Documente Academic
Documente Profesional
Documente Cultură
Laura Cruz
Edited by
Laura Cruz
Dr Robert Fisher
Series Editor
Advisory Board
Dr Margaret Sonsor Breen
Professor Margaret Chatterjee
Dr Salwa Ghaly
Professor Michael Goodman
Professor Asa Kasher
Mr Christopher Macallister
Volume 18
A volume in the Probing the Boundaries project
Making Sense Of: Dying and Death
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any
form or by any electronic, mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information storage or retrieval systrem,
without permission in writing from the publishers.
ISBN: 1-904710-17-4
Contents
Introduction
PART I
PART II
PART IV
11
PART III
ix
21
35
43
55
61
PART V
PART VI
75
81
93
PART VII
115
PART VIII
PART IX
143
PART X
183
PART XI
Notes on Contributors
219
Introduction
There is a powerful current in modern thought and practice, the
tendency to treat death as shameful and forbidden.1 Indeed, by the
twentieth century death had become so proscribed that one anthropologist
was prompted to call its status pornographic.2 Herman Feifel, a
psychiatrist working with the Veterans Administration in San Francisco,
is widely credited with breaking the taboo on discussions of death and
dying with his book, The Meaning of Death (1959). The collected articles
stemmed from a symposium on death and dying held in 1956, which
produced a surprising fervour amongst its participants. In his introduction,
Dr. Feifel lamented the profound contradictions this taboo had
introduced into contemporary thought processes.3 Recognizing that these
contradictions had broad implications and sources, his work drew from a
wide array of perspectives and turned scholarly interest once again
towards the ancient and profound question, what is the meaning of death?
The Making Sense of Death and Dying conference, held in Paris in 2003,
marks a continuation and expansion of the cross-disciplinary discussion
begun by Dr. Feifel more than forty years ago.
As a continuation, the discussion remains strongly
interdisciplinary. Contributors to the conference and this volume include
philosophers, historians, literary scholars, nurses, physicians, sociologists,
gerontologists and psychologists. As an expansion, the discussion crosses
many new borders, both figuratively and literally. While thanatology has
its roots in the United States, especially after the phenomenal popular
success of Elisabeth Kbler-Rosss book, On Death and Dying (1969), the
discussion has broadened geographically and contributors to the
conference came from New Zealand, Australia, and the Philippines, in
addition to representatives from Western Europe, Canada, and the U.S.
The discussion is also widening thematically. While Feifels original text
focused largely on death itself, most contributors employ a wider
understanding of death as a process, to include individual experiences of
dying, grief, and mourning, as well as the aggregate effects of these
processes on entire societies or groups.
The first paper from the conference, Asa Kashers Philosophy
and Practice in Israel neatly encompasses this tension between personal
and aggregate experience on several levels. After a rigorous dissection of
the logic of collective emotions, Kasher emerges with what he calls the
variable of diffusive meaning. In short, he faced head-on the idea that in
any given society, not every individual will feel the force of grief from
collective experiences the same way. Grief can and in fact, usually does,
have a differential impact, but if it is sufficiently diffused in a society,
even those who are not personally mourning a loss can recognize the
presence of grief in those around them. This recognition then serves as the
basis for policy makers, and also for scholars. By imagining the presence
Introduction
Introduction
xi
xii
Introduction
Introduction
xiii
xiv
Introduction
Notes
1. Philippe Aries, Western Attitudes towards Death: From the
Middle Ages to the Present. Baltimore and London: The Johns Hopkins
University Press (1974), 85.
2. Geoffrey Gorer, The Pornography of Death, as reprinted in
Death, Grief and Mourning. Garden City, N.Y. : Doubleday, 1967.
3. Herman Feifel, Introduction. In Herman Feifel (Editor), The
Meaning of Death (pp. xi-xvi). New York: McGraw-Hill (1965).
Part I
Cross-Cultural Practices of Mourning
believes in that context that every member of the family or almost every
member of the family moved from the city to the country. Sentence (2b) is
assertible, by a certain speaker in a certain context of utterance, only if the
speaker believes in that context that the committee has followed a
procedure of deliberation. Moreover, the committees deliberation, so the
speaker believes in that context, has resulted in what counts as the
committee having made a decision that the view of the committee is that
stem cell research should not be banned. Sentence (3b) is ambiguous in the
following sense: it is assertible, by a certain speaker in a certain context of
utterance, only if certain conditions obtain - conditions that are similar to
those we mentioned with respect to the assertibility of (1b) or conditions
that are similar to those we mentioned with respect to the assertibility of
(2b). That is to say, the sentence The townsfolk wish Suzie to be the
mayor of town can be happily used for assertion, only if one of two
conditions obtains. First, everyone among the townspeople or almost every
one of them wishes Suzie to be the mayor of town. Second, the
townspeople have performed a procedure that resulted in what counts as
the town having established the wish that Suzie be the mayor of town.
Generally speaking, assertibility conditions of sentences that
ascribe an action, a view or a wish to a group of people, such as a family, a
committee or a town, are of the following kinds:
(CA1)
(CA2)
(S2)
(S3)
Asa Kasher
(S4)
(S5)
(S6)
Clearly, none of such pairs of sentences can be asserted at the same time,
since what is asserted by means of one member of such a pair is
incompatible with what is asserted by means of the other member of the
pair. For example, the family cannot, at one and the same time, move from
the city and stay in it. Sentences such as (1b) and (1c) are used in the
distributive meaning (CA1). For (1b) to be assertible in some context of
utterance, every member of the family or almost every member of it
moved from the city to the country. For (1c) to be assertible in the same
context, every member of the family or almost every member of it stayed
in the city, that is to say, did not move. Thus, what is required for (1b) is
incompatible with what is required for (1c). Similarly, the pairs (2b)-(2c)
and (3b)-(3c) can be shown to involve a parallel incompatibility.
Now consider the following pair of sentences:
(4b)
(4c)
We take it that a single person cannot be both sad and happy, at one and
the same time. A person can have, at one and the same time, reasons for
being happy, such as The war is over, and reasons for being sad, such as
Casualties are numerous. A person can even show, at one and the same
time, both features of happiness and features of sadness, in his behaviour.
However, a person cannot be, at one and the same time, both happy and
sad. However, the town can be, at one and the same time, both happy and
sad. When the first sentence of (4b) and the first sentence of (4c) are used
in the diffusive meaning, under circumstances similar to those of (S1)(S6), the town is both happy and sad. The town is happy, since in the
vicinity of every member of the townsfolk there is a happy person and
there are public features of happiness. The town is sad, since in the
vicinity of every member of the townsfolk there is a sad person and there
are public features of sadness.
Asa Kasher
Asa Kasher
citizens of the state die during the same circumstances, national mourning
ought to be proclaimed, where X is some number that is considered
large. To see the reasons for such a constraint, consider the difference
between a disaster in which X-1 persons died and a disaster of the same
nature in which X persons died. The difference between the case of X-1
casualties and the case of X ones does not seem to be of any significance
that would warrant a formal difference between the former, as not leading
to a national mourning, and the latter, as leading to it.
Sometimes we do use numerical criteria. For example, according
to any practice of elections, citizens are eligible to vote only if they were
born before a certain day. A one-day difference between the dates of birth
of two citizens does not seem to involve any significant difference in their
general qualifications with respect to those elections, but we still use it in
delineation of eligibility to vote. However, what fits eligibility criteria
does not fit national mourning criteria. The distinction is clear: eligibility
to vote naturally rests on considerations of age. Only the exact
specification of any particular age seems at least somewhat arbitrary,
though indispensable. National mourning does not seem to naturally rest
on any numerical consideration. Therefore, any specification of a
threshold X would be strictly arbitrary and completely unjustifiable.
The reason underlying constraint (C1) rests on principles of
human dignity. When we consider two events in which human life is lost,
it would be immoral to consider one of them as a disaster and the other
one as not being a disaster, on grounds of the numerical difference
between them. It would be immoral to consider an event to be a disaster
only if it involves the death of so many persons, as if the death of a single
person or of few persons is not a disaster. Strictly speaking, the death of
73 persons at one and the same time is not a single disaster but rather a
cluster of 73 disasters taking place at one and the same time. Moreover, a
cluster of 73 disasters can be created during a longer period. Again, it
would be immoral to draw a distinction, when principles of human dignity
and fairness should be strictly followed, between two clusters of 73
disasters, one that was created by a single collision, another that was
created by a series of battles, accidents and other disastrous events.
Our second constraint is of a different nature:
(C2)
The reason for constraint (C1) was strictly moral. The reason for
(C2) is of a different nature. A period of national mourning must be
exceptional for it to involve special and manifest respect paid to the
mourned. Respect should, indeed, be paid to every deceased person,
whether privately or within a community. National mourning is meant to
express respect for the deceased within a broader sphere. The only natural
reason for a move from the sphere of a community to the sphere of the
nation is that the occasion is unique to an extent that justifies special
attention of an appropriate kind. Hence, regular proclamations of national
mourning would involve regular attention. The distinction between the
attention paid on the national level to that paid on a communal level would
disappear and the whole idea of national mourning would become
superfluous.
On the background of these constraints the following two criteria
were proposed by our commission. Let us dub them the top down
criterion (TD) and the bottom up criterion (BU).
(TD)
The reason for having a top down criterion is that some officers of a
state stand for it, whether directly or indirectly. The president of the state
stands, in a clear sense, for the whole state. The head of any of the three
authorities, the legislative, the executive and the judiciary, stands for a
major constitutive element of the democratic state. The reason for having
that particular top down criterion (TD) is that those four persons hold the
highest offices of the state, according to any conception of the nature of
the state and the structure of the regime. Notice that not every officer of
the state is on a par with the head of ones authority, as far as the symbolic
nature of standing for the state is involved. No minister, for example,
stands for the state in the same symbolic way and to the same practical
extent as the Prime Minister does.
To be sure, the list of officers according to some alternative to
(TD) could have included many other high-ranking officers, without
violating our former constraint (C2). However, any extension of the list
would have resulted in violations of the very rationale of a top down
criterion. An extension of the list to include justices, for example, beyond
the President of the Supreme Court, would have led to a required
extension of the list to include members of the parliament beyond the
Speaker. However, even the deputy speakers of the parliament are
generally viewed as directly standing for their parties more than indirectly
Asa Kasher
standing for the state. The only list of officers that is compatible with
common societal conceptions of the regime and conceptually justified is
that of criterion (TD).
We turn now to the second criterion for proclamation of national
mourning, a bottom up criterion. Naturally, a bottom up criterion
involves two steps, one at the bottom and one at the top:
(BU)(bottom)
(BU)(top)
(BU)(top-2)
10
deceased, even if in a diffusive way and not a distributive one, the state
joins its citizens, so to speak, embraces them, and respects their emotions.
Introduction
12
worship in the Black Church that provides meaning and sources of healthy
grieving to African Americans dealing with grief and loss.
2.
13
14
4.
15
Notes
1
16
Ibid., 110.
Ibid.
12
Dona J.Reese, Robin E. Ahern, Shankar Nair, Joleene D.
OFaire, and Claudia Warren. Hospice Access and Use by African
Americans: Addressing Cultural and Institutional Barriers through
Participatory Action Research. Social Work. 1999. 44. 6. 553.
13
Richard Payne and LaVone V. Hazell. A Training and
Education Program in Palliative and End of Life Care for Clergy and
Allied Caregivers in Minority and Medically Underserved Communities.
(Proposal to the Nathan Cummings Foundation. New York. 2001). 2.
14
Richard Payne and LaVone V. Hazell. Palliiative Care/Endof-Life Care Training and Education Program for Caregivers in Minority
Communities. (Final Report to the Nathan Cummings and Altman
Foundations. 2003). 3.
11
References
Cone, J.H. Speaking the Truth: Ecumenism, Liberation, and Black
Theology. Grand Rapids, Mich.: Wm. B. Eerdmans Publishing Co. 1986.
Glazier, S.D., New World African Ritual: Genuine andSpurious. Journal
for the Scientific Study of Religion. 1996. 35. 420-31.
Haight, W.L. Gathering the spirit at First Baptist Church: Spirituality as a
protective factor in the lives of African American children. Social Work.
1998. 43. 3. 213-221.
Hardman-Cromwell, Y.C. (2000). Freedom From. Negro Preaching of
the Nineteenth-Century. 14. 4. 277-95.
Jones, N. T. Born a Child of Freedom Yet A Slave. Hanover and London:
Wesleyan University Press & University Press of New England. 1990.
Kalish, R. A. & Reynolds, D.K. Death and Ethnicity: A Psycho-cultural
Study. Los Angeles: University of Southern California Press. 1976.
Moore, P. J. & Phillips, L. (1994). Black American communities: Coping
with death. In AIDS and the new orphans, Eds. B. O. Dane & C. Levine.
Westport, CT: Auburn House. 101-120.
17
Part II
Friends, Others, and a Postmodern Ars Moriendi
22
himself is unable to find any solace in the humanistic values in any part of
the book.
So what is left? What does Conroy offer us to make the
protagonist of White Noise happy? With the connection to the past
generations broken, Conroys reading offers us only celebrity and status.3
After all the struggles to find some stability in his life, after he has been
exposed to the cloud of harmful chemicals, and found out that his wife
Babette is cheating on him in order to get the secret wonder-drug that is
claimed to keep the fear of death at bay, Jack is reborn as the image of the
times:
Only as that quintessentially passive figure, the
consumer, does Gladney have the faint glimpse of
immortality now allowed him.4
Conroy does not acknowledge the prevalent ambiguity, the difference
between Jack (as the more or less unreliable and biased first-person
narrator of the events) and DeLillo. We must realize that for DeLillo as an
author, the search is more important than the final resolution. The
groundbreaking study on DeLillos novels by Tom LeClair, In the Loop:
Don DeLillo and the Systems Novel (1987), emphasizes that DeLillos
characters
try to understand new information rather than cause
events to happen; they learn the processes in which they
participate, rather than dictate circumstances.5
In other words, these characters are more in the process of
constant search than in the actual fulfillment that the modernist novel, for
example, seems to grant the protagonist(s) as the narrative unfolds.
However, LeClair does not discard the prevailing criticality that the author
harbours.6 In a rare interview that the usually reclusive author gave, Don
DeLillo tells about his motives as a writer. For him, certain American
realities have a characteristic that his novels try to grasp time after time.
DeLillo speaks about the combination of frustration, fear and violence in
some of his characters and connects it to the overabundance of material
goods:
I see this desperation against the backdrop of brightly
colored packages and products and consumer happiness
and every promise that American life makes day by day
and minute by minute everywhere we go.7
As such, DeLillo denies having any political agenda, left-wing or
otherwise.8 One remarkable feature prominent in his novels is an irony
Mikko Kallionsivu
23
24
Mikko Kallionsivu
25
needs a solution at first, at least. So there are these two views, Jacks and
Murrays, which I will concentrate on in turn. Bauman compares the two
present strategies of approaching the idea of ones own death and sees
them to be in many ways the very opposites of each other. The older one
the modern strategy, and as I claim, Jacks strategy tries to diminish the
fear of death and anxiety of over our mortal condition by slicing the
problem into manageable little bits. This approach, however, does not
eradicate death from the world but makes it all-pervasive, as life becomes
a continuing rehearsal to live in a rational way.17 Needless to say, this is of
course a very instrumental approach, bound to over-emphasised
rationality, prone to the language of science, with elements of mixed
paranoia and hubris.18 Natural death has become unnatural, something
outside the system. Only death with an explanation is tolerable, as we can
then put the blame on a specific cause. Jacks wife Babette, who is also a
firm believer in the modern life strategy, formulates her approach in the
following way:
Given the right attitude and the proper effort, a person
can change a harmful condition by reducing it to the
simplest parts. [ ] I know how to break things
down, how to separate and classify. We can analyze
posture, we can analyze eating, drinking and even
breathing. How else do you understand the world, is my
way of looking at it.19
It happens that Babette is in fact teaching older people how to
stand, sit and walk, eat and drink. Bauman would identify this kind of
action as a part of
the strategy long established by modern medicine and,
more generally, by modern therapeutic society deeply
influenced in its world-image and its pragmatic
principles by medical discourse.20
Bauman judges this strategy to be ultimately ineffective, because medical
practices are surrogate solutions to the existential predicament that allows
no solution.21 The problem with the Gladneys is that although they
believe in the modern strategy, DeLillo doesnt. So the modern life
strategy can only lead to denial. As Bauman puts it, death is the ultimate
Other of the modern project, and so it
has no meaning that can be expressed in the only
vocabulary we are trained and allowed to use; the
vocabulary geared, above all, to the collective and
26
Mikko Kallionsivu
27
At first Jack does not notice the main point that Murray is making that
death is the end of attachments to things, and not a problem. But he
starts to imagine death at a personal level. This leads to the fantasy of
Attila the Hun, who was younger than Jack when he died:
I want to believe he was not afraid. He accepted death
as an experience that flows naturally from life, a wild
ride through the forest, as would befit someone known
as the Scourge of God. This is how it ended for him,
with his attendants cutting off their hair and disfiguring
their own faces in barbarian tribute, as the camera pulls
back out of the tent and pans across the night sky of the
fifth century A.D., clear and uncontaminated, brightbanded with shimmering worlds.26
The irony here is, of course, that Jack is using the media imagery. He is
not choosing religious figures after all, Christ is the most prominent
model for brave death in Western history and Imitatio Christi would be a
long and well-marked tradition to follow but ones from a movie epic.
