remained present. In one sense, the Puritan death was, as Weber argued, intensely personal and perhaps excruciatingly so. Stannard notes that “the Puritans were gripped individually and collectively by an intense and unremitting fear of death” (p. 79). On the other hand, this occurred while they were “simultaneously clinging to the traditional Christian rhetoric of viewing death as a release and relief for the earth bound soul” (p. 79).
We can imagine that this experience was perhaps not so different from that of Puritans in Europe. What was different—and is worth consideration, according to Stannard—was that, in contrast to Aries’s supposition that the extended family was the primary familial structure in the 17th and early 18th centuries, the nuclear family was already present and central in Puritan life in both America and England. Stannard (1977) suggests that this proposition does not seriously compromise Aries’s thesis, however, “since the central idea of his argument is not really dependent upon … the changing structure of the individual family life” (p. 169). Aries’s argument is not dependent upon this changing structure because, for Stannard, Puritan nuclear families formed interfamilial relationships that functioned in much the same way as extended family structures. Might we not suppose, however, that this difference, insignificant in Puritan 17th-century America, would gain significance as the world of Puritan New England gave way to a world of increasing industrialization, capitalism, science, and medicine? According to Aries, it is exactly in the growing relations of the nuclear family where the dead would begin to be shunned, pitied, and lied to. It was the members of the nuclear family, as much as the doctors and the institutions, who would eventually turn their heads away at the moment of death.
It is not so difficult to imagine that the relative speed and thrust of capitalism and the emerging Industrial Revolution were central to these changing attitudes. In Puritanism, the community was held close through interfamilial structures as well as through the Puritans’ own understanding of themselves and their divine mission on earth (Stannard 1977:169). The speed with which the Puritan view of death lost its sway, as America moved from provincialism to “the nineteenth century attitude towards death and dying that was characterized by self-indulgence, sentimentalization, and ostentation” (Stannard 1977:171) underscores the rapid movement from an intensely religious worldview to one characterized by growing emphasis on commerce, individualism, and productivity. As Aries (1974) notes, in the 19th century
in the United States, everything was happening as if the Romantic interval had never existed, and as if the mentality of the eighteenth century had persisted without interruption. [But] this hypothesis was false. It did not take sufficient account of American Puritanism, which is incompatible with confidence in man, in his happiness … We must concede [however] that the phenomenon we have just observed occur much later than the French Enlightenment. (P. 96)
It is not merely that these phenomena occurred later, but that they occurred much more rapidly, within the contexts of three devastating wars (the Civil War and World Wars I and II), a series of economic depressions including the Great Depression, rapid advances in medicine and science, increasing longevity, and an emerging normalized rubric of health and life. Stephenson (1985) argues that perhaps the massive carnage and loss of life stemming from World War II, following so closely on the losses of the Great War, produced a kind of “death overload” in which “the extensive mourning process and the sentimental approach to grief of the past were seen as old fashioned” (p. 31). If such an overload existed, perhaps it was not so much because of the wars themselves—after all, wars, plagues, and massive illness were common to modern Europe. Rather, perhaps it was within the expectation of longer and healthier lives, induced no doubt in part through the increasing medicalization and commodification of daily life, that the tragedy of war, both in the United States and Europe, became most present.
A note of caution to anyone who would seek any single explanation for Aries’s tentative thesis: If a rapid change—an exclusion—of death has characterized much of the 20th century, there are still substantive differences among France, Great Britain, and the United States, for example, that require explanation. The practice of embalming, common in the United States for at least the past hundred years, has made hardly any inroads in either Britain (where cremation is common) or France. If the United States has exported its denial and exclusion of death, why has this practice that seemingly refuses to acknowledge death (a practice devoted to making the dead appear as lifelike and serene as possible) not taken hold? Similarly, the rise of memorial services in the United States, with their requisite managed, contrite emotionality, has not been imitated in other countries, where more traditional funerals are still the norm. In many respects, common characteristics exist; the institutionalization and medicalization of death, to a greater or lesser degree, stands central to all Western cultures. But within these cultures, if we assert that something like a mentalité of death exists, we must temper our assertion with a recognition of the enormity of difference and distinction present throughout the West.
Epilogue: Toward A New Acceptance of Death?
In the past 30 years, “back-to-death movements” have challenged our growing alienation from and exclusion of death. Much has been written on the hospice movement in both Britain and the United States, for example, as a humane response to the growing impersonalization and dehumanization of death in hospitals and nursing homes. Death awareness, spurred on by the publication of Elisabeth Kübler-Ross’s On Death and Dying (1969), has challenged the notion that death should remain hidden behind closed doors. Marilyn Webb (1997) writes of the return to prepared dying—a mix of traditions from both the East and the West that seeks an alternative to the medicalized and insular institutional death. Even primetime television, it seems, has a response to the “taboo pornography” of death in the HBO television series Six Feet Under, in which semimorbid humor attempts to interject the discussion and visibility of death back into the world of the living, or at least the world of the living who are able to view HBO.
Such movements, however, have their detractors as well. All of these movements are in some way mediated through the reality of commerce. Is good dying merely becoming good business? Ron Rosenbaum (1982) has said of the back-to-death movement inspired by Kübler-Ross:
What’s been lost in the general approbation of Kübler-Ross’s five stages is the way her ordering of those stages implicitly serves a behavior control function for the busy American death professional. The movement from denial and anger to depression and acceptance is seen as a kind of spiritual progress, as if quiet acceptance is the … highest stage to strive for. (P. 34)
In a bifurcated and even schizoid culture, the effectiveness of death professionals seems reasonable. In a culture that reasons death.
When a friend’s mother recently passed away—in the hospital—all anyone could think to say was “I’m sorry.” Our friend later confessed that he felt dirty, used, taken advantage of. People were unable to address him directly, permitting nothing but the most hollow of phrases. He refused to engage in conversation about his mother’s death with anyone who had not earned the right to participation in her life. In many deaths, including those of close family members, we have witnessed much the same thing—a medicalized and excruciatingly painful death followed by awkwardness and a sense of bewilderment.
Somewhere between the nether regions of the dying who inhabit the county hospital and HBO’s guarded optimism, people are seeking alternatives. The hospice movement, although not uncontroversial, is testament to the success of social movements that are increasingly concerned not only with the question of life but also the manner of death. It is unclear, however, if such movements can continue to shoulder the burden of caring for the dying in a world increasingly defined by the attenuation of social welfare, huge gaps in the distribution of wealth, burgeoning medical costs, and a growing elderly population. If the redefinition of life that Foucault describes as the separation of the organic and nonorganic signified the beginning of the era of biology, it is the medicalization of life, so defined, that remains for most of us the likely conclusion to the biographies we seek of ourselves.