But the attempt to see death as an experience that flows naturally from
life is honest. Later on Jack has more personal death fantasies, but they
tend to be more philosophical and intimate in nature.27
And so Jack has arrived at Zygmunt Baumans second life
strategy, which he claims to be prevalent at the moment. This life strategy
differs from its modern predecessor and counterpart in that it attempts to
resolve the haunting issue of survival by making it less frightening. As we
learned before, in the modern life strategy, immortality is defined as a
prospect, and so the future has a modality of a product.28 The prize is
always there to be seen, but it is never ours to grasp. The postmodern
strategy differs from its modern counterpart in that it promises instant
satisfaction:
It deprives mortality of its vile terror by taking it out of
hiding, and tossing it into the realm of the familiar and
the ordinary to be practiced there day in, day out.
Daily life becomes a perpetual dress rehearsal of death.
What is being rehearsed in the first place, is
ephemerality and evanescence of things humans may
acquire and bonds humans may weave.29
Baumans views of the postmodern life strategy are not altogether
positive. Whereas modern strategy causes paranoia, postmodern strategy
has another side effect: The prize of exorcising the spectre of mortality
proved to be a collective incapacity to construct life as reality, to take life
seriously.30 But this is the media-saturated world of White Noise already.
28
Mikko Kallionsivu
29
Notes
1. For more on the subject, see Nancy Lee Beaty, The craft of
dying: A study in the literary tradition of the Ars moriendi in England
(New Haven: Yale University Press, 1970). See also Mary OConnor, The
Art of Dying Well: The Development of the Ars Moriendi (New York:
AMS Press, 1966 [1942]).
2. Mark Conroy, From Tombstone to Tabloid: Authority
Figured in White Noise, in Don DeLillos White Noise, ed. Harold Bloom
(Broomal: Chelsea House Publishers, 2003), 154.
3. Ibid, 164.
4. Ibid, 166.
5. Tom LeClair, In the Loop: Don DeLillo and the Systems Novel
(Urbana & Chigaco: University of Illinois Press, 1987), 17.
6. Ibid, 27.
7. Anthony DeCurtis: An Outsider in This Society: An
Interview with Don DeLillo, in Introducing Don DeLillo, ed. Frank
Lentracchia (Durham: Duke University Press, 1999), 57-58.
8. Ibid, 65.
9. Daniel Aaron, How to read Don DeLillo, in Introducing Don
DeLillo, ed. Frank Lentricchia (Durham: Duke University Press, 1999),
70.
10. DeCurtis, p. 63.
11. Don DeLillo, White Noise, in White Noise: Text and
Criticism, ed. Mark Osteen (New York: Penguin Books, 1998 [White
Noise was originally published in 1985]), 259.
30
Works Cited
Aaron, Daniel, How to Read Don DeLillo. In Introducing Don DeLillo,
edited by Frank Lentricchia, 67-81. Durham: Duke University Press, 1999.
Bauman, Zygmunt. Mortality, Immortality & Other Life Strategies.
Cambridge: Polity Press, 1992.
Beaty, Nancy Lee. The craft of dying: A study in the literary tradition of
the Ars moriendi in England. New Haven: Yale University Press, 1970.
Becker, Ernest. The Denial of Death. New York: The Free Press, 1973.
Mikko Kallionsivu
31
Part III
Images of Dying and Death
36
One great battle has been the focus of much of this poetry. On the
15th day of June 1389, the Ottoman army met and was engaged by the
defenders of the lands threatened by it. Serbian princes, dukes and sundry
other clan-leaders assembled under the command of Prince Lazar,
acknowledged Tsar of all the Serbs for the purposes of the occasion. The
battle took place at Kosovo, a wind-swept undulating valley surrounded by
medieval monasteries.
At the end of that day most of the warriors were dead. The Turks
had won, with their remaining forces managing to establish supremacy
over the Serbs, for whom Kosovo was the decisive mortal blow. The battle
had wiped out most of the able-bodied men of the generation, including
almost all sons of the patrician military families - the great warrior clans of
the powerful 13th century state.
These dead men are the legendary heroes of the Kosovo cyclus
poems which have been recited and passed on through 500 years of
Turkish rule, and thereafter, too - and thus, in a sense, have been culturally
embalmed. Much lauded by the whole populace for both their beauty and
their meaning, the poems came to constitute a major component of the
common stock of knowledge within which the identity of the emerging
nation was formed. As Mircea Eliade points out, the fidelity of a people
to one or another mythical scenario, to one or another exemplary image,
tells us far more about its deeper soul than many of its historical
accomplishments.1
This deeper soul is my main concern here. I will attempt to
identify some salient features of female and male protagonists in Serbian
heroic poetry, with particular attention to the ways in which death
differentiates between women and men. The interpretations offered in this
paper are based on the assumption that the poets have given indirect
expression to implicit social knowledge, the non-discursive knowing
about what moves people, which is essentially inarticulable and
imageric.2
1.
Part I
The Kosovo cyclus is huge. Many of the poems concern the same
set of characters: Tsar Lazar, his wife Milica and their clan. Some
typical examples:
On the eve of the battle, Milica beseeches each of her nine
brothers to stay in the castle with her, so that she would have one male
head left to her. (Note anticipation that all will be killed in battle.) Of
course, all the brothers ride off, looking like this:
Upon a stallion, in shining garments;
his cross-bearing banner covers him,
Oh brother, down the horses belly;
Mira Crouch
37
38
Mira Crouch
39
words and deeds. In one poem, for instance, Tsar Lazar drinks and chats
with his friends and relations. Milica walks by and says
My Lord, renown Prince Lazar,
I cringe at the very sight of you,
And am loth to converse with you,
But it must be, I will address you.
She berates him for not spending his riches and effort on building
monasteries and churches, like his predecessors did. He is humbled, and
promises to build her a church. And here it is
The splendid men do and die; by contrast, the more subtle women
wait and grieve. Women are at home while men are on the move. Even in
poems not referring to the battle, men have numerous adventures: they
carry out errands, escort brides from abroad, negotiate deals and work on
military contracts. They undertake journeys for both business and
pleasure, visit one anothers homes, drink and argue. And always they
display strength and bravery.
Women, too, have courage. But this is not demonstrated in action;
rather, it is contained in their endurance of suffering. Overwhelming grief is as
inevitable a fate for them as death is for their men. And just as the death of men
and the pain of women are inextricably bound together, so mens flamboyant
and unsettled life determines womens monotonous and captive existence.
While men are roaming about on horseback, women are close to walls and
doorsteps, confined in their forts, alone, waiting and afraid for their men.
Where men drink and make merry, women ponder and keep watch.
Thus the poems recognise women and men to be creatures who
live their lives characteristically different ways. Men do not go into
skirmishes and battles purely in response to circumstances, but also
because they are adventurous and seek out action. Women, too, do not
simply wait and grieve; they have qualities of stoicism and wisdom that
enable them to endure their plight. But that is not all: as some poems of
the pre-Kosovo times show, deeper moral issues are at stake and these
are illuminated by the manner in which women die.
2.
Part Two
40
Afterwards the wife becomes ill and lingers for nine years, and
Grass grows and tangles through her bones
And in the grass poisonous vipers dwell.
She asks her husband to kill her in the same way as sister, and he
does. Subsequently
Wherever a drop of blood fell,
Thorny bushes and nettles grew;
Where her body last came to rest
A lake of deep waters opened:
In the lake a black stallion swims,
On his back a golden cradle
With a grey falcon at its head;
In the cradle a boy child sleeps
With his mothers hand on his chest,
his own hands on the golden handles
of the two deadly daggers.
In another poem, three brothers are building a fort. An evil witch
destroys at night what work is achieved each day. Eventually she calls for
a sacrifice the wife of any one of the brothers. The brothers agree to let
fate decide: whoever brings food to the site next day will be the victim.
The two elder brothers let their wives in on the secret; and so the youngest
wife turns up. When she sees the walls going up around her, she realises
what is happening and asks for openings to be left in one wall so she can
nurse her baby son. After the entombment, her voice was heard, crooning
to her son, for another week, but the nourishment for her infant lasted for a
year. The poem concludes:
As things were then, so they are today,
Still the milk flows out of stone walls
A miracle and a medicine
For women who cannot nurse their own.
In these poems women are either good or evil, but it takes death
to make this clear. Unlike men who die in collective action and are then
valorised, one and all, women die singled out as individuals who are
evaluated and whose deaths flow from judgements passed upon them.
And, while saintliness follows unquestionably the heroes sacrifice,
Mira Crouch
41
Part Three
42
Notes
1. Mircea Eliade, Zalmoxis: The Vanishing God (Chicago,
University of Chicago Press, 1972).
2. Taussig, Maurice, History as sorcery, Representations 7,
1984: 87-109; 87.
3. All translations are mine. Translations of the whole of The
Fall of the Serbian Empire, The Maid of Kosovo, The Death of the
Mother Jugovich and The Building of Scutari (Skadar) are available in
Butler, Monumenta Serbocroatica. The Serbo-Croation (as it was then)
versions of the poems have been sourced from Antologija Narodnih
Junachkih Pesama, ed. Vojislav Djurich (Beograd: Srpska Knjizevna
Zadruga, 1977).
4. West, Rebecca, Black Lamb and Grey Falcon (New York,
Penguin Books, 1982[1941]); 1145.
5. The sacred/profane distinction as it is made here draws on the
work of Durkeim; see Durkheim,Emile, The Elementary Forms of
Religious Life, Trans. Joseph W. Swain, 2nd edition (London, Allen and
Unwin, 1976).
44
Virgin Mary hung next to picture of the communist ruler, Josip Tito, on the
walls of many homes in Komiza until the 1990s.
People, especially older women, meet for daily mass preceded by
recitation aloud of the rosary. There are two main churches in Komiza, one
on either side of the village. There is also a smaller chapel in the centre of
town for daily mass. Every evening at 5pm, the chapel fills with villagers as
older women dressed in black lead the rosary, chanting in an unusually highpitched register. Most of these women are widows routinely praying for their
dead. There are often a few older men at daily attendance. There is one male
priest for the approximately 4,000 people on the island but priests from the
mainland visit the approximately 1500 people in Komiza regularly. Although
traditional women usually defer to men, especially priests, the older women
are in charge of the chapel and the daily mass and rosary. Their age,
assiduous attendance, and customary ownership of their daily practices in
the small village church, requires the priest to defer to their schedule and
expectations.
The island of Vis belonged to Italy at various times historically.
The dialect is replete with Italian words most things Italian are met with a
sense of simpatico. It is a point of pride that the current peripatetic Pope has
visited Croatia more than any other country.1 There is a strong element of
Catholicism within Croat nationalism. On the island of Vis and the village of
Komiza on the island, that religious/national patriotism bears the emblem of a
unique blend of Catholicism with the communist-socialism of the former
united Yugoslavia. This is in part because many Komizans died in support of
the united communist-socialist Yugoslavia during World War II, but also
because the refuge of Catholicism has distinguished Croatia from the state
religion of Serbia, the Serbian Orthodox Church.
Komizans enjoy friendly relations with the dead if they know they
have fulfilled the obligation to send the soul on its way to heaven. Applying
van Genneps schemata on rites of passage (1960) to the death and dying
rituals of Komizans, rites of passage include separation, the communicative
isolation between the living and the dying during the process of dying and the
act of death (the death watch, a gathering in prayer at the bedside of the
dying), transition, preparation for burial and the funeral act, and reincorporation. The re-incorporation focuses on sending the dead properly
into heaven and establishing their new persona as deceased. The reincorporation includes religious rituals employing incense and candles,
specially sanctioned words and prayers led by a religious expert or experts,
proper handling of the body, and all the associated social features of public
burial. While dying may be ultimately an individually isolative act, death is
ultimately social.
The dead body is not static and the repercussions of death are not
terminated with the death of the body. Most funerary rites on Vis traditionally
involved a body that had not been embalmed. Non-embalmed bodies decay at
different rates and, depending on circumstance, may explode. The dead may
Kathleen Young
45
46
respected and cared for with the proper burial. The visual affirmation of the
propriety of the death and burial rituals was intended to comfort all connected
to the deceased through kinship or association.
The closeness of the kin relationship and the kind of death often
determined aspects of the length and kind of funerary rituals (and attendant
emotional, psychological, and social expressions). Gratitude towards the dead
or the familial obligation of gratitude also predicated involvement in the
death ritual, even by individuals who never knew the deceased in the flesh.
One informant recalled spending hours every day, for what seemed to her
like days on end, on the hard wooden pews of the Catholic Church in her
village on Vis in vigil prayer for some first generation American-Croatian
fishermen who had died in a fishing related accident in Alaskan waters. The
Mardesich brothers were related to many people in the village and although
the brothers had been born in the States and few in the village knew them
personally, the Mardesich family had continued to send money to kin in the
village. Their deaths were cause for extensive communal praying. Closer
relatives to the Mardesich brothers on Vis were expected to make a novena, a
nine day or nine week (depending on the closeness of the relationship) ritual
of temporal prayers morning and night.
Prayers for the dead are so important because, as a point of belief,
a dead person could move from purgatory to heaven, based on the prayers of
the living. Old prayer books and missals list plenary indulgences for different
prayers. According to informants, these plenary indulgences can be banked
like money and saved up to redeem or release a dead person from purgatory
and get them out early. There is no escape from the fires of hell, but those
with venal sins are kept in purgatory until cleansed of sin. Once in heaven,
the beloved dead can be called on to intercede in the heavenly realm for
favours for the living, especially those who prayed long and hard to get them
into heaven in the first place! When does a person stop praying for the
beloveds soul and start praying to them? Heavens time is not as easily
marked as a persons birthday, death, or a nations Independence Day. In the
realm of the spirit and relations of a spiritual nature, it is the communion of
spirits via prayer that consummates relations between the embodied and
disembodied. Time cannot measure the movement of souls.
The sense of shared identity modifies van Gennep's schemata of a
rite of passage as a finite act of separation, transition, and re-incorporation.
Death and disposal of the body are not so definitive or bounded by a
beginning, middle, and transformative end without regard to the on-going
social context. The sense of shared identity welds the living and dead,
sustaining the relationship over time. The circumstances of the individual
death are collectively discussed and shared. If the circumstances were
onerous, the sharing of the responsibility and the repercussions of the death
were also potentially onerous.
An individual who had the power of the evil eye (usually an
older woman who did not fit the social norm), a noted sinner, someone
Kathleen Young
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48
Kathleen Young
49
50
Kathleen Young
51
people left the island than moved to it because there were few jobs. Since the
island had been closed to tourists following World War II, islanders were
deprived of the foreign currency enriching other areas along the coast. Vis
had been one of the least populated regions in the Republic of Croatia but
now that is all changing. The post-war years have seen a boon in tourist
dollars along the coast because more of the money is kept locally instead of
being siphoned off to Belgrade, according to the locals. Now that Vis is open
to tourists, people are moving on to the island instead of away. The legacy of
the communist past and the horrors of the recent war have not made the
people look backwards in anger or anticipate revanchism. The future looks
extremely different than the past.2
The extreme makeover began with the dismantling of the war
memorial. The cosmetic changes to the Komiza cemetery were more than a
surface makeover. Even the dead appear to enjoy a better future.
Notes
1. I was invited to join 6,000 Croatians in the Vatican prior to this
conference. Their visit and audience with the Pope in early November,
2003, was a thank you to the Pope for all that he has done in support of
Croatia.
2. The newly independent Croatia Airlines in-flight magazine
makes no mention of the devastation of the recent war (Ziof 2003).
References Cited
Halpern, Joel and David A. Kideckel, Eds. Neighbors at War. University
Park: The Pennsylvania State University Press. 2000.
Hammel, Gene. "Structural Factors in the Collapse of Yugoslavia and How
to Do It Right Next There and At Home," Paper presented to the American
Anthropological Association, November 20, San Francisco, California, 1997.
van Gennep, Arnold. The Rites of Passage. Chicago: University of Chicago
Press, 1960.
Young, Kathleen. The Diversity of Croat-Dalmatian Ethnic Identity in
Northern Puget Sound. Ph.D. Dissertation. Simon Fraser University., 1994.
Zarkovic, Radmila Manojlovic. I Remember. Writings By Bosnian Women
Refugees. San Francisco: Aunt Lute Books, 1997.
Ziof, Ksenja. Croatia. Zagreb: Croatian Airlines. Autumn, 2003.
Part IV
Death Beyond Words:
The Art, Music, and Poetry of Death
56
Brother Lee was in charge. Lee, it had been rumoured, was attempting a
theological experiment, a fusion of disciplines designed to awaken the
secondary-student conscience and to keep zippers zipped and bras safely
fastened for quite some time. Donning beret and Left Bank persona, Brother
Lee waffled on, lisping aesthetic philosophy to the hormone-stricken crowd:
God is the artist, spoke Lee, the original who never paints by numbers.
The air was charged with energy. Laughter rippled under feigned
bronchial coughs and sneezes. Then it began. With a flick of a remote control
button, music filled the aira mystic, New Age mlange of earth sounds,
cicada creaks, flowing waters, and floating synthetic strings, all the sounds that
traditionally accompany health-food shopping, wellness workshops, guided
meditations, and massage therapy. The atmosphere for spirituality was set; the
crowd made its way to a lone easel, the locus of the schools corporate work of
art. Each student visited the work in progress whenever the spirit called,
dabbing paint on a canvas far too small to accommodate one thousand globs of
goo.
While Brother Lees art experiment was not a success, his
inclusion of music was effective. Even if the canned music accompanying
chapel day did not move students to new depths of spirituality, the music
drew the participants into the event. Like a movie soundtrack or hymn for
the dead, Lee's music helped the students appropriate the experience for
themselves. For his performance Brother Lee used a technique often
employed by writers and filmmakers. The technique? The inclusion of
aural elements that help facilitate a relationship between a text (a thing
capable of being woven or interpreted; a thing capable of being used to
generate meaning[s]) and its receiver.2
For several years, I've been thinking about how modernist
writers, who, in expressing loss, rely upon the affective power of music.
The writers I've consideredT.S. Eliot, Gunter Grass, James Joyce,
Thomas Mann, Aldus Huxley, E.M. Forster, Marcel Proust, and Viginia
Woolflived through a tumultuous time and created aesthetic
masterpieces. Attempting to upright a toppled world, they fashioned oneof-a-kind artifices like Joyce's Ulysses, Proust's la recherche du temps
perdu and T.S. Eliot's Waste Land that stand as testaments to the
imagination's ability to fuse disparate elements into comprehensive forms.
Often writing with each other in mind, these artists believed, perhaps
innocently, perhaps romantically, egotistically, that elaborate books might
remedy the world's failed attempts at meaning-making. If the world is
Humpty Dumpty and there is no way to get him back together again, then
the best you can do is reveal his fragmented pieces and ask readers to
reconstruct something from scattered shards.
While all these writers laboured to represent the modern
individual coming to terms with loss: the death of God, the death of
tradition, the death of purpose, I've chosen to discuss Marcel Proust,
Thomas Mann, and James Joyce here today. With literary modernism,
Blake G. Hobby
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Blake G. Hobby
59
operatic arias into a mirror reflection of his reality. Bloom weaves music into
his own experience. The bar sounds, given in a musical language, echo
Blooms interior experience as he listens. After pondering the affair his wife is
having and his own misfortune, Bloom's thoughts turn to all who have gone
before him, the dead, those whose memory the bar's music has conjured.
Bloom works within boundaries: an outhouses confines, the
distance between his daily destinations, a vacant space in a funeral
carriage, the limits of discourse and argument, and the music heard as it
trickles from another room. These boundaries become framings: the
essential limitations that comprise understanding.
We understand music and death by supplying lived experience to
account for what we cannot place in language. We cannot imagine
abstract, metaphysical entities like music and mortality without placing
these things in a present, temporal framework. If remembering is an
experience conditioned by random associations, by our selection of
random elements as they enter the mind, and by the feelings that surface
from the selections we make, then remembering may be said to be a
musical experience. Listening to music involves following chance
associations as well as intentionally selecting elements and attaching
significance to them in a voluntary act where cognitive puzzle pieces and
emotional responses eventually meld together to form understanding.
When we reference music in books and play music for the dying
and the bereaved, we facilitate an internal dialectic: the experience of
recollecting, associating, grouping, and generating meaning. We make
sense out of living and dying through translating, taking what is ultimately
unknowable and placing it within the bounded-forms that compromise our
knowledge: books, photographs, songs, poems, eulogies, theories,
diagnoses, medical reports, autopsies.
Whatever lives as we pour our experiences into words dies when we
lift our pens from the page. If we write well, we coax readers into bringing dead
sheets with ink marks to life. To bring things back from the dead involves
relying on another. Understanding this quandary, modernist writers present
music, an invitation for the reader to perform -to make and remake what their
narratives bind. But they also bring awareness of time, the ever-moving world
of change whose end is death, the one thing that we can never lose.
As we try to make sense of death and dying, we play a game that lies
beyond the printed page and cannot be described in terms of what it means or
produces. At stake is understanding, an experience that only a clever and
deceptive game can begin to convey. This game raises more questions than it
answers. When we are actively reading or lost in music, however, we
experience what Gabriel Josivopici calls a momentary freedom from
imprisonment.6 Here the confines of our lives and the limits of writing
intersect in the spiralling circle of interpretation that defines our existence. This
movement, as Maurice Blanchot observes, is indeed a dance with an invisible
partner in a different space.7 To enter this movement is to experience what
60
words cannot express -the very real and awe-inspiring way life presents itself,
impresses its joys and pains upon us, forces us to keep moving to survive, and
inspires us to make sense out of death and dying.
Notes
1. Gadamer, 1980, 548.
2. Here I play with the Latin root of text: the verb texere and its
participle textum, meaning to weave.
3. Anthony Heilbut notes that Klterjahn is a local idiom denoting
ample testicles, 158.
4. Schopenhauer, 70.
5. Richard Winston points out that Spinell is the German word for
an oxide of magnesium and aluminum. It has a red variety which
resembles and is often found with a ruby. Thus, the writer looks like, but
is not, a precious stone, 150.
6. Josipovici, 308.
7. Blanchot, 255.
References
Maurice Blanchot, The Sirens Song: Selected Essays by Maurice
Blanchot, ed. Gabriel Josipovici (Bloomington: Indiana UP, 1982).
Hans-Georg Gadamer, Truth and Method, trans. Joel Weinsheimer and
Donald G. Marshall (New York: Continuum, 1996).
Heilbut, Anthony. Thomas Mann: Eros and Literature (New York: Knopf,
1996).
Gabriel Josipovici, The World and the Book (Stanford: Stanford UP,
1971).
James Joyce, Ulysses, ed. Hans Walther Gabler, Wolfhard Steppe, and
Claus Melchior (New York: Vintage International, 1986).
Thomas Mann, Death in Venice and Seven Other Stories, trans. H. T.
Lowe-Poeter (New York: Vintage, 1930, 1989).
Marcel Proust, Remembrance of Things Past (three volumes), trans. C. K.
Scott Moncrieff and Terence Kilmartin (New York: Vintage, 1981).
Arthur Schopenhauer, Essays and Aphorisms, trans. R. J. Hollingdale
(New York: Penguin, 1971).
Richard Winston, Thomas Mann: The Making of An Artist (New York:
Peter Bedrick, 1981).
62
Michele Petrone
63
and death are familiar to you. But what is it really like when its your own
illness? What is it really like when your life feels as if its being taken
from you?
The Journey (painting)
My journey has two intertwined threads elements which mirror
each other as exactly as the two chains of the double helix. One is the
medical history. The physical injury, the illness, the happening, the
happened, the inevitable and the unavoidable. The parallel thread is my
emotional response. The disbelief, the grief, the doubt, the flung out, the
anger, the banter, the bargaining, the accepting, the clenching of teeth, the
sick to the teeth, the pain, the no-gain. Why me? Why me now?
As time goes by, night follows day and day follows night - a
natural cycle without beginning, without end and without gaps. Lifes
cycle continues without interruption - or at least it should do so. Suddenly
illness arrives, uninvited, unexplained. I found myself caught between life
and death, light and dark, banished to an unknown place - between night
and day.
Cast Out (painting)
In the process of splitting night from day, the arrival of the lump
in my neck cast me out from my normal life. I should have been preparing
for two exhibitions; instead I was sitting in a hospital bed waiting for a
biopsy and being told I needed an AIDS test. Cast out? Outcast!
Marginalized, ostracised. Everyone else gets on with their life while the
freeze frame button is pressed on the video of my life. I wait, alone, to find
out if I have cancer or what. Will I fall to the ground or will someone
catch me in time. Has it been caught in time?
The Pain of It All (painting)
So now I have a diagnosis: Hodgkins disease. Lets call it
cancer. Ive heard of that. I know what it is - Fiona, a woman I live with is
having chemotherapy for breast cancer. This is different Im told. They
dont tell you that an 80% chance of a cure means a 20% chance of death.
Youre left to work that one out for yourself. Death. Life is bad enough,
thats what I thought. But who do I tell? Mum, I want to die. Hey, lover of
mine, I think forever might be closer than I thought. Hi, good friend, want
to talk about euthanasia and making a will?
Were all in pain, why cant we share our pain?
64
Death and illness are almost taboo subjects even though we will
all die eventually. Who isnt frightened and doesnt find it difficult to talk
to someone they know might be dying? I wasnt prepared, neither were my
family and friends. Whos going to help me, listen to me, understand me,
be there for me - just for me. Not be frightened by my thoughts and
feelings of having my life threatened, changed and maybe dying at the end
of it all anyway.
Loss (painting)
Delilah cut Samsons hair and sapped his strength. My doctors
dont need to cut my hair; the chemotherapy just made it fall out and my
strength just fell out too. Was it just my hair they cut off or was I castrated
as well? The chemotherapy took my fertility away.
The journey of illness is not only about the physical illness but
also the emotional response. My doctor is attempting to cure me, but who
is going to help me deal with the emotional aftermath, to try and heal that
side of me and heal all of me? Its not easy, but counselling offers a space,
a place, some time and a face, a person to listen to me. Someone who will
not be frightened by me and will help me heal emotionally.
The Fragility of Life (painting)
Three months after completing treatment I got a pain in my
shoulder. Funny it should be worse after a drink. And why all this itching
again? A bone scan showed a hot spot. A biopsy was negative but my
doctor didnt believe it so he arranged another. That too was negative. I
didnt believe it. Another pain, my hip this time. Another bone scan,
another hot spot, another biopsy. Third time lucky - or unlucky. This was
positive. I had relapsed. Meanwhile Fiona after further chemotherapy
herself had died in our home. I needed more chemotherapy now. Not
gentle chemotherapy like last time. (Whoever said the last lot of
chemotherapy was gentle hasnt undergone it). This time it would be high
dose chemotherapy strong enough to kill all my bone marrow. It might
even kill me before the disease has a chance to. Here I am walking the
tightrope between life and death. If I wobble, if I slip, if I lose my nerve or
if my supporters fail me, Im gone.
The Maze of Trees (painting)
Im confused. Im lost as to which way to turn - who to turn to.
Before, everything seemed so clear. Now, which way to turn, which path
to follow? Help me please somebody show me the way.
I had an exhibition on then called Into the light. It was
designed as a celebration of my return to health - but in fact it marked my
Michele Petrone
65
relapse. Was the light into which I might be going, the great celestial
light?
Carry Me This Way (painting)
This illness has invaded my life, knocked me off balance and
made me feel out of control. I no longer feel the strength and direction I
once had. Im just a passenger being carried whichever way these arms
take me. But I still feel a need to direct my life, to feel this life of mine is
still mine. So please: carry me this way.
The Healing Touch (painting)
I need to know that this body is my body. And I need to know
everything that is happening to my body. But most of all I need to know
that you know that within my body there is me.
Healing is brought about not just by medicine, its not just
treatment which cures you, but all that encompasses the human touch. A
smile means more than an antibiotic injection, a hug means more than a
platelet transfusion. The face - of my friends, my family, my nurses and
yes - even my doctors, shows sympathy, compassion and understanding.
This human face contributes so much to healing of the tortured soul.
The Visible and the Invisible (painting)
The physical illness is visible and life threatening. The emotional
feelings, the electrical impulses of my soul cannot be seen. As they are
invisible it is easy to pretend that they are not really there. They dont at
first seem to be as important as the cancer on the microscope slide.
The Journey to Where? (painting)
I dont know where life will take me. I dont know how the river
bends or where the rapids may be.
My journey isnt finished, I dont know what lies upstream.
There are no certainties in life except death, and we have to accept this
unknowing and knowing into our lives. Something we find hard to do
and fail to do.
Colour Our Feelings (painting)
Painting can be a way of expressing one's emotions, almost
unknowingly. Every brush stroke is decided, if not consciously, certainly
subconsciously. What is wonderful about art, is that there are no rules, as
in the construction and expression of the written and spoken word. It is
66
free, for the artist, to express in whatever, and in whichever manner the
artist wishes to do so. 'Truth did not' One will not receive the truth in any
other way...one must enter through the image into the truth.' The Gospel of
St Philip Painting can be used as a tool of exploration, but it can also be
fun, be recreational, and almost dreamlike: close your eyes and see the
picture within. It can allow a freedom of expression, of emotions maybe
too difficult to express in words. As the saying goes, a picture can say a
thousand words. The expression through this medium is indirect, giving an
almost sideways glance into oneself, through the image. An image of the
invisible, made visible through paint. 'Colour Our Feelings', the project
from which these wonderful images and words are taken, provided an
opportunity for anyone affected by cancer, to come and 'colour' their
feelings. Those affected are not restricted just to patients, but also to
carers, loved ones, family and friends, and even professionals, who also
have emotional responses in such intense situations.
As a community, we fail to realise that one lives through illness
and dying. As an individual, the feelings that manifest in each of us, are in
fact, because we are alive. The feelings of fear, pain, disbelief and anger,
only give more importance to the feelings of love, happiness and the value
of life. How surprising it will be to some, that through illness and dying,
there can be very positive feelings, and the realisation that life is for
'living'. Sometimes the possibility of dying, gives permission for a way of
living, not previously allowed. This is not to diminish the trauma of
illness, the loss, the anger and the isolation. Freedom of expression, for all
one's feelings, is so important. A feeling also that one is not alone in
feeling these emotions. Who does not find it difficult to talk to someone
who might be dying? The person assumes an aura of fragility, that cannot
afford a mistake. We are all human, we all make mistakes, how else do we
learn and go forward. Everyone is different, choosing various ways of
coping, some want to know everything that is happening, others not at all,
some pick solitude, others search for contact with others who understand.
Some choose to believe that there is a reason for their illness/dying, a
metaphor for their life. Whatever the individual chooses to inform,
supplement and even heal their life should be respected. The medical
treatment only forms a part of the journey of illness. It is also important to
note that healing can exist in death as well as life. Healing can be a
coming to terms with illness, or death. There are so many facets to illness,
to cancer, and these paintings and stories here, provide a few. A few, I
hope that will help others to understand the feelings that one can
encounter, and a feeling that one isn't alone with one's feeling. The
language is universal, and I hope this will help to break down the barriers
of isolation, and help to heal in some way.
Michele Petrone
67
Tracy (painting)
This painting is a description of how they saw me, the me in the
hospital bed. I was considered to be a patient and I was treated like a
patient and this rather negated the rest of my life - the life that had been
going on outside up until the moment I was admitted. As soon as you're
diagnosed the medical profession sees you as being the illness with a
person attached. Actually you are an ordinary person, with something
dreadful that has happened to you, absolutely dreadful. That doesn't mean
that all the rest of your life isn't carrying on. Maybe you're going to have
to withdraw from some of it because of the physical limits, but things like
relationships will still be there. So this picture is about how you are
viewed: as the illness, a cancer patient in that bed, somebody who's had a
colostomy. I don't blame anybody; I'm just saying that's how it feels.
Katy (painting)
We were never ill. Yet you get cancer. My mum and sister died
from ovarian cancer, mum aged 54 in 1975, my sister aged 45 this March,
within a year and despite strong chemotherapy. Dad died, aged 69 in 1986,
prostate cancer and I get Motor Neurone Disease. Two brothers fine. Odd.
My four grandparents and their many siblings made very old bones and
mum's three sisters and their families are all fine. My neurologist reckons
it's a lottery - if your numbers come up you win the jackpot! Ho ho! I'd
like to do a painting for my sister. She was energetic, gregarious,
organised with a real zest for life. Good cook, loved a houseful. She
collected elephants (not real ones!) from their travels, so may I have that
outline with trunk high, in blue (her favourite colour), legs moving. Inside
outline, top middle, big yellow sun, below their house (wide bay window,
terraced). My sister, hubby, three kids (as stick people), steaming cooking
pot, glasses, balloons, friends all around, colourful. On the right, bed with
my sister. High above foot of bed, waning green moon, flowing tears to
river under bed. Yellow angel at bedhead. White dove above bed flying
upwards, twinkling stars. Clumps of white flowers. Outside colour, light
blue. You do have to work through the gamut of emotions and adjust and
move forwards. Life is full of challenges; Motor Neurone Disease has
been my hardest. I hate what it's done to my body, taken my 'doing' roles,
changed my life, forcing me to be dependant when I was so competent;
but I still give of myself. Despite all the difficulties through my adult life,
I'm happy and feel truly blessed. Obviously I do get angry, upset and
frustrated but thankfully not often. We just give up or fight? I believe that
with support we can live alongside the illness even if it claims us in the
end. It's trying that matters. I leave you with a poem I came across a year
ago and memorised. It says it all:
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Barbara (painting)
These compartments are the drawers to my soul. The first one is
very peaceful and calm like a colourful garden. The hearts and rings, this
was when I was very much in love. The next one is when you get days
when you feel pretty grim, a blank door with no on in there. The next one
is the nights, because sometimes they are not so easy to cope with.
Sometimes I find it harder at night time. I don't really think I'm afraid of
dying - well I hope I'm not. I think it is the fear of the unknown; that's
what it is. You hope that you'll cope with whatever gets thrown at you but
how do you know until you try. The next one, the cross, is my faith, which
I hope will be strong enough. The last one is a butterfly, the fragility of
things.. My illness has made me appreciate my life and my family much
more. I think I live from day to day, because I have to. Having a heart
condition, I've known for some years that it could be any moment now, so
the two added together make death more certain. I think you have to get on
and make the best of it. I've got two daughters, and I've got grandchildren
whom I would like to have seen grow up, but there's not a lot of hope of
that. Never give up hope. I'm sure that must be the answer. There is no
answer to why - none at all. It's just life. Gets hold of some and it doesn't
others.
Rose (painting)
The purple scene (bottom left) shows a different part of my road.
This is an image of my inner soul, the emptiness and desolation I
sometimes feel.
Pam (painting)
The soul painting, I found quite difficult to deal with, to release
what is inside. The squiggly bits at the bottom are anger, and things I don't
know. The pointy bits are peace, flying away, like the little bird, which is
how I see the soul. There is a real sense of release despite the angry bit.
Having cancer makes you realise how precious things are, especially your
family and nature and love. Often you don't feel these things when you are
well. Sometimes you need to have a big thing to contend with, in order to
Michele Petrone
69
release the feelings, which are deep down. It can be positive and not
negative, and most of the people that I have met feel positive. They
haven't been moaners and whiners; they have just got on with it. The main
thing is to have a purpose, a reason to get up in the morning, joy. Some
people never have that in their lives.
Pieta (painting)
The one word, 'isolation', sums up a lot for me. My husband
chose isolation. It was his way of dealing with his cancer. He was very
angry. He didn't want anybody to know, not his friends, his family or the
children, who were six and nine. For me that was not the way I function. I
found ways of talking with the children about illness and death at bedtime,
in story terms, answering their questions when they felt ready to ask them.
My husband was very strong, very capable, full of life and lived life to the
full. For him his cancer was just another challenge. It was something to
fight, find the best treatment, pay what was necessary, get himself better
and nobody need know. He was someone who really played with life. He
had lots of confidence, very different from me. I find life a struggle. It
struck me at the time and it has struck me since, we are each given a hand
of cards we'd find most difficult to play. This image came from a dream I
had moments before waking. I opened my hand and there was a butterfly
just sitting there. As I opened my hand fully the butterfly flew away. This
happened several months after my husband's death, but as I woke I knew
that the butterfly was really him. I don't know how, but that was the
feeling with the dream. The worst thing is running out of time, hoping for
an oasis of calm near the end - wanting the physical responsibility taken
off me to focus on our relationship and his death. In the last two or three
weeks he was having hallucinations. I think now that he died with a lot of
unspoken stuff. He really wanted to be a grandfather; it is a huge regret not
to see the children grow up.
There were regrets about not having enough time together. I felt I
was with him at the end, as he wanted, the nurse on one side and me on the
other. There were still ten minutes left of the workshop and I felt there was
something I needed to say before I left. Sometimes you're having a
conversation with someone and then you find yourself saying something
very important just before you go out. I started doing this long sweeping
curve which really is the incision on my husband's back where they took
his lung out. This involved cutting his vocal cords. Something neither of
us even suspected was that he would have no voice. He was a man who
needed a voice, to be in control. He wouldn't be seen as vulnerable. It was
very frightening to see him with this huge scar sitting up all night every
night. It's also like a train track and these are staples holding it together. I
was shocked: something so huge as having your lung taken out of your
body and all you see on the surface is this neat little pink line with the two
70
Michele Petrone
71
References
The Emotional Cancer Journey by Michele Angelo Petrone (MAP
Foundation)
The Emotional Cancer Journey Report by Margaret Felton (East Sussex
Health Authority)
Touching the Rainbow: The Paintings and Stories of Patients and Carers
by Michele Angelo Petrone (MAP Foundation/St Peters & St James
Hospice/East Sussex Health Authority/Lewes District Council)
Moving Pictures exhibition (Michele Angelo Petrone/MAP
Foundation/St Michaels Hospice/Sara Lee Trust/East Sussex Health
Authority)
Healing is a Fine Art by Jonathan Richards The Times 25.03.03
72
Part V
Grief, Bereavement, and Counselling
Principles of Care
76
the person who has died and therefore goes on to have a mourning experience
that is unique to them and to that relationship. Traditionally we have
understood grieving in terms of phase and stage models, which outline the
reactions, themes and the course of what is considered - dare I use the word normal grieving process. However these models do not I believe, account
for individual diversity and difference. This is especially important within
families where conflict often arises when members compare one expression of
grief to another and have difficulty understanding or tolerating difference.
Mourning is a life long process, I believe of making sense of both the
absence of someone close and also of their continuing presence in the life of
the mourner. The playwright Tom Anderson wrote after the death of his wife
that death ends a life, but it does not end a relationship (Anderson, 1974).
The intensity and nature of grief and sorrow changes and for many may lessen
over time. Nonetheless, the loss and its meaning remain something to be
struggled with and renegotiated again and again. Silverman & Nickman (1996)
speak of grieving as the paradox of letting go and remaining involved.
In terms of service development we believe that one size does not fit
all. Therefore, we have sought in our bereavement service to develop a
continuum of care which begins with end of life care, and is informed by the
hospice friendly approach within hospitals which is promoted by The Irish
Hospice Foundation. We are developing responses to the bereaved at a number
of different levels from information giving to one-to-one therapy, using both
individual and group approaches which I shall say more about later.
We work from a strengths perspective where the focus on what the
bereaved person is coping with daily (Saleebey, D., 1997). This does not mean
ignoring their story or minimising their pain. A strengths approach rather than
focusing on pathology means actively listening for anything that a bereaved
person does to endure following a loss and using this to promote a greater
sense of coping and mastery for the griever.
Information is knowledge, and sharing knowledge with those who
are bereaved instead of holding it to ourselves can empower them to have a
greater understanding of their grief and to take ownership of it. I believe this
approach helps in the process of trying to make sense of loss and it gives
people coping with loss a language with which to express and validate their
experience. This has been our experience particularly in the Bereavement
Support Programme where participants comment that the talk at the beginning
of each session helped them to put words on what they were experiencing
following the death.
Peer support and mutual help have been found to be beneficial. A
good example is The Compassionate Friends organisation for bereaved
Siobhan ODriscoll
77
78
Bereavement Care
Pyramid
Individual,
family & group
counselling
Parent support days. Risk
assessment. Referral to
community or specialist services
Care of the dying and their families. Hospice
friendly approach within Beaumont. Helping families
meet the needs of bereaved children. The
Bereavement Support Programme -Coping After a
Death.
Bereavement out-reach. Bereavement information pack. When
Someone Close Dies. Adult & childrens remembrance services.
Awareness raising through various media. Links with community.
Bereavement skills training for health care workers. Study groups. Peer support
groups. Study days. Evaluation and research.
Fig. 1
3.
There are four levels of direct service provision. The further you
ascend the pyramid, the more specialised the intervention and the smaller
number of people to whom it is offered.
The broadest level in our bereavement service is about reaching out to
the bereaved. Therefore the bereavement out-reach service is offered to all
next-of-kin following a death in Beaumont Hospital. At ten weeks following a
death a letter of condolences is sent by the bereavement co-ordinator and a
bereavement information pack is included. This pack contains information
about grief reactions, practical problems, support available if required and
encourages further contact with the hospital if necessary or wished for.
Annual adult and childrens remembrance services are offered to
all bereaved in Beaumont. The planning groups for these ceremonies are
interdisciplinary. Tony Walter (1999) suggests that memorial services
Siobhan ODriscoll
79
80
4.
References
Anderson, R. (1974). Notes of a survivor. In S. B. Troop & W. A. Green
(Eds.), The Patient, death and the family. New York: Scribner.
Klass, D., Silverman, P. & Nickman, S. (1996). Continuing Bonds New
Understandings of Grief. Taylor & Francis.
Saleebey, D. (1997) The Strengths Perspective in Social Work. Longman, New
York.
Walter, T. (1999). On Bereavement the Culture of Grief. Open University
Press: Buckingham/Philadelphia.
1.
Introduction
In the novel The World According to Garp the main character finds
Marriage Counsellors in the Yellow Pages while looking for Lumberyards. He is
surprised that there are more of the former than the latter. He is curious about those
who call themselves Christian counsellors, or cite their qualifications; Garp wonders
who had certified her?, or whether her Ph.D. is in marriage? Dr. O. Rothrock,
self-esteem workshop; bank cards accepted is clearly a charlatan while a simple
entry M. Neff, by appointment only, is serious; M. Neff had vision, Garp could
tell. 1
82
Jeremy Weinstein
83
existing services fail to reach out beyond the standard service user: white,
articulate, middle class?
2.
So this leads us into the need, before exploring the research in more
detail, to explore outline the contested nature of bereavement counselling.
As already argued, bereavement counselling is a growing phenomenon, at least
in the English speaking world where an estimated one third of all major
bereavements are taken to professionals.5 It is suggested that the bereaved turn
to counsellors because the systems that once offered comfort have largely
disappeared, whether this is religion or the family.6 Society is also confused by
death with open acceptance of mortality forbidden7 as increasing numbers of
people die not in the community but in hospitals in a medicalised, technocratic
process.
And some are wary of this growing reliance on counsellors who,
Walter8 argues, police grief, sustaining unhelpful models of grieving when
they echo Freudian concepts that encourage the bereaved to break the bonds
with the deceased and experience and express the pain of loss. Walters
biographical model stresses instead the need for an enduring sense of the
dead, building a shared and increasing picture of the deceased through
conversations with others who knew him or her, which would normally
preclude a counsellor.
Parkes research and clinical experience values the role of counselling
and cautions that it can be misapplied with already vulnerable individuals. He
warns against blandness, against an emphasis on catharsis, lest it engenders in
already emotional and distressed individuals increased feelings of insecurity
and fosters a dependent attachment to the counsellor. Further, too cognitive a
response can prove collusive to those clients who need help to be put in touch
with their emotions. In a powerful phrase he warns that, like any drug,
counselling can be most poisonous if used in the wrong dose.9
There are also persistent problems in defining counselling. Leick and
Davidsen-Nielsen10 has a continuum from grief help, through grief therapy
to crisis intervention, the latter demanding active, professional measures in
the initial period of loss.
Parkes11 distinguishes between the counselling offered by (a) the
professional services of trained doctors, nurses, social workers and
psychologists, (b) voluntary services in which selected and trained volunteers
are supported by professionals and (c) self-help groups in which bereaved
84
Jeremy Weinstein
85
way others express their mourning and sense of loss and allow oneself to be
the firm ground on which the other stands.17
3.
86
Male
Female
1
1
1
1
3
6
1
1
Jeremy Weinstein
87
88
thought and suddenly I seem closer to it than I ever did before. Yet he feels
silenced with all of this sometimes continuing upset, unable to talk to his
brother, who he feels would become intensely uneasy with such disclosures
or even his wife who is more openbut again theres this slight feeling that,
after a certain point, that its self indulgent.
A third group consists of those who started the counselling process but
failed to engage fully. The following quotations come from the community based
research.
The bereavement was straightforward of a very elderly and
infirm father I felt I was wasting the counsellors time (a daughter)
I felt the atmosphere morbid talking about Death and such I
was not sure what was expected of me (a 60+ son).
I would have liked some feedback, left feeling why did I have
counselling. Needed someone to talk, not just listen. (43 year old widower).
I told the counsellor I was much better and that he did not need to
come any more. I know how busy the service is as I had to wait a while
before seeing anybody (46 year old widow).
My doctor recommended counselling but I only had a couple of
sessions. My husband was such a private person it just didnt feel right
talking about him like that, felt like a betrayal (widow).
I only had two sessions I feel that the woman could not
understand
my problems and could not answer my questions (16 year
old sister).
The counsellor was a very pleasant young lady although she
encouraged me to talk she was unable to understand how I felt This lady
could have no idea of the grief and emptiness and the coldness I felt to be
a counsellor to the bereaved one must have lost somebody they dearly love
(67 year old widow).
4.
Some Conclusions
In this paper I sought first to set the wider context, to understand what
bereavement counselling offers and to appreciate the concerns and caution of
some important commentators and researchers who regard it as a mixed
blessing. And I then turned to the respondents of two different bereavement
counselling projects. Through the words the bereaved I have sought to get
their sense of the grieving process, where and how counselling has helped,
when the bereaved seek out counselling, or refuse its offer and for some their
regrets at not having it. Its a rich and complex picture and one which we need
to understand better. If bereavement counselling is gaining ground in our
Jeremy Weinstein
89
Notes
1. Irving, 1986, 230/231.
2. DArdenne & Mahtani, 1989.
3. Weinstein, 1997.
4. Weinstein, 2002.
5. Raphael, 1983.
6. Worden, 1991.
7. Aries, 1974.
8. Walter, 1999.
9. Parkes, 2000, 19.
10. Leick & Davidsen-Nielsen, 1991, 5.
11. Parkes, 1980.
12. Edwards, 2002, 16.
13. Stroebe & Stroebe, 1987, 230/1.
14. Danbury, 1996.
15. Parkes, 1980, 25.
16. Marris, 1974, 153.
17. Zinker, 1994, 262.
References
Aries, P. (1981), The Hour of Our Death. London: Allen Lane.
Danbury, H. (1996), Bereavement Counselling Effectiveness. Aldershot:
Avebury.
dArdenne, P. and Mahtani, A. (1989), Transcultural Counselling in Action.
London: Sage Press.
Edwards, K. (2002), Bereavement Counselling in the hospice movement,
Counselling and Psychotherapy Journal vol. 8, no. 7.
Irving, J. (1986), The World According to Garp. London: Black Swan.
Leick, N. and Davidsen-Nielsen, M. (1991), Healing Pain, Attachment, Loss
90
Part VI
Survivors and Protagonists
94
Jennifer Hart
95
able lay her eggs unless she has a blood meal. The Yersinia pestis bacterium
prevents the flea from digesting a blood meal. This evidence suggests that
infected female fleas would be unable to reproduce. Since Yersinia pestis was
dependant on a high rat and flea population for transmission the absence of the
black rat and the fleas anatomy would indicate that this could not be Yersinia
pestis.
Yersin also relied on signs and symptoms when identifying the
plague of medieval Europe. When looking at the plague tracts of medieval
Europe, most historians focus on those signs and symptoms which coincided
with the plague in modern Asia. In 1894, the most common and consistent
bubonic sign was the appearance of the plague buboes on the victims bodies.8
The majority of the Asian victims had these swellings in their groin, armpits,
and the neck region. Pulmonary signs included the coughing and spitting of
blood. Plague tracts in Europe, on the other hand, reported signs of the plague
which were more diverse than the plague episodes of the nineteenth century.
The physical manifestations included carbuncles, boils, and buboes that
appeared not only on the lymph nodes, as they had in Asia, but also all over
the body. The lesions varied in size with some as large as a hens egg and
some just small black dots on the skin. In addition to the skin lesions, the
plague tracts discussed other disorders including high fever and an inability eat
and drink which were not noted in the Asian cases. 9
Stephen Bradwell, a physician in the seventeen century enumerated
these signs and symptoms in his treatise, Physick for the Sicknesse Called the
Plague, published in 1638. 10 In addition to the symptoms listed above, he
noted, headache and prickling pains there, vomiting and loathing the
stomach, bleeding at the nose, lethargy or extreme drowsiness, convulsions
and cramps, dry cough, and spitting of blood.11 Bradwell also described the
plague sores, or Gods Tokens, as the most faithful sign of the plague. He
wrote that the tumours, some againe are flat broad and spreading even over
halfe the Thorax.12 According to Bradwell, the tumour could lie deep in the
flesh and the physician could only discover it by feeling for it. Some tumours
could be as big as a Nutmeg or Walnut, yea even to the size of a mans fist or
penny-loaf.13 According to this account, he had seen tumours which were
smaller and varying in shape. Twentieth century physicians usually describe
Yersinia pestis buboes as single tumours located solely on the lymph nodes
and not as multiple swellings that vary in size and location.14
At first glance, some of these symptoms seem to mirror the signs and
symptoms reported in Asia. However, the pustules in the groin, armpit and
neck, the spitting and coughing of blood, lethargy and drowsiness, are not
unique to Yersinia pestis. Diseases which present similarly to the plague
96
include cholera, typhus, trench and typhoid fevers, as well as anthrax. Each
one of these illnesses presents with skin lesions, high fever, and delirium and
have pulmonary components.15
Historians have been equally as intractable when examining the
physicians response to the plague. They have highlighted the most ineffectual
remedies such as the letting of blood, purging the intestines, wearing of
amulets, and fragrant sachets. In addition, historians have tended to focus on
the more fantastic causes posited for the plague: poisonous vapours in the air,
the movements of the stars, and punishment of a wrathful God. 16 Closer
inspection of the medical community, based on their own writings, illustrates
that there were practitioners prescribing remedies which could alleviate
against many of the symptoms of the plague or other diseases.
The university medical schools in medieval and early modern Europe
taught an amalgamation of Hippocrates, Galen, and other ancient writers.
Hippocrates writings advocated the importance of the reputation of the
physician and the ability to inspire confidence in the patient and his family.
Roger French called this process, the good story.17 To his, universities added
Galens philosophies of the body and diseases. According to Galen, an
imbalance in the humours of the body caused diseases. The strict regulation of
these humours would prevent or cure all illnesses. To alleviate a build up of
the humours, Galen advocated purifying the body by methods designed to
regulate its fluids, usually by removing excess quantities of the offending
liquid.
These philosophies taught by the universities seemed successful until
the Black Death. The plague dismantled the relationship of trust between the
physician and patient because the Galenic remedies did not work and
endangered the good story. Historians have highlighted those physicians who
admitted defeat in the face of the plague claiming that it was the work of a
wrathful God or the result of the misalignment of the stars.
When studying medical practitioners historians have focused
primarily on the trained physicians at the expense of a greater understanding of
the practice of medicine in early modern Europe. Besides the university
trained physician there were wise women, apothecaries, and barber/surgeons.
These practitioners practiced on the fringes of the medical community and/or
administered to patients who could not afford conventional medicine. By
examining these healers more closely a complete picture emerges of the
medical community in Medieval and Early Modern Europe.
Many medical professionals did not feel defenceless and published
tracts in hopes of providing their communities or all of Europe with relief from
the plague. In 1522, an anonymous author in Montpellier wrote a pamphlet he
Jennifer Hart
97
claimed was for the good of the public health.18 He began his remedies by
declaring he would root up the vines of mistrust and deceit to make room for
the growth of his ideas and his cures, which went against conventional
wisdom.19 His advice to patients afflicted with was plague was practical. For
example, he told them to break the plague sores and sear the wounds,20 which
can slow the course of the disease. His attitude was atypical because he
believed that the plague was not the work of a divine agent punishing a sinful
world nor was it caused by planetary influences. 21 Therefore, the plague had
an earthly cause and regardless of where a person lived, they were susceptible
to it.
Still grounded in the philosophies of the ancient masters, there were
physicians who freely integrated a variety of methods into their practices. Don
Alexis of Piedmont, for example, incorporated the use of medicinal herbs. A
nobleman, who in his travels learned many of the recipes published in his four
books of Secrets. He wrote in the first books introduction that he chose to
publish the recipes because he refused to help a man and who then died and
the guilt compelled him to seek new solutions.22 His first publication sold out
in a year; it went into a second printing in 1557 in almost every European
language.23 Following his book of Secrets, many other authors published
similar books.24
Don Alexis discussion of recipes designed to regulate the humours in
the body constituted only a few pages in the beginning of his text. The
majority of his recipes did not come from the extensive body of university
training but from the careful study of the countries in which he travelled. 25
They included procedures to alleviate, prevent, and cure a wide variety of
aliments, from baldness, infertility, and to the ever-present plague. One
modern historian who has examined Don Alexis work chose to highlight his
reliance on exotic ingredients which were not easily found in Europe and his
unpleasant recommendations, such as placing a plucked hen' bottom on a
plague wound, at the expense of those herbs that have properties that were
effective against the symptoms of the plague.26
Don Alexis did recommend common ingredients as plague cures,
including figs, walnuts, and garden rue. He claimed that if a person took a
concoction of those foods every morning they would be safe27 One hundred
years later, the College of Physicians in London, prescribed these same
ingredients in their remedies for the plague.28 Don Alexis and the College
prescribed not only the mixture of walnuts, figs, and rue but also garlic, St
Johns Wort, juniper berries, salt, honey, wine and vinegar.29 Modern
pharmacology has established that many of these foods can be effective in
treating the symptoms of diseases such as typhus, cholera, or anthrax.
98
Jennifer Hart
99
Notes
1
Norman Cantor, In the Wake of the Plague: The Black Death and
the World it Made. (New York: Free Press, 2001.), 12; Francis Gasquet, The
Black Death of 1348 and 1349. 2d ed. (New York: AMS Press, 1977.),8-10;
100
David Herlihy, The Black Death and the Transformation of the West. ed
Samuel Cohn. (Cambridge, M.A.: Harvard University Press, 1997),22;
Jonhannes Nols, The Black Death: A Chronicle of the Plague, trans. C.H.
Clarke. (London: Unwin Books, 1961),8-9; Philip Zeigler, The Black Death
(New York: Harper and Row, 1969),18.
10
Stephen Bradwell, Physick for the Sickness Called the Plague [London,
1636) Amsterdam: Walter J. Johnson, 1977], 42-43.
11
Ibid., 43.
12
Ibid., 44.
13
Ibid.
Centers for Disease Control, (5 December 2003).
<http://www.cdc.gov/ncidod/dvbid/plague/diagnosis.htm>.
15
Centers for Disease Control, (5 December 2003).
<http://www.bt.cdc.gov/agent/anthrax/faq/signs.asp>;
<http://www.cdc.gov/travel/diseases/rickettsial_table.htm>;
<http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm>.
16
see for example: Norman Cantor, In the Wake of the Plague: The
Black Death and the World it Made. (New York: Free Press, 2001.),; Francis
Gasquet, The Black Death of 1348 and 1349. 2d ed. (New York: AMS Press,
1977.); Jonhannes Nols, The Black Death: A Chronicle of the Plague, trans.
C.H. Clarke. (London: Unwin Books, 1961); Colin Platt, King Death: The
Black Death and its aftermath in late-medieval England (Toronto: University
of Toronto Press, 1997); Philip Zeigler, The Black Death (New York: Harper
and Row, 1969).
17
Roger French. Medicine Before Science, The Rational and Learned
Doctor from the Middle Ages to the Enlightenment (United Kingdom:
Cambridge University Press, 2003),2.
18
Remede Tres Utile Contre La Peste, trans. Jennifer Hart
(Montpellier: Montier de Boys, 1522) 145, 2 med (3) microfilm.
19
Ibid.
20
Ibid.
21
Remede Tres, 145, 2 med (3) microfilm.
22
Alessio Pietmontese The Secret trans William Ward [(London,
1558) Amsterdam: Walter J. Johnson Inc 1975],
14
23
134.
24
Eamon,161.
25
Eamon, 143.
Jennifer Hart
26
101
Eamon, 144.
27
James Duke Medicinal Plants of the Bible (New York: TradoMedic Books), 68.
34
Culpeper, 304.
Jonhannes Nols, The Black Death: A Chronicle of the Plague, trans. C.H.
Clarke. (London: Unwin Books, 1961), 63-64.
35
36
Duke, 140.
Judith Summer, The Natural History of Medicinal Plants (Hong
Kong: Timber Press Inc, 2000), 172.
38
The Garlic Information Center
http://www.mistral.co.uk/garlic/antibiotic.htm (5 December 2003).
39
Duke, 16; Amazing Herbs, (5 December 2003).
<http://www.amazingherbs.com/meduseofgari.html>; Medicinal Herbs
Online, (5 December 2003) <http://www.egregore.com/herbs/garlic.html>.
37
References
Benedict, Carol. Bubonic Plague and Modern China, Modern China 14, 2
(April, 1988), 107-155.
Bradwell Stephen. Physick for the Sickness called the Plague, [(London, 1636)
Amsterdam: Walter J. Johnson , 1971]
Campbell, Anna M. The Black Death and Men of Learning. New York: AMS
Press, 1966.
102
Cantor, Norman. In the Wake of the Plague: The Black Death and the World it
Made. New York: Free Press, 2001.
Centers for Disease Control
<http://www.cdc.gov/ncidod/divbid/plague/diagnosis.htm> (5 December
2003).
Centers for Disease Control
<http://www.bt.cdc.gov/agent/anthrax/faq/signs.asp> (5 December 2003).
Cohn, Samuel. The Black Death Transformed: Disease and Culture in Early
Renaissance Europe. Great Britain: Arnold, 2003.
College of Physician, Certain Directions for the Plague (London, 1636)
Amsterdam: Walter J. Jonhnson, 1979).
Culpeper, Nicholas, Culpeper Completely Herbal Consisting of
Comprehensive Description of Nearly All Herbs with Medicinal Properties
and Directions for the Compounding the Medicines Extracted for them, (Great
Britain: The Bath Press).
Davis, David. The Scarcity of Rats and the Black Death: Ecological Study,
Journal of Interdisciplinary History 16, no 3 (Winter, 1986): 455-470.
Dols, Michael W. Black Death in the Middle East. Princeton, N.J.: Princeton
University Press, 1977.
Duncan, Christopher J., and Scott, Susan. Biology of the Plague, Evidence
from Historical Populations. United Kingdom: Cambridge University Press,
2001.
Eamon, William. Science and the Secrets of Nature, Books of Secrets In
Medieval and Early Modern Cultural. New Jersey: Princeton University Press,
1994.
Jennifer Hart
103
French, Roger. Medicine Before Science, The Rational and Learned Doctor
from the Middle Ages to the Enlightenment. United Kingdom: Cambridge
University Press, 2003.
Gasquet, Francis. The Black Death of 1348 and 1349. 2d ed. New York: AMS
Press, 1977.
Getz, Faye. Medicine in the English Middle Ages .Princeton, N.J.: Princeton
University Press, 1998.
Griggs, Barbara, Green Pharamacy, A History of Herbal Medicine. New York:
Viking Press, 1981.
Herlihy, David. The Black Death and the Transformation of the West. ed
Samuel Cohn. Cambridge, MA: Harvard University Press, 1997.
Horrax, Rosemary. The Black Death: Manchester Sources Series. New York:
Manchester University Press, 1994.
Nols, Jonhannes. The Black Death: A Chronicle of the Plague, trans. C.H.
Clarke. London: Unwin Books, 1961.
Pelling, Margaret. The Common Lot, Sickness, Medical Occupation, and the
Urban Poor in Early Modern England. New York: Addison Wesley Longman,
1998.
Pietmontese, Alessio. Secrets. Trans. William Ward [(London, 1558)
Amsterdam: Walter J. Johnson Inc., 1975].
Platt, Colin. King Death: The Black Death and its aftermath in late-medieval
England. Toronto: University of Toronto Press, 1997.
Remede Tres Utlile Contre La Peste, trans Jennifer Hart. Montpellier: Montier
de Boys, 1522 145 2 med (3). Microfilm.
104
Karen Thornber
107
walls have collapsed, and fire is raging through the city. Prior literature,
prior emotions, prior concerns, particularly the incessant concern with the
self, all have been stripped of relevance.
The rejection of past literature at times is more explicit. Early in
Summer Flowers the narrator comments that the childhood garden that
once had given him such a sense of peace now seems cold and heartless;
he states that the phrase "The Fall of the House of Usher" suddenly echoes
in his mind. Edgar Allan Poe's "The Fall of the House of Usher" (1839)
begins with the narrator looking at the melancholy House of Usher and
commenting that he is infected with a sense of insufferable gloom,
insufferable because poetic sentiment, usually serving as a filter for
images of the desolate or terrible, has lost its effectiveness. But while
Poe's narrator has the luxury of contemplating the house of Usher and
speculating as to the origins of his unnerving, Hara's narrator has no
choice but to leave the ruins of his home and escape the engulfing fires.
The melancholy of Poe's narrator has been rendered superficial, his
laments as to the powerlessness of art, here and elsewhere in "The Fall of
the House of Usher," appear foolish at best.
Summer Flowers also can be read as a rewriting, if not criticism
of Hara's own earlier accounts of the atomic aftermath, particularly his
"Genbaku hisaiji no noto" [Notes From the Atomic Destruction, 1945],
composed only days after the bombing. The notes are terse, orderly, and
concise, and as such offer a much more straightforward, easily read
account of the immediate atomic aftermath than that presented in Summer
Flowers. In the latter text, the narrator emphasizes the terrible confusion
and sense of unreality that characterized the days following the dropping
of the bomb; he features a number of individuals attempting to determine
what has befallen their city, suggesting that the "reality" of Hiroshima was
far more complex than the portrait painted in "Notes from the Atomic
Destruction."
In Auschwitz and After Delbo also reveals a growing
disillusionment with some of the literary texts with which she had
previously related quite strongly, both her own and those of others. At
times the criticism is implicit. Auschwitz and After, completed twenty-five
years after the conclusion of World War II, is in many ways a response to
earlier literature of the Holocaust, particularly that written in France in the
late 1950s and early 1960s. Echoes of Andr Schwarz-Bart's Le dernier
des justes [The Last of the Just, 1959], Piotr Rawicz's Le sang du ciel
[Blood From the Sky, 1961], and Jorge Semprun's Le grand voyage [The
Long Journey, 1963] can be found throughout Auschwitz and After, but
always with a twist, one that underscores the latter's struggle with the
aestheticism of the former. For instance, at one point in The Last of the
Just, M. Krmer is said to feel as though an octopus has settled upon his
class and is devouring them all without discrimination. In "None of Us
Will Return," the single devouring octopus has become a group of lethal
Karen Thornber
109
Karen Thornber
111
Part VII
Palliative Care and Hospice Organization
1.
116
117
2.
Dissonance Theory
118
3.
119
120
4.
121
the death of the patient was hastened. The principle of double effect has
long been invoked in medicine and is recognised as an acceptable ethical
principle.31 However, it could also be recognised as a psychological
mechanism employed as a way of addressing the resultant dissonance
between engaging in death hastening actions and a prohibition on killing
the patient,32 an action that hospice philosophy has traditionally eschewed.
Thus the "real situation" (hastened death) was "counteracted" as Festinger
proposes, by representing this as a secondary consequence to the primary
intent of reducing pain. The inception of a "movement" that addressed
suffering in this way incorporated those who subscribed to this
philosophical principle and provided "social support" for this approach to
the problem of terminal suffering.
The existence of dissonance will lead to seeking out
others who already agree with a cognition that one
wants to establish or maintain and will also lead to the
initiation of communication and influence processes
in an effort to obtain more social support In
situations where many persons who associate with
one another all suffer from the identical dissonance,
dissonance reduction by obtaining social support is
very easy to accomplish33.
Long before the modern hospice movement was developed, and
the discipline of palliative care was refined to its present level, the
Netherlands used euthanasia as a way of addressing the suffering of dying
patients. In the same way that New Zealand and other countries may
arguably have addressed and rationalised treatment that hastens death as a
way of addressing the suffering of some dying patients by invoking the
principle of double effect, the Dutch may have rationalised their adoption
of euthanasia policies. The dissonance experienced between seeing
intractable suffering and feeling helpless to control this in any way other
than killing the patient, was resolved by invoking the defence of
"overmacht"34 as a warrant for an action that elsewhere would be called
murder. In this way "overmacht" may have been adopted by the Dutch as
part of the interpretative repertoire surrounding their particular end of life
care practices.
The important psychological variables are not personal attributes
as such but the limitations on individuals' systems for making sense of
themselves and their environment: the limitations, in other words, inherent
in the ideologies to which people have access.35
122
5.
Notes
1. Potter & Wetherell, 1987
2. Ibid, p. 149.
3. Burr, 1995
4. Ibid, p. 119.
5. Ibid
6. Quill et al., 2000, p. 488
7. Oregon Health Division
8. Griffiths et al. 1998
9. Wherever physician assisted death has been legalised, this is
only available on patient request.
10. Festinger, 1957, p. 4.
123
11. Ibid, p. 3.
12. A later emphasis on commitment as a prerequisite to change
was argued to be "encompassed by the idea of resistance to
change". Wicklund & Brehm, 1976, p. 315.
13. Festinger, 1957
14. Nel, Helmreich, & Aronson, 1969;
15. Scher & Cooper, 1989
16. Goethals, Cooper, & Naficy, 1979
17. Cooper & Fazio, 1984, p. 261
18. Bem, 1967
19. Aronson, 1969, p. 27.
20. Sabini, 1995, p. 549.
21. Sabini, 1995, p. 553.
22. Kade, 2000
23. Ibid, p. 506.
24. Ibid, p. 506.
25. Ibid, p. 506.
26. Billings & Block, 1996
27. Mount, 1996
28. Festinger, 1957, p. 21.
29. Ibid, p. 21.
30. Ibid, p. 262.
31. Sulmasy, 1999
32. Loewy, 2001
33. Festinger, 1957, p. 265.
34. Under Dutch law this is a defence for euthanasia - (the result
of a force it is reasonable not to resist) Griffiths et al., 1998, p. 99.
35. Wetherell et al., 1987, p. 69
36. Sulmasy, 1999, p. 549.
37. Ibid.
38. Parker, 1992, p. 17.
References
Aronson, E. (Ed.). (1969). The theory of cognitive dissonance: A current
perspective (1st ed. Vol. 4). New York: Academic Press.
Bem, D. J. (1967). Self-perception: an alternative interpretation of
cognitive dissonance phenomena. Psychological Review, 74, 183-200.
Billings, J. A., & Block, S. D. (1996). Slow euthanasia. Journal of
Palliative Care, 12(4), 21-30.
Burr, V. (1995). An introduction to social constructionism. London:
Routledge.
124
125
128
In this cultural context the family members interpret the mild delirium
symptoms of auditory and visual hallucinations as signals that the dead
relatives are gathering around the patient who may be near death. This
interpretation cues the family members that the patients medical condition is
crucial and is near death. One oncologist had noted that when the patient is
young, the family members often tell the patient not to join the deceased
relatives, while if the patient is aged, they would tell the patients to accept to
join the deceased loved ones. With this cultural interpretation of mild delirium
symptoms and minimal disruptive episodes, family members do not recognize
the need for psychiatric referral.
One possible function of the cultural interpretation of mild delirium
symptoms, is the facilitation of the family members acceptance of the
possibility of death of the patient.
PATIENT
FAMILY
PHYSICIAN
PSYCHIATRIST
Mild
Normal
Does not detect
Symptoms_____ Cultural_______ Delirium_______ No referral
|
Interpretation
|
|
|
|
|
|
|
Refuse _______ Detect ________ No referral
|
Psychiatric
Delirium
|
|
Referral
|
|
|
|
|
|
|
|
|
|
Severe
Psychiatric
Detect
Referral
Symptoms_____ Interpretation___Delirium_______Psychiatry
Figure 1: Schema of Cultural Interpretation of Delirium Symptoms and
Psychiatric Referral
The clinical picture changes when the patients delirium mild
symptoms progress to severe delirium symptoms. The patient now
manifests behavior similar to a crazy person and the agitation and
potentially harmful behaviors are interpreted as a threat to the safety to the
patient and family members. In this context, the family members of the
patient accept psychiatric referral.
Although the cultural interpretation of mild delirium symptoms
may provide coping strategies for the family to accept the possibility of
death of the patient, the persistence of any delirium symptoms does not
facilitate the patients coping with death and dying since the patients
mental functioning is impaired by the delirium symptoms. The terminally
ill patient will have to cope with a multitude of issues and hence would
need mental clarity, not the mental clouding caused by delirium symptoms
-whether mild or severe.
Part VIII
HIV and Grief
133
Distracted Grieving
135
137
grandparents who are not working only have their state pension of R650
per month (equivalent to 56 or US$75) as the only family income, unless
the children drop out of school to do piece work. From this money they
have to pay rent, which can be as much as 2/3 of their pension, school
fees, uniforms and books, food and clothes. In South Africa there are
foster care and child care grants available but the up take of these has been
very low. One reason for this is that many elderly people are illiterate and
found accessing these grants very difficult, due to the complicated
administrative process and the need to provide the appropriate
documentation which has often not been left with them when the parents
have died.
At a South African conference on the role of the elderly, which
marked International Day of Older Persons, the Minister of Social
Development said that the selfless willingness of the elderly to share their
pensions had kept most of South Africas poorest children alive and
nourished over the past five years. Evelyn, aged 75, who is looking after
her grandchildren, says the same prayer every morning, Dear God, thank
you for sparing my old bones through another night so that these children
do not starve.
Elderly people often struggle with their own health issues. High
blood pressure and diabetes are very prevalent. These, plus decreasing
energy levels, can make it difficult for them to cope with the demands of
young children
Catherine, aged 15, the eldest of eight grandchildren being cared
for by 80-year-old Irene, says, Our grandmother is so wonderful, she
helps us in so many ways. She feeds us, dresses us and brings us up
properly. When we see her, we see our mother. If she were not here, we
would be scattered around other families and would not be treated in the
same way. We are so grateful that she is still with us.
Some children are not as lucky as this, as they are separated from
their siblings and sent to various family members or guardians. They have
to cope not only with the loss of their parents, but a new home, in a new
area which can be unfamiliar and frightening. Some children spoke of
staying with aunts and uncles who mistreated them and often gave them
less to eat and wear than their cousins. The most vulnerable group,
however, are the children who have no adult guardian and either become
responsible for child-headed households or take to living on the street,
where they often join gangs and are involved in crime in order to survive.
Some children as young as 11, were trying to earn a living to
support their siblings. They would try and earn money through piecework
such as washing for the more affluent, street vending or small scale trading
such as selling small amounts of charcoal.
One young girl, responsible for looking after ten children, said,
We suffer so much since my mother died. I do not manage to provide
sufficient food and clothing for my siblings as well as pay their school
***
139
stagnant green; the very crutches on which the ruins are propped,
decaying. (Chapter 8.96)
I was glad when we came to the brickmakers house; though it
was one of a cluster of wretched hovels in a brickfield, with pigsties close
to the broken windows, and miserable little gardens before the doors,
growing nothing but stagnant pools. Here and there an old tub was put to
catch the droppings of rain-water from a roof, or they were banked up with
mud into a little pond like a large dirt-pie. At the doors and windows,
some men and women lounged or prowled about and took little notice of
us. (Chapter 8.106)
Part IX
Diagnosis: The Receiving End
144
chronic or terminal illness. The present is most usually spent, not just
editing and reliving our past but also preparing for a future into which all
our hopes are projected.1, 2 It is this comfort zone that is threatened by the
prospect of a terminal diagnosis.3, 4, 5 One of the respondents I met whilst
doing my PhD, and whom I will refer to in more detail later, Louise, told
me how, when she was a medical undergraduate, a lecturer had informed
her class that demographically it was probable that in y number of years, x
number of them would be dead. She told me:
We laughed; we thought it was so funny. Quite a few
laughed, others shivered. I know at least one has died, in an
accident, two of us have cancer, various other things have
happened, nervous breakdowns, divorces and we have not
hit 40 yet. No one expects it at their doorstep and we all feel
immune from it. Your mortality has just been waved in front
of your face, it is not surprising really.
This paper draws substantially on my interviews with 36 year-old Louise,
who explained that she had been forced to retire from her career as
General Practitioner [GP], because of her breast cancer that, she had
recently been told, was not curable. Prior to my meeting with her, her
husband, a professor, had had a brain haemorrhage and, following an
enormous stroke, was left blind, unable to speak, epileptic and in a
wheelchair. As our longitudinal interviews developed over an 18-month
span, her four year-old daughter, Laura, was diagnosed with Leukaemia.
This paper examines how professional medical knowledge
impacts on how clinicians behave when they are ill. It also explores, in
more depth than I have previously, the interactions that occurred between
medics and the doctors who were responsible for their treatments.6
In the same way as cats are not supposed to bark or pigs to fly, so
medics are not supposed to become ill or die.7 Medical schools, like many
others, serve not only to teach the skills of their occupation but also
disseminate the various social rules and the ethos that will dominate. For
example, trainee clinicians learn to adhere to the regimented clock time
observed in hospitals and clinics.8 Leak quoted in Zerubavel points out
how the American Medical Association educate medical students of their
new temporal expectations and priorities by including, in the opening
chapter of their code of ethics, the following instruction. A physician
should be ever ready to obey the calls of the sick' 9, 10 Doctors and
consultants are, consequently, reasonably expected to be in contact at any
time to enquire about their patients progress and earn their respect by
having the facility to break through the frontiers of the night'.11 Roles
and scripts, such as the doctors seeming invulnerability and their almost
constant availability to patients are passed on to trainees, learned and
assimilated. Nurses, too, acquire the attitudes and mindsets that affect their
Angela Armstrong-Coster
145
146
Angela Armstrong-Coster
147
148
Angela Armstrong-Coster
149
150
matter out of place. More than that, her doctors were conscious that her
knowledge extended to an awareness of their limited capacity to cure. At
one stage, she actually felt in danger of being thrown out of a consultation
because, as she said, she can see that they do not know that much at all.
Her medical training afforded her knowledge of the realities of medical
limits and that truth threatened her doctors.
Louise realised that if, at least to her treating doctors, she could
distance herself from her self as patient or the maternal role and instead
become set in a medical persona, she would be better positioned to acquire
more knowledge of the case and that might act to her advantage. In this
way, while speaking with her own doctors and those of her daughter, she
attempted to present herself as medic rather than patient.
Louise rationalised her position and decided that the medical
team who were managing the illnesses, responded more comfortably to her
when she presented in one role - that of professional - rather than risk the
danger inherent in managing anomalous situations. So, when dealing with
her health professionals, she preferred to provisionally dispense with her
social persona as mother or patient and assume instead her professional
medical role. This cannot have been easy.
In deliberately presenting herself in her professional role, rather
than that of patient, or as the mother of a patients, she was attempting to
balance the inequity that exists in the doctor/patient/carer relationship - to
avert the anxiety which would have been created if they had assumed their
other roles - matter out of place.
In an endeavour to learn more about medics as patients, this
paper has explored the experience of a medical professional, who
encountered serious illness both personally as a mother. My research
supports especially that of Jaye and Wilson among others, who explore the
delaying tactics employed by doctors who are ill, in presenting before
colleagues for professional opinion.29 It also examined how doctors
behaviour is changed when they are treating colleagues who are ill. To
explain this behaviour, I have applied Douglass classification theory,
which suggests how entities that are anomalous create anxiety, which
needs to be managed.
Notes
1. Platt, J.R. (1966)
2. Bourdieu, P. (1990)
3. Del Vecchio, M.J., Good, M., Munakata, T., Kobayashi, Y.,
Mattingly, C. & Good, B.J. (1994)
4. Nekolaichuk, C. L. & Bruera, E. (1998)
5. Nowotny, H. (1994)
6. Armstrong-Coster 2004.
7. Ingstad, B. & Christie, V. (2001)
Angela Armstrong-Coster
151
8. Frankenberg, R. (1988)
9. Leak, W.N. (1948)
10. Zerubavel, E. (1981)
11. Melbin, M. (1987)
12. Jaye, C. & Wilson, H. (2003)
13. Hahn, R. H. (1985)
14. Douglas, M. (1988)
15. Ibid. p. 161.
16. Douglas, M. (1988)
17. Ardener, S. (1981)
18. Ingstad, B. & Christie, V. (2001)
19. Hahn, R. H. (1985)
20. Ibid.
21. Jaye, C. & Wilson, H. (2003)
22. Hahn, R. H. (1985)
23. Ibid.
24. Jaye, C. & Wilson, H. (2003)
25. Chambers, R. 1993
26. Jaye, C. & Wilson, H. (2003)
27. Douglas, M. (1988), p. 161.
28. Hahn, R. H. (1985)
29. Jaye, C. & Wilson, H. (2003)
Bibliography
Ardener, S. (1981) Ground Rules and Social Maps for Women; An
Introduction (1981), Oxford, Berg.
Armstrong-Coster, A. ( 2004) Living and dying with cancer. Cambridge:
Cambridge University Press.
Bourdieu, P. (1990) Time Perspectives of the Kabyle in J. Hassard (ed.) The
Sociology of Time, London: The Macmillan Press Ltd.
Chambers, R. (1993) What should doctors do if they become sick. Family
Practice 10(44), 416-423.
Del Vecchio, M.J., Good, M., Munakata, T., Kobayashi, Y., Mattingly, C. &
Good, B.J. (1994) Oncology and Narrative Time: Social Science and
Medicine 38(6), 855-862.
Douglas, M. (1988) Purity and Danger: an analysis of concepts of pollution
and taboo, London: Ark Paperbacks.
152
154
Elizabeth Gill
2.
155
Since most hospice patients, at some point in their illness while under
hospice care, will be placed in a medical facility, the volunteers must be able to
operate within an organizational environment that is not designed to
accommodate the inefficient, non-professional and unspecified nature of their
role. In order to explain social action within the health care setting, social
theorists must develop a conceptual framework that accounts for the complex
interaction between the human agent and the structure. For the purposes of my
research, I drew upon the recent work of Hans Joas, who, writing within a
symbolic interactionist, or pragmatist, orientation, emphasizes the creativity of
human agents. Joas concept of situated creativity calls upon us to focus on
the novel ways in which a human agent may respond to a particular situation,
acknowledging the physical possibilities, normative expectations, and
institutional arrangements that structure the field in which the action occurs.4
As I analyzed the data on hospice workers, I discovered that the
reshaping of organizational contexts may vary considerably from situation to
situation and from volunteer to volunteer. I have found that volunteers employ
structure creatively by 1) carving-out social space, 2) combining resources of
the organizations in creative ways by soliciting the help of other organizational
actors (i.e. sympathetic professionals), and 3) using selective elements of the
structure to achieve their objectives. Based on their image of the organization
and their position within it, the strategies employed by volunteers enabled them
to operate effectively within the structured medical environment by
circumventing certain systemic barriers and constraints.
A. Carving-Out Social Space
The volunteer has no clearly defined role within the health care
setting. Even within the hospice organization itself, volunteers are
considered to be gap-fillers when it comes to caring for a dying
individual and the family/caregivers. In my research, the hospice volunteer
role dramatizes the slippage between the agency and structurally defined
expectations. The volunteer role itself is unique in that it is not
characterized and defined by strict guidelines mandated by professional
affiliation. In fact, hospice training stresses the tenuousness of role
constraints. Each situation is evaluated on its own merit; thus, the
volunteer must adapt to a myriad of possibilities and constraints within a
given situation. Volunteer responses reflect how the fluidity of the
situation affected their role performance within the medical setting:
Case 1: I go slowly into each new situation. I try to be
very observant and I listen to assess what my role will
be. Now I realize that it will never be the same as any
156
Elizabeth Gill
157
158
Elizabeth Gill
159
160
Elizabeth Gill
161
Notes
1. David Moller, Confronting Death: Values, Institutions &
Human Mortality (New York, New York: Oxford University Press, 1996),
24.
2. Max Weber, From Max Weber, trans. and ed. by H. Gerth and
C. W. Mills (New York, New York: Oxford University Press, 1946).
3. Jurgen Habermas, The Theory of Communicative Action:
Lifeworld and System: A Critique of Functional Reason (Boston,
Massachusetts: Beacon Press, 1987).
4. Hans Joas, The Creativity of Action (Chicago, Illinois:
University of Chicago Press, 1996), 133.
5. Anthony Giddens, The Constitution of Society (Berkely,
California: University of California Press, 1984).
Part X
Voluntary Death and Suicide
166
Laura Cruz
167
168
Laura Cruz
169
infanticide. It is not clear from the records whether or not she committed
suicide, but the court ordered that her body be donated to the University
for anatomical research.23 The court usually dictated that female suicides
be buried at the Vrouwenkerk, though in 1624 they indicated that the body
of a male suicide, Pieter Isaaxszn Bats, be buried there as well.24 Burial at
night was certainly not desirable, but it was preferable to the alternative of
public display in the gallows field. In 1633, the court explicitly stated that
it would not condemn one suicide to the gallows field because it appeared
that he was not mentally normally and instead sentenced him to a night
burial.25 In several instances, family intervention swayed the courts to
hand down the lighter sentence of night burial.
The Leiden court did not seem to be inclined to judge the crime
of suicide harshly, even as their punishments for other crimes, such as
theft, escalated. This suggests that underreporting of suicide may not have
been as prevalent as it was in other places. On the other hand, the Leiden
judges still faced the problem of detection. Of the eighteen cases which
reported the method of suicide, thirteen were death by hanging, two by
stabbing, two by drowning, and one by poison. The court usually called
upon surgeons to perform the post-mortem investigations, but their
methods were certainly not foolproof. For example, in 1625, the case of
the body of Dionijs Maertenszn. baffled the authorities.26 They could not
determine the method of death and the court noted that there was no
apparent use of poison or signs of disease. In the absence of proof, they
granted permission for her body to be properly buried.
Drownings were more problematic. The court performed the vast
majority of post-mortem investigations upon bodies that had been
recovered from one of Leidens many canals. Living in a community
surrounded by water made drowning an all-too-frequent occurrence. While
they could easily establish the cause of death, the judges were less able to
ascertain whether the drownings were intentional or accidental. In light of
this, several early laws required that drowning victims be left with their
feet in the water by their point of recovery and other laws emphasized the
importance of witnesses and extenuating circumstances. In the period from
1575 to 1646, the court investigated 130 cases of death by drowning.27
Forty-four of these were children under the age of eighteen and so were
unlikely to be suicides. Thirteen cases were noted as being clearly
accidental. The other seventy-three cases are all possible suicides, though
the high incidence of drowning in the winter months strongly suggests that
people frequently found themselves literally and figuratively skating on
thin ice. The court consistently bestowed the benefit of the doubt in these
cases and allowed full burial privileges.
Many of the patterns exhibited by the Leiden court will not be
surprising to those familiar with the history of early modern suicide. In
England and Geneva, the end of the seventeenth century marked the
beginning of a period of relative leniency towards the punishment of
170
Laura Cruz
171
172
Netherlands were among the first places to discontinue witch hunts and
trials, and there is little evidence of a belief in possession stemming from
the court records.41 By mid-century, the Leiden judges displayed clear
sympathy towards those suicides whose friends and relations testified that
they suffered from melancholy or mental incompetence. It is also possible
that the judges took the principle of freedom of conscience, as espoused
most eloquently by William of Orange, seriously and saw that it applied to
the freedom to choose ones own death, as is the case with modern Dutch
laws governing euthanasia and assisted suicide.42
Unfortunately, there is little evidence to support the idea that
Leiden city officials had developed a noble, ideological defence of suicide.
The rulings on suicide were not mitigated when it came to cases that did
not involve mental distress. The question is not prominent in the writings
of Dutch scholars. Spinozas contributions to the subject, for example, are
brief and largely oppositional.43 On the other hand, the subject was
definitely not ignored by Reformed preachers who continued to expand on
the evils of suicide, which had been recurrent topics with Luther and
Calvin. Popular books of Dutch emblems and poems spoke about suicide
as an affront to God, and images of Biblical suicide were reproduced in
popular forms, including Delftware tiles. The lesson to be learned? Life
was precious and not to be squandered by suicide.44 In the Netherlands,
popular culture was replete with pressure not to commit suicide.
It is far more likely that they had to discontinue their
investigations of suicide because the court simply became too busy to
handle its caseload. From 1550 to 1599, the court handled 131 cases,
including violent crimes and post-mortem investigations, the latter of
which constituted approximately 16% of its casework. From 1600 to 1649
that number jumped to 556, nearly 30% of which were post-mortem
investigations. These cases could be complicated as they could involve
conferring with experts, witnesses, and family and friends of the deceased,
especially with the apparent increased attention paid to the state of mind at
the time of the act. With few severe penalties other than ritual execution,
an act that was widely falling into disfavour, it would make sense for the
court to spend its time more efficiently elsewhere, especially in the
prosecution of violent crimes.45
Durkheim argues that modern suicide rates vary inversely with
homicide rates and that as a society develops, the latter will fall while the
former rises. Historians have generally assumed that suicide rates were
low during the Middle Ages, though records are scarce, and that rates
began to rise first in England during the seventeenth century and in the rest
of Europe during the eighteenth. In eighteenth century Geneva, Watt
found that suicides did increase precipitously and though homicides
decreased, they did so less dramatically.46 In Stockholm, the trend was
similar, though suicides did not increase as rapidly, perhaps due to an
increase in suicidal murder.47 This pattern directly contradicts the
Laura Cruz
173
precocious modernity thesis because it suggests that the suicide rate in the
Netherlands remained pre-modern in the seventeenth century, despite the
trappings of modernity. Because suicide statistics are not available for
eighteenth century Leiden, it is not known if its rates followed a similar
pattern, though the decline is evident in other Dutch towns, such as Breda,
where not a single suicide took place from 1700-1795.48 Violent crime,
including homicide, assault, and rape in Leiden did markedly decline, both
relatively and absolutely, starting from the middle of the century, as Figure
1.1 shows.
FIG 1.1: Rates of Suicide and Violent Crime in Leiden
155016001650170017501599
1649
1699
1749
1799
#Violent Crimes 110
390
44
77
21
# Suicides
9
26
N/A
N/A
N/A
Population
12,000
55,000
65,000
45,000
31,000
(Approximate)
* The figures in column 1 (1550-99) and column 3 (1650-1699)
are likely to be distorted, as population was rising rapidly in the first
period and falling rapidly in the second. The average population figures
used does not adequately take this into account.49
Durkheim believed that the transition from high rates of homicide
to high rates of suicide was attributable to the alienation brought on by
modern economic life, including an advanced division of labour and the
nature of urban, industrial work. If this is the case, we are again left with
an apparent paradox as Leiden was primarily an industrial city, with an
urban workforce geared towards the mass production of goods for export
markets. The primary output of the city was in textiles, and from 1580 to
1648 annual output exploded to over 130,000 pieces valued closed to 10
million guilders.50 Of the 399 cases of accidental death investigated by the
court, 202 were identified by profession and of those 92 worked in the
textile industry (46%). Of the 38 cases of suicide, fifteen were identified
by profession and of those, 8 (53%) worked in the textile industry. At its
height, the textile industry employed roughly half the urban work force in
Leiden, so these percentages suggest that their numbers were not overrepresented in the frequency of suicide.51
In his study of Geneva, Watt proposed an alternative to
Durkheims definition of modernity. Similar to their Leiden counterparts,
the judges in the Consistorial court made thorough examinations of the
state of mind of suicidal men and women. In his examination of these
proceedings, Watt found that an increasing number of suicides felt
compelled to take their lives for what can prosaically be called reasons of
the heart. With the exception of spikes in suicidal behaviour during
174
Laura Cruz
175
the middle and eventually the lower classes, the result was a society with
much lower rates of violent crime, but also one that could more easily be
ruled by a central authority, which Elias linked to the acceptance of
totalitarian regimes in the 1930s.58 In looking at crime and capital
punishment in the Netherlands, Spierenburg has found ample evidence to
support the spread of the civilizing process, albeit in a slightly different
form than Elias original, and has linked it to not only the decline in
violent crime, but also to the end of exemplary punishment. 59
Michel Foucault has also looked at changes in crime and
punishment in the early modern period. In some sense, his conclusions are
similar to Elias in that discipline played a decisive role in changing
attitudes, but he puts the locus of discipline not on the individual but on
the state and state-sponsored bodies. Rather than trickling up, discipline
trickles down in Foucaults model, as states work to achieve and
institutionalise docile populations.60 Both theorists conclude that the
ultimate result of disciplinary regimes, be they personal or political, is
increased power for the centralized state. This conclusion is clearly
problematic for the Dutch republic, which lacked a central bureaucratic
apparatus sufficiently large to effect such changes or to take on such
powers, and it continued to lack these until well into the nineteenth
century.
Supporting the conclusions made earlier against Durkheims
religion thesis, John Bossy says that the period of the Reformation did not
produce many significant differences between Catholic and Protestant
societies. Protestantism and Counter-Reformation Catholicism, he argues,
were simply slightly different responses to the same underlying reality, the
transition to a radically new social structure.61 In both Protestant and
Catholic countries, the result was the same--the migration of the holy, as
he calls it, or the shift in the responsibility for order and control from the
Church to the State, in which sense he concurs with Elias and Foucault.
The problem is that in the early modern Netherlands, the holy had
nowhere to migratethe central state was simply too weak to perform
these functions. Instead, those functions fell by default on the new and
previously existing intermediary institutions---guilds, church, family, the
military, public funds, orphanages, etc. The strength of these institutions
explains why factors that would normally affect suicide rates-economic
and political upheaval, large amounts of immigration -result in very little
change in suicide rates in Leiden.
The court records support such a conclusion in several ways.
First, the few suicides that are found are drawn overwhelming from the
ranks of those not fully incorporated into these networks. Most of the
suicide victims had been born elsewhere and none of them appeared to
have obtained full citizenship in the town, even during the period when the
fees for this privilege had been greatly reduced. Only two of the Leiden
suicides have entries in the rolls of the local churches (both Protestant). At
176
least three had been prisoners. Finally, the suicide rates were higher for
those who lived and work outside of the city (i.e. in rural areas), a trend
that has reappeared in the twentieth century and has no known parallel
anywhere else.62 These suicides were men (and women) on the margins of
the social world.
One such intermediary body was guilds. Although the Dutch may
have possessed the first modern economy, they did not achieve this by
consciously applying the principles of classical economics. Their economy
was driven by workers who were firmly enmeshed in a moral economy
normally considered incompatible with modern capitalism or a modern
worldview in general. In Leiden, guilds were not primarily instruments of
self-regulation, but of social control. According to Robert DuPlessis and
Margaret Howell, the town magistrates supported and maintained the guild
system in order to keep the amount of work spread out among a number of
small enterprises, thus preventing the rise of larger conglomerations. Such
conglomerations could potentially threaten not only the livelihoods of a
large number of town residents, but also the power of the town to control
its own affairs.
Accordingly, in Leiden a large number of the suicides were
apprentices or temporary workers (about 20% of those reported), many of
them middle-aged or older, who were not subject to the full benefits of
guild membership. This may suggest poverty as a cause of suicide, but
wages in the Netherlands were higher than the rest of Europe and rose
throughout most of the seventeenth century. Certainly, fluctuations in the
fortunes of the textile industry (and others) produced structural
unemployment, but there is considerable evidence that temporary workers
floated from town to town throughout the republic, and possessed the
ability to move to where work could be found. Suicide was not limited to
the economically marginal, as it also took the life of the daughter of the
schout and several men who practiced highly-skilled trades that would
have been in heavy demand.
Another powerful social intermediary was the church. The
disciplinary tactics of the Reformed Church are well-known, especially as
practiced in the Calvins model godly community in Geneva. How do they
apply, though, in a state such as the Netherlands where church and state
were separate? In a 1993 article, Philip Gorski argues as follows:
Calvinismconsisted not only of a work ethic but an
ethic of self-discipline. In order to maintain selfdiscipline, the Calvinists employed a wide variety of
techniquesthese included regular devotional readings,
frequent prayer, and moral logbooks or journals. Yet why
would anyone voluntarily adhere to such a harsh creed?
Part of the answer no doubt lies in purely religious needs
and interests. But self-discipline also contained a status
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178
child. In five cases, the family of the suicide victim intervened on his or
her behalf, but it is not clear if this means children, parents, or extended
family members. There were changes made in the structure and curriculum
of schools during the period, in many ways designed to impart moral
messages and to instil in children the values of obedience and restraint.67
The fragmentary evidence available from the Leiden court
records suggests that the intermediate, corporate groups in Dutch society
acted as effective agents of social cohesion, knitting together the disparate
elements of the Dutch state, in a manner that was strengthened by the
absence of interference from a centralized state. Rather than instituting a
repressive regime, theirs was a grass roots movement, achieved not by any
central mechanism, but by the collective decisions of thousands of Dutch
people adapting to the circumstances in which they found themselves after
independence. The social forces of the Dutch towns produced a state and a
people much stronger, politically, economically, and morally, than either
historians or contemporaries have been willing to give them credit for.
Notes
1
Laura Cruz
179
180
30
Laura Cruz
48
181
182
65
1.
184
successfully completed that beheading, and then cut off Moritas head as
well after the latters botched attempt to follow Mishima in ritual suicide.
Mishimas suicide struck many Japanese observers as
anachronistic nonsense. Arguably just as reflective of popular Japanese
attitudes toward the self-destruction samurai-style emulated by Mishima is
the movie Seppuku (1962, directed by Kobayashi Masaki). This film
brutally emphasized the cruelty and barbarism of the seppuku custom, as a
desperate young samurai in the early 17th Century is forced to carry out the
ritual act with a bamboo sword, having pawned his real sword due to
poverty.
Westerners, and sometimes the Japanese themselves, tend to
exaggerate the tendency toward self-murder in Japanese culture.2 For
instance, Emile Durkheim remarked: The readiness of the Japanese to
disembowel themselves for the slightest reason is well known.3
Durkheims careless comment may indicate a different understanding of
suicide in Japanese culture and in the West. What he considers the
slightest reason was, after all, more important than even human life itself
to those who killed themselves in this manner.
Actually, though, the suicide rate of Japan in both premodern and
modern times may not be significantly higher than in the rest of the world.
Modern Japanese suicide rates are only slightly higher than the average of
other developed countries (and given the attitudes toward voluntary death
we consider here, there may be less reason for those who take their lives to
hide their suicide in Japan). Recent data show that impoverished former
Soviet countries like Lithuania and Belarus have higher rates of suicide
than Japan. But so do France and Austria.
Yet as Mishimas death confirms, at least some Japanese still
have a traditional tolerance, or even a respect and admiration for those
who take their own lives. How are we to explain the persistence of these
very traditional values in a postmodern context? The historical cultural
heritage of samurai seeking death before dishonour is surely pertinent.
Other cultural influences include non-Christian concepts of reincarnation
coming from the imported Indian religion of Buddhism, and a preference
for groupism over individualism, which may translate into less emphasis
on the sanctity of individual lives. As the method of Mishimas suicide
suggests, one key to understanding the culture of suicide in Japan lies in
the past, in the traditional values embedded in its long history.
2.
185
186
3.
187
188
189
190
Arishimas mother and three sons, he provided little explanation for why
he was dying, but basically merely asks their forgiveness. He was
apparently aware that to explain his death to these people was an
impossible task. He told his mother and three sons that I know that to act
in this way is abnormal (ij).10 But, he continued, it cannot be helped.
His farewell letter to his family ended with the seemingly cold: Until it
came to this decision, how much I loved you! It seems that at the time of
his death, Arishimas love towards Hatano Akiko knew no bounds, even to
the extent of making the love he felt for his children and mother only
relative. In terms of the philosophy of Love the Plunderer, one would
have to conclude that Arishima died a satisfied man, even as he acted in a
manner sure to bring grief to his family.
In Arishimas final three letters he is more explicit about why he
and Hatano Akiko were taking their lives, probably thinking it more likely
that his siblings (who were fellow artists) and friends could understand his
decision to die than his mother and children. Writing at midnight on the
train to Karuizawa, he told his younger siblings that since he fell in love
with Akiko, he had realized my true fate for the first time in my life. He
emphatically stated that their death together had absolutely nothing to do
with any outside pressure. Rather, the two were full of freedom and joy as
they faced death. He reported that even as the train arrived at Karuizawa,
he and Akiko were laughing and chatting happily with each other. He
asked his siblings to consider he and Hatano apart from convention.
Likewise, in his brief note to Asuke Soichi, Arishima reported that they
had finally arrived at the dark Karuizawa villa, drenched from their long
walk in a heavy downpour, but that far from feeling gloomy, they were as
playful as two infants. Why? Until this moment, I had not realized that
death is nothing in the face of love. (He also asked Asuke to help take
care of Arishimas children, by providing them with the royalties from his
writings.) The note concluded with the frank remark that their bodies
would probably be rotten by the time they are discovered (indeed they
were). In Arishimas final letter, to Morimoto Kkichi, his close friend
since they were students together in Hokkaido, he requested that
Morimoto keep an eye on the communal farm, and once again insisted, for
the last time: We are dying together at the peak of our love. We are not
dying because someone is threatening us.
Further insight into Arishimas death emerges in his Masters
thesis, a review of the entire course of Japanese civilization from its
origins to the 19th century, written (in English) at Haverford College.11 In
the same way he had pondered what had motivated Fujimura Misao to kill
himself, in his thesis Arishima is fascinated by the highly emotional
motives that led characters in Tokugawa-era drama to commit love
suicide. He reveals the degree to which he treasures the emotional side of
life. He deplores how the feudal Tokugawa regime used the imported
philosophy of Confucianism to stifle the free expression of the Japanese
191
192
(Sometimes this was literally true; one survivor of the supposedly allvolunteer Kamikaze corps reported that he was ordered to volunteer.)
Instead of that gruesome history, let us conclude with two more recent
stories, horrible enough in their own right.
In January 1985 a 33-year-old Japanese housewife walked into
the waves off Santa Monica, California. She took her 4-year-old son and
infant daughter with her. Pulled from the water by two passing college
students, Mrs. Kimura Fumiko survived to stand trial for the murder of her
children, who drowned. She insisted that she had not intended to live, but
was seeking to die and by taking them with her, to save her children from
the horrors of life without a mother.
For most Americans, regardless of any extenuating factors,
Kimura was clearly a murderer. Yet in Japan, it is a common defence that
such cases are not simply murder, but parent-child suicide (oya-ko
shinj). This form of suicide is illegal in Japan, but is generally
punished more lightly than murder. Kimuras attorney did not stress this
cultural explanation for her behaviour at the trial, but rather argued that his
client was temporarily insane. But the 20,000 signatures from Los Angeles
Japanese Americans on a petition for leniency may well have swayed the
judges sentence. The petition argued that in such cases, the mothers
intent is to save the child from a life of suffering without her. Indeed,
Kimura herself claimed that her children were extensions of her.12 For
this Japanese mother, her death was really the same thing as the death of
her children; she did not grant them an individual existence. Mrs. Kimura
seems to confirm an ongoing distrust of individualism and borderline
admiration for suicide among todays Japanese.
The response to Kimuras case also suggests that the emotional
resonance that Arishima Takeo had for love suicide in the plays of
Chikamatsu persists in the attitudes of many Japanese (and Japanese
Americans). As a penultimate example of this, consider one of the leading
members of a small Japanese terrorist group, the Red Army. Three
members of this group carried out a gruesome attack in the arrivals
terminal of Tel Avivs Lod Airport in May 1972. These Japanese terrorists
murdered 26 travellers (mostly Puerto Rican nuns) and wounded 76 other
bystanders.13 One of the three apparently threw himself onto his own hand
grenade after he ran out of machine gun ammunition. The only surviving
member of the terrorists was Okamoto Kozo, who had also tried to kill
himself by throwing grenades at a plane on the runway. Only when the
plane did not explode did Okamoto try to escape.
Only after the Israeli officer interrogating Okamoto, Major
General Rehavam Zeevi, promised the Japanese terrorist a gun and a
single bullet to commit suicide did Okamoto begin to talk.14 Interviewed
in jail, Okamoto spoke of his admiration for Japanese traditions of suicide
old and new: Even though Mishima and other Japanese suicide heroes
believed in anti-revolutionary or reactionary ideologies, their emotions
193
Notes
1
The Chinese characters for seppuku may also be read (in reverse
order) as hara-kiri, literally belly-cutting.
2
For the use of the term voluntary death, see Maurice Pinguet.
Voluntary Death in Japan (Polity Press, 1993).
3
Emile Durkheim, Suicide: A Study in Sociology. The Free Press,
1951, 222.
4
Yamamoto Tsunetomo, Hagakure: The Book of the Samurai,
trans. William S. Wilson (NY: Kodansha International, Ltd., 1979), 17.
5
Steven Heine. Tragedy and Salvation in the Floating World:
Chikamatsus Double Suicide Drama as Millenarian Discourse. The
Journal of Asian Studies 53, no. 2 (May 1994): 367-393.
6
Ikegami Eiko, The Taming of the Samurai: Honorific
Individualism and the Making of Modern Japan (Cambridge,
Massachusetts and London, England: Harvard University Press, 1995),
219.
7
Sumiya Mikio,Dai Nihon Teikoku no shiren, 196.
8
In several emotional diary entries and letters Arishima confesses
feelings of despair. In a few cases he vaguely refers to being unable to
write, facing a deadlock or a terrible crisis. But he never explicitly links
these personal problems with his voluntary death. Rather, all of his
references to suicide are positive and strongly-worded. Furthermore,
Arishima attributes most of his difficulties in writing and the frustrations
in his life to the ongoing burden of his private property and how it
interferes with his creativity.
9
Arishima Takeo, Shi e no itsudatsu, Arishima Takeo zensh,
Vol. 9, 157-158.
10
The letters discussed here are found in Arishima Takeo zensh,
Vol. 14, 666-669.
11
Arishima Takeo, Development of Japanese Civilization From
the Mythical Age to the Times of Decline of Shogunal Power. Masters
Thesis, Haverford College, 1904. Thanks to Ms. D.F. Peterson of the
Haverford Library staff for arranging access to the thesis. (I later found
that it is also reprinted, albeit without Arishimas excellent penmanship, in
Arishima Takeo zensh, Vol. 1, along with a complete Japanese
translation.)
194
12
References
Arishima Takeo. Arishima Takeo Zensh. 14 Vols. Tokyo: Chikuma
Shob, 1980-1985.
Bryant, Tamie. Oya-ko Shinju: Death at the Center of the Heart. Pacific
Basin Law Journal, 8 (1).
Farrell, William R. Blood and Rage: The Story of the Japanese Red Army.
Lexington, Massachusetts and Toronto: D.C. Heath and Company, 1990.
Headley, Lee A., ed.. Suicide in Asia and the Near East. Berkeley:
University of California Press, 1983.
Heine, Steven. Tragedy and Salvation in the Floating World:
Chikamatsus Double Suicide Drama as Millenarian Discourse. The
Journal of Asian Studies 53, no. 2 (May 1994): 367-393.
Ikegami Eiko. The Taming of the Samurai: Honorific Individualism and
the Making of Modern Japan. Cambridge, Massachusetts and London,
England: Harvard University Press, 1995.
Lifton, Robert Jay, Kat Shuichi, and Reich, Michael R. Six Lives/Six
Deaths: Portraits from Modern Japan. New Haven and London: Yale
University Press, 1979.
Minamoto Ryen. Giri to ninj. [Duty and Passion] Tokyo: Ch
kronsha, 1969.
Morgan, Robin. The Demon Lover: The Roots of Terrorism. 2001.
Morris, Ivan. The Nobility of Failure: Tragic Heroes in the History of Japan.
New York: Holt, Rinehart and Winston, 1975.
195
198
the 1920s, but because they embedded the victim and her act in a social
framework that provided for both public and private reconciliation to an
untimely and violent death.4
That framework in the 1920s was constructed out of the gender and
generational tensions of modernity. No figure captured the essence of
"modern" better than the flapper, the hedonistic young woman whose lifestyle
challenged a femininity that was submissive, domestic, matronly, and asexual.
5
As witnesses and reporters (and occasionally the girls themselves) recounted
the suicide stories, they did so in light of the behavior, the manners, and the
morals the cultural script of modern young womanhood.6
1.
Who
Kathleen Jones
199
200
2.
When these young women chose to die, they also chose the setting
and in describing the physical context of each act reporters did more than add
sensation to their stories. Press images of the bedroom suicide and the public
suicide memorialized and moralized about the expectations of young women
in modern society.
When a young woman was found lying on her bed, with a picture of
her lost love on the pillow, or lying on her bed with a book open to a poignant
passage, or lying on her bed with love letters strewn about,10 witnesses and
reporters interpreted their poses as evidence of the failure of modern romance.
The easy companionship between young men and women that seemed a
benefit of 1920s youth culture showed up in suicide stories as potentially
disastrous for the girls. The flappers boyfriend, according to these dramas,
was a fickle fellow, his promises not to be trusted.11 Other young women
chose public spaces and audiences of strangers for their suicide performances.
In these instances, the news reports often told stories of thwarted romance
similar to those of the bedroom suicides, Whats the trouble love affair? a
police officer asked Gloria [Seeho] Seijo, on her way to the hospital after
jumping in front of a subway train. Youve struck it, the eighteen-year-old
reportedly replied.12 But the tale of the public suicide conveyed other
messages as well. The public places ranged from high school corridors to
ferry boats to subway platforms, from standing in front of a police station to
standing in front of a church, to standing in front of a Chinese restaurant, from
Morningside Park in the morning when mothers were walking their babies to
the corner of Broadway and 49th at 1:00 AM with a city patrolman nearby.
According to these stories, the modern young women could be found nearly
anywhere, doing nearly anything, including expiring, in public.
News reports allowed readers to stare at both the bedroom scenes and
the public spectacles of youth suicide, but the death notices offered more
protection from lurid reporting to those who died in their beds. Based on these
reports readers might assume that those who died at home did so decorously,
with poison, gas, or the occasional gunshot wound. Their actions suggested
elements of true womanhood; their deaths fit more closely the sentimental
death scenes of nineteenth-century Victorian drama. And their suicides could
be contained within well-understood hierarchies of age and gender. In
contrast, those who chose to act in public often did so before strangers and the
accounts given by witnesses suggest that these strangers saw in the acts the
kind of flair associated with the new-style young woman of the 1920s. The
public settings for these stories pointed to the opportunities young women
Kathleen Jones
201
found in the modern city; the suicides cautioned that when young women
attempted to take advantage of these opportunities, their actions might well
culminate in an unnatural death.
Suicide settings outside the home also gave reporters license to
describe the consequences in gruesome detail. Contrast the description of
pretty Betsy Tevis, found in her room, her gown now stained red with blood,
with that of Dorothy Wilson, the pretty well-dressed girl whose leap in front
of a train left her wedged between the engine and the platform, being slowly
crushed to death13 or the even more gruesome description of the
dismemberment of another subway jumper, her head and leg falling to the
platform below.14 Descriptions of appearance after suicide made clear that
despite their modernity, girls still faced special risks in public, even when the
ultimate aim was self-destruction.
In news accounts the location of the body, like the identity, positioned
suicide as an emotional consequence of unsettled gender and generational
relationships.
3.
Why
Beyond who and where and how, the reporters wanted to write about
why and the stories from the 1920s ascribed the young female suicide to one
of four reasons: unrequited love, poverty, illness or school problems.
In her recent work on gender myths in suicide research the
psychologist Silvia Canetto argues that, by projecting female suicidal behavior
as primarily a response to problems in personal relationships, the current social
science literature is merely reflecting popular assumptions about female
dependence and passivity.15 Current literature, Canetto might have added, is
built on a long tradition of assigning to love the explanation for a womans
suicidal behavior.
The suicide stories from the 1920s certainly did a great deal to
substantiate beliefs that women turned to suicide when prevented from being
with a particular suitor. The press was captivated by stories of the suicides of
young women who had been jilted and reporters and editors also liked the
melodrama of a couple kept apart by unreasonable circumstances, the Romeo
and Juliet scenario.
The references to love as a motive for the female suicides of
the1920s might be read as popular belief in female dependence, as Canetto
argues, because the stories certainly contained a message about the importance
modern young women attached to marriage. 16 But Id like to suggest that in a
decade rife with stories about companionate marriages and other forms of
202
sexual freedom, dying for love stories can be read as more than commentary
on female foolishness or female dependency. Suicide also warned young men
that their behavior, their relationships with women were not inconsequential.
Dying for glory (to use Canettos phrase for achievementmotivated suicides) may not be a part of the current social science mythology
of female suicidal behavior, but it was certainly a component of folk beliefs
about the young female suicide as represented in press accounts from the
1920s. For younger girls, school provided a context for accomplishment;
academic failure or a teachers reprimand could explain the suicidal behavior
of adolescents. For young adults, it was sometimes college, but more often the
world of work shaped their ambitions and framed accounts of their suicides.
News reporters deemed the failure to get or keep a job an understandable
motive for suicidal behavior. But reporters, quoting witnesses and victims,
also observed that leisure was as great a necessity for young women as was
employment or school. Or, as Lillian Feinstein, put it in a letter to her mother,
all my life is work and there is no time for pleasure . . . I do not care to live17
The expectations of her work as a maid kept Lillian from pleasure.
More often, however, restriction on leisure time or social activities came from
parents. This motive situated suicide in conflicts between mothers and
daughters over appropriate female behavior.
The new forms of public amusement available to the young were
central to these conflicts, and in press accounts both mothers and daughters
saw suicidal behavior as a reaction to the limits mothers imposed on when and
where daughters could go, and the punishment mothers imposed for going
out without permission. Seventeen-year-old Estelle Corrigans suicide, for
example, took place after her mother chastised her for going out so much in
the evenings.18
If marriage was the goal to which young women aspired, they also
expected getting there to be fun. The suicide stories reminded parents of the
limits on their ability to constrain the social activities of their modern
daughters much as the stories of thwarted love cautioned men about the
serious consequences of toying with modern romance.19 Amusement and
romance, freedom and marriage, public and private, the young women of the
1920s were individualists intent on tradition and traditionalists intent on
breaking boundaries. Similar explanations for female suicide can be found in
other eras but how those explanations made sense of suicide in the 1920s was
specific to the way young women were positioned and positioned themselves
in the decades realigning of gender and generational relationships.
Kathleen Jones
4.
203
Conclusion
The meaning of suicide was written on two levels in the news stories
of the 1920s. On the one hand, the stories offer up the shared beliefs used by
the press and the public to explain the individual untimely death. On the other,
the stories reveal a deeper cultural meaning, one in which accounts of suicide
served as a conduit for messages about gender, youth, and modernity.
In looking for motive, the press and the public defined suicide as a
conscious choice in light of a specific situation. Such a characterization, I
would argue, made the suicide death easier to absorb than the current
characterization of suicide as illness signified by hopelessness, depression,
and despair. And it may help to explain why suicide, tho the subject of so
many stories in the press of the 1920s was not yet perceived to be a public
health problem of any import.
Beyond accounting for an unnatural and untimely death, the suicide
stories of the 1920s appeared in the press as cautionary tales not only for
young women, but also for young men, and their elders. In the descriptions of
the victims, the accounts of the death scenes, and the interpretations of
motives, the news items warned that modernity brought risks and came with
costs. Such a reading, however, would represent only a part of the meaning of
these youth suicides. Taken together, the stories resonate with tension:
between the limited opportunities for the young to affect their social situations
and the power they claimed through acts of self destruction; between the
individual expression of death and the blurring of individual identity in the
explanations that followed; between the expectations of feminine behavior and
gruesome acts of self-destruction these women perpetrated; and between the
intimacy or privacy of death and the public forums in which young women
chose to exhibit suicidal behavior. In many ways, the suicidal behavior of
these young women can be read as one of the signs of modernity. By telling
suicide stories the reporters and the witnesses underscored the emotional
ambivalence with which this culture confronted modern life.
Notes
1
204
(new series) 21 (1986): 311-328; Silvia S. Canetto and David Lester, Gender,
Culture, and Suicidal Behavior, Transactional Psychiatry 35 (1998): 163190; Lisa Lieberman, Leaving You; The Cultural Meaning of Suicide
(Chicago: Ivan R. Dee, 2003); and E. Thomas Ewing, "Personal Acts with
Public Meanings: Suicide by Soviet Women Teachers in the Stalin Era ,"
Gender & History 14 (2002): 117-137.
3
Suicide, to quote Barrie M. Ratcliffe, is a banality which is never
mundane. Suicides in the city: Perceptions and Realities of Self-Destruction
in Paris in the First halfof the Nineteenth Century, Historical
Reflections/Reflexions Historiques 18 (1992): 2.
4
Howard Kushner has argueded that in the nineteenth-century
psychiatry became the language used by the public to express a connection
between suicide and modernity. This essay suggest that folk beliefs about
suicide were much less influenced by psychiatric models than Kushner
suggests. See Howard I. Kushner, Suicide, Gender, and the Fear of
Modernity in Nineteenth-Century Medical and Social Thought, Journal of
Social History 26 (1993): 461-490.
5
See Laura Davidow Hirshbein, The Flapper and the Fogy:
Representations of Gender and Age in the 1920s, Journal of Family History
26 (2001): 112-137; and Paula S. Fass, The Damned and the Beautiful;
American Youth in the 1920s (New York: Oxford University Press, 1977).
Birgette Solands study of young women in Denmark also shows the
connection drawn between the flapper and modernity. See Becoming Modern;
Young Women and the Reconstruction of Womanhood in the 1920s (Princeton:
Princeton University Press, 2000).
6
Canetto discusses cultural scripting or patterning in her work on
gender and suicide, see the previously cited article Gender, Culture, and
Suicidal Behavior; and also Meanings of Gender and Suicidal Behavior
during Adolescence, Suicide and Life-Threatening Behavior 27 (1997): 339351.
7
Scar New York Times (NYT) 1/4/1925, p.28; leg deformity -- NYT,
12/3/1923, p. 13; freckles, NYT, 6/29/1922, p. 7.
8
Soland, Becoming Modern, discusses the significance of bobbed
hair. On the significance of body image see also Joan Jacobs Brumberg, The
Body Project; An Intimate History of American Girls (New York: Random
House, 1997); and Margaret A. Lowe, Looking Good; College Women and
Body Image, 1875-1930 (Baltimore: Johns Hopkins University Press, 2003).
Kathleen Jones
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Part XI
At The End of Life
Introduction
210
Methods
Results
The nurses all spoke at length, and with some passion, about their
work and the way in which they tried to do the best job possible for the
patients and their relatives. All the nurses said they tried to work within
professional boundaries and were proud of being able to maintain their
integrities as professionals. As we shall see later, this was not always as clear
cut as they thought! For the remainder of this paper I shall use the word
relatives to mean family and friends close to the patient and involved with
their care.
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212
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But integrity is closely linked to dignity and the nurses were keen to
maintain patients dignity before and after death. They tried to maintain
physical dignity for example by making sure that the patient wasnt exposed
in a way, physically, that they wouldnt have wanted.
We had a gentleman who was huge and who was nursed
without any clothes on. And he died and it was obvious
that we werent going to be able to get him into our
fridge we had just taken him down in the mortuary
area but not in a fridge and I came back up and realised this
chap had got no boxer shorts on. And that to me was just
awful. I mean people said youre actually going to hurt
yourself trying but in fact I managed to rope a couple of
people in and we found some boxer shorts and slit them
and put them on.
Maintaining patients integrity involves more than physical needs
though - it seems to involve treating the patients with respect.
I treat everybody and every person with respect and that
counts right up till their death.and after, till theyve
disappeared from here.
There was also an awareness of the patient as a person. This need to
respect integrity lasted through the period of dying into the initial care of the
dead body, which I will discuss below.
C. How nurses cared for the patients after death
All the nurses felt that their duty of care extended beyond the
patients death, until the body left the building, with one maintaining that it
continued until the funeral. Most of the time they treated the body as though it
were alive, or as they felt the patient would have wanted to have been treated.
You know ... it is still Mrs Jones or Mrs Smith isnt it and
[even though] theyre deceased theyre still a person arent
they still a human being...Im still identifying them with
being alive I supposeuntil they go from the ward.
One nurse found it difficult to talk of a dead patient as a body:
214
In many ways the nurses treated the bodies as though the patient was
still biologically alive, with likes and dislikes still intact. This extended to
talking to the patients while laying them out - in the following quote one nurse
describes talking to a patient who has just died. She talks of laying out the
body, with the help of a colleague:
But I suppose whatever youre talking about well you might
say what do you think of that? and you know theyre not
going to answer but its like involving them. Still!
Not all nurses did this and for some it depended on whether they had
had a close relationship with the patient before death. It certainly seemed
easier for nurses to maintain the patients personhood if they had had a close
relationship with them before death.
I think when youve cared for somebody and got to know
them as a friendyou also find out if they like a
particular item of clothing say.... And I think its important
to me that I would carry that on after death as well.
Nurses drew on their own personal views and values when deciding
how to treat a body. With no patient preferences to guide them they used their
own personal experience, sometimes trying to imagine what they would want
if they were dead. For example, one of the hospices moved dead patients on a
bed through open areas of the building. There was then a dilemma over
whether to cover the dead patients face. One nurse expressed her strong
feelings:
I always used to say, Oh God dont ever cover my face up
like that when Im dead, when Ive gone
All of the nurses maintained that they were treating the bodies as they
did out of respect and acknowledgement of the person that they had been.
However, it seemed that the strategies they used also served to help them
personally to deal with the constant presence of dying and death in their work.
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216
This study suggests that for the nurses interviewed the relationship
between themselves and the patient and family is of paramount importance.
Nurses spent a great deal of time explaining and illustrating how they took
great care to make a good relationship with the patient and family with
consequences both before and after death. They used different types of
knowledge personal, professional and intuitive - to gain as good an
understanding of the individual person as possible.
4.
Discussion
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217
as not what you do, but how you se the patient how better, then, to
maintain dignity after death than by seeing the body as somehow still alive.
Anna Taube talked earlier today about the need to maintain body image and
personhood when confronting serious illness. I argue that these nurses
maintain both of these at and beyond death, and hope to open up discussion as
to why they did this and how it helped them and the relatives. Perhaps this
type of care altered the care tenor of the institutions and was therefore
influential in the care of the living.
In her book, The Dying Process, Julia Lawton discusses the
phenomenon of patients being treated as bodies by hospice staff even while
they were alive.5 This leads to criticism of the hospice movements claim to
maintain patients integrity as people until the very end of their lives.
However, a recent study by Kabel and Roberts interviewed a large number of
staff in two inpatient units and found that they treated the unconscious patient
with respect, trying to maintain personhood.6 The nurses in my study described
extending this practice to the way in which they spoke to and interacted with
patients bodies after death.
5.
Further Work
The time surrounding death is difficult for families of the dying patients,
as well as for nurses. Whilst the number of nurses interviewed was small, the
recurrent themes which emerged from their interviews, and the personal and
professional experiences within the team, would seem to suggest that these nurses
experiences are not unusual within Specialist Palliative Care Units. It would be
interesting to replicate this study with hospital nurses, as this may illuminate
differences in philosophy and practice between different health care sectors, which
may in turn help with educational programmes to help improve care at the end of
life in non-specialist institutions.
Notes
1. Glaser BG and Strauss AL, Awareness and Dying (Chicago, Aldine
1965).
2. Timmermans S, Dying of awareness: the theory of awareness
contexts revisited, Sociology of Health and Illness 16 (1994): 322339.
3. Field D and Copp G, Communication and awareness about dying
in the 1990s, Palliative Medicine 13 (1999): 459468.
4. Mulkay M and Ernst J, The changing profile of social death,
European Journal of Sociology 2 (1991): 176-196.
218
Notes On Contributors
Dr Angela Armstrong-Coster
Dept. of Social Work
University of Southampton
Southampton, UK
aac@socsci.soton.ac.uk
Sally Cameron
Sue Cameron
Clinical Nurse Specialist
Centre for Palliative Learning
Pembridge Palliative Care Unit
Sungardens Hospice
St Charles Hospital
Pretoria, Ladbroke Grove
South Africa
Mira Crouch
Visiting Senior Research Fellow
School of Sociology
University of New South Wales
Sydney, Australia
Laura Cruz
Assistant Professor of History
Western Carolina University
Cullowhee, NC 28723, USA
lcruz@wcu.edu
Lawrence Fouraker
Department of History
St. John Fisher College
Rochester, NY 14618, USA
Elizabeth Gill, Ph.D.
Associate Professor of Sociology
Randolph-Macon College
Ashland, Virginia 23005 USA
220
Contributors
Jennifer Hart
Graduate Program in European History
Western Carolina University
Cullowhee, NC 28723 USA
Blake G. Hobby
Assistant Professor of English
University of North Carolina at Asheville
Asheville, NC, USA
Penelope Johnson Moore
Department of Health Care Programs
Iona College
New Rochelle, NY, USA
Kathleen Jones
Department of History
Virginia Polytechnic University
Blacksburg, VA, USA
Mikko Kallionsivu
The Finnish Graduate School of Literary Studies
Department of Literature and Arts
University of Tampere, Finland
Asa Kasher
Laura Schwarz-Kipp Professor of Professional Ethics
Philosophy of Practice and Professor of Philosophy
Tel-Aviv University, Israel
Kay Mitchell
Department of Psychology
University of Auckland, New Zealand
Siobhan ODriscoll,
Bereavement Co-ordinator,
Medical Social Work Department,
Beaumont Hospital,
Dublin,Ireland.
Contributors
